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Review of Family Therapy and Substance Abuse Treatment
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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.
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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.
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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
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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
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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.
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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
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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
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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
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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
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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
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Life ContextIncludes those in the immediate household
and those systems outside the family in which the family members participate
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Techniques
Effective strategies (3 Ps)PracticalProblem FocusedPlanned
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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).
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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
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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
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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
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BenefitsImproved treatment outcomesFamily support of client recoveryFamily recoveryIntergenerational ImpactReduced resistanceIncreased flexibility
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LimitationsLack of structureAdditional trainingMindset shift: individual to family
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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
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Level 3 Specialized SkillsElicit family member's concernsEmpathically listenForm preliminary assessmentEncourage efforts to copeTailor education to the familyIdentify dysfuctions, make referrals
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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
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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
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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
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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
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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
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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
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Solution Focused Brief Focuses on what life will be like when the
problem is solved Miracle question
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3 Stages of RecoveryAttainment of SobrietyAdjustment to SobrietyMaintenance of Sobriety
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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
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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
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Stage 3: MaintenanceRenegotiate relationships with larger systemsEmploy support groups
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Special PopulationsDomestic ViolenceRacial/Ethnic MinoritiesGLBT People with DisabilitiesChildren/AdolescentsOlder Adults (elder abuse, culture norms)Rural PopulationsHomeless clientsVeterans
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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
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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
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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
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