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MFTs IN SCHOOLS
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Running head: MFTs in schools
Adolescent-Focused Family Therapy
Michelle Pavlick
Touro University Worldwide
MFT 630
MFTs IN SCHOOLS
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Introduction
In this signature assignment I will discuss the need for psychological services in the school
setting, highlighting the role MFTs can play in the school system, particularly as it relates to children
who experienced school violence or are at risk of substance abuse. I will explore the qualifications an
MFT has that makes him/her a suitable professional to provide services in the school setting. I will
then discuss theories that the therapist could use to work with students who experienced violence at
school or engage in substance use. Finally, I’ll also address how a systems approach can provide a
framework for assisting adolescents and their family in addressing concerns related to these
situations.
Need for School-Based Psychological Services
According to Dowdy and colleagues (2015), psychological services in the academic setting
have utilized a medical model that focuses primarily on remediation, rather than a developmental
approach that addresses prevention and intervention at an age-appropriate level. Additionally, school
psychologists have typically functioned as a “gatekeeper for special education classes,” most notably
as a psychometrist to determine student eligibility for additional services and accommodations
(Dowdy, et al., 2015, p.183). While this has traditionally been the role of the school psychologist,
there is a movement toward school psychologists having the ability to work with mental health
challenges, with the goal of eliciting changes through prevention and intervention. In some areas
school psychologists are beginning to be seen as part of a treatment team where they triage students
who are emotionally and behaviorally “at risk” and assist with implementation and intervention
development before a crisis occurs (Dowdy et al., 2015, p. 183-184).
However, despite the growing movement toward utilizing school counselors as part of a team
approach to working with students who have experienced trauma, student who are at risk for
substance use, and those in need of mental health services, school counselors are limited in their
MFTs IN SCHOOLS
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ability to provide these services. Additionally, there are a number of barriers that prevent students
from seeking the support and guidance of a school counselor. A study examining the prevalence of
mental health needs and barriers to services found that 80% of participants in the study exhibited
significant mental health problems, yet none had sought out mental health services (Biolacti, Parlareti
& Mameli, 2018, p. 45). Unfortunately, there are a number of barriers that prevent school-aged
adolescents from seeking treatment, both in the school-setting and out in the community. There are a
number of common themes when examining barriers to mental health services, including stigma and
embarrassment, as well as lack of accessibility (e.g., transport, time), knowledge of the provider, and
importance of confidentiality (Biolacti, Parlareti, & Mameli, 2018, p. 46, 50).
Most specifically,
adolescents report hesitancy in seeking out psychological support from school counselors due to their
fears that there is not enough privacy at school, and that the counselor has a dual role in providing
emotional support while at the same time, enforcing school rules. Additionally, students have
concerns with confidentiality, trust, and feeling the school counselor is “out of touch” with adolescent
problems (Biolacti, Parlareti, & Mameli, 2018, p. 46). Despite barriers to receiving mental health
services at school, school-based services provide a number of advantages including more successful
access to mental health treatment when referred for school-based services, rather than community-
based services (Colognori et al., 2012). Although school counselors provide a critical and
fundamental service to students, they are limited in their capacity to provide comprehensive mental
health therapy. School counselors are often viewed as having too many students to provide adequate
care, as well as concerns regarding counselor training and knowledge (Biolcati, 2015, p. 46).
However, if we can begin to address these barriers, services to students could be instrumental
in prevention of further decompensation. Implementing interventions in the school can have a
considerable impact on the normalization of mental health services, as they can be embedded into the
educational curriculum. This would have the benefit of decreasing stigma, increasing accessibility
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(e.g., transportation, family schedules), and assistance in preventing a mental health crisis before it
begins to impair an adolescents ability to function (Biolacti, 2015). While assessing and treating
mental health issues in an academic environment may increase willingness to seek and receive
services, there is no guarantee that the adolescents utilizing these services are those at high risk for
mental illness. Research suggests that adolescents who internalize problems (depression) or
externalize problems (substance abuse) are less likely to seek treatment (Biolcati, 2015, p. 47). This
suggests that further research is needed to determine effective means of increasing services to those at
the greatest risk.
MFTs in Schools
1 in 5 children are diagnosed with a mental illness and 1 in 10 experience serious emotional
disturbances. However, only 33% of adolescents receive mental health treatment (AAMFT, 2018).
Given that participation of family members is integral in an adolescents’ clinical outcomes, it is
suggested that family involvement in the treatment of adolescents is critical—particularly since MFTs
are the only mental health professional required who receive official training in family therapy
(AAMFT, 2018). Additionally, MFT core competencies highlight the skills and knowledge base of
therapists. MFT competencies are divided into 6 primary domains—admission to treatment, clinical
assessment and diagnosis, treatment planning and case management, therapeutic interventions, legal
issues/ethics/standards, and research and program evaluation—and 5 secondary domains—
conceptual, perceptual, executive, evaluative, and professional (AAMFT, 2004). MFTs are required
to be knowledgeable of each of these 128 competencies, with many competencies being applicable in
the school setting. When reviewing MFT core competencies there were a few that were integral in
supporting the benefit of MFTs providing treatment in a school-setting. I found these to be
particularly important: 1.2.1- Recognize contextual and systemic dynamics, 2.1.1- Understand
principles of human development, human sexuality, gender development, psychopathology,
MFTs IN SCHOOLS
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psychopharmacology, couples processes, and family development and processes (e.g., family,
relational, systems dynamics); 2.3.2- Provide assessments and deliver developmentally appropriate
services to clients, such as children, adolescents, elders, and persons with special needs; 3.1.1- know
which models, modalities, and/or techniques are most effective for presenting problems, and 4.3.8-
Empower clients and their relational systems to establish effective relationships with each other and
larger systems (AAMFT, 2004).
Taken together, the competencies of an MFT highlight the benefits of utilizing such mental
health professionals in the school environment. This is particularly important when working with
adolescents who have experienced a traumatic event (e.g., school shooting) or are experiencing
significant mental health issues (e.g., substance abuse). According to Murtonen and colleagues
(2012), it is important that adolescents receive professional support as soon as possible after a
traumatic school shooting—particularly if family support is limited. Additionally, these researchers
suggested that if mental health concerns following a traumatic event are left untreated, adolescents
may develop substance abuse problems, mood and anxiety disorders, and/or PTSD. They noted that
early crisis intervention was not sufficient, and professional screening and follow up services were
necessary in addressing trauma (Murtonen, et al., 2012).
With respect to substance abuse in adolescents, 1 in 10 adolescents 12-17 years of age report
illicit drug use and 18.1% report binge drinking in the past month (SAMHSA, 2010). While many
school counselors attempt to reach all students in distress, many counselors are unable to provide
services to those most vulnerable, at-risk youth. This is the result of a multitude of issues, including
limited availability (one counselor, too many youth), competency in treating substance abuse/trauma,
significant barriers to treatment, as well as concerns with confidentiality/privacy (Biolcati, et al.,
2012). Thus, incorporating MFTs as a part of the treatment team may have considerable benefits,
including the ability to assess and identify those students most at risk and provide evidence-based
MFTs IN SCHOOLS
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treatment. MFTs have the potential to collaborate with families, school staff, and community supports
with the goal of improving the health and functioning of the adolescent. MFTs can provide
interventions and services in the school-setting, thus reducing barriers, and increasing the
accessibility of effective treatment modalities.
Theoretical Approach
Theories provide clinicians with a framework to understand the development of an
adolescent’s beliefs, worldview and behaviors. Theories help guide clinicians in conceptualizing a
client’s presenting concerns, as well as influence the treatment plans and interventions they choose to
use. MFTs have a number of theoretical orientations and strategies that they can utilize in the
academic setting to treat adolescents, including those who have witnessed violence at school or are at
risk for substance abuse.
If I were the clinician working with an adolescent who had experienced a
school shooting, I would likely utilize a lifespan integrative theory that incorporates approaches that
address the complex nature of human development. I would use approaches and techniques that
incorporate components of Maslow’s humanistic approach, as well as Cognitive Behavioral Therapy
techniques (e.g., TF-CBT strategies, progressive muscle relaxation, guided imagery) to address
emotional and behavioral dysregulation (Milvesky, 2014).
Maslow’s humanistic approach suggests that people have an inner drive to seek self-
actualization and achieve our greatest potential. Maslow described a hierarchy of needs that we are
all driven to progress through. The hierarchy begins with a person’s basic needs for food and safety.
As an individual attains his/her basic needs, s/he then progresses toward more advanced needs of
social contact, self-esteem, and ultimately self-actualization (Milvesky, 2014). I find Maslow’s idea
that people are “naturally healthy” and can use their inner needs to ultimately reach self-actualization
empowering for adolescents and encourages an intrinsic desire for change.
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Maslow’s approach is particularly helpful in a school setting after a school shooting or other
violent act, as there is considerable focus on providing the adolescent with a sense of safety, security,
and basic needs, then progresses to meeting social needs and self-esteem—all of which can be
supported in the academic setting. This is particularly important if the adolescents needs are not being
met (or are unable to be met) in the home environment. The school environment provides the
structure and resources that can be instrumental in supporting the adolescent meeting his/her basic
needs for food, shelter, and safety.
When working with an adolescent in a school setting that is struggling with substance abuse, I
would use an integrative approach where I integrate aspects of Motivational Interviewing and
Cognitive Behavioral Therapy, as these modalities have been shown to be empirically supported
treatment modalities for substance use in adolescents (Mash & Barkley, 2014). I would also
incorporate Harm Reduction strategies that assist the adolescent in minimizing risk and controlling
use (Miller & Miller, 2014). I have found that the problem-focused structure of CBT helps clients
develop skills to avoid or address cravings and/or triggers that usually result in alcohol or drug use.
They learn to identify destructive thought patterns, modify behaviors and improve their coping skills
to address distressing emotions.
In working with an adolescent at a school with a substance abuse problem, my first step
would be to complete an assessment of use. I would want to assess when the client is using, how
much s//he is using—both quantity and frequency, what the context is when s/he is using (e.g.,
friends, alone), examine intrapersonal factors such as coping skills, any comorbid diagnosis, and
environmental factors (Mash & Barkley, 2014).
I would also want to assess whether the client’s use is experimental or problematic and assess
for negative consequences associated with use. I would take the client’s age and developmental stage
into consideration and start treatment by meeting the client where s/he is at (e.g., precontemplation,
MFTs IN SCHOOLS
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contemplation, etc) and work to enhance the client’s motivation for change. I would look at his/her
beliefs about use, the consequences s/he has experienced as a result of his/her use, motivations about
use—including intrinsic and extrinsic motivations, and the factors that precipitate and perpetuate use
(Mash & Barkley, 2014). During treatment I would help the client recognize the consequences
associated with use, with the hopes that this will increase his/her motivation to change. I would also
work to decrease his/her use by working with the client to develop coping skills to challenge peer
pressure, develop relaxation skills, challenge negative thoughts and beliefs about alcohol and drug
use, and teach the client harm reduction techniques—with the goal of decreasing risk and harm from
use (Canadian Pediatric Society, 2014).
Systems Approach
When working with adolescents, it is critical to include families and community supports
(including the educational system) in the treatment process. Behaviors by families or individuals in
the system (or system as a whole) are seen as a means of communication, with behaviors having a
purpose toward communication. Behaviors that are symptomatic of dysfunction are seen as a way to
communicate something that may be too difficult or dangerous to say (Dallos & Draper, 2010, p.
146). It is the role of the MFT to determine the meaning of specific behaviors and actions and to
bring these ideas into the awareness of the family and/or educational system. The therapeutic process
is a shared activity, and while the therapist brings these ideas into awareness, s/he is acting as a guide
and facilitating the family to work collaboratively with the therapist and the school (Dallos & Draper,
2010, pp. 147). Family members are crucial in treatment, either being a wonderful support system or
possibly a function of the presenting concerns. Including family members into treatment is
particularly important when working with adolescents, as they are not yet independent and rely on
family for support and survival. The therapist’s role is to tease out how the family perpetuates the
MFTs IN SCHOOLS
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problematic symptoms and behaviors or how they can assist the therapist in working toward
facilitating change in the client.
When working with an adolescent with a substance abuse problem, a therapist working from a
systems approach can assist the family in coming to terms with the client’s concerns by fostering
communication among all individuals and systems involved. The therapist can help the client develop
an intrinsic desire for change and encourage the family members and school staff to be “on board”
and work with the client toward change. If members of the system continue to enable problematic
alcohol/drug use or are unwilling to change the family/school/social dynamics that are perpetuating
the problematic use, it will be extremely likely that the adolescent will struggle and may relapse
(Dallos & Draper, 2010).
The therapist should work with the family to help facilitate honest communication, assess the
true nature of the substance use, how it has affected family members, and examine any potential
negative feedback loops that may be present within the family dynamics. Often times family
members may enable the client and prevent change from happening by making the client feel shame
for his/her drinking, resulting in the drinker continuing his/her use of alcohol. Drinking may also be a
way for the adolescent to medicate and numb his/her emotions, occasionally as a result of
maladaptive family relationships, power struggles, fear of failure (school), etc. In order to address
change and the familial dynamics, a therapist will need to assess and address all areas during the
treatment process—working simultaneously with the client and family (Dallos & Draper, 2010).
Conclusion
In this signature assignment I discussed the need for psychological services in the school
setting, focusing on the role of MFTs, particularly as it relates to children who are at risk of substance
abuse and experiencing school violence. I explored the qualifications of an MFT that makes them a
suitable professional to provide services in the school setting and highlighted the importance of
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incorporating MFTs into the school setting. I then discussed theoretical approaches an MFT could use
to work with at risk adolescent clients. Finally, I addressed how a systems approach could provide a
framework for assisting adolescents and his/her family in addressing concerns related to these
difficult situations.
References
American Association for Marriage and Family Therapy. (2018). Family therapists in schools.
Retrieved from
https://www.aamft.org/advocacy/family_therapists_in_schools.aspx
American Association for Marriage and Family Therapy (2004). Marriage and family therapy core
competencies. Retrieved from
https://www.coamfte.org/Documents/COAMFTE/Accreditation%20Resources/MFT
%20Core%20Competencies%20(December%202004).pdf
Biolcati, R., Palareti, L., & Mameli, C. (2018). What adolescents seeking help teach us about a
MFTs IN SCHOOLS
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school-based counseling service.
Child and Adolescent Social Work, 35,
45-56.
Canadian Pediatric Society (2014). Harm reduction: An approach to reducing risky health behaviours
in adolescents. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2528824/
Cavanaugh, B. (2016). Trauma-informed classrooms and school.
Beyond Behavior, 25
(2), 41-46.
Colognori, D., Esseling, P., Stewart, C., Reiss, P., Lu, F., Case, B., & Warner, C.M. (2012). Self-
disclosure and mental health service use in socially anxious adolescents.
School Mental
Health, 4
(4), 219-230. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3763858/
Dallos, R. & Draper, R. (2010).
Introduction to Family Therapy
. Retrieved
from:
http://ebookcentral.proquest.com/lib/touromain-eBooks/detail.action?docID=557089
.
Dowdy, E., Furlong, M., Raines, T. C., Bovery, B., Kauffman, B., Kamphaus, R.W., Dever, B.V.,
Price, M., & Murdock, J. (2015). Enhancing school-based mental health services with a
preventative and promotive approach to university screening for complete mental health.
Journal of Educational and Psychological Consultation, 25,
178-197.
Frydman, J.S. & Mayor, C. (2017). Trauma and early adolescent development: Case examples from a
trauma-informed public health middle school program.
Children & Schools, 39
(4), 238-247.
Miller & Miller (2014).
Learning the Language of Addiction Counseling.
Wiley: Hoboken, NJ.
Murtonen, K., Suomalianen, L., Haravuouri, H., & Marttunen, M. (2012). Adolescents’ experience of
psychosocial support after traumatization in a school shooting.
Child and Adolescent Mental
Health, 17
(1), 23-30. Retrieved from
http://web.a.ebscohost.com.lb-
proxy9.touro.edu/ehost/pdfviewer/pdfviewer?vid=3&sid=6643168b-b9fd-41d1-9e75-
c780bd7d36d1%40sdc-v-sessmgr04
Pearlman, D., Venetti, T., & Hill, J. (2018). Linking public school and community mental health
services: A model for youth suicide prevention.
Rhode Island Medical Journal,
36-38.
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Substance Abuse and Mental Health Services Administration (2010). Results from the 2009 national
survey on drug use and health: Mental health findings (NSDUH Series H-39, HHS
Publication No. SMA 10-4609). Retrieved from
http://www.gmhc.org/files/editor/file/a_pa_nat_drug_use_survey.pdf
Searcey van Vulpen, K., Habegar, A., & Simmons, T. (2018). Rural school-based mental health
services: Parent perceptions of needs and barriers.
Children & School, 40
(2), 104-111.
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