Our “Heal The Family” workshop at The Canyon is conducted the second weekend of every month, including multi-family groups as well as individual family sessions. There is an emphasis on educating families on the disease of addiction and how to deal with what their loved one is going through as well as the issues it creates in their own lives. One of the strongest aspects of our program is the individual sessions held throughout the treatment process. Heal the Family runs from Friday afternoon through Sunday, with family members staying locally to maximize participation.
About Family Therapy
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A man sits at a bar, sipping his solitary drink. A woman rolls up a dollar bill and prepares to take another hit of cocaine. A teen sits in front of the computer, logging into an online gambling site. All these people may struggle with addiction, and they all may be isolated by addiction. But, this is far from a solitary disease. The family members and friends of these addicts may have struggles of their own, and sometimes, the way they cope with these challenges can make the addiction even stronger.
Where traditional addiction therapies might keep a tight focus on the person with the addiction, family therapy takes a step back, widening the angle and looking for everyone who needs help. Then, this entire group, including both the addict and his/her loved ones, work together to learn more about addiction and how it can be controlled.
A Quick History
The idea of including family members in therapy isn’t new. In fact, therapists have included the family in sessions for a variety of issues, including:
- Mental illness
- Financial concerns
According to the Mayo Clinic, the idea behind family therapy is to help strengthen ties between individual members, so they learn to communicate more openly, share information and get through stressful times with a bit more grace. Given this background, it’s easy to understand why family therapy would have a place in addiction medicine. After all, through the course of addiction, the family dynamics often change, and stress and dysfunction results. The Substance Abuse and Mental Health Services Administration (SAMHSA), in summing up research in the field of addiction, reports that families tend to develop the following patterns, in response to addiction:
- Negativity. Complaints and criticisms dominate, and family members use negative statements in order to gain attention.
- Inconsistency. The rules are fluid and boundaries are unclear. This can be of particular concern to small children, who may not know what is permissible from one moment to the next.
- Denial. Family members may consistently deny that there is an issue.
- Repressed anger. Since expressions of emotion are often misconstrued or turn into arguments, family members may be uncomfortable with expressing any anger whatsoever.
It’s clear that some of these patterns could be difficult for the family members themselves. Living in a home that is negative, for example, could be difficult for anyone. But, some of these patterns could also trigger or enable an addiction. An addict who faces rising inconsistency at home, for example, may not know what the rules are regarding addiction and this stress could lead to an increase in substance abuse.
Family therapy is designed to help uncover these patterns, helping families to understand how the behavior they’re exhibiting as a group could be making an addiction problem worse. In addition, family therapy is designed to help the entire family understand the process of addiction, so they’ll know their enemy and work together to combat it.
Choosing a Format
Addiction medicine is built upon the idea that each addiction, and each addict, is slightly different. An intervention that works on one person may not work on another person, and an intervention that works one year may not work the next. Addictions are complicated, pulling from many different areas of life, and the treatment must be customized in order to be effective. Therefore, two families who sign up for “family therapy” may be getting two completely different forms of intervention. And sometimes, the form of family therapy they receive changes as their family changes.
When the family agrees to enter therapy, according to an article published by SAMHSA, the therapist must answer a few basic questions:
- What sorts of problems does the family face now?
- How did the family get here? Is there a hidden trauma in the past?
- Who will agree to treatment? Will it work if some people refuse to attend?
- What sort of communication style does the family prefer? Are they confrontational, or do they prefer reassurance?
- How much time does the family have available?
- What therapy might match the cultural needs of this family?
In order to obtain this information, the therapist might interview the addict and each member of the family on a one-on-one basis. The therapist might also pull all of the family members into one room and ask them to discuss issues normally, while the therapist observes the action. By spending time on research in this way, the therapist can think closely about what sorts of techniques might help this family move past their issues and heal.
There are literally hundreds of options therapists can choose from when pulling together a family therapy plan, but these three models may help to explain how models typically differ from one another.
Therapists working with addicted teens may use the brief strategic family therapy model. The idea behind this model is that teen addiction is rooted in poor family interactions, a lack of structure and the idea that the teen alone is responsible for the addicted behavior. In order to amend this situation, the family meets with a counselor in eight to 24 sessions, and those sessions take place at any location that is convenient for the family. Some sessions are even held in the family’s home. In the early stages of the therapy, the entire family just talks and acts normally, while the therapist listens and observes. Then, as therapy progresses, the therapist begins to highlight interactions that might be considered inappropriate or harmful, and helps the family develop new ways to speak to one another.
According to the National Registry of Evidence-Based Programs and Practices (NREPP), several studies have demonstrated the efficacy of this type of therapy. For example, in one study, adolescents who received this therapy significantly reduced their marijuana use, compared to adolescents who received another form of therapy. In another study, adolescents showed lower forms of aggression than did adolescents who received another form of therapy. This might be a useful tool when dealing with adolescence and addiction.
Family Behavior Therapy
This type of therapy might be more appropriate for adults who are dealing with addiction and another issue, such as mental illness or depression. Here, the idea is that addiction might have its roots within a variety of other issues in the addict’s life, such as unemployment, poor coping skills or a lack of sober friends. The entire family comes together to identify these issues, and they learn how they can support the addict to make good choices and improve these other aspects of life. They might learn how to communicate supportively, and they might help to create an environment that is not supportive of or conducive to the use of drugs or alcohol. They may even help to encourage the addict to take classes or gain training to get a better job and improve life skills.
According to a NREPP report on this therapy, efficacy has been remarkable. In one study, participants who received this form of treatment reduced their alcohol use by nearly 50 percent, while those who only received supportive treatment didn’t change their use rates at all. In another study, the percentage of days employed rose from 52.2 percent to 73.6 percent after treatment.
Multidimensional Family Therapy
This model is quite similar to the family behavior therapy model, but there is one important distinction. Where family behavior therapy is designed to help addicts who are in outpatient care and living at home, multidimensional family therapy is designed for people who are living in a hospital or some other facility and receiving care for their addictions. The therapist works with the addict, in order to help him/her understand the addiction and make better decisions that could lead to sobriety, but the therapist also works with the family, helping to address any dysfunctional communication styles and underlying trauma that might contribute to the disease. The idea is to work with the family members, to help them prepare to support the addict when he/she emerges from residential care and needs a safe place to live.
This form of therapy has also been reported on by the NREPP, but the results are a bit more mixed. In some instances, substance abuse rates declined after this therapy was provided, but in some of those studies, those rates of decline weren’t markedly different than the rates of decline seen when other interventions were provided.
Finding the Right Mix
Ultimately, family members are rarely required to submit an opinion on which form of therapy they’re provided. After all, no one expects family members to become experts on all forms of addiction and treatment. They often have more pressing issues to concern themselves with. But, the take-home message is that family therapy is an important part of the process of healing for many addicts.
There are some addicts who are not ready to enter a treatment program, for whatever reason. Even though the addict will not get care, this does not mean that family members can’t enter treatment in advance, shielding themselves from future harm and preparing to help the addict when he/she is ready to get needed help. There are several ways that families can do this. Some families enter family therapy with their own addiction counselor, holding their own sessions as described above without the presence of the addict. Other families choose to enroll in a 12-step support group such as Al-Anon. According to the Al-Anon website, meetings are designed to help people impacted by someone else’s addiction share their stories and learn how others have coped with the same issue. The meetings are private, and not all participants are required to speak. Instead, they may just listen to the stories of others and in so doing, begin to understand their own issues just a bit better. While this is not technically a form of “therapy,” as there is no counselor present and no real treatments are provided, it might be a good option for family members dealing with an addict who simply will not get treatment. By learning the basics at Al-Anon meetings, the family members will be ready to provide help, just as soon as the addict is willing to accept it.
At The Canyon, we believe strongly in family therapy and we provide many forms of that care in our programs. Throughout the treatment process, we offer individual sessions with family members, providing targeted care. And, on the second weekend of every month, we provide a “Heal the Family” workshop that provides both individual family sessions as well as group sessions. Please contact us to find out more.