Assessment Learning Plan 6 Family Systems (550-150) Jennifer Dohl November 22, 2013

1. Assessment Learning Plan 6 Family Systems (550-150) Jennifer Dohl November 22, 2013

2. Family TherapyAdult Children of Alcoholics

3. Substance abuseA Family Disease The targeted audience for this presentation is Adult Children of Alcoholics Siblings in Family Therapy

4. Objectives of Presentation • Working with the counselor, the clients will gain an understanding of how substance abuse is a family disease that affects the entire family system. • The clients will understand the characteristics of adult children of alcoholics and begin to recognize these characteristics in themselves. • The clients will recognize how family therapy is a crucial component to begin the healing process for the ACoA. • Clients will begin to develop their own genogram that depicts three generation of their family of origin.

5. A Family Disease Many substance abuse treatment counselors base their understanding of a family’s relation to substance abuse on a disease model of substance abuse. Within this model, counselors have come to understand substance abuse as a family disease(Substance Abuse Treatment and Family Therapy. Chapter 3 Approaches to Therapy., 2004).

6. Family Disease • A family disease is a disease that affects all members of a family as a result of the substance abuse of one or more members and that creates negative changes in their own moods, behaviors, relationships with the family, and sometimes even physical or emotional health (Substance Abuse Treatment and Family Therapy. Chapter 3 Approaches to Therapy., 2004).

7. Family Disease • Many adult children of alcoholics realize that things are not working in their lives, but it never occurs to them that it might have something to do with the patterns they formed growing up in an alcoholic family (Adult Children of Alcoholics Need Intervention, 1984).

8. Who is an ACoA? • You are considered an adult child of an alcoholic (ACoA) if you were raised in a household where one or both parents abused alcohol or other substances. • This group is generally defined as people over 20 years of age. Many are no longer living with their family of origin. They are beginning adult relationships or have started their own families(Adult Children of Alcoholics Need Intervention, 1984).

9. ACoA • Therapists say that many ACoA’s (some in their fifties and sixties) are reporting various behavioral problems related to feelings about themselves and their interpersonal relationships. • Many therapists believe these problems begin from behavior patterns learned at a young age in the alcoholic family of origin. • These behaviors are inappropriate and often self-destructive(Adult Children of Alcoholics Need Intervention, 1984).

10. ACoA • ACoA‘s are at particularly high risk for developing their own alcohol problems as adults. According to estimates, as many as 60% of alcoholics in treatment were raised in a home where at least one parent was an alcoholic • Many of these adults report that they never associated their current problems and feelings with their experiences as the child of an alcoholic parent many years ago (Adult Children of Alcoholics Need Intervention, 1984).

11. Statistics for ACoA’s A study of 400 ACoA’s and 400 controls (not ACoA’s) showed that the answers given by the ACoA’s to 13 survey questions were significantly different from those given by the control group. • 60% of the ACoA‘s said their inability to trust people was a major problem in their lives, compared with 35% of the controls • 59% of ACoA’s said they found it difficult to identify their feelings, compared with 35% of controls • 65% of ACoA’s said they could not express their feelings easily, compared with 51% of controls • 74% said they had problems identifying their own personal needs, compared with 60% of controls (Adult Children of Alcoholics Need Intervention, 1984)

12. What is Family Therapy? • Family therapy is a compilation of treatment approaches that rely on family-level assessment and intervention. • A family system is like a board game in progress, and like in any game, each piece is related to all the other pieces. Subsequently, a change in any piece of the family system will bring about changes in all other pieces. • The basic goal for family therapy is for each family member to reach a higher level of functioning and emotional maturity (Curtis, 1999). • Family therapy relies on the strengths of families to bring about change in a range of diverse problem areas, including alcoholism and substance abuse (Substance Abuse Treatment and Family Therapy TIP 39).

13. Family Systems Perspective • The family therapist is can be looked at as a relationship or context therapist. • The family therapist’s goal is to help families understand and relate to each other in ways that are reciprocally satisfying. • The family therapist’s goal is not to try to solve an individual person’s problems. • The family therapist interacts with clients utilizing his awareness of the situation in which problems or symptoms began. • To achieve the goal of a reciprocally satisfying relationship among the family members, the family therapist assists in the formation of a new context in which mutually desired behaviors become the common response (Becvar & Becvar, 1999).

14. Is Therapy Needed for ACoA’s? • ACoA’s may need aggressive and long term therapy. Ignoring the damage only allows it to infiltrate intimate relationships and cause the relationship to deteriorate. These patterns may then be passed on to the next generation. Growing up in a dysfunctional alcoholic home is traumatizing and the symptoms of trauma can surface much later when the ACoA starts their own family (Dayton, 2012).

15. What are the characteristics of an ACoA? Not all ACoA’s will have every characteristic listed here but if you look closely you may recognize a few that you can identify with. Problems with Self- Regulation • Wide mood swings back and forth between feeling overwhelmed with intense emotion then shutting down. The ACoA may feel uncomfortable living without trauma because they are so used to living in chaos (Dayton, 2012).

16. Hyper-vigilance/Anxiety • ACoA are constantly try to read the faces of those around them so that they can protect themselves against perceived danger. They are always “waiting for the other shoe to drop". They may see trouble coming when there is none and may act out to protect themselves when there is no provocation. They are always on full-alert for turmoil coming their way.

17. Hyper-reactivity/Easily Triggered • Living with relationship trauma can over sensitize us to stress. The ACoA may over react to stressful situations and blow small conflicts out of proportion. Any situation that is reminiscent of their past relationship trauma may trigger those feelings and cause the ACoA to act out disproportionately to the situation (Dayton, 2012).

18. Emotional Constriction • ACoA’s that were raised in a home where certain emotions were not encouraged to be expressed may feel uncomfortable to express those feelings and emotions as an adult. Loss of Trust and Faith • As a child in an alcoholic home their world and the relationships within it become very unpredictable or unreliable. The child experiences a loss of trust and faith in both relationships and in life's ability to restore itself (Dayton, 2012).

19. Unresolved Grief • ACoA’s have suffered deep losses. As children they were not able to rely on their parent/parents to meet their needs. They lost any sense of security, stability or predictability in their lives. They may have had to face the loss of a family member who succumbed to their addiction. ACoA’s often need to mourn not only what happened, but what never got a chance to happen (Dayton, 2012).

20. Traumatic Bonding • Traumatic bonds are unhealthy bonding styles that are created in families where a sense of fear is always present. When children feel lost and frightened they may "rescue" each other. This increases their sense of loyalty and bonding. The children feel they have survived together and this may create a bond of loyalty that must be preserved no matter what, even if the bond becomes problematic or dysfunctional (Dayton, 2012).

21. Learned Helplessness • Learned helplessness happens when people become conditioned to believe that a situation is unchangeable or inescapable.The children raised in a home where substance abuse is present may lose their ability to make any changes to a situation they are in even when they are adults and away from home. • Somatic Disturbances • Some effects of emotional experiences may show up as physical symptoms such as; back pain, chronic headaches, muscle tightness or stiffness, intestinal disturbances, heart pounding, shivering or trembling (Dayton, 2012).

22. Tendency to Isolate • People who have felt traumatized may isolate and withdraw to protect themselves when they are feeling vulnerable. Isolation is also a symptom of depression. • Cycles of Reenactment • We repeat the relational patterns that are familiar to us even if they do not get us what we really want. The reenactment dynamic is one of the most common ways that trauma gets passed down from one generation to the next (Dayton, 2012).

23. High Risk Behaviors • Most adult children of alcoholics grew up in a high stress living environment. The ACoA may be drawn to high risk behaviors because they crave the rush of adrenaline during high stress situations. Some examples are; speeding, risky sexual behavior, spending, fighting, drinking or drugging, working excessively or other behaviors done in a way that puts one at risk. • Survival Guilt • The person who "gets out" of a dysfunctional family system has feelings of guilt because other family members still remain inside. The ACoA may become preoccupied with solving their family’s problems to resolve their feelings of guilt over leaving (Dayton, 2012).

24. Shame • For ACoA, shame is not so much a feeling that is experienced in relation to an specific incident or situation, but it is a basic attitude about themselves. ACoA’s who feel shame may lack vitality and may not be able to accept love or caring in an ongoing relationship. Symptoms of shame may include impulsive decision-making, or not being able to make decisions at all. • Development of Rigid Psychological Defenses • People who have been hurt emotionally and are not given the opportunity to discuss it freely may develop rigid psychological defenses to cope with their fear and pain. Examples of these defenses include; dissociation, denial, splitting, repression, minimization, intellectualization, projection (Dayton, 2012).

25. Relationship Issues • When a child sees only dysfunctional relationships in their home while growing up they may repeat those same dysfunctional relationship patterns as an adult if those issues are not addressed in treatment or counseling. • Depression with Feelings of Despair • A consequence of growing up in an alcoholic household that includes chaos and trauma may be having trouble controlling feelings such as anger, sadness and fear, all of which may contribute to depression. Trauma and stress experienced as children may cause the body to continually over react to stressors (Dayton, 2012).

26. Distorted Reasoning • Children make sense of the world around them in a way that meets their needs. If a child is growing up in a chaotic dysfunctional world, he or she may tell themselves whatever is necessary to stay connected. The child learns to deny the truth that is in front of them in an attempt to make the situation less frightening and confusing. These self-preserving acts may carry through to adult hood and adult relationships. • Loss of Ability to Take in Caring and Support from Others • If a person has been hurt and let down by others over and over, it may be very hard or impossible for them to let their guard down and let someone care for them(Dayton, 2012).

27. Desire to Self Medicate • It is common for the ACoA to become an addict. The trauma growing up in an alcoholic home can lead to self medication by drugging or drinking. Self medicating can seem to be a solution in the immediate moment, as it really does make pain, anxiety and physiological problems temporarily disappear, but in the long run, it creates many more problems than it solves. In order for the ACoA, who has now become an addict, to recover and stay in recovery she must deal with all the issues of her childhood growing up in a dysfunctional home (Dayton, 2012).

28. How Do We Survive Living with an Addict? • Family members often develop survival roles that allow them to experience the least amount of trauma possible while living with an addict. • Family members repress their feelings with survival roles that defend them against the pain. • Family members are unaware they are playing the survival role. • These survival roles permit family members to live in delusion just as denial allows the addict to avoid dealing with the reality of the addiction. • The whole family loses touch with reality as the addiction and the dysfunctional family dynamics progress over time, family members become increasingly entrenched in their behavioral role with the addict (Ferguson, 2011).

29. Survival Roles • You may recognize yourself or a family member when you were growing up in one of these survival roles. These survival roles include; • Chief enabler/Codependent Family Member • Family Hero • Lost Child • Scapegoat • Mascot

30. The Codependent Person or Chief Enabler • This person can be the spouse, an adult child enabling the parent, or a parent enabling a child, adolescent or adult child. • The chief enabler is usually the person closest to the addict. There is often a mutual dependence between the addict and the chief enabler. As the addiction progresses over time, the chief enabler/codependent family member feels increasingly compelled to attempt to take control of the situation. • The codependent family member internalizes their fear, anger, hurt, guilt, and pain with seriousness, self-blaming, super-responsibility, manipulation, self-pity, and fragility (Ferguson, 2011).

31. The Family Hero • The family hero is often the oldest child. This child often knows more about the family situation than anyone else. • They attempt to reduce the family pain by trying to make things better. The family hero often does well in school, plays sports, may hold a part-time job, and help with younger siblings. • The hero can’t keep up with the chaos substance abuse is causing in the family so she internalizes her feelings of loneliness, anger, hurt, inadequacy, confusion, he becomes an overachiever and seeks approval by going above and beyond what should be expected of him. • The hero may develop a life away from the family and put up a façade of being in control and self- assured (Ferguson, 2011).

32. The Family Scapegoat • The scapegoat is considered the problem child in the family. His job is to provide focus and distraction for the family system. • The scapegoat gets in trouble at home and at school so the family can focus on his behavior and continue to deny the larger problems the substance abuse is causing. • The scapegoat seeks approval from a peer group instead of the family. • The scapegoat internalizes his feelings of loneliness, anger, fear, hurt, and rejection by withdrawing from the family. • He or she may choose to use or drink or act out in other self-destructive ways. If these issues go untreated, the scapegoat may continue as an adult to get into trouble at work and socially (Ferguson, 2011).

33. The Lost Child • The lost child is often the middle child. This child survives by withdrawing into himself/herself. • The lost child’s goal is to stay out of the way and not attract attention to himself. This child would be daydreaming in class, probably has few friends, and typically fits in invisibly. • The lost child’s role is to provide relief because no one has to worry about him/her. • The lost child internalizes his feelings of loneliness, anger, fear and rejection by being quiet, indifferent, detached, and very independent. The lost child keeps and emotion distance between himself/herself and the family(Ferguson, 2011).

34. The Family Mascot The mascot is often the youngest child. They are charming, charismatic, and the class clown at school and at home. They are not taken too seriously by the family. Their role is to distract from the dysfunction in the family by providing fun and humor. This child usually knows least what is going on in the family. The mascot internalizes his feelings of fear, insecurity, confusion, and loneliness by providing entertainment. Their hyperactive, funny, cute, goofy behavior gets them the attention that they desire (Ferguson, 2011).

35. What is a Genogram? • One technique used by family therapists to help understand family relations is the genogram. • It is a symbolic chart of three generations of a family, marking marriages, divorces, births, geographical location, deaths, and illness. • The genogram is developed as sessions progress. Genograms can be used to help identify root causes of behaviors, allegiances, and issues of shame within a family. • Working on a genogram can create bonding and increased trust between the therapist and client (Substance Abuse Treatment and Family Therapy Chapter 3 Approaches to Therapy, 2004).

36. Genograms The genogram has become a basic tool in many family therapy approaches. Important physical, social, and psychological dysfunction may be added to it. Most genograms begin with the legal and biological relationships of family members. They also chronicle significant events such as births, deaths, and illnesses, religious affiliation, and the character of relationships such as alliances and conflicts. A genogram can make it easier for a family member to chronicle the dysfunctional or negative aspects of the family system (Substance Abuse Treatment and Family Therapy Chapter 3 Approaches to Therapy, 2004).

37. Genogram Objectives • The counselor and clients will explore the complicated relationships, problems, and attitudes of multigenerational families. • The clients will begin to see themselves and their family of origin relationships in a new light. • The clients and counselor together will begin to understand how family relationship patterns over multiple generations affect clients and their current relationships (Substance Abuse Treatment and Family Therapy Chapter 3 Approaches to Therapy, 2004).

38. The Making of a Genogram • In the genogram the family members are represented by a square for each male and a circle for each female. • A double line symbol is used to represent yourself in the genogram. • Family relationships are represented by lines. Begin the genogram with the father on the left and the mother on the right. The husband and wife have a horizontal line between them with the date of marriage/separation/divorce. • Add children under the line of marriage listing the oldest to the youngest from left to right (Curtis, 1999).

39. Genogram cont’d • Above each family members symbol write the year of birth and death (mark an X in the symbol) if applicable. • Their name is written above the symbol and their age is written in the circle. • Information such as the type of relationship between 2 people, if a person is currently abusing substances or in recovery, or if a person has mental illness can be depicted by using the symbols on the previous slide (Curtis, 1999).

41. Jim was born in 1951Mary was born in 1955Married in 1972 This genogram has started with the parents. You can then add the generation above them and the generation behind them

42. Father and Mother (Far right, Far left)3 children oldest to youngest Oldest daughter is Sue (40) born in 1973 John (35) is the subject of the genogram, born in1978 Holly (32) born in1981

43. Father (Jim) is an active alcoholicMother (Mary) is in recoverySon (John) is also in recovery

44. Father(Jim) and daughter(Sue) have a detached relationship Father (Jim) and son (John) have a hostile relationship Father (Jim) and daughter (Holly) have a distant relationship

45. Genograms • For each family member information can be added about their education, occupation, geographical location, religious background, major relocations, career changes, major illnesses, cause of death, and ethnic background. • Significant emotional events can also be included. A genogram is a work in progress. It can be added on to throughout the therapeutic process. It can be very insightful to see the patterns that emerge from your family genogram (Curtis, 1999).

46. References • Adult Children of Alcoholics Need Intervention. (1984, January). Retrieved from National Institute on Alcohol and Alcoholism: http://www.ncada-stl.org/factsheets/adult_children_of_alcoholics_need_intervention.pdf • Becvar, D. S., & Becvar, R. J. (1999). Systems Theory and Family Therapy. Lanham: University Press of America, Inc. • Curtis, O. (1999). Chemical Dependency A family Affair. Belmont: Brooks/Cole Cengage Learning. • Dayton, T. (2012). Adult Children of Alcoholics. Retrieved from Huff Post Addiction and Recovery: http://www.huffingtonpost.com/dr-tian-dayton/adult-children-of-alcoholics_b_1835677.html

47. References • Ferguson, P. L. (2011). Survival Roles Develop Within The Family of Alcoholics and Addicts. Retrieved from Peggyferguson.com: http://www.peggyferguson.com/userfiles/10846/file/Survival%20Roles%20Develop%20Within%20The%20Family%20of%20Alcoholics%20and%20Addicts.pdf • Substance Abuse Treatment and Family Therapy TIP 39. (n.d.). Retrieved from U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Substance Abuse and Mental Health Services Administration: http://store.samhsa.gov/shin/content//SMA05-4032/SMA05-4032.pdf • Substance Abuse Treatment and Family Therapy. Chapter 3 Approaches to Therapy. (2004). Retrieved from Center for Substance Abuse Treatment. Substance Abuse Treatment and Family Substance Abuse and Mental Health Services Administration: http://www.ncbi.nlm.nih.gov/books/NBK64259/