tip_39: family therapy

Family Therapy

TIP 39

Copyright 2008-2012 AllCEUs.com a subsidiary of CDS Ventures, LLC

What is a Family?Types

Traditional families Single parents.Foster relationships.Grandparents raising grandchildren.Stepfamilies.Extended familiesElected families

In general: Family can be defined according to the individual’s closest emotional connections.


Impact of Substance Abuse on Families

Financial: Money spent for drug use; Psychological denial or protection of the

addict, chronic anger, stress, anxiety, hopelessness, inappropriate sexual behavior, neglected health, shame, stigma, and isolation.

Environmental (homelessness, safety)FASD in children of women who abuse alcohol

during pregnancy Older adults cared for by their children.


Parent’s substance use can have cognitive, behavioral, psychosocial, and emotional consequences for children, including:Impaired learning capacityA propensity to develop a substance use disorderAdjustment problems, including increased rates

of divorce, violence, and the need for control in relationships

Depression, anxiety, and low self-esteemChildren forced prematurely to accept adult

responsibilities


Family Therapy vs. Family InvolvedFamily therapy

a collection of therapeutic approaches that share a belief in the effectiveness of family -level assessment and intervention.

In family therapy the unit of treatment is the family and the individual within the family system

Family-involved therapy uses a individual-level assessment and

intervention, while educating the family


Family therapy in substance abuse treatment has two main purposesuse family’s strengths and resources to help find

or develop ways to live without substances of abuse

to ameliorate the impact of chemical dependency on both the identified patient and family.


Assessmentassess for the potential for domestic violence

or abuseDo not accept the family's version of the

problemnot interested in the content of family's stories,

but more in the process of the family’s interaction

Resonance defines the emotional and psychological accessibility or distance between family members and needs to be assessed in the context of culture

The counselor should announce at the beginning that she or he will not keep secrets


Initial TreatmentDenial and Resistance are essential to both

family and substance abuse treatmentA therapeutic alliance is built around

individual goals that family members can reach in therapy

One of the most useful strategies a counselor can use is to support the existing family power structure


Family TherapyThe unit of treatment is the family, and/or the

individual within the context of the family system. The person abusing substances is regarded as a

subsystem within the family, The familial relationships within this subsystem

are the points of therapeutic interest and intervention.

In family therapy, content is what the family talks about and process is how the family interacts

Family therapy cannot take place unless all participants are present


By observing process the counselor learns the unwritten rules that guide the family's communication

For every action there is a corresponding reaction from the rest of the family is the definition of the principle of complementarity


Goals of family therapy in substance abuse treatment

Helping families become aware of their own needs

Providing genuine, enduring healing for family members

Working to shift power to the parental figures in a family

Improving communicationHelping the family make interpersonal,

intrapersonal, and environmental changes affecting the person using alcohol or drugs

Keeping substance abuse from moving from one generation to another (i.e., Prevention).Copyright 2008-2012 AllCEUs.com a subsidiary of

CDS Ventures, LLC

Systems & ContextsSystems

IndividualFamilyCultureSociety

5 ContextsFamilyPeersCultureNeighborhoodCounseling


Life ContextIncludes those in the immediate household

and those systems outside the family in which the family members participate


Techniques

Effective strategies (3 Ps)PracticalProblem FocusedPlanned


ComplementarityMembers behave in ways that fulfill

unconscious needs and demands of the otherEach member's recovery needs must be

explored in relationship to the othersThe Addict.The Hero.The Mascot.The Lost Child.The Scapegoat.The Caretaker (Enabler).


BoundariesTypes

EnmeshmentDisengagementHealthy

FunctionRegulate flow of informationMaintain structure to permit function

Setting clear rules and consequences is one of the best ways to start setting the boundaries between parent and child


Homeostasis and ResistanceCurrent behavior patterns preserve order and

stabilityThe system will resist changeIt is appropriate to work with a family if one

or more members attends the session under the influence of alcohol or other drugs

The most frequently observed type of family resistance is an identified patient withtoo much power or control


TriangulationA third member is drawn into a problem

between two othersIn detraingulation, the counselor changes a

way of interacting by coaching one member to do or say the opposite of what he or she would normally do


BenefitsImproved treatment outcomesFamily support of client recoveryFamily recoveryIntergenerational ImpactReduced resistanceIncreased flexibility


LimitationsLack of structureAdditional trainingMindset shift: individual to family


Levels of InvolvementLevels

Level 1: MinimalLevel 2: PsychoeducationLevel 3: Address feelings/supportLevel 4: Systematic assessment and

interventionsLevel 5: Family Therapy

Determined by: The counselor's level of experience and comfortThe family's needs and readiness to change


Level 3 Specialized SkillsElicit family member's concernsEmpathically listenForm preliminary assessmentEncourage efforts to copeTailor education to the familyIdentify dysfuctions, make referrals


Level 4 Specialized SkillsEngagementFacilitate expression from all membersAssess family's level of functioningSupport individuals and avoid coalitionsReframe the problem(s)Encourage viewing solutions through

collaborative lenseHelp generate alternative coping methodsCalibrate roles


Level 5: Specialized SkillsEngage difficult membersGenerate and test hypotheses about

interactional patternsEscalate conflict to break impasseTemporarily side with one memberDeal with resistance to changeNegotiate collaborative relationships


Integrated ModelsStructural Strategic

Family structure is repeated patterns of interaction

Family structure determines individual behaviorPower of the system is greater than that of the

individualGoals

Identify the function of substance abuse in maintaining family stability

Guide changes in family structure


Multidimensional Family Therapy (Adolescents)Goals-Adolescent

Positive Peer RelationsHealthy Identity FormationBonding to Prosocial ActivitiesAutonomy within the Parent-Child relationship

Goals-ParentIncrease parental commitmentImprove communicationIncrease parenting skills


Behavioral Family Therapy

AssumptionsAddicted Families have skill deficits'Family member reactions influence the behaviorDistorted beliefs lead to dysfunctional behavior

GoalsContingency contracting to change reward paradigmsSkills training to provide alternative behaviors to rewardCognitive Restructuring to replace irrational thoughts

with positive ones


BFSTPatterns of interaction in the family influence

the behavior of each family memberBFST it is important that the counselor joins

into the "system“Interventions change maladaptive patterns of

interaction

Elements of the family's interactions examinedOrganizationResonanceDevelopmental StagesIdentified Patient


Solution Focused Brief Focuses on what life will be like when the

problem is solved Miracle question


3 Stages of RecoveryAttainment of SobrietyAdjustment to SobrietyMaintenance of Sobriety


Stage 1: AttainmentMotivate family to engage client in detoxContract with the family for abstinence and

treatment complianceDefine problemsEmploy support groupsUse the “network” to motivate treatmentInterview family in relation to the larger

systemIntroduce the difference between facts and

reactions


Stage 2: AttainmentRestructure family rolesRealign subsystem and generational

boundariesReestablish family and the larger system

boundariesTeach relapse preventionIdentify communication dysfunctionUse contingency contractingAsk scaling and relational questionsIdentify exceptions to behaviorIdentify problem and solution sequences


Stage 3: MaintenanceRenegotiate relationships with larger systemsEmploy support groups


Special PopulationsDomestic ViolenceRacial/Ethnic MinoritiesGLBT People with DisabilitiesChildren/AdolescentsOlder Adults (elder abuse, culture norms)Rural PopulationsHomeless clientsVeterans


AdolescentsAdolescents needing substance abuse treatment

TruancyViolent or aggressive Risky sexual behavior

Both under and overinvolvement of parents have been linked to adolescent problem behaviors

In families of addictedadolescents, parents have a difficult time determining what is age-appropriate

In the event of a powerful identified patient (adolescent) the counselor should align with the youth from the start


ViolenceScreen for partner violence, child abuse and

elder abuseScreen for personality disorders which may

indicate a propensity for violence toward self or others

Develop a safety plan as necessaryReport abuse as required


SummaryFamily therapy considers the problem to be

instigated and maintained by the whole family, not the identified patient

There are multiple approaches to family therapy

It is important to be aware of cultural implications for family therapy


tip_39: family therapy

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