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Review of TIP 39. Narrated version available at http://www.allceus.com

Review of TIP 39. Narrated version available at http://www.allceus.com

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Tip 39 Tip 39 Presentation Transcript

  • 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 families
      • Elected families
    • In general: Family can be defined according to the individual’s closest emotional connections.
    Copyright 2008-2012 AllCEUs.com a subsidiary of CDS Ventures, LLC
  • 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.
    Copyright 2008-2012 AllCEUs.com a subsidiary of CDS Ventures, LLC View slide
    • 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
    Copyright 2008-2012 AllCEUs.com a subsidiary of CDS Ventures, LLC View slide
  • 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
    Copyright 2008-2012 AllCEUs.com a subsidiary of CDS Ventures, LLC
    • 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.
    Copyright 2008-2012 AllCEUs.com a subsidiary of CDS Ventures, LLC
  • 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 beginning that she or he will not keep secrets
    Copyright 2008-2012 AllCEUs.com a subsidiary of CDS Ventures, LLC
  • 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
    Copyright 2008-2012 AllCEUs.com a subsidiary of CDS Ventures, LLC
  • 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 participants are present
    Copyright 2008-2012 AllCEUs.com a subsidiary of CDS Ventures, LLC
    • 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
    Copyright 2008-2012 AllCEUs.com a subsidiary of CDS Ventures, LLC
  • 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 to another (i.e., Prevention).
    Copyright 2008-2012 AllCEUs.com a subsidiary of CDS Ventures, LLC
  • Systems & Contexts
    • Systems
      • Individual
      • Family
      • Culture
      • Society
    • 5 Contexts
      • Family
      • Peers
      • Culture
      • Neighborhood
      • Counseling
    Copyright 2008-2012 AllCEUs.com a subsidiary of CDS Ventures, LLC
  • Life Context
    • Includes those in the immediate household and those systems outside the family in which the family members participate
    Copyright 2008-2012 AllCEUs.com a subsidiary of CDS Ventures, LLC
  • Techniques
    • Effective strategies (3 Ps)
      • Practical
      • Problem Focused
      • Planned
    Copyright 2008-2012 AllCEUs.com a subsidiary of CDS Ventures, LLC
  • 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 Addict.
      • The Hero.
      • The Mascot.
      • The Lost Child.
      • The Scapegoat.
      • The Caretaker (Enabler).
    Copyright 2008-2012 AllCEUs.com a subsidiary of CDS Ventures, LLC
  • 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
    Copyright 2008-2012 AllCEUs.com a subsidiary of CDS Ventures, LLC
  • 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
    Copyright 2008-2012 AllCEUs.com a subsidiary of CDS Ventures, LLC
  • 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
    Copyright 2008-2012 AllCEUs.com a subsidiary of CDS Ventures, LLC
  • Benefits
    • Improved treatment outcomes
    • Family support of client recovery
    • Family recovery
    • Intergenerational Impact
    • Reduced resistance
    • Increased flexibility
    Copyright 2008-2012 AllCEUs.com a subsidiary of CDS Ventures, LLC
  • Limitations
    • Lack of structure
    • Additional training
    • Mindset shift: individual to family
    Copyright 2008-2012 AllCEUs.com a subsidiary of CDS Ventures, LLC
  • Levels of Involvement
    • Levels
      • Level 1: Minimal
      • Level 2: Psychoeducation
      • Level 3: Address feelings/support
      • Level 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
    Copyright 2008-2012 AllCEUs.com a subsidiary of CDS Ventures, LLC
  • 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
    Copyright 2008-2012 AllCEUs.com a subsidiary of CDS Ventures, LLC
  • 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
    Copyright 2008-2012 AllCEUs.com a subsidiary of CDS Ventures, LLC
  • 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
    Copyright 2008-2012 AllCEUs.com a subsidiary of CDS Ventures, LLC
  • 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
    Copyright 2008-2012 AllCEUs.com a subsidiary of CDS Ventures, LLC
    • 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
    Copyright 2008-2012 AllCEUs.com a subsidiary of CDS Ventures, LLC
  • 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
    Copyright 2008-2012 AllCEUs.com a subsidiary of CDS Ventures, LLC
  • 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
      • Organization
      • Resonance
      • Developmental Stages
      • Identified Patient
    Copyright 2008-2012 AllCEUs.com a subsidiary of CDS Ventures, LLC
    • Solution Focused Brief
      • Focuses on what life will be like when the problem is solved
      • Miracle question
    Copyright 2008-2012 AllCEUs.com a subsidiary of CDS Ventures, LLC
  • 3 Stages of Recovery
    • Attainment of Sobriety
    • Adjustment to Sobriety
    • Maintenance of Sobriety
    Copyright 2008-2012 AllCEUs.com a subsidiary of CDS Ventures, LLC
  • 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
    Copyright 2008-2012 AllCEUs.com a subsidiary of CDS Ventures, LLC
  • 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
    Copyright 2008-2012 AllCEUs.com a subsidiary of CDS Ventures, LLC
  • Stage 3: Maintenance
    • Renegotiate relationships with larger systems
    • Employ support groups
    Copyright 2008-2012 AllCEUs.com a subsidiary of CDS Ventures, LLC
  • Special Populations
    • Domestic Violence
    • Racial/Ethnic Minorities
    • GLBT
    • People with Disabilities
    • Children/Adolescents
    • Older Adults (elder abuse, culture norms) ‏
    • Rural Populations
    • Homeless clients
    • Veterans
    Copyright 2008-2012 AllCEUs.com a subsidiary of CDS Ventures, LLC
  • 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 the youth from the start
    Copyright 2008-2012 AllCEUs.com a subsidiary of CDS Ventures, LLC
  • 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
    Copyright 2008-2012 AllCEUs.com a subsidiary of CDS Ventures, LLC
  • 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
    Copyright 2008-2012 AllCEUs.com a subsidiary of CDS Ventures, LLC