Families, Partners, and Children

1. Families, Partners, and Children Sheeva Ebrahimi, Harmon Hanson, Joanna Mitchell 

2. Families - Overview Relationship Can be Viewed in Two Ways • "Wet" State and "Dry" State Communication Within Family Suffers • Refusal to discuss issues and acting out • "Power without Responsibility" • Recursive communication  What then becomes normal? Recovery Timeline • Early recovery: 1st to 2nd year • Middle recovery: 3rd to 5th year • Ongoing recovery: 4th or 5th year

3. Families - Treatment Develop an Individualized Treatment Plan • Develop a contract • Create an appropriate timeline (i.e., 3 years) • Family should be included in the treatment process Intervention • Family and friends are included • Used to break through the abusers denial and confront he/she with "the facts"

4. Treatment Continued Gender Sensitivity • Gender differences can play a role in recovery Support Systems • Families should attend their own treatment groups • Helping children can be challenging because of the parents denial Discuss Abuse • Physical or sexual abuse should be addressed directly

5. Families - Treatment Continued Address Distrust in the Family • Explain it to the family as a normal part of therapy • Trust is action, not words • Intervention: "Distrust days" Assist in Improving Communication  • Learning how to make "I" statements, instead of "you" statements • Practice Conflict Management through role play with the abuser and family

6. Treatment Continued Creation of New Behaviors • Follow up with the family on their new behaviors at home or in public • Take small steps and have low expectations Termination with Family • Complete the Contract • Agreement from both parties that goals have been achieved

7. How would you feel? http://www.youtube.com/watch?v=ebmn5B7fvr4 http://www.youtube.com/watch?v=nAvspf49UTE&feature=related

8. Partners - Overview Differences between Enabling and  Co-Dependency Minnesota Model of Chemical Dependency  and the Family Disease Model  Strong Sense of Denial in Partners of Addicts • Important for Partners to also seek treatment Ask of Partner's Using Patterns • Anxiety and Depression Common in Co-Dependents • Discuss behavioral patterns and use of prescribed medications 

9. Partners - Treatment Treatment Tasks:  • Change Enabling Behaviors • Explore History of Dysfunctional Family of Origin • Include Psychoeducational Information • Discuss Impact of These Relationships on Current Actions Emphasize importance of Involvement in Self-Help Groups for Family Members • Very few facilities offer care to family members • Groups such as Al-Anon, Nar-Anon, Co-Anon, Families Anonymous, and Co-Dependents Anonymous • These groups offer both cognitive behavioral change and spiritual comfort

10. Partners - Treatment Continued Behavioral Martial Therapy - O'Farrell • Goals: Alleviate marital distress, learn better relationship skills (i.e., improved communication and negotiation) Strengths-Based Relational Approach to Recovery • Important to recognize and acknowledge genuine love, utilizing it as a powerful clinical tool • Rebuild the relationship with the love that remains and other strengths of the couple when the excessive dependency is removed in recovery

11. Partners - Treatment Continued "Chapter 9" Program • Based on AA and Al-Anon, not affiliated • Opportunity for couples to pursue their recovery together • Provides a model for recovery and increases the likelihood of change Family Systems Therapy • Focuses on the systems of relationship that problem drinking occurred and altering the interactions that maintain drinking • Does not require abstinence, but remains neutral until the family decides a change in the drinking pattern is necessary

12. Children - Overview Common Attributes Between Children of Chemically Dependent Parents • "Special case of narcissistic injury suffered at the hands of empathically impaired parents"  Do Not Understand the Physiology and Behavioral Effects of Chemical Dependency • Parents value drugs more than children • Parents are emotionally unavailable • Strong fear of inadequacy and                                                 development of coping mechanisms Some Children are Resilient Despite a Traumatized                                  Upbringing

13. Adult Children of Substance Abusers High Risk for Types of Substance Abuse and Compulsive Behaviors or Process Addictions • Careful assessment and appropriate interventions are imperative  Damage to Self-Esteem and Tend to be Dissatisfied in interpersonal relationships • Blind Trust • Excessive Shame • Boundary Confusion Issues of Countertransference • Sense of entitlement or dissatisfaction • Client may defend against displays of vulnerability, potentially criticizing or frustrating the therapist

14. Children - Treatment Presence of a Responsive-Empathetic Self-Object • Important to meet the normal mirroring and idealizing needs of the child • Necessary to facilitate the development of a coherent, well-integrated self Participation in Groups • Reduce isolation, provide peer support and prepare for involvement in self-help groups for teens (Ala-Teen or Nar-Teen) Multi-Dimensional Family Therapy •  Involves family in reduction of adolescent's drug abuse and delinquency by improving family functioning • Useful for teens who rely on outside sources of comfort, such as substance abuse, gambling, eating disorders, etc.

15. Role Play • Client 3 - Chad/Son • Stage: Pre-Contemplation • Process: Self Re-Evaluation  • Client 4 - Shelly/Daughter • Stage: Contemplation • Process: Emotional Arousal Client 1 - Denise/Mother • Stage: Action •  Process: Self Liberation Client 2 - David/Father • Stage: Contemplation • Process: Consciousness Raising Therapeutic Techniques: Multi-Dimensional Family Therapy

16. Discussion • In what ways (and situations) would you address an individual differently when their family is present in the room as opposed to individual therapy?  What limitations exist? • What are some of the difficulties  you see in working with spouses  that are in different stages of change in relation to their addiction/recovery? • How did the individual roles of the family members play into their addictive behaviors?

17. Useful Website Substance Abuse & Mental Health Services Administration: Partners for Recovery  http://pfr.samhsa.gov/about.html • Connects professionals to resources to improve services and systems of recovery for those with addictions and other co-occurring mental disorders • Includes information on individuals, families and community resources and support

18. References Cattapan, O. & Grimwade, J. (2008). Parental illicit drug use and family life: reports from those who sought help. Australian & New Zealand Journal of Family Therapy, 29(2), 77-87. Markowitz, R. (2004). Dynamics and treatment issues with children of drug and alcohol abusers. In Straussner, S.L.A. (Ed.), Clinical work with substance-abusing clients (2nd Ed., Chapter 13). New York: The Guilford Press. McIntyre, J.R. (2004). Family treatment of substance abuse. In Straussner, S.L.A. (Ed.), Clinical work with substance-abusing clients (2nd Ed., Chapter 11). New York: The Guilford Press. Ripley, J. S., Cunion, A., & Noble, N. (2006). Alcohol Abuse in Marriage and Family Contexts: Relational Pathways to Recovery. Alcoholism Treatment Quarterly, 24(1/2), 171-184. doi:10.1300/J020v24n01-10

19. References Seljamo, S.; Aromaa, M.; Koivusilta, L.; Rautava, P.; Sourander, A.; Helenius, H.;  Sillanpaa, M. (2006). Alcohol use in families: a 15 year perspective follow-up study. Addiction, 101(7), 984-992. Tracy, S. W., Kelly, J. F., & Moos, R. H. (2005). The Influence of Partner Status, Relationship Quality and Relationship Stability on Outcomes Following Intensive Substance-Use Disorder Treatment. Journal of Studies on Alcohol, 497-505. Retrieved from EBSCOhost.    Van Der Zwaluw, C.S.; Van Der Vorst, H.; Engels, R. (2008). Parent effects and bidirectional parent-child effects in family alcohol use. European Addiction Research, 14(2), 106-112. Zelvin, E. (2004). Treating the partners of substance abusers. In Straussner, S.L.A. (Ed.), Clinical work with substance-abusing clients (2nd Ed., Chapter 12). New York: The Guilford Press.