CHAPTER 9: Applying Family Systems Approaches in the Treatment of Substance Abuse and Addiction

1. CHAPTER 9: Applying Family Systems Approaches in the Treatment of Substance Abuse and Addiction Substance Abuse and Addiction Treatment: Practical Application of Counseling Theory First Edition Todd F. Lewis Developed by Katie A. Wachtel, University of North Carolina at Greensboro

2. Introduction • Children and families suffer from abuse, neglect, and psychological/behavioral problems as a result of addiction • Because of the negative impact substance use can have on relationships, it is important to include families and address these issues in counseling • The goal of this chapter is to outline family therapy from a “systems” perspective and to discuss the application of family theory and therapy in counseling chemically dependent families

3. The Major Tenets of Family Therapy • Family therapy can differ depending on theoretical orientation • Examples of family therapy • Adlerian Family Therapy • Bowenian Family Therapy • Empowerment Family Therapy • Integrative Family Therapy • Narrative Family Therapy • Satir Family Therapy • Solution-Oriented Family Therapy • Structural Family Therapy

4. Major Tenets of Family Therapy Continued • Systems theory is the foundation for many family therapy approaches • Systems theory sees the family as an organism with a focus on the relationship between members • Behavior of the client cannot be understood without emphasizing the whole interactions and patterns between and among family members

5. Major Tenets of Family Therapy Continued • Boundaries • Rules of interaction for family members that can be rigid or loose • Homeostasis • The tendency among families to maintain a sense of coherence, equilibrium, and structure in the face of change • Subsystems • Smaller systems within the larger family system • Rules • Spoken or unspoken codes that develop through interaction and reaction

6. Bowen Systems Family Theory • Differentiation of self • The ability of a person to separate his emotional and reactive self from his intellectual self • Triads (or Triangles) • The inclusion of a third member into a dyad in order to alleviate anxiety between members of the dyad • Nuclear family emotional system • The pattern of emotional forces within a nuclear family

7. Bowen Systems Family Theory Continued • Family projection process • When parents transfer their low differentiation onto the children • Multiple generation transmission process • Progression of how differentiation increases or decreases over multiple generations in a family • Emotional cutoff • A psychological coping mechanism designed to block off or withdraw from intense emotional feelings within family relationships

8. Characteristics of the Addicted Family • The Addicted Family • Addicted members act out family problems or turn to addiction because of family problems • Chemically dependent families almost always have a negative impact on children • Common characteristics: discouraging change or growth, conditional love, emotional withdrawal, rigid boundaries, distorted sense of responsibility • Family Roles • Typically depend on the individual’s position within the family • The Chemically Dependent Person, The Chief Enabler, The Family Hero, The Scapegoat, The Lost Child, The Mascot

9. Characteristics of the Addicted Family Continued • Enabling • Knowingly behaving in a way that allows another member to use chemicals without consequences • Codependency • An unhealthy pattern of relating to others that results from being too closely involved with an addicted individual • Controversy: little empirical evidence, biased against women, everyone can be considered codependent to some extent, fails to consider social context of behavior

10. Application of Family Therapy with Substance Abuse Populations • Bowen Systems Family Therapy • Encourage a balance between autonomy and intimacy • Orient the family by: • establishing a working relationship, • decreasing anxiety, • making sure everyone is heard, and • modeling emotional neutrality • The clinician becomes part of the triangle and helps family members form healthy triangles • Conduct an assessment of the family relationship history (family mapping, family genogram, Adlerian Lifestyle Assessment)

11. Application of Family Therapy with Substance Abuse Populations • Techniques and Strategies • Joining • Assigning tasks • Creating enactments • Segmenting • Family Sculpting • Drawing • The solving circle

12. Sequential Family Addictions Model • A structured model where each stage focuses on the family. Families may not need all seven stages. • Stage one: Motivational Interviewing • Stage two: Solution-Focused Family Therapy • Stage three: Cognitive-Behavioral Family Therapy • Stage four: Structural Family Therapy • Stage five: Extended Family Systems Therapy • Stage six: Modified Intergenerational Family of Origin Therapy (may not fit for all families) • Stage seven: Psychodynamic object relations principles (long-term and used only when other stages are unsuccessful).

13. Other Family Therapy Approaches • Evidence-based approaches have emerged to address family issues when the teenager is the identified client with the addiction problem • Examples: • Multidimensional Family Therapy (MDFT) • Brief Strategic Family Therapy (BSFT)

14. Family Systems Therapy in the Treatment of Diverse Populations • Many family systems approaches do not account for cultural differences in the definition of a family • The dynamics of the family must be understood before implementing family therapy strategies • Clinicians must examine the cultural fit between clinician and client by addressing multicultural issues with the client • Barón’s Integrative Cross-Cultural Model can be helpful in addressing multicultural issues in counseling

15. Running Case Study: Michael • Michael identified ways his substance use may be impacting his wife and children • Clinician conducts a genogram to provide insight regarding relationship patterns, generational transmission processes, and projection processes within the family • Clinician creates a triad between family members to alleviate tension • Clinician assesses family roles within the family and provides an avenue for all members to share their voice

16. Strengths, Limitations, and Ethical Issues Related to Family Therapy • Strengths • As effective as individual therapy • Addresses systemic factors that create and maintain substance abuse • Believes that psychological symptoms are a product of dysfunctional systems, thus correcting faulty relationship patterns can alleviate substance use • Does not blame the individual or the family for the problems, but focuses on creating healthy ways to adjust to the family system

17. Strengths, Limitations, and Ethical Issues Related to Family Therapy Continued • Limitations • Can be complex, creating confusion if not sufficiently trained • Does not focus exclusively on the substance abuse problem • Individual perspectives can get lost • Ethical Issues • Family therapy takes skill and understanding to use effectively. Clinicians who lack proper training may be practicing unethically • Ethical issues (e.g. confidentiality) can play a role in family therapy