Families and Enabling: A Family Systems Perspective

Kyle S. King, LMFT, LCPC

April 28, 2016

Evergreen Council on Problem Gambling

Focus on the Future Conference

Welcome

● What backgrounds and fields of expertise are represented among the audience members?

● By a show of hands, who has had professional experience interacting with the family members of problem gamblers?

● Personal reflection: Have you had any personal experiences in your own family or social circle with problem gamblers and their families?

– What have those experiences been like for you?

Introduction to Families as Systems (Murray Bowen)

● The family is an emotional unit. The family system is more than the sum of its parts. Individuals should be considered a part of the larger system. It operates in patterned and predictable ways.

● Each member of the family has a role. Roles are unspoken and develop over time to serve the needs of the system.

● All families have a set of unwritten rules: how we communicate, which topics are taboo, who is aligned with whom, which members (roles) are protected or privileged, which members (roles) are scapegoated or sacrificed, and so forth.

● The rules, roles, and operations of the family system maintain the emotional status quo, or homeostasis.

Families as Systems, Cont. (Murray Bowen)

● Family systems use triangles (triangulation) to stabilize dyads that are tense or in conflict.

● Differentiation describes a process by which children are able to formulate identities that are both a part of the family system and separate from it.

● Family projection process occurs when adults attract mates at a similar level of differentiation as themselves and reproduce a similar family system to the one in which they were raised.

Functional Families

● Healthy or functional families share these qualities:– Each member of the family feels they get their needs met a

generally equitable proportion of the time.

– Communication is clear, direct, and allows for a relatively free flow of feelings and ideas.

– The boundary around the family is firm enough that the members of the family know who is part of the system and who is not; but flexible enough to allow outside relationships and new members, as appropriate.

– The boundaries between the family members are firm enough to allow differences and disagreements; but flexible enough to allow members to emotionally access one another.

Functional Families, Cont.

– Triangles are infrequent, occurring mainly in the course of parenting minor children or as temporary workarounds.

– Parents have an authoritative (neither permissive nor authoritarian) subsystem and perform the parental functions in a reliable manner.

– The system can adapt to changing circumstances and move through the family life cycle stages appropriately (for example, transitioning teens to adulthood).

– Problems, either with individuals or within the system, can be sensitively but effectively addressed as they arise.

– Family members feel that their family is generally a warm, supportive place.

“All happy families are alike; each unhappy family is unhappy in its own way.”

~ Leo Tolstoy, Anna Karenina

What is it like to live in a family impacted by problem gambling?

● In an Australian study of families involved in a family counseling program for problem gamblers, the most common issues reported were:

– a loss of trust in the gambler (63%), anger towards the gambler (61%), depression or sadness (59%), anxiety (58%), distress due to gambling-related absences (56%), reduced quality of time spent with the gambler (52%), and a breakdown in communication (52%).

(Dowling, Suomi et al., 2014a)

● Family respondents to a national gambling addiction hotline poll reported:

– emotional distress (98%), negative impacts on the family relationship with the gambler (96%), negative impacts on the family's social life (92%), financial hardship (91%), diminished work capacity (84%) and physical health problems (77%).

(National Council on Problem Gambling, 2007)

What is it like to live in a family impacted by problem gambling?

● A study of Concerned Significant Others (CSOs) found these correlations:

– Greater severity of the gambling problem predicted a greater level of distress in spouses.

– Lower relationship satisfaction was associated with fewer consequences experienced by the gambler.

– Spouses of problem gamblers who are female and young are the most likely to experience distress. (Hodgins et al., 2007)

● Nearly 53% of families of problem gamblers report domestic violence in the home within the past 12 months.

● Female intimate partners of problem gamblers are 10.5 times more likely to visit an emergency room as a result of domestic violence than other women.

(Suomi et al., 2013)

What is it like to live in a family impacted by problem gambling?

● A study using the Family Environment Scale found that family members of male problem gamblers:

– are significantly less assertive, less decisive, and less self-sufficient than others;

– are less likely to offer help, encouragement or support to family members;

– are less likely to endorse direct communication of needs and feelings among family members;

– are less involved in cultural and recreational activities in their communities;

– and report more expressions of anger and aggression in their homes.

● A second study also using the Family Environment Scale found that family members of female problem gamblers:

– report significant disruption in marital and parent-child relationships.

– but do not report levels of psychological disruption similar to those families of male problem gamblers. (Dowling, Smith & Thomas, 2009)

“It was like trying to stop a tidal wave. Fear, incredible fear and issues of safety. … Fear for your life. Fear for the future. I would be shaking with anger as I went through his stuff … there was the fear of finding something. I was a mess... Your self-confidence, I think, just gets destroyed. … I would go through his stuff to see if he was still gambling. I became the worse version of myself. I became someone who I hated.”

~ “Gail,” wife (Holdsworth et al., 2013)

Defining “Enabling”

● Enabling is any behavior used to excuse, justify, ignore, deny, or smooth over an addiction or patterned problem behavior or its consequences.

● This notoriously allows the enabled person to avoid facing the full consequences of his or her addiction, and the addiction or problem behavior is able to continue.

Who Are Enablers?

● Enablers can be anyone who cares about someone who exhibits an addiction or patterned problem behavior. AKA Concerned Significant Others (CSOs). Enabling is always born out of love.

● Enablers, counter-intuitively, tend to be the members of a family system who are the most severely negatively affected by the addiction or problem behavior (parents, spouses). They subjectively report feelings of terror, horror, intense shame and guilt about both the existence of the enabled behavior, and their own enabling.

● Enabling often takes the form of solving a short-term problem, but at the expense of allowing the deeper or longer-term problem to persist.

● Enablers take more responsibility for the problem and its consequences than the person with the addiction or problem behavior.

“If only I can keep my spouse going through his or her current crisis, it will buy us another day.”

“If I can’t change what they’ve done, at least I can help limit the damage of that choice.”

“Maybe my loved one will wake up and come to his or her senses. Maybe a real solution is waiting right around the next corner.”

Enabling Behaviors

● There are three broad categories of enabling:

1. Covering up/covering for the gambler

– Lying to creditors or debt collectors

– Lying about injuries incurred from domestic violence

– Lying to the gambler's boss about absences while gambling

– Picking up the gambler if stranded or drunk while gambling

– Asking children not to tell anyone “how bad things have gotten”

– Blaming someone other than the problem gambler for the behavior

– Keeping visitors out of the home

– Borrowing money for gambling debts on dishonest premises

– Simply “lying by omission” by not alerting support persons

Enabling Behaviors, Cont.

2. Attempting to control the gambler's behavior

– Following the gambler around hoping to intervene in gambling behavior (modern version: tracking their cell phone!)

– Pleading with casino staff, bartenders, etc. to disallow the gambler or cut off the gambler at a certain point

– Taking money out of a purse, wallet or bank account to prevent access to it, reporting credit cards lost or stolen, putting holds on cell service

– Searching the belongings of the gambler for clues to behavior

– Locking the gambler out of the home, calling police

– Yelling or fighting in hopes the gambler will “get the message”

– Triangulating others, e.g. extended family, friends, bosses to intervene with the gambler on the enabler's behalf

Enabling Behaviors, Cont.

3. Becoming complicit in the problem behavior or its cycle

– Giving the gambler money on demand

– Working overtime to replace money lost to gambling

– Bailing out of jail or helping to reduce/avoid legal consequences

– Passing on messages from, or directly paying bookies, loan sharks and others associated with the gambling

– Committing fraud or other crimes to finance gambling

– Personally gambling with, arranging betting schemes with, or otherwise participating in the problem gambling behavior

– Not challenging the gambling problem because it “balances out” the Enabler's own problem behavior (addiction, affair, etc)

Warning Signs of Enabling in Families

1. A constant stream of short-term problems are being solved. Family lives crisis to crisis.

2. Someone in the family seems “immune” from the consequences of his or her actions.

3. Someone in the family feels like a martyr.

4. There is a big family secret that everybody knows, but nobody is allowed to talk about.

How Enabling is Maintained by Family Systems

● In dysfunctional families, an addiction or other problem behavior organizes the system.

● The addict or problem gambler (“Person X”) is at the center of the system, and his or her role is privileged and protected at all costs.

● The enabler is enmeshed with “Person X” and takes on the worry, shame, and responsibility for the behavior of “Person X.”

● The enabler continually tries to prevent the problem behavior, contain it, or clean up the consequences of it. Therefore, the problem behavior and its cycle actually become the homeostasis of the system.

● The other family members are recruited to perform various roles to maintain the homeostasis of the family system while the problem behavior continues because it is part of that homeostasis.

“Peacemakers” vs. Enablers

● Peacemakers:

● Wait to be asked to help

● Intervene temporarily to work through misunderstandings or hurt feelings

● Assist family members to communicate openly and express themselves honestly

● Facilitate dyads to resume healthy functioning

● Enablers:

● Route communication through themselves

● Attempt to control who knows what and who talks to whom

● Shut down, shame or scapegoat any truth-speakers

● Reinforce taboo, secret or off-limits topics

Secondary Dysfunctional Roles

● The Hero: Overachiever, often a perfectionist, frequently parentified. The Hero serves homeostasis by diverting the attention of outsiders from the problem.

● The Truth-Speaker/Scapegoat: Attempts to make the family talk about or pay attention to the problems. When he or she speaks (or acts) out, he/she becomes scapegoated in order to serve homeostasis by assigning this child blame for unhappiness or conflict in the family (rather than Person X or the Enabler).

● The Lost Child: This child drops under the radar, avoids family interaction, may escape into a sport, job or friend's home; but may also escape into video games, TV, drugs. Serves homeostasis by simply not asking any questions.

● The Mascot: Often the youngest, serves homeostasis by distracting the family from conflict by making jokes, being affectionate or doing silly things.

● The Conscript: Is enmeshed with the Enabler. Enabler may over-disclose to this child, using him or her to shore up the Enabler's own dysregulated self-concept.

Differentiation and Family Projection Process

● In addition to the demonstrable heritability of problem gambling as well as other addictions, which paves the way for multigenerational transmission of these patterns;

● Adults who were themselves raised in dysfunctional families (where addiction, abuse, “shameful” mental illness, etc. were present) are likely to have taken on one or more of the aforementioned secondary roles as children. They may carry a template forward for becoming Enablers themselves.

● Adults with a relatively low level of differentiation, as seen with any of the aforementioned roles, tend to attract and marry mates with a similarly low level of differentiation.

Problem Gambling is a Multigenerational Issue

The “heritability” of problem gambling:● “Those with a parent or sibling with a gambling problem are 2 to 10

times more likely to experience gambling problems than people without a parent or sibling with a gambling problem.

● People with problem gambling fathers were 11 to 14 times more likely to have gambling problems.

● People with problem gambling mothers were 7 to 11 times more likely to have gambling problems.”

(Dowling, N., 2014)

When Boundaries are too Rigid

● The boundary around families of problem gamblers – the one that is there to delineate who is in and who is not in the family – is often too rigid.

– A too-rigid boundary around the family keeps family members from forming appropriate relationships with friends, teachers, coaches, therapists, and even extended family members who may take an active caring role in their lives.

● Too-rigid boundaries between family members prevent communication, emotional expression, and affection from flowing. This leads to isolation from one another.

When Boundaries are too Diffuse

● When the boundary around the family is too diffuse, the family members are never sure who is in and who is not in the family.

– Family members may frequently be threatened with being kicked out, disowned or otherwise dissociated from the family as a punishment for upsetting the homeostasis.

– Person X's addiction or problem behavior may bring a string of itinerant outsiders through the intimate middle of the family system, with inappropriate sharing of the family's resources - money, space, and time.

● When the boundaries between family members are too diffuse, it enmeshes members, erasing individual identities and needs, conscripting or parentifying children, collapsing parent subsystems, and creating chaotic communication and affection patterns. Family members learn to take responsibility for one another instead of for themselves.

Enabling vs. Healthy Help

● Enabling:

● Focus on “today's crisis”

● Enabler is the problem solver

● Do it for the person: call/email pretending to be them, fill out applications for them, forge their signature

● Threaten the person (but not follow through) if they don't comply

● Neglect to care for self or children

● Route communication through the Enabler to ensure control

● Keep boundaries too rigid or too diffuse

● Healthy Help:

● Focus on long-standing issues

● Person X is responsible for taking action, with assistance from outside persons and resources

● Provide information: contact numbers, emails, meeting times

● Offer to proofread applications, list questions and take notes to help access services

● Take care of oneself even if the other refuses to take the steps to become healthier

● Serves open, direct and honest communication and self-expression

● Keep firm but flexible boundaries

Healthy Help Examples

1. Individual counseling for the Enabler

2. Individual and/or family counseling for the children as needed

– School social workers are often a one-stop-shop for in-school services as well as those in the community

3. Al-Anon, AlaTeen support groups for all family members as needed

4. Individual and/or marital counseling for the problem gambler

– If they refuse to go, provide phone numbers for potential counselors

– Depression, Anxiety, and PTSD are all frequently comorbid with problem gambling behavior

– Ongoing or recent (within 12 months) domestic violence is a contraindication for marital counseling***

Healthy Help Examples, Cont.

5. Gamblers Anonymous

– Lists of meetings, contact information

– Pamphlets and books about problem gambling

6. AA, NA, SAA and/or certified drug and alcohol counseling for the problem gambler

– If they refuse to attend, provide lists of meetings and providers with contact information

– Alcohol abuse and other addictions are frequently comorbid with problem gambling behavior

7. Financial services such as credit recovery, budgeting, financial planning

– Provide contact information and notes on how to access

– Offer to attend, list questions, take notes, or help make a budget

Case Study #1: The Smiths

● Pam is the daughter of an alcoholic father. She met James in high school, and the two were married in the short time between high school graduation and James's enlistment in the Marines. Pam was pregnant with their first child, Ivan, by the time James deployed to Iraq in 2003. The couple gave birth to their second child, Naomi, between James's second and third deployments. James left the military eight years later with a Silver Star, nightmares, flashbacks, and a 12-beer-a-day drinking habit.

● Pam went to work as a receptionist while James took the occasional temporary laborer position during the recession. James began to spend his days gambling on online poker sites. He then found an illicit poker club in his area and began to stay out all night. Pam frequently confronts James when he returns home at 2 or 3 a.m. Loud fights break out, and James has assaulted Pam on three recent occasions. Pam calls the police, but always lies to them when they come, sparing James an arrest. When the children have awoken to the fights, both Pam and James attempt to get the children onto “their side” by revealing each others' bad behavior.

● Ivan, now age 13, has recently been arrested for carrying a knife and marijuana to school. His probation officer is recommending a caseworker to visit the home and assess the family, but they have thus far no-showed all visits by the caseworker. Naomi, age 9, watches TV 6 hours a day and is struggling at school to make friends and pay attention in class.

Case Study #2: The Carpenters

● Frank and Debra Carpenter are the parents of Wesley, age 26. Frank has built a lucrative career as a corporate attorney, while Debra stayed at home to raise Wesley and, later, pursued philanthropic volunteer work. In recent years, Debra's involvement with her church's outreach program has brought a number of disadvantaged foster-care teens into the Carpenters' home. Each time Debra takes in a teen, Frank spends up to 14 hours a day at the office and takes travel assignments. He does not share Debra's passion for foster parenting, but he has never discussed the matter with her.

● Their son, Wesley, grew up attending a posh private school where he excelled at lacrosse and was Prom King. Through his early 20s, Wesley failed out of a succession of colleges and trade programs as he smoked marijuana daily and lacked direction and focus. He left home briefly a number of times but would move back home within months. He continued to smoke marijuana regularly. Wesley received a trust and the balance of his college fund when he turned 25, at which time he began to spend days at the horse races, off-track betting, and later at the roulette table on the riverboat downtown. He has nearly spent down his trust fund, and has begun taking loans out from a casino acquaintance named Mark to fund his losing streaks. He has also begun to sell small amounts of marijuana to acquaintances.

● While meeting with their accountant, Frank was alerted to the trust fund situation, but he was too shocked to ask his son where the money went, and preferred not to upset his wife. Meanwhile, a horrified Debra learned that one of her foster teens had obtained marijuana from Wesley. When she confronted him with evidence, he begged her not to tell his father, and fearing Frank would put an end to her fostering, she agreed to keep the secret. Wesley counts on neither of them asking any questions.

Case Study #1: The SmithsQuestions

● Who is Person X?● Who is the Enabler?● Which secondary roles do the children display?● Describe the boundaries in this family system – both

around the family system and between the members.● What are some Healthy Help referrals or

interventions you might recommend to this family?

Case Study #1: The SmithsInterventions

Case Study #2: The CarpentersQuestions

● Who is Person X in this family system?● Who is the Enabler?● How do you see triangulation occurring in this

family?● Describe the boundaries in this family system – both

the boundary around the family system and those between family members.

● What are some Health Help referrals or recommendations you might make to this family?

Case Study #2: The Carpenters Solutions

Conclusion

● Questions?● Comments?● Personal Reflections?

Thank you!!!

Cited Works and References

● Calderwood, K.A. & Rajesparam, A. (2014). Applying the codependency concept to concerned significant others of problem gamblers: Words of caution. Journal of Gambling Issues, 29, 1-16.

● Cunha, D., Sotero, L., & Relvas, A.P. (2015). The Pathological Gambler and his Spouse: How do their Narratives Match? Journal of Gambling Issues, 31, 112-141.

● Dickson-Swift, V.A., James, E.L., & Kippen, S. (2005). The experience of living with a problem gambler: Spouses and partners speak out. Journal of Gambling Issues, 13.

● Dowling, N. (2014). The Impact of Gambling Problems on Families. Australian Gambling Research Centre Discussion Paper, 1, 1-12.

● Dowling, N., Smith, D., & Thomas, T. (2009). The Family Functioning of Female Pathological Gamblers. International Journal of Mental Health and Addiction, 7, 29-44.

● Dowling, N.A., Suomi, A., Jackson, A.C., & Lavis, T. (2015). Problem Gambling Family Impacts: Development of the Problem Gambling Family Impact Scale. Journal of Gambling Studies, 1-21.

Cited Works and References, Cont.

● Hodgins, D.C., Shead, N.W., & Makarchuk, K. (2007). Relationship Satisfaction and Psychological Distress Among Concerned Significant Others of Pathological Gamblers. Journal of Nervous & Mental Disease, 195(1), 65-71.

● Holdsworth, L., Nuske, E., Tiyce, M., & Hing, N. (2013). Impacts of Gambling Problems on Partners: Partners' Interpretations. Asian Journal of Gambling Issues and Public Health, 3(11).

● Lee, B.K. (2014). Where Codependency Takes Us: A Commentary. Journal of Gambling Issues, 29, 1-5.

● National Council on Problem Gambling. (2007). Family Issues Info Sheet. Retrieved from http://www.ncpgambling.org/programs-resources/resources/

● Suomi, A., Jackson, A.C., et al. (2013). Problem gambling and family violence: family member reports of prevalence, family impacts and family coping. Asian Journal of Gambling Issues and Public Health, 3(13).

● Urbanoski, K.A. & Rush, B.R. (2006). Characteristics of people seeking treatment for problem gambling in Ontario: Trends from 1998 to 2002. Journal of Gambling Issues, 16.