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Family Counseling with Addiction Issues Back to Course Index

 

 

Introduction

 

Some people look forward to the day they leave home to leave their family and childhood problems behind. However, many find that they experience similar problems, as well as similar feelings and relationship patterns, long after they have left the family environment.  We learn so much from our family of origin, both positive and negative patterns frequently get repeated.

 

 A healthy family system functions out of love, care, and concern for its members in a manner, which creates and maintains order through consistent behavior.  This system furthermore, seeks balance when that order is upset by crisis, using flexible problem-solving and decision-making skills.  Roles in a healthy family are determined by natural birth order with clearly noticeable boundaries set up through behavior from parent to child and sibling to sibling.  Rules that affect the functioning are set for as long as they are deemed appropriate and developmentally necessary and are changed as needed in ways that offer all members clearer choices about their behavior.  A healthy family, therefore, functions in loving, life-affirming, educative, disciplined, creative, and responsible ways which offer growth opportunities through agreement/disagreement and/or individual choice.

 

When chemical substances or obsessive/compulsive behaviors are introduced into, maintained, or used by members to delay, cope with or kill the pain of crises, adequate problem-solving skills begin to breakdown because there is no longer a baseline of consistent behavior or a rational thinking process that can support those skills or the skills needed for flexible decision-making.

Addiction is a family disease. Family therapy allows for all members of the family unit to be present and active in counseling and intervention. Family therapy may include one-on-one counseling to provide individual insights with the therapist in preparation for all the family members coming together in family therapy. Family therapy provides family members opportunities to share how their members have experienced each other and their feelings related to those experiences. During family therapy in the recovery process, relatives can learn if they have been helpful as they intended or unknowingly harmful to their loved one’s addiction.

Each family member subconsciously takes on a role that can often be codependent. An example of a family role in a dysfunctional family is the “scapegoat,” the member who gets blamed, sometimes wrongly, for all of the family issues. The scapegoat often feels rejected and unloved. Another family role is the “hero,” who appears to be well-adjusted and high functioning. The hero gives the appearance that the family does not have any issues and is often the one who attempts to resolve family problems. All family roles impact the family system and how addiction/recovery is experienced. For example, the scapegoat may take most of the responsibility for an addicted relative’s behavior or even be the member with the addiction and the codependent parent can be considered an enabler. Such family dynamics can be complex and difficult to identify; however, professionals can better assess each member’s role. With a medical professional or interventionist present, everyone from the relative to the person seeking treatment becomes aware of ways they have contributed to various problems within the family dynamic. In such cases, family members can have structured sessions to improve communication, resolve conflicts, and promote healing and growth.

Family therapy includes relatives to provide insight to facilitate resolution. The result can be closer relationships and resolving conflict.

 

Various theories relating to family therapy have been developed over the past 50 years to assist the counselor when working with a dysfunctional family.  Specific techniques are used to repair and strengthen family connections and repair the overall well-being of family members. There are many types of family therapy practices, all focusing on specific problems and providing solutions. Some of the more prominent theories are introduced in the following paragraphs.   

 


Behavioral Family Therapy

 

Behavioral family therapy suggests that all behavior is learned and thus can be unlearned.  Leading experts in the field of behavioral family therapy include Geral Patterson, Richard Stuart, Robert Liberman, Neil Jacobse, and Gayla Margolin.   

 

Although the goal of this therapy would be to modify behavior, i.e., change or control the triggers of substance use; change the family’s codependent reactions to the substance abuser, etc., using behavioral techniques to modify behavior without looking into the underlying dysfunction in the family relations is can be of limited effectiveness.  For example, family members may be trained to eliminate substance use and codependency on substance use.  Such techniques will not be successful, however, if the family patterns of communication continue to be dysfunctional.

 


Structural Family Therapy

 

This model suggests that chemically dependent families respond best to interventions that use a “here and now”, “directive” and “concrete” approach.  Structural family therapy offers a clear, precise framework for understanding and treating family dysfunction.  A core belief is that improvement in the family will result in improvements in individuals in the family.  Salvador Minuchin developed structural family therapy.

 

 Proponents of this model suggest that dysfunctional behaviors, including substance abuse, occur when there are unclear levels of power and authority within the family when mutual expectations are misunderstood, and when rigid or diffuse boundaries exist within the family. 

 


Strategic Family Therapy

 

Strategic family therapy emerged in the 1970s as an offshoot of the communication model of family therapy.  Strategic family therapy focuses on the interaction patterns that maintain problematic behavior and uses problem-oriented strategies to disrupt those patterns.  The focus is on establishing specific goals to address identified symptoms.  There are three primary “schools” of strategic family therapy:  Jay Haley and Cloe Madenes’ problem-solving approach combines structural theory and communication theory.  The focus is on the presenting problems and the sequence of family events that maintain them.  The Milan group (Selvini Palazzoli) subscribes to indirectly approaching chemical dependence in the family unit by using “positive connotation”, (a form of paradoxical relabeling), giving the family an injunction not to change, which soon leads them to change.  Mental Research Institute’s “brief family therapy” is associated with the work of Bateson and Erickson.  This approach is primarily communicational and often lasts only ten sessions or fewer. 

 

The therapeutic goal of strategic family therapy is not to change the family but to resolve the family’s current problem as efficiently and quickly as possible.  They believe that resolution of the current problem will naturally lead to positive change in the family structure.  Don’t we all wish this approach were always successful?

 


Communications Family Therapy

 

The communication model proposes that substance abuse, like family dysfunction, results from faulty communication patterns.  Such communication problems might result in the form of a “double bind”, (contradictory messages with primary and secondary injunctions), or might result from a lack of problem-solving or interpersonal skills.  The belief is that family interactions are governed by family “rules” (often covert and that the purpose of the rules is to maintain family homeostasis).  Contributors to this theory are Bateson, Satir, and Haley.  The goal of communication therapists is to alter the interactional patterns that maintain the presenting symptom.  Satir identified five styles dysfunctional families adopt when communicating with one another:  placating, blaming, computing, distracting, and leveling.  Satir describes games that families play as being either for survival: rescue games, coalition games, lethal games; or for growth.

 

Communication therapy is active and directive, following a fixed treatment sequence and involving a great deal of teaching.

 


Family System Model

 

This model prescribed the belief that each family member is directly interrelated to the others and that change in the family member necessitates a change in other family members.  The research and development of family systems therapy are attributed to Murray Bowen.  Because the family is viewed as a system, the etiology of chemical dependence is viewed primarily in terms of the interrelationships among family members.  Within this perspective, substance abuse is seen as a homeostatic mechanism that serves to maintain the family’s sense of balance. The idea of homeostasis suggests that other family members will attempt covert ways to maintain the chemical dependent’s behavior to maintain a comfortable and familiar balance in the family.  In essence, the chemical-dependent system is a system in which alcohol or other drug consumption is a major organizing principle for the patterns of interaction in the family.  In a family system with a chemical-dependent member, substance use often occupies a key position as a core identity issue for the family.

 

Bowenian Family Therapy

Bowenian family therapy is ideal for people who do not want family involvement in their treatment and recovery process. Systemic therapy hones in on unconscious communication and underlying meanings behind certain actions. Additionally, the therapist may observe how the family interacts with each other but takes a neutral or distant approach. Structural therapy enhances the family dynamic by keeping parents in a position of authority. Furthermore, it can include boundary setting and active therapist involvement. Lastly, strategic family therapy provides members of each session with tools for growth like “assignments” and the therapist has a direct approach. Other methods of problem-solving exist depending on the family therapist and can include more approaches to therapy.

 

Generally speaking, any situation or a problem that affects relationships between family members and family functioning and its supportive role, can benefit from systemic family therapy. Similarly, any problem of an individual that affects his/her life regarding his/her relationships with family and wider contexts will benefit from a systemic approach. Involving others in an individual’s family or social network in the treatment can help to avoid the pathologizing of that individual and also address the problem more effectively.


Theoretical
 Summary/System Theory Detailed

 

The aforementioned theories all have value and each may be beneficial in a specific situation and certain family situations.  However, individuals and families are unique, and frequently if a therapist gets “locked in” to one technique it can lead to detrimental outcomes in counseling sessions.  Said slightly differently, we have proven that the concept of “one size fits all” does not work and this also holds in family counseling.  The therapist must be knowledgeable and flexible so that they may match the appropriate counseling concept to the specific need of the family they are working with. 

 

It is recommended that therapists working with families be knowledgeable in system theory.   This approach has proven effective and is generally favored by most family therapists.  Initially, it must be recognized that families are multifaceted and are typically very complex with numerous interactions between individuals and others.  Some interactions are direct and easily understood while others may have hidden agendas and are generally difficult to comprehend and understand.  With this degree of complexity, an organizational orientation is effective when attempting to understand relationships within the family and interactions with others outside the family.  Consequently, the system’s orientation is frequently the universally accepted framework by which to view the family.  An overview of selected system concepts follows.

 

A system is a group of elements, which interact to form an organic whole.  For example, a tree, an automobile, a nation, and a family may all be viewed as systems.  In each of these, the parts interact in ways, which maintain integrity and balance with the whole entity.  Consequently, the actions of one part affect the actions of the other parts, which, in turn, change the first part; the components of a system are interdependent.  In families, one can observe members reacting to each other in this circular, interdependent fashion, as in the following examples:

 

  • The more parents question a teenager about his or her whereabouts and activities, the more briefer and less informative the teenager becomes, which prompts more questions, etc.

  • To the degree that the father is strict with the daughter, the mother becomes more protective.

  • To the extent that the grandmother spoils the grandchildren, the mother becomes more accommodating with them to win back their affections.

  • The father reacts with more authority toward the children, displacing onto them his anger at the permissiveness of his wife and mother-in-law.

  • The process continues along the lines of “equal and opposite” reactions to many of the issues that arise in the family.

 

A family has a “set” of engrained characteristics and the better a counselor gets to know and understand them the easier and more productive working with a family can be.  For example, a family has:

  • A structure and hierarchy:  Different roles are defined for different members and power is not distributed evenly.

  • Powerful rules of conduct:  Most of which are unspoken and unacknowledged.

  • A set of politics:  Particular members are closer to some members than to others; two members will support each other against a third; one member may temporarily defer to another out of self-interest.  The politics may change depending on the situation.

  • Habitual patterns:  The content of the interaction between members changes, but how they deal with the content tends to be repetitive.

  • A history:  Anyone who becomes involved in a family, steps into their history.

  • Influencers from the outside: From the extended family, from the neighborhood, from the work and school community, form the environment.

  • A tendency to resist change:  A family, like an individual, has a sense of self, and it will resist a challenge to its self-definition.

 

The systems-oriented counselor will focus on the following:

  • Treat the family, rather than individuals, as the primary unit of change.  Individual change is assumed to be created within relationships in the family.  Mapping is a technique, which brings family relationships into focus.

  • Use a broad definition of “family” to include anyone who may be enabling the problem to continue or who may be a resource for solving it

  • Be aware that change in one relationship may produce a change in another.  When the mother and stepfather begin to work more effectively together, the siblings may get along better.

  • Take a wide-angle view of the physical and social context of the problem—the home, extended family, neighborhood, community, and culture.  A systems orientation urges the practitioner toward a broad network focus.

 

THE SYSTEMS ORIENTATION (In practice)

 

The counselor works more with the reciprocal relationships between the family members than with the individual dynamics of each member.  Even while talking to individual members, the systems counselor is exploring family patterns and repetitive sequences of actions and reactions between members.  Family functioning is the target for change.

 

The following examples – which contrast the individual and systems orientations assume a teenage son is the identified patient; his mother calls for an appointment.  Also in the home a father and sister:

         

­­­­­­­­­­­­­­­­­_____________________________________________________________

          Individual Orientation                          Systems Orientation

_____________________________________________________________

           The counselor:                                   The counselor:

_____________________________________________________________

Invites the son and mother in               Invites everyone living in the home

for counseling

 

Stays central—the “switchboard”        Is sometimes central, but also

for communication in the room           encourages members to talk to each

                                                          other.

(To mother): How do you feel when    “How do you and your husband

and your son do that?                            react together when your son does

                                                          that?”

 

Elicits feeling from a member              Does this, but also gently directs

while the family listens.                       the talking member to “tell him/her

                                                          how you feel”.

 

Focuses on individual members,         Comments on relationships between

one at time members.

 

Attends only to the person speaking    Notices all members when one is

                                                          speaking.

 

Sees a talkative, dominant wife            Sees a couple that has co-created

and a silent husband                           a pattern where she talks and acts

                                                          more than he does.

 

Assumes that the people who Inquire about others who may play

present are the only players with a role in maintaining (and solving)

in the drama.                                      the problem.

 

 

The systems-oriented counselor is the manager and director of the session—sometimes focusing on individuals, sometimes spotlighting the interaction between two or more members, and sometimes stepping back to see the family as a whole.  To keep a balanced view and to understand the family balance, the counselor is working with sets of relationships, not individuals acting independently.

 

Other examples of systemic questions and comments by the counselor:

 

To father, while mother and son are talking: “Where are you in this conversation?”


(To son):  “I noticed that when you are silent, you may be sending a message to your parents.  Could you find out what message they are getting?”


(To daughter):  How does your mother react when your father and brother disagree?”


(To mother and father):  “Each time the two of you disagree, your daughter interrupts your conversation.  Could you find out from her what this is about?”


“Who outside the home is aware of and concerned about the problem?”

Learning to work interactionally and systemically takes some adjustment, since most counselor education and training is individually oriented.  Be patient and it will become easier over time.

 

 

Theoretical Summary/System Theory Detailed

 

The stages that a family goes through to come to grips with alcoholism (and/or other addictions) were first described by Joan Jackson in her classic monograph “Alcoholism and the family” in 1954.  Her research was developed through meetings and interaction with members who were known as AA Auxiliary.  Later the auxiliary became what we now know as Al-Anon.  Her research was based on a family in which the husband and father were alcoholics. However, later finding have concluded that the stages may be viewed as describing any family with an alcoholic (and/or other addictive) member.  The following six stages are identified and discussed in the sequence they normally occur in a substance-related dysfunctional family.

 

Denial

Denial is when family members initially explain excessive use of alcohol and/or other drugs away.  For example, early in the emergence of alcoholism, drinking is explained away because it is due to tiredness, worry, nervousness or a bad day at work, or some other similar reason.  The assumption is that the episode is an isolated case and therefore is not problematic.  Most of the time excessive drinking may be in conjunction with a social event where it is customary for persons to overdrink. 

 

Early Problem Solving


The addicted spouse’s partner recognizes that use is not normal and attempts to pressure him or her into either reducing the amount consumed or stopping altogether.  Typically, neither of these suggestions is followed long-term.  The next attempt is to use psychology and to pressure him or her to quit by using phrases such as “pull yourself together and use some willpower” or, “if you love me you will stop”.  Again, this approach is seldom successful and it generally results in the alcoholic beginning to mask how much and how often he or she drinks and also drinking outside the home.  At about this stage, the children began to exhibit problems in response to the family stress.


Some psychologists indicate the early attempts to eliminate or reduce alcoholism in the family have been successful and in such cases, neither formal substance abuse treatment nor support groups such as Alcoholics Anonymous (AA) are needed.  However, the consensus is that professional help is warranted in most cases to protect against denial and the progression of alcoholism from social drinking to dependence.  If it is not addressed and treated as a primary disease the family outcome is generally catastrophic.  Historically, the danger for families at this point is that they might enter into a general counseling program with clergy, a family friend, or a social worker that fails to address the problem head-on.  This “general counseling approach” could be a way for the alcoholic to continue drinking and for both partners to pretend to be doing something about it.  Substance abuse professionals are generally more knowledgeable about the symptoms of excessive use and how the disease of alcoholism progresses; consequently, the chances of alcohol problems going undetected are less likely.

 

Disorganization and chaos

 
The family system becomes disorganized and chaotic.  The spouse can no longer keep everything under control and pretend everything is okay and he or she spends most of their time going from crisis to crisis.  Typically families began to encounter physical, psychological, and financial problems.  Spouses may seek help from friends who know less than they about alcoholism or they may turn to the family clergy.  Often they seek help from the family physician who might treat the symptom by prescribing a tranquilizer when confronted by the distraught condition.  If at this stage the nonalcoholic partner seeks professional assistance and/or becomes involved with support groups the process may take a different course altogether.


Regroup

 
Coping strategies have been developed and strengthened and the enabling partner gradually assumes the larger share of responsibilities for the family.  This often means seeking employment outside the home and assuming complete financial control of the family.  The major focus is directed toward family survival as opposed to “getting” their partner to change his or her behavior.  In essence, the nonalcoholic spouse takes charge and develops a functioning family system even though the alcoholic partner may still be in the home.  This concept can have important implications for the welfare of children in the family.  Children fare better in families in which the family rituals are maintained, whether these are celebrations such as holidays, birthdays, or other things “we always do together”.

 

Escape


Families with alcoholism have a high rate of separation and/or divorce.  In many cases, the nonalcoholic spouse may not have any other viable option other than to separate.  This is especially true if spousal abuse or domestic violence is present.  If the family unit remains intact, the family continues living around the alcoholic member.

 

 
Family Reactions To Chemical Addiction

 

Denial, as noted previously, is the first stage that a family goes through when they are faced with a family member that abuses alcohol and/or other drugs. It is also considered the most prevalent and measurable reaction to chemical addiction in the family.  For example, with most co-dependents, denial arises from the need to not have to happen what is indeed happening.  This is not happening; he cannot be an alcoholic because… the only reason his drinking has increased is that his boss stays on his back all the time; I promised myself that I would never marry anyone like my father and I didn’t, he is not nearly as bad; it’s those people that he hangs around with…The list goes on to infinity but the bottom line is that they refuse to accept that a problem exists in their family.  Also, most families are in denial regarding denial and choose to blame others and situations outside the home for their problems.  Unfortunately, denial is a major obstacle to effective treatment, as it is difficult to help someone who does not recognize they have a problem.  Consequently, the first major challenge of family counseling is to help the family recognize the problem and to be willing to work together to make the necessary changes to fix the problem.

 

Bargaining begins when family members begin to recognize the problem and attempt to eliminate it.  An example of typical bargaining sessions goes something like this: I will stop complaining if you will stop drinking or using whichever the case may be; if you don’t stop I will file for divorce; beg; coerce; threaten; plead; cry; agree to comprise (you don’t have to go to treatment, just don’t drink at home- Just cut down; just switch from hard liquor to beer); or a million other things to attempt to get the alcoholic to recognize the pain that he or she is putting the family through.  Excessive use of alcohol and/or other drugs is selfish.  It’s doing exactly what the individual wants to do without regard to how it might affect others—generally the ones the alcoholic claims to love the most. 

 

Disorganization and dysfunction begin to occur in the family structure.  The family system begins to break down.  Crises occur almost continuously and the family spends most of their time “putting out fires”.  Crises may include financial problems, trouble with the authorities, loss of employment, stress-related illnesses, and disintegration of family values.

 

Reorganization is marked by frantic attempts to restore sanity and balance to the family.  The family system generally reorganizes with new roles to adjust to the chaos and pain.

 


Adjusting Mechanisms

 

Both the chemically dependent and the family members use adjusting mechanisms as a coping technique for surviving in a chemical-dependent system.  The mechanisms may be either conscious or subconscious.  The most frequent defense mechanism used by dependent individuals is denial.  This denial, in essence, ignores the problem.  The average length of time between the first accusation of being an alcoholic and the recovery of the family system is 13 years.  Using denial for that length of time creates an ingrained attitude.  The stages of breaking denial are admission, acceptance, and action.  Other adjustment mechanisms include:


PROJECTION: Blaming others for our actions, reactions, and feelings.  Blaming outside of him/herself doesn’t have to change.


RATIONALIZATION:  Making logical but unrealistic excuses for behavior.


WITHDRAWAL:  Figurative, sometimes literal removal from the source of hurt.  Usually accompanied by feelings of inadequacy and inferiority.


AGGRESSION:  Designed to protect vulnerability and at times to manipulate others.  Most often verbal but can be physical.  Also can be implied (i.e., ignoring someone, walking away, etc.).


CONVERSION REACTION:  Converting emotional problems into physical problems.


DISPLACEMENT:  scapegoat someone or something else for the problem.

 

RULES OF SHAME-BASED FAMILIES

 

· Always do the right thing (except that no one has told you what the right thing is).

· If it doesn’t go as planned blame someone or something.

· Always be in control; use whatever works: seduction, abuse, or martyrdom.

· Never talk about “it”.

· Don’t expect accountability or consistency.

· Stay out of touch with your feelings

· Above all:  deny, deny, deny

 

 

Rules In The Chemically Dependent Family

 

Rule 1: The dependent’s use of chemical substances is the most important thing in the family’s life.  For example, he or she is obsessed with maintaining his or her supply, and the rest of the family is just as obsessed with cutting it off.  While he or she hides bottles, they search for them.  While he or she stockpiles, they pour liquor down the drain.  Like two football teams, their goals lie in opposite directions, but they are all playing the same game.  They will plan their days around the dependent’s drinking hours—to be sure that nothing interferes to frustrate his or her plans or to arrange to be home to meet his or her demands or to arrange not to be home to avoid his or her fury or possible embarrassment in front of their friends.  The dependent’s use of alcohol is the overriding family concern around which everything else revolves.

 

Rule 2: Alcohol and/or other drug use are not the cause of the family problems.  At first, the user and his family deny that he or she is abusing any substances.  When a dependency is glaringly evident, they insist that it is only a complicating factor or the result of the problems, not the root of whatever difficulties have led them to seek help.

 

Rule 3: Someone or something else caused the dependency:  He or she is not responsible.  Here the dependent’s increasing tendency to project his or her guilt and to blame someone else for his or her situation gets crystallized into a rule and imposed on the rest of the family.  The scapegoat may be his or her spouse or a child in trouble or a job he or she does not like—anything.  Curiously, the scapegoat often goes along with the allusion and is overwhelmed with guilt and feelings of worthlessness.

 

Rule 4: The status quo must be maintained at all times and costs.  It is easier to understand the extremely rigid ways an alcoholic family responds to change by looking at a mobile of a group of butterflies.  If a butterfly were to become snagged on some outside object, the string with which it is attached would pull taut and the supporting sticks would become rigid.  Something similar happens when one family member gets snagged on a chemical.  What’s more, he or she is afraid to get unsnagged, for he or she feels that without it they could not survive.  So as a rule-maker, he or she makes sure that the sticks and stings of the family system stay rigid enough to protect him or her from change.

 

Rule 5: Everyone in the family must be an enabler.  When members of an alcoholic family are asked how they feel about the dependent’s drinking, they are quick to say that they would do anything to get him or her to stop.  But all the while, they are unconsciously helping him or her to continue— “enabling” him or her to continue to use.  One person in the family plays the role of the chief enabler, but according to this unwritten rule, everyone else must do their part also to protect the dependent and his dependency.  They alibi for him, cover up, take over his responsibilities and accept his rules and quirks docilely rather than rock the boat.  These actions may be defended on grounds of love or loyalty or family honor, but their effect is to preserve the status quo.

 

Rule 6: No one may discuss what is going on in the family, either with one another or with outsiders.  This is exactly the sort of rule we would expect in a system as unhealthy and closed as a dependent family.   Feeling threatened, the rule-maker tries to avoid letting people outside know about family affairs—specifically the degree of his or her dependency and the magnitude of its impact on his spouse and children— and, letting family members have access to new information and advice from outside that might undermine their willingness to enable.

 

Rule 7: No one says what he or she is feeling.  This is a standard rule in severely dysfunctional families.  The rule-maker is in so much emotional pain that he or she simply cannot handle the painful feelings of his or her family, which make his or her feelings even sharper.  As a result, communication among family members is severely hampered.  What there is tends to be rigid, distorted, and incomplete, the messages bearing little resemblance to the real facts and feelings that exist.

 

Eventually, as his or her disease advances, the alcoholic completely represses his feelings and unconsciously puts in their place false emotions that are less painful.  These are the feelings that seem on the surface to prompt his or her actions.  But to those of us who know him or her well, their performance is not quite convincing.  They may respond as though they took his or her behavior at face value, but at some level, they sense a second, subliminal message coming from the real self that he or she has repressed.

 

They are thus confronted with contradictory messages coming from different parts of the dependent.  Once they hear with their rational minds, the other with intuition.  They feel confused because the two messages are saying such different things:

          “If these kids would show a little responsibility about money, I

          wouldn’t have to be so hard on them.”   I’m so worried I’m going

          to lose my job because I’ve called in sick so many Monday mornings.

 

          “If you were more affectionate, I wouldn’t stay out late at night”  (I

           know I’m not satisfied with you—I don’t know what has happened to 

           me lately).

 

“Why should I go to church?  That new minister is only interested in money.”  (I’m no good.  I can’t face the minister, or the congregation either.)

 

Most often, the false emotion expressed in his or her behavior is the opposite of the true emotion that lies underneath.  Aggressiveness masks fear; blaming masks guilt; controlling masks helplessness.  But, ironically, his or her behavior evokes the same painful feelings in family members that the dependent is feeling underneath.  In the table below we can see the dynamics of contagion by which the family members gradually come to manifest the psychological symptoms of alcoholism.

 

DEPENDENT DEPENDENT’S             FAMILY MEMBER’

TRUE FEELINGS          BEHAVIOR                   FEELINGS

 

Guilt, self-hatred              Self-righteousness,          Guilt, Self-hatred

                                      Blaming

 

Fear                                Aggressiveness, anger     Fear

 

Helplessness                   Controlling (of others)     Helplessness

 

Hurt                                Abusiveness                    Hurt

 

Loneliness,                      Rejecting                        Loneliness,

Rejection                                                               rrejection

 

Low self-worth                Grandiosity,                    Low self-worth

                                      Criticalness

 

——————————————————————————————–

  

            

Family Mapping

 

A technique of using symbols to depict family relationships is referred to as mapping.  The map indicates who is aligned with whom, who has close relationships, who has distant relationships, and who is in conflict with whom.  The map also shows who is the authority figure and has the most influence in the family.  A map may be multi-generational, is subjective rather than factual, and gives little social history.  In general, a map is informational about the current relationships and situations between members.

 

The purpose of the map is to help the counselor to organize and display his or her impressions of the family, help to maintain a systems focus for the counseling sessions, and to indicate a broad goal for counseling with the family.   The symbols used and what they mean are as follows:

 

Ö                          Female

                  

          ڤ                          Male

 

Ö m                      Mother

 

ڤ f                        Father

 

Ö f/age                  Female child/age

 

ڤ m/age                Male child/age

 


Map characteristics:

 

· Relative size of the figures indicates apparent power in the family.

· Identified Patient (IP)—The IP is identified by placing IP below his or her symbol.

· Boundary line is shown to separate between parents and children

· Relationships are indicated by different lines between members:

 

Dashed line:  Less than normal connection

Single solid line: Normal connection

Double solid line:  More than normal connection

Triple solid lines: Enmeshed

Diagonal slashed line:  stressful relationship

Diagonal line:  Argumentative/no physical conflict

Double diagonal lines:  Infers verbal conflict, mild physical conflict

Triple diagonal lines: Heavy conflict

No symbol:  Unknown relationship

 

Mapping an ideal family reveals the counselor’s assumptions about how family relationships function best.  For example:

·  Mother and father are of equal size (equal power in the family)

·  Children are below the parent-child boundary (clear line of authority)

·  Children are smaller than parents (parents are in control of the family)

·  The older child is slightly larger than the younger (natural birth order)

·  The map has no conflict lines.

 

It is left as an exercise for the reader to develop the pictorial representation of this ideal family. Not many families look like that, certainly not all the time.  It’s a model, an ideal; it gives a standard to aim for in counseling.

 

A typical family with a chemically dependent member could have the following characteristics:

 

· Sever conflict between parents and a difference in size (apparent power) between them.

·  The older child is larger than the mother (too much power and influence)

·  The older child is above the parent/child boundary (again, indicating too much power and influence)

·  The father and daughter are over-involved (enmeshed)

·  The daughter conflicts with her mother and brother

·  The father-son bond is weak

·  Siblings are in conflict

 

Assuming the daughter is the Identified Patient (IP), the following are examples of systemic goals for counseling (while of course, the focus is on solving the presenting problem).

 

· Help the parents reach an agreement regarding their limits on the daughter’s behavior.  If they are more in agreement, the father-daughter closeness will decrease.  This will place the daughter in a less powerful position in the family, especially the mother.

· Explore the father-son relationship, creating conversations (enactments) between them during the sessions.  If the father-son becomes more communicative, it will also decrease the father-daughter closeness.

· Likewise, explore the mother-daughter relationship.  If they become better able to communicate, the daughter-father closeness will be diminished.

 

A map helps to clarify what we currently believe about the family organization and what may be contributing to the presenting problem.  However. It’s a current working hypothesis about relationships and is subject to change as we learn more about the family.  Again, it is left to the reader to construct the map.

 

Summary

 

There is a great deal of variability in how often dysfunctional interactions and behaviors occur in families, and the kinds and the severity of their dysfunction.  This is why it is crucial for counselors to know several techniques and recognize the most appropriate times to use each.

 

With new awareness and knowledge, new choices about how to live life, by discovering and changing conscious and unconscious behavioral patterns that presently cause difficulty, can be made.  The family system can be taught new ways, effective ways to create change.

  • Family-focused work is an important means of preventing various problems that may become a serious burden for society in general.
  • Family therapy is considered a highly effective approach to the prevention and treatment of various emotional and behavioral problems in childhood and adolescence.
  • Family therapy can help family members to use their resources in providing support to each other in various stressful situations including mental and physical illness.
  • Properly trained family therapists and systemic consultants may use their skills in diverse contexts such as organizations and institutions, where they can foster teamwork and problem-solving. They can also participate in conflict resolutions and negotiation processes in social and political crises.
  • A systemic perspective in its broadest sense can contribute to strengthening solidarity, tolerance, trust, and collaboration, the cornerstones of a healthy society.

 

 

References

Center for Substance Abuse Treatment. Substance Abuse Treatment and Family Therapy. Rockville (MD): Substance Abuse and Mental Health Services Administration (SAMHSA) (US); 2004. (Treatment Improvement Protocol (TIP) Series, No. 39.)

Fishman, H. C., Minuchin, S. (2009). Family Therapy Techniques. United States: Harvard University Press.

National Institute on Drug Abuse. (2012). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition): Family Behavior Therapy.

O’Farrell, T.J., and Fals-Stewart, W. (2000). Behavioral couples therapy for alcoholism and drug abuse. Journal of Substance Abuse Treatment 18(1): 51-54.

Varghese, M., Kirpekar, V., & Loganathan, S. (2020). Family Interventions: Basic Principles and Techniques. Indian journal of psychiatry62(Suppl 2), S192–S200. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_770_19

 

 

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