TIP 39

Family Therapy

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What is a Family?
Types
Traditional families Single parents. Foster relationships. Grandparents raising grandchildren. Stepfamilies. Extended families Elected 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 capacity A propensity to develop a substance use disorder Adjustment problems, including increased rates

of divorce, violence, and the need for control in relationships Depression, anxiety, and low self-esteem Children forced prematurely to accept adult responsibilities
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Family Therapy vs. Family Involved
Family 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 purposes

use 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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Assessment
assess for the potential for domestic

violence or abuse Do not accept the family's version of the problem not 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 Copyright 2008-2012 AllCEUs.com a subsidiary of beginning that she or he will not keep CDS Ventures, LLC secrets

Initial Treatment
Denial and Resistance are essential to both

family and substance abuse treatment A 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 Therapy
The 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 Copyright 2008-2012 AllCEUs.com a subsidiary of CDS Ventures, LLC participants are present

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 communication Helping the family make interpersonal, intrapersonal, and environmental changes affecting the person using alcohol or drugs Keeping substance abuse from moving from one generation tosubsidiary of Copyright 2008-2012 AllCEUs.com a another (i.e., Prevention).
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Systems & Contexts
Systems
Individual Family Culture Society

5 Contexts
Family Peers Culture Neighborhood Counseling
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Life Context
Includes 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)
Practical Problem Focused Planned

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Complementarity
Members behave in ways that fulfill

unconscious needs and demands of the other Each member's recovery needs must be explored in relationship to the others
The The The The The The

Addict. Hero. Mascot. Lost Child. Scapegoat. Caretaker (Enabler).

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Boundaries
Types
Enmeshment Disengagement Healthy

Function
Regulate flow of information Maintain 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 Resistance
Current behavior patterns preserve order and

stability The system will resist change It 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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Triangulation
A third member is drawn into a problem

between two others In 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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Benefits
Improved treatment outcomes Family support of client recovery Family recovery Intergenerational Impact Reduced resistance Increased flexibility

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Limitations
Lack of structure Additional training Mindset shift: individual to family

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Levels of Involvement
Levels
Level Level Level Level

1: Minimal 2: Psychoeducation 3: Address feelings/support 4: Systematic assessment and interventions Level 5: Family Therapy
Determined by:
The counselor's level of experience and comfort The family's needs and readiness to change

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Level 3 Specialized Skills
Elicit family member's concerns Empathically listen Form preliminary assessment Encourage efforts to cope Tailor education to the family Identify dysfuctions, make referrals

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Level 4 Specialized Skills
Engagement Facilitate expression from all members Assess family's level of functioning Support individuals and avoid coalitions Reframe the problem(s) Encourage viewing solutions through

collaborative lense Help generate alternative coping methods Calibrate roles
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Level 5: Specialized Skills
Engage difficult members Generate and test hypotheses about

interactional patterns Escalate conflict to break impasse Temporarily side with one member Deal with resistance to change Negotiate collaborative relationships

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Integrated Models
Structural Strategic
Family structure is repeated patterns of

interaction Family structure determines individual behavior Power of the system is greater than that of the individual
Goals
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 Relations  Healthy Identity Formation  Bonding to Prosocial Activities  Autonomy within the Parent-Child relationship

Goals-Parent
 Increase parental commitment  Improve communication  Increase parenting skills

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Behavioral Family Therapy
Assumptions
 Addicted Families have skill deficits'  Family member reactions influence the behavior  Distorted beliefs lead to dysfunctional behavior

Goals
 Contingency contracting to change reward paradigms  Skills training to provide alternative behaviors to reward  Cognitive Restructuring to replace irrational thoughts

with positive ones

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BFST
Patterns of interaction in the family influence

the behavior of each family member BFST it is important that the counselor joins into the "system“  Interventions change maladaptive patterns of interaction
Elements of the family's interactions

examined

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Organization Resonance Developmental Stages Identified Patient

Solution Focused Brief

Focuses on what life will be like when the problem is solved Miracle question

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3 Stages of Recovery
Attainment of Sobriety Adjustment to Sobriety Maintenance of Sobriety

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Stage 1: Attainment
Motivate family to engage client in detox Contract with the family for abstinence and

treatment compliance Define problems Employ support groups Use the “network” to motivate treatment Interview family in relation to the larger system Introduce the difference between facts and reactions
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Stage 2: Attainment
Restructure family roles Realign subsystem and generational

boundaries Reestablish family and the larger system boundaries Teach relapse prevention Identify communication dysfunction Use contingency contracting Ask scaling and relational questions Identify exceptions to behavior Identify problem and solution sequences
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Stage 3: Maintenance
Renegotiate relationships with larger systems Employ support groups

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Special Populations
Domestic Violence Racial/Ethnic Minorities GLBT People with Disabilities Children/Adolescents Older Adults (elder abuse, culture norms) Rural Populations Homeless clients Veterans

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Adolescents
Adolescents needing substance abuse

treatment

Truancy Violent 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 Copyright 2008-2012 AllCEUs.com a subsidiary of CDS Ventures, LLC the youth from the start

Violence
Screen for partner violence, child abuse and

elder abuse Screen for personality disorders which may indicate a propensity for violence toward self or others Develop a safety plan as necessary Report abuse as required

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Summary
Family 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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