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Experiences of Young Offenders Involved in Multisystemic Therapy

ProQuest Dissertations and Theses, 2011
Dissertation
Author: Madelyn Harvey
Abstract:
Juvenile offenders are punished when they engage in behaviors that can be self-destructive and pose harm to others in society. Juvenile justice systems favor multisystemic therapy (MST) as a means of correcting behavior in young offenders. Although there is literature to support MST as a successful therapeutic model to use with juveniles, there is no research to indicate whether the youth themselves believe MST to be successful in changing their behavior. The goal of this phenomenological study was to obtain information directly from young offenders regarding their experience with MST. Youth were asked open-ended questions to elicit their experiences with MST. Verbatim statements obtained from 6 clients were recorded, transcribed, coded for a priori themes, and synthesized into textural and structural descriptions using NVivo9. MST clients reported starkly different perceived experiences with therapy across the 2 separate components of the MST program. Those in the problem sexual behavior (PSB) component expressed a sense of validation and satisfaction with MST, whereas those in the oppositional defiant disorder component (ODD) expressed nullification and dissatisfaction. Those in the ODD program felt excluded from therapy sessions with their parents and attributed behavior change to fear of jail versus MST. In contrast, participants of the PSB program who had been included in the therapeutic process attributed change in their behavior to MST. Implications for positive social change include informing improvements in the use of the MST model as a means of dissuading recidivism of juvenile offenders at a fraction of the cost of incarceration.

i Table of Contents List of Figures....................................................................................................................iv Chapter 1: Introduction to the Study....................................................................................1 Background....................................................................................................................1

Problem Statement.........................................................................................................6 Research Question.........................................................................................................9 Purpose of the Study......................................................................................................9 Conceptual Framework................................................................................................10 Nature of the Study......................................................................................................13

Chapter 2: Description of Literature Search......................................................................18 Review of the Literature…………………………………………………………......20

Motivational Interviewing & Relaxation Training with Adolescents......……………21

Locus of Control & Negative Behavior in Adolescents…………………………......21 Multidimensional Family Therapy & Relaxation Training with Adolescents….........35

Reality Therapy & Negative Behavior in Youth…….................................................49 Summary of the Literature..........................................................................................63 Chapter 3: Research Method..............................................................................................67 Qualitative Research Methods.....................................................................................68 Research Design………………………………………………………………….......69 Selection of Participants and the Environment......................................................70 Interview Questions...............................................................................................71

ii Role of the Research..............................................................................................71 Research Setting, Consent & Ethical Considerations............................................71 Data Collection............................................................................................................72 Data Analysis...............................................................................................................72 Summary of the Methodology.....................................................................................73 Chapter 4: Results..............................................................................................................75 Introduction..................................................................................................................75

Recruitment Process...............................................................................................75 Profiles of the Youth……………………………………………………………..76 Data Collection & Storage..........................................................................................77 Data Analysis...............................................................................................................78 Data Analysis.........................................................................................................78 Findings..................................................................................................................78 Responses from Youth in the ODD Program........................................................81 Responses from Youth in the PSB Program..........................................................82 Summary of Findings...................................................................................................90 Chapter 5: Interpretation & Recommendations.................................................................91 Introduction..................................................................................................................91 Interpretation................................................................................................................92 Theoretical Framework................................................................................................94

iii Implications of Social Change.....................................................................................96 Recommendations........................................................................................................97 Researcher’s Experience with Process.......................................................................100 References........................................................................................................................103 Appendix A: Permission for Contact Letter....................................................................109 Appendix B: Parent Consent Form..................................................................................111 Appendix C: Assent Form for Participants......................................................................115 Appendix D: Interview Guide..........................................................................................118 Curriculum Vitae.............................................................................................................120

iv List of Figures Figure 1.Chart showing an association between M1 and F3 83 Figure 2. Chart showing an association between M2 and M6 84 Figure 3. Chart showing an association between F3 and M1 85 Figure 4. Chart showing an association between M4, M2, M5,and M6 86 Figure 5. Chart showing an association between M5 and M4 87 Figure 6. Chart showing an association between M6, M2,and M4 88 Figure 7. Chart showing an association for all participants 89

1 Chapter 1: Introduction To The Study Background Those in the juvenile justice system believe the multisystemic therapeutic approach (MST) is the best method by juvenile justice systems to correct delinquency and change negative behavior in youth. According to Borduin, Schaeffer,and Heiblum (2009), MST is an effective method in treating juvenile offenders (pp.26-37).The overriding goal of MST is to empower parents with the skills and resources needed to independently address the inevitable difficulties that arise when raising adolescents and to help them cope with familial problems.(Letourneau et al.2009,p. 93).According to a study conducted by Letourneau et al. (2009), family therapy, multidimensional therapy and MST have been effective in changing antisocial behavior in adolescents because they incorporate a dependence on significant others. MST emphasizes and encourages a need for involvement of significant family members to change undesirable behavior in youth but little consideration has been given to youth who do not have parents involved in their lives.According to Schaeffer and Borduin (2005), improved peer and family relationships,and success with education as well as occupational and other tasks are attributed to MST intervention (p. 451). However, consideration has to be given to unforeseen changes within the family which could prevent further involvement by significant others resulting in regression in the child’s behavior.

2 MST has been found to be an effective method to reduce delinquency and substance abuse amongst adolescents. Letourneau, Henggeler, Schewe, Borduin,and McCart (2009), found MST to be a much more successful in reducing antisocial behavior, especially sexual offender recidivism, when family members engaged in therapy with the client (pp.89-102). I propose that a therapeutic model that empowers youth to take responsibility for their actions by building positive self-esteem and a sense of self-worth will ultimately teach participants that they can make the choice to behave in a manner,that will help them fulfill unmet needs such as taking control over their lives without the dependence on others. According to Hogue, Dauber, Stambaugh and Cecero (2006), the success or failure of young offenders treated for drug addiction was dependent upon the consistency of parental alliance. The authors did not use MST,but instead used cognitive behavioral therapy, which focuses more on an individual’s emotions and way of thinking; however, their therapeutic method also required the involvement of family members in the therapy sessions. It was noted in the study that youth whose alliances started low but improved during therapy showed symptom improvement, while those with declining parental alliance had symptoms,which escalated (Hogue, Dauber, Stambaugh & Cecero 2006, p. 127). The escalation of symptoms indicated a need for continued parental involvement which indicated a dependency on significant others for change to occur.

3 According to Wubbolding (2007),choice theory, reality therapy,indicates there are four principles which originate from within a person and which do not come from one’s external world. The first principle is that human motivation is internal; people are born with the need for belonging, power or inner control, freedom or independence, fun or enjoyment, and for survival or self-preservation.The second principle is the difference between what a person wants and what one has is the cause for behavioral choices.The third principle is that actions, thinking, feeling and physiology comprise “total behavior,” while the fourth principle states that human beings see the world through a perceptual system, similar to a camera with two lenses (Wubbolding.2007, p. 253). These principles suggest that people are born with certain needs for love, safety, and autonomy. When these needs are not met, negative emotions surface. The way people think and feel about themselves, others,and their environment tends to contribute to their overall behavior. Wubbolding (2007) claimed people see the world through a perceptual system similar to a camera with two lenses;in other words perception of self is determined by the way it is believed others perceive us.The camera with two lenses, therefore, is analogous to looking in a mirror. Parental involvement early in a child’s life may be the key to decreasing the number of delinquent youth. Davalos, Chavez, and Guardiola (2005), examined the influence of parental support on delinquent behavior with Mexican American, Latinos

4 and Hispanic youth and found that parents who are involved early on in their children’s lives positively influence their behavior. Parental involvement at later ages,especially when the youth have been involved with a juvenile justice system, was found to be less effective. These findings suggest that parents are less likely to have an effect on helping to change antisocial behavior in their youth if they were not instrumental in the child’s life during the early developmental stages. Incorporating MST with young offenders to change negative behavior is less likely to be effective in situations where there has been no parental involvement. With inconsistent parenting, it is assumed children do not learn what is acceptable and unacceptable behavior; therefore,they do not see anything wrong with what are considered their delinquent acts (Davalos et al.2005, p. 63).Involving family members in the therapeutic process with children who have had little or no previous parental involvement is not likely to be successful, especially with those children who are juvenile offenders.“Many theories have emphasized inadequate parenting is a risk factor in the development of delinquency during adolescence” (Keijsers, Frijins, Branje, & Meeus 2009, p. 1314). The involvement of significant others in rehabilitating young offenders has been emphasized but there is little discussion or research on how delinquent behavior might be affected should there be changes within the adolescent’s support system, or a regression in behavior resulting fromnew family dynamics. A multisystemic therapeutic approach is often used with delinquent youth to modify behavior. “MST produced both short and long-term changes in youths’ criminal behaviors and incarceration” (Borduin,

5 Schaeffer, &Heiblum, 2009, p.35).Little consideration is given to youth whose significant family members are unable or unwilling to be involved in MST,but yet MST is a method used frequently with juvenile offenders. Youth who cannot rely on significant others for change will have to depend solely on themselves for change to occur. Wubbolding’s (2007) principles support an overall need for inner control which should be a crucial factor in bringing about change with delinquency. Humans have the ability to make choices regarding how they will behave if their needs are not adequately met.Glasser (1998) based choice theory on the same principles as his reality therapy concept indicating people have the ability to make a choice to behave responsibly. Unwanted behavior can be changed if individuals are cognitively re- programmed to believe they are in charge of their emotions and can choose how they will relate to environmental factors or situations which they previously believed were responsible for their negative emotions. For instance, a probation officer might inform delinquent youth that they will be taken off probation within 30 days if their urine is free of drugs. Delinquent youth who desperately want to be off probation may refrain from abusing drugs for 30 days to gain the reward of having probation terminated, but they are likely to return to abusing illegal substances. In this case the negative behavior would have been changed for 30 days to appease the probation officer. The youth will not have made an independent decision to refrain from engaging in illegal activity. They have not learned responsible decision making skills by being taught to think independently but instead change is coerced by those in authority.

6 When punishment does not work, invariably punishment becomes harder which results in little progress. Choice theory explains that people are internally motivated. To achieve and maintain the relationships needed they must stop choosing to coerce, force, compel, punish, reward, manipulate, boss, motivate, criticize, blame, complain, nag, badger, rank, rate, and withdraw. Destructive behaviors must be replaced by choosing to care, listen, support, negotiate, encourage, love, befriend, trust, accept, welcome, and esteem. These words define the difference between external control psychology and choice theory/reality therapy (Glasser 1998, pp. 5-21). More research is needed to test choice theory,which states people have the ability to make responsible choices. Most research has been conducted on external control psychology,rather than on a method that teaches internal control. Problem Statement Although research indicates that MST is an approach considered to be effective in changing negative behavior with young offenders, there is nothing in the research examining how youth might be affected when significant others become inconsistent with treatment. For MST to be effective parents must practice the skills they have learned even after therapy ceases.Inconsistency or the non-involvement of significant others in therapy sessions can contribute to recidivism. According to Ramchand, Morral, and Becker (2009) each year there are 2 million arrests of people under the age of 18 years. In Los Angeles alone, 144,000 adolescents were sent to a treatment center during 2002

7 (Ramchand et al. 2009,p.864). These statistics indicate a major problem with delinquency even with the implementation of therapeutic approaches like MST, yet there have been no changes in the methods used to rehabilitate young offenders who engage in serious crimes,including murder, assault, rape, and gang violence. Information directly from the youth regarding their experiences with MST may help determine what changes are needed to decrease the number of delinquencies. There are no current studies that indicate whether adolescents and caregivers are consistent with the skills taught with MST once therapy ceases, nor are there studies that have obtained information directly from the youth with respect to their experience with MST. “Antisocial youth who are adept at ‘looking good’ during the honeymoon phase of therapy may actually be less inclined or equipped to sustain positive relations and make treatment progress as therapeutic demands intensify over time” (Hogue, Dauber, Cecero, &Liddle 2006, p.127). The problem, therefore, with rehabilitating young offenders using MST is a dependency on others for change to take place, rather than a reliance on themselves to make good decisions and develop a desire to want to change, as with other therapeutic models like that of reality therapy/choice theory. Whether individuals are loved or not, to be worthwhile they must maintain a satisfactory standard of behavior. To do so people must learn to correct themselves when they do wrong and to credit themselves when we do right. If individuals do not evaluate their behavior, or improve conduct where it is below standard,they will not fulfill their need to be worthwhile and will suffer as

8 acutely as when they fail to love or to be loved. Morals, standards, values, or right and wrong behavior are all intimately related to the fulfillment of a person’s need for self-worth.(Glasser 1965, pp.10-11.) As Glasser (1965) noted a sense of self-worth will be developed when individuals assume responsibility for assessing and making a decision to change behavior.Behavioral change which is not coerced, influenced or expected by others places the responsibility on the individual for success or failure. Individuals then learn to take responsibility for their actions and for the consequences that ensue from those actions whether negative or positive. This will ultimately teach people that they have power and control over their destiny and that they are capable of bringing about change in their lives without having to rely on others.Because the involvement of significant others is necessary for MST to be successful,little is known about the success or failure of treatment for those youth whose parents or caregivers have been inconsistent with treatment. One of the ways to determine what effect MST has had on delinquent youth is to gain information directly from themregarding their experience. If it is determined that young offenders are adversely affected as a result of the inconsistencies of significant others in the treatment process,or if it is determined that young offenders are dissatisfied with the method in which therapy is administered,then there will be a need to re-visit therapeutic models used to correct their behavior. It is imperative for all those involved with juvenile youth to understand exactly what impact MST has on them since this is a model supported by most juvenile justice systems.

9 Research Question The overarching question for this research study was, “how young offenders describe their experiences with MST?” The sub-questions were: 1.When describing experiences with MST,do young offenders mention any positive experiences which have taken place? 2.What do young offenders believe would be the best approach to changing behavior in young people? 3.What changes, if any, would young offenders like to see with the therapeutic process? Purpose of the Study The purpose of this phenomenological study is to describe the experiences young offenders have had with MST. Ramchand, Morral, and Becker (2009) performed a study on youth in Los Angeles between the ages of 20-24 years who were 13-17 years old at the time they became delinquent and were placed in group homes.The authors discovered that 37% of the youth who had been involved in some sort of rehabilitation during their delinquency had re-offended; 50% of these youth were incarcerated within a 90 day period and approximately 1% had died before reaching the age of 25 years. Ramchand, Morral, and Becker stated:“Results indicated the majority of youth were still criminally active seven years after treatment. Such high rates of ongoing crime and justice involvement raise about whether the rehabilitation programs offered are having the desired effects” (p.864).With the increase in criminal activity after therapeutic

10 intervention has been implemented there is a need to find other alternatives which might be much more effective with changing undesirable behavior of young people. There is nothing in the literature to show whether significant others who become involved in the treatment of youth maintain their commitment by being consistent with the treatment process, nor are there any studies which have acquired information directly from the youth regarding their overall experience with MST. Although research on multisystemic and multidimensional therapy indicates the involvement of family members has had a positive effect on treating this population, this study is not designed to dispel those findings but to gather information directly from the youth regarding their involvement with the program. This study will help those involved with delinquent youth to consider other treatment alternatives for young offenders if there is concern that the program is not meeting the needs of young offenders.Some thought may need to be given to an approach which will empower youth to think for themselves and to take responsibility for their actions making them less dependent on others for change and more willing to effect change on their own if there is an indication this might be necessary.Researchers have not as yet explored the idea of a therapeutic approach with young offenders which would not require them to depend on significant others for change to occur. Conceptual Framework Much of the research on juvenile offenders associates inadequate parenting to dysfunctional family backgrounds as the cause for criminal behavior in young people but

11 according to Glasser (1998) child abuse, rejection, and neglect are far from the main reason families are unhappy. The majority of family unhappiness is the result of well- intentioned parents trying to make children do what they do not want to do (p. 195). Glasser believed individuals may choose to behave appropriately if given the opportunity to do so. Parents are the most important people in their children’s lives up to about age 15 years, even if they do not get along well with the children. But after 15 years of age most children who have not followed their parent’s direction for a long time stop listening seriously to what their parents have to say. If parents would use choice theory from the start, this might not happen as often as it does. But as long as they live in a world dominated by external control, adolescents and parents are going to have a lot of conflict. (Glasser, 2000, pp. 183-184). Glasser (2000) believed dominance, authority, and control is what causes children to rebel and become oppositional. If provided with more choices, especially the choice to behave appropriately, children’s need for power and control might be better satisfied. External forces within the environment are believed to contribute to negative behavior. Most adolescents will not hesitate to express their frustration with society and those most significant in their lives. Negative emotions such as anger and resentment are expressed at times in violent ways depending on the degree to which the emotion is felt. When behavior becomes uncontrollable or threatens others in some way or another, youth could find themselves involved with the juvenile justice system.

12 Correcting the behavior of young people has been a challenge for most juvenile justice systems. Although the problem is being addressed with the use of multisystemic therapy, this population remains of interest to researchers as the judicial system continues to see an influx in delinquent youth. Helping individuals understand themselves better and commit to changing undesirable behavior will ultimately decrease delinquency.The question is does MST really help to change negative behavior with delinquent youth since there is a dependency on others for change to take place?As stated previously, the literature shows MST to be effective in changing negative behavior but limitations with the studies indicate there is no evidence of long-term effects of the therapy should caregivers make changes in discipline or if youth are negatively influenced by peers. Very few studies have been conducted on other therapeutic models which will empower young offenders to change their behavior without the involvement of significant others. “Reality therapy anticipates the client will assume personal responsibility for his or her well-being. The acceptance of responsibility helps an individual achieve autonomy or maturity whereby he or she relies on his or her own internal support” (Gibson and Mitchell, 1981, p. 272). Individuals are then expected to exercise internal locus of control rather than external locus of control by developing a responsible attitude. Children who exercise external locus of control are believed to be less dependent on others to control their behavior and are able to exercise better decision making skills. While children who display internal locus of control are usually guided by others and have less success in controlling their behavior. (Santrock 1988, p. 423).

13 Regardless of the reasons for delinquency and severe behavioral problems in adolescents, there is the need to have corrective measures put in place which will have lasting effects on developing young people who feel good about themselves and the world they live in. A dependence upon others for change does not teach young people to develop a sense of responsibility for their behavior. Encouraging significant others to be involved in the therapeutic process of adolescents could send a message these individuals are the cause of the youth’s behavior therefore they should take some responsibility for changing it. Providing children with choices will send thema clear message that they are trustworthy and have the ability to make proper choices. Rather than be controlled by others, they will develop self-reliance which has to produce feelings of confidence and a sense of self-worth. Having the power to be in control over a situation and make independent decisions allows individuals to fulfill a need for power and control. The same has to be true for adolescents when given the ability to make decisions and control their destinies. Nature of the Study This study explored the experiences of delinquent youth who have been involved with multisystemic therapy. A phenomenological research design is implemented for the study which allows the youth to provide direct input on their experiences with MST. Participants have extensive involvement with a juvenile justice system.An interpretation of the data gathered is based on identified themes or patterns in what the adolescents

14 report. A detailed analysis is provided describing the experience the delinquent youth have had with MST. Definition of Terms Juvenile delinquency:Youth between the ages of 11 and 17 years who engage in criminal activity and become involved with the juvenile justice system. Multisystemic therapy:Directly addresses factors that are associated with the youth’s serious antisocial behavior, including sexual offending. (Letourneau et al. 2009, p. 93). Negative behavior: Behavior which is undesirable according to societal expectations and laws. Reality therapy: Rejecting unrealistic behavior, teaching responsible behavior and person involvement are three of the criteria involved with reality therapy (Glasser,1969). Assumptions The following are assumptions with respect to this study: It was assumed adolescents would be open and honest about their involvement with multisystemic therapy otherwise it would be impossible to obtain an accurate description of their experiences. It was anticipated the youth understood the reasons for their involvement in the MST program otherwise they would not be able to give feedback regarding their experiences.

15 Delimitations/Limitations This study was limited to delinquent youth, meaning those who have engaged in criminal behavior and who have appeared before a juvenile judge.Youth were between the ages of 11 and 17 years and involved with multisystemic therapy or had previous involvement with MST.I did not interview those who were not involved with multisystemic therapy,or those who had not been labeled delinquent by a juvenile justice system as it would have been of no benefit to this study.This study is a qualitative design confined to a specific group of participants who are experiencing the same phenomena. It eliminates statistical data which can be obtained from a quantitative design on a larger scale and likely to produce totally different results.The research was conducted on a small sample of delinquent youth therefore it would be unfair to assume that the findings apply to all youth involved in MST. A more in-depth study on delinquent youth will have to be conducted to draw any major conclusions. Significance of the Study This study is significant as there is still an apparent need to effectively change behavior in youth and reduce recidivism with delinquency. The research is currently focused on what environmental, external factors, might be causing delinquent behavior; however, the focus might need to be changed to the internal needs this population may be trying to meet if behavior is to be effectively changed. According to Glasser (1990) “we all have the same needs but we vary in our ability to fulfill them” ( Glasser 1990, p. 9). Most juvenile offenders are delinquent because of a lack of family involvement.

16 Social support is the experience or perception of being cared for, valued, and guided by others, especially one’s family, peers, and/or community members. Studies show increased risk of adolescent problems is the absence of, or decreased levels of parental support. (Steese, Dollette, Phillips, Hossfeld, Matthews,&Taormina 2006, p. 60). This study could reveal a need for a new approach to be used with young offenders which will teach them to behave responsibly and decrease behavior which places them and others at risk. Information from this research will be important to juvenile justice systems and those involved in rehabilitating delinquent youth. Helping young people fulfill their needs, develop a sense of self-worth, think independently and make proper choices will ultimately bring about positive social changes that will benefit society as a whole. Juvenile justice systems that support the MST model will have to re-examine their method of treating these youngsters if there is an indication MST is not meeting their needs. Consideration needs to be given to the fact that parents and caregivers who have failed to meet the emotional needs of their children are not likely to suddenly show a commitment to the child who has become delinquent. Now that the study is complete, major social changes are likely to occur in the way this population is perceived and treated in the future.

Full document contains 133 pages
Abstract: Juvenile offenders are punished when they engage in behaviors that can be self-destructive and pose harm to others in society. Juvenile justice systems favor multisystemic therapy (MST) as a means of correcting behavior in young offenders. Although there is literature to support MST as a successful therapeutic model to use with juveniles, there is no research to indicate whether the youth themselves believe MST to be successful in changing their behavior. The goal of this phenomenological study was to obtain information directly from young offenders regarding their experience with MST. Youth were asked open-ended questions to elicit their experiences with MST. Verbatim statements obtained from 6 clients were recorded, transcribed, coded for a priori themes, and synthesized into textural and structural descriptions using NVivo9. MST clients reported starkly different perceived experiences with therapy across the 2 separate components of the MST program. Those in the problem sexual behavior (PSB) component expressed a sense of validation and satisfaction with MST, whereas those in the oppositional defiant disorder component (ODD) expressed nullification and dissatisfaction. Those in the ODD program felt excluded from therapy sessions with their parents and attributed behavior change to fear of jail versus MST. In contrast, participants of the PSB program who had been included in the therapeutic process attributed change in their behavior to MST. Implications for positive social change include informing improvements in the use of the MST model as a means of dissuading recidivism of juvenile offenders at a fraction of the cost of incarceration.