Tip 39

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

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  • Tip 39

    1. 1. Family Therapy TIP 39 Copyright 2008-2012 AllCEUs.com a subsidiary of CDS Ventures, LLC
    2. 2. What is a Family? <ul><li>Types </li></ul><ul><ul><li>Traditional families </li></ul></ul><ul><ul><li>Single parents. </li></ul></ul><ul><ul><li>Foster relationships. </li></ul></ul><ul><ul><li>Grandparents raising grandchildren. </li></ul></ul><ul><ul><li>Stepfamilies. </li></ul></ul><ul><ul><li>Extended families </li></ul></ul><ul><ul><li>Elected families </li></ul></ul><ul><li>In general: Family can be defined according to the individual’s closest emotional connections. </li></ul>Copyright 2008-2012 AllCEUs.com a subsidiary of CDS Ventures, LLC
    3. 3. Impact of Substance Abuse on Families <ul><li>Financial: Money spent for drug use; </li></ul><ul><li>Psychological denial or protection of the addict, chronic anger, stress, anxiety, hopelessness, inappropriate sexual behavior, neglected health, shame, stigma, and isolation. </li></ul><ul><li>Environmental (homelessness, safety) ‏ </li></ul><ul><li>FASD in children of women who abuse alcohol during pregnancy </li></ul><ul><li>Older adults cared for by their children. </li></ul>Copyright 2008-2012 AllCEUs.com a subsidiary of CDS Ventures, LLC
    4. 4. <ul><li>Parent’s substance use can have cognitive, behavioral, psychosocial, and emotional consequences for children, including: </li></ul><ul><ul><li>Impaired learning capacity </li></ul></ul><ul><ul><li>A propensity to develop a substance use disorder </li></ul></ul><ul><ul><li>Adjustment problems, including increased rates of divorce, violence, and the need for control in relationships </li></ul></ul><ul><ul><li>Depression, anxiety, and low self-esteem </li></ul></ul><ul><ul><li>Children forced prematurely to accept adult responsibilities </li></ul></ul>Copyright 2008-2012 AllCEUs.com a subsidiary of CDS Ventures, LLC
    5. 5. Family Therapy vs. Family Involved <ul><li>Family therapy </li></ul><ul><ul><li>a collection of therapeutic approaches that share a belief in the effectiveness of family -level assessment and intervention. </li></ul></ul><ul><ul><li>In family therapy the unit of treatment is the family and the individual within the family system </li></ul></ul><ul><li>Family-involved therapy </li></ul><ul><ul><li>uses a individual-level assessment and intervention, while educating the family </li></ul></ul>Copyright 2008-2012 AllCEUs.com a subsidiary of CDS Ventures, LLC
    6. 6. <ul><li>Family therapy in substance abuse treatment has two main purposes </li></ul><ul><ul><li>use family’s strengths and resources to help find or develop ways to live without substances of abuse </li></ul></ul><ul><ul><li>to ameliorate the impact of chemical dependency on both the identified patient and family. </li></ul></ul>Copyright 2008-2012 AllCEUs.com a subsidiary of CDS Ventures, LLC
    7. 7. Assessment <ul><li>assess for the potential for domestic violence or abuse </li></ul><ul><li>Do not accept the family's version of the problem </li></ul><ul><li>not interested in the content of family's stories, but more in the process of the family’s interaction </li></ul><ul><li>Resonance defines the emotional and psychological accessibility or distance between family members and needs to be assessed in the context of culture </li></ul><ul><li>The counselor should announce at the beginning that she or he will not keep secrets </li></ul>Copyright 2008-2012 AllCEUs.com a subsidiary of CDS Ventures, LLC
    8. 8. Initial Treatment <ul><li>Denial and Resistance are essential to both family and substance abuse treatment </li></ul><ul><li>A therapeutic alliance is built around individual goals that family members can reach in therapy </li></ul><ul><li>One of the most useful strategies a counselor can use is to support the existing family power structure </li></ul>Copyright 2008-2012 AllCEUs.com a subsidiary of CDS Ventures, LLC
    9. 9. Family Therapy <ul><li>The unit of treatment is the family, and/or the individual within the context of the family system. </li></ul><ul><li>The person abusing substances is regarded as a subsystem within the family, </li></ul><ul><li>The familial relationships within this subsystem are the points of therapeutic interest and intervention. </li></ul><ul><li>In family therapy, content is what the family talks about and process is how the family interacts </li></ul><ul><li>Family therapy cannot take place unless all participants are present </li></ul>Copyright 2008-2012 AllCEUs.com a subsidiary of CDS Ventures, LLC
    10. 10. <ul><li>By observing process the counselor learns the unwritten rules that guide the family's communication </li></ul><ul><li>For every action there is a corresponding reaction from the rest of the family is the definition of the principle of complementarity </li></ul>Copyright 2008-2012 AllCEUs.com a subsidiary of CDS Ventures, LLC
    11. 11. Goals of family therapy in substance abuse treatment <ul><li>Helping families become aware of their own needs </li></ul><ul><li>Providing genuine, enduring healing for family members </li></ul><ul><li>Working to shift power to the parental figures in a family </li></ul><ul><li>Improving communication </li></ul><ul><li>Helping the family make interpersonal, intrapersonal, and environmental changes affecting the person using alcohol or drugs </li></ul><ul><li>Keeping substance abuse from moving from one generation to another (i.e., Prevention). </li></ul>Copyright 2008-2012 AllCEUs.com a subsidiary of CDS Ventures, LLC
    12. 12. Systems & Contexts <ul><li>Systems </li></ul><ul><ul><li>Individual </li></ul></ul><ul><ul><li>Family </li></ul></ul><ul><ul><li>Culture </li></ul></ul><ul><ul><li>Society </li></ul></ul><ul><li>5 Contexts </li></ul><ul><ul><li>Family </li></ul></ul><ul><ul><li>Peers </li></ul></ul><ul><ul><li>Culture </li></ul></ul><ul><ul><li>Neighborhood </li></ul></ul><ul><ul><li>Counseling </li></ul></ul>Copyright 2008-2012 AllCEUs.com a subsidiary of CDS Ventures, LLC
    13. 13. Life Context <ul><li>Includes those in the immediate household and those systems outside the family in which the family members participate </li></ul>Copyright 2008-2012 AllCEUs.com a subsidiary of CDS Ventures, LLC
    14. 14. Techniques <ul><li>Effective strategies (3 Ps) </li></ul><ul><ul><li>Practical </li></ul></ul><ul><ul><li>Problem Focused </li></ul></ul><ul><ul><li>Planned </li></ul></ul>Copyright 2008-2012 AllCEUs.com a subsidiary of CDS Ventures, LLC
    15. 15. Complementarity <ul><li>Members behave in ways that fulfill unconscious needs and demands of the other </li></ul><ul><li>Each member's recovery needs must be explored in relationship to the others </li></ul><ul><ul><li>The Addict. </li></ul></ul><ul><ul><li>The Hero. </li></ul></ul><ul><ul><li>The Mascot. </li></ul></ul><ul><ul><li>The Lost Child. </li></ul></ul><ul><ul><li>The Scapegoat. </li></ul></ul><ul><ul><li>The Caretaker (Enabler). </li></ul></ul>Copyright 2008-2012 AllCEUs.com a subsidiary of CDS Ventures, LLC
    16. 16. Boundaries <ul><li>Types </li></ul><ul><ul><li>Enmeshment </li></ul></ul><ul><ul><li>Disengagement </li></ul></ul><ul><ul><li>Healthy </li></ul></ul><ul><li>Function </li></ul><ul><ul><li>Regulate flow of information </li></ul></ul><ul><ul><li>Maintain structure to permit function </li></ul></ul><ul><li>Setting clear rules and consequences is one of the best ways to start setting the boundaries between parent and child </li></ul>Copyright 2008-2012 AllCEUs.com a subsidiary of CDS Ventures, LLC
    17. 17. Homeostasis and Resistance <ul><li>Current behavior patterns preserve order and stability </li></ul><ul><li>The system will resist change </li></ul><ul><li>It is appropriate to work with a family if one or more members attends the session under the influence of alcohol or other drugs </li></ul><ul><li>The most frequently observed type of family resistance is an identified patient withtoo much power or control </li></ul>Copyright 2008-2012 AllCEUs.com a subsidiary of CDS Ventures, LLC
    18. 18. Triangulation <ul><li>A third member is drawn into a problem between two others </li></ul><ul><li>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 </li></ul>Copyright 2008-2012 AllCEUs.com a subsidiary of CDS Ventures, LLC
    19. 19. Benefits <ul><li>Improved treatment outcomes </li></ul><ul><li>Family support of client recovery </li></ul><ul><li>Family recovery </li></ul><ul><li>Intergenerational Impact </li></ul><ul><li>Reduced resistance </li></ul><ul><li>Increased flexibility </li></ul>Copyright 2008-2012 AllCEUs.com a subsidiary of CDS Ventures, LLC
    20. 20. Limitations <ul><li>Lack of structure </li></ul><ul><li>Additional training </li></ul><ul><li>Mindset shift: individual to family </li></ul>Copyright 2008-2012 AllCEUs.com a subsidiary of CDS Ventures, LLC
    21. 21. Levels of Involvement <ul><li>Levels </li></ul><ul><ul><li>Level 1: Minimal </li></ul></ul><ul><ul><li>Level 2: Psychoeducation </li></ul></ul><ul><ul><li>Level 3: Address feelings/support </li></ul></ul><ul><ul><li>Level 4: Systematic assessment and interventions </li></ul></ul><ul><ul><li>Level 5: Family Therapy </li></ul></ul><ul><li>Determined by: </li></ul><ul><ul><li>The counselor's level of experience and comfort </li></ul></ul><ul><ul><li>The family's needs and readiness to change </li></ul></ul>Copyright 2008-2012 AllCEUs.com a subsidiary of CDS Ventures, LLC
    22. 22. Level 3 Specialized Skills <ul><li>Elicit family member's concerns </li></ul><ul><li>Empathically listen </li></ul><ul><li>Form preliminary assessment </li></ul><ul><li>Encourage efforts to cope </li></ul><ul><li>Tailor education to the family </li></ul><ul><li>Identify dysfuctions, make referrals </li></ul>Copyright 2008-2012 AllCEUs.com a subsidiary of CDS Ventures, LLC
    23. 23. Level 4 Specialized Skills <ul><li>Engagement </li></ul><ul><li>Facilitate expression from all members </li></ul><ul><li>Assess family's level of functioning </li></ul><ul><li>Support individuals and avoid coalitions </li></ul><ul><li>Reframe the problem(s) ‏ </li></ul><ul><li>Encourage viewing solutions through collaborative lense </li></ul><ul><li>Help generate alternative coping methods </li></ul><ul><li>Calibrate roles </li></ul>Copyright 2008-2012 AllCEUs.com a subsidiary of CDS Ventures, LLC
    24. 24. Level 5: Specialized Skills <ul><li>Engage difficult members </li></ul><ul><li>Generate and test hypotheses about interactional patterns </li></ul><ul><li>Escalate conflict to break impasse </li></ul><ul><li>Temporarily side with one member </li></ul><ul><li>Deal with resistance to change </li></ul><ul><li>Negotiate collaborative relationships </li></ul>Copyright 2008-2012 AllCEUs.com a subsidiary of CDS Ventures, LLC
    25. 25. Integrated Models <ul><li>Structural Strategic </li></ul><ul><ul><li>Family structure is repeated patterns of interaction </li></ul></ul><ul><ul><li>Family structure determines individual behavior </li></ul></ul><ul><ul><li>Power of the system is greater than that of the individual </li></ul></ul><ul><li>Goals </li></ul><ul><ul><li>Identify the function of substance abuse in maintaining family stability </li></ul></ul><ul><ul><li>Guide changes in family structure </li></ul></ul>Copyright 2008-2012 AllCEUs.com a subsidiary of CDS Ventures, LLC
    26. 26. <ul><li>Multidimensional Family Therapy (Adolescents) ‏ </li></ul><ul><ul><li>Goals-Adolescent </li></ul></ul><ul><ul><ul><li>Positive Peer Relations </li></ul></ul></ul><ul><ul><ul><li>Healthy Identity Formation </li></ul></ul></ul><ul><ul><ul><li>Bonding to Prosocial Activities </li></ul></ul></ul><ul><ul><ul><li>Autonomy within the Parent-Child relationship </li></ul></ul></ul><ul><ul><li>Goals-Parent </li></ul></ul><ul><ul><ul><li>Increase parental commitment </li></ul></ul></ul><ul><ul><ul><li>Improve communication </li></ul></ul></ul><ul><ul><ul><li>Increase parenting skills </li></ul></ul></ul>Copyright 2008-2012 AllCEUs.com a subsidiary of CDS Ventures, LLC
    27. 27. Behavioral Family Therapy <ul><ul><li>Assumptions </li></ul></ul><ul><ul><ul><li>Addicted Families have skill deficits' </li></ul></ul></ul><ul><ul><ul><li>Family member reactions influence the behavior </li></ul></ul></ul><ul><ul><ul><li>Distorted beliefs lead to dysfunctional behavior </li></ul></ul></ul><ul><ul><li>Goals </li></ul></ul><ul><ul><ul><li>Contingency contracting to change reward paradigms </li></ul></ul></ul><ul><ul><ul><li>Skills training to provide alternative behaviors to reward </li></ul></ul></ul><ul><ul><ul><li>Cognitive Restructuring to replace irrational thoughts with positive ones </li></ul></ul></ul>Copyright 2008-2012 AllCEUs.com a subsidiary of CDS Ventures, LLC
    28. 28. BFST <ul><li>Patterns of interaction in the family influence the behavior of each family member </li></ul><ul><li>BFST it is important that the counselor joins into the &quot;system“ </li></ul><ul><ul><ul><li>Interventions change maladaptive patterns of interaction </li></ul></ul></ul><ul><li>Elements of the family's interactions examined </li></ul><ul><ul><li>Organization </li></ul></ul><ul><ul><li>Resonance </li></ul></ul><ul><ul><li>Developmental Stages </li></ul></ul><ul><ul><li>Identified Patient </li></ul></ul>Copyright 2008-2012 AllCEUs.com a subsidiary of CDS Ventures, LLC
    29. 29. <ul><li>Solution Focused Brief </li></ul><ul><ul><li>Focuses on what life will be like when the problem is solved </li></ul></ul><ul><ul><li>Miracle question </li></ul></ul>Copyright 2008-2012 AllCEUs.com a subsidiary of CDS Ventures, LLC
    30. 30. 3 Stages of Recovery <ul><li>Attainment of Sobriety </li></ul><ul><li>Adjustment to Sobriety </li></ul><ul><li>Maintenance of Sobriety </li></ul>Copyright 2008-2012 AllCEUs.com a subsidiary of CDS Ventures, LLC
    31. 31. Stage 1: Attainment <ul><li>Motivate family to engage client in detox </li></ul><ul><li>Contract with the family for abstinence and treatment compliance </li></ul><ul><li>Define problems </li></ul><ul><li>Employ support groups </li></ul><ul><li>Use the “network” to motivate treatment </li></ul><ul><li>Interview family in relation to the larger system </li></ul><ul><li>Introduce the difference between facts and reactions </li></ul>Copyright 2008-2012 AllCEUs.com a subsidiary of CDS Ventures, LLC
    32. 32. Stage 2: Attainment <ul><li>Restructure family roles </li></ul><ul><li>Realign subsystem and generational boundaries </li></ul><ul><li>Reestablish family and the larger system boundaries </li></ul><ul><li>Teach relapse prevention </li></ul><ul><li>Identify communication dysfunction </li></ul><ul><li>Use contingency contracting </li></ul><ul><li>Ask scaling and relational questions </li></ul><ul><li>Identify exceptions to behavior </li></ul><ul><li>Identify problem and solution sequences </li></ul>Copyright 2008-2012 AllCEUs.com a subsidiary of CDS Ventures, LLC
    33. 33. Stage 3: Maintenance <ul><li>Renegotiate relationships with larger systems </li></ul><ul><li>Employ support groups </li></ul>Copyright 2008-2012 AllCEUs.com a subsidiary of CDS Ventures, LLC
    34. 34. Special Populations <ul><li>Domestic Violence </li></ul><ul><li>Racial/Ethnic Minorities </li></ul><ul><li>GLBT </li></ul><ul><li>People with Disabilities </li></ul><ul><li>Children/Adolescents </li></ul><ul><li>Older Adults (elder abuse, culture norms) ‏ </li></ul><ul><li>Rural Populations </li></ul><ul><li>Homeless clients </li></ul><ul><li>Veterans </li></ul>Copyright 2008-2012 AllCEUs.com a subsidiary of CDS Ventures, LLC
    35. 35. Adolescents <ul><li>Adolescents needing substance abuse treatment </li></ul><ul><ul><li>Truancy </li></ul></ul><ul><ul><li>Violent or aggressive </li></ul></ul><ul><ul><li>Risky sexual behavior </li></ul></ul><ul><li>Both under and overinvolvement of parents have been linked to adolescent problem behaviors </li></ul><ul><li>In families of addictedadolescents, parents have a difficult time determining what is age-appropriate </li></ul><ul><li>In the event of a powerful identified patient (adolescent) the counselor should align with the youth from the start </li></ul>Copyright 2008-2012 AllCEUs.com a subsidiary of CDS Ventures, LLC
    36. 36. Violence <ul><li>Screen for partner violence, child abuse and elder abuse </li></ul><ul><li>Screen for personality disorders which may indicate a propensity for violence toward self or others </li></ul><ul><li>Develop a safety plan as necessary </li></ul><ul><li>Report abuse as required </li></ul>Copyright 2008-2012 AllCEUs.com a subsidiary of CDS Ventures, LLC
    37. 37. Summary <ul><li>Family therapy considers the problem to be instigated and maintained by the whole family, not the identified patient </li></ul><ul><li>There are multiple approaches to family therapy </li></ul><ul><li>It is important to be aware of cultural implications for family therapy </li></ul>Copyright 2008-2012 AllCEUs.com a subsidiary of CDS Ventures, LLC

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