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iCAAD Paris 2019 - Dr Colleen Kelly - Addiction and families - the solution is also inside the problem

How does the alcoholic or addicted individual effect the family and community? In what way do they equally become sick? What does intervention, treatment and aftercare look like for the family and how does this effect the individual with addiction?

This masterclass will examine the origins of addiction throughout a family’s history and find new ways to transform those old stories of shame and blame to survival and resilience. Participants will be provided a number of key points aimed at enhancing professional knowledge and performance. We will examine alternative ways to think beyond individual treatment, which include the entire family not only though current Family Therapy models, but by examining the stories and pain of past generations. This cutting-edge thinking regarding family work can transform the lives of generations yet to come who may escape the prison of addiction due to our ability to stand with our clients in their multigenerational story of trauma and adaptation. In conclusion, participants will examine how family therapy techniques including examining generations of Transgenerational Grief provide an opportunity for feelings that have been previously denied and lost in the family story can be named, explored, reframed and viewed as strength and hope.

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iCAAD Paris 2019 - Dr Colleen Kelly - Addiction and families - the solution is also inside the problem

  1. 1. Dr. Colleen Kelly colleenkellymft@mac.com 06 07 11 97 23 3 Rue de Varize, 75016 Paris
  2. 2. Meditation 70 to 80 thousand thoughts daily, 50 thousand repetitive ones Meditation increases our awareness and slows down our racing Reduce reactivity, increase well being, strengthening of prefrontal cortex Increase immunological response, increase ability to manage pain Increase present state attentiveness Lowers blood pressure, reduction in amydala (fear)
  3. 3. Attachment Theory How our closest relationships are vital to our growth, development, and well being. John Bowlby (b.1907) found that without a loving connection to a caregiver a child’s physical, emotional, intellectual growth was stunted. After the war not enough caregiver in orphanages so children who had medical care, shelter, food, toys, education were still not developing. Their brains were not developing properly and many of the children died. Without holding and interacting. Failure to thrive. Suddenly science was interested in relationships. Children form expectations about the reliability and accessibility of their caregivers then these expectation and how well they were met get generalized to other intimate relationships across the person’s lifespan. One example is having a depressed mother. Child internalizes that mom and forms ideas about who they are and what they can expect from the world and carries that unmet need into, gives up or becomes anxiously attached.
  4. 4. Neurobiology of addiction Under threat, real or perceived, physical or emotional - it’s registered the same way by the brain. “A coward dies a thousand deaths.” - Shakespeare We are wired to connect. Fear and uncertainty activate our attachment needs for comfort and safety. You can track where clients are by the physical changes of where they are in their perceived threat level. Alcoholic families live in fear and uncertainty convinced that fixing the patient would solve this. Because of homeostasis, they are sick now too. Addiction is the antidote to intimacy.
  5. 5. Neurobiology of addiction Our experience of Pain and fear can be modulated by being in contact with someone we love or trust. Attachment theory in adult relationships says we can go to our partner or family member for comfort and understanding (sometimes) but the key is the ability to self soothe. Intimate relationships exist to expose all the unhealed, empty and unmet needs in us. The task is for us to grieve, acknowledge and heal them not to ask the other person to fill them today. We can stand by each other and be supportive but we cannot heal childhood wounds for each other. Dr. Sue Johnson’s MRI landmark study: Soothing the threatened brain www.drsuejohnsoncom
  6. 6. The Hungry Ghosts (Dr. Gabor Mate) “Drinking in Ireland is not simply a convivial pastime, it is a ritualistic alternative to real life, a spiritual placebo, a fumble for eternity, a longing for heaven, a thirst for return to the embrace of the Almighty.” – John Waters (Irish journalist)
  7. 7. Benefits of Family/Couples Therapy -- Primary problems in family functioning are delineated. -- Neutralize Scapegoating. -- Decrease guilt and blame. -- Increase empathy for differences.. -- Challenge family myths and nonfunctional rules. -- Form new agreements for living together. -- Improve the mental and physical state of each family member -- Prevent the substance abuse from spreading throughout the family or down generations. -- Improve communication styles and relationship quality. -- Assist the substance user to gain awareness of their needs and behaviors. -- Help families understand and avoid enabling behaviors. -- Address codependent behavior. -- Permit family members to gain self-care interventions to improve their own well being. -- Develop problem solving skills, motivation for change, and accountability. -- Emphaze the strengths of the complete family and diminish the influence of substance use for all family members.
  8. 8. Risks of Family/Couples Therapy Risks are low but include: One member of the family feeling attacked. An escalation of anger and violence in a family member. The substance user being triggered to continue to increase use. - Thoroughly screen and assess each member of the family before treatment begins to ensure safety.
  9. 9. Specific skills for the Family Therapist - The ability to deal specifically with high conflict families and behavioral issues. - Must have strong communication skills and be comfortable acting as traffic cop and controlling high conflict sessions - Must be able to listen to various points of view from various family members in session without over-identifying with one member or appearing judgmental - Must be comfortable facilitating the communication process in live time between family members when they are reluctant to talk about certain issues or even acknowledged that they exist.
  10. 10. Specific Skill set for Family Therapist - Must be perceptive enough to understand each members varied point of view and have the empathy to place themselves in each person’s shoes. - Need strong leadership skills to develop the necessary trust to persuade family members to follow the recommended course of action - Need the necessary teaching skills to educate families about addiction and family systems. - Must be skilled at various steps in conflict resolution The Family or the Couple is the client not the individual
  11. 11. CHARACTERISTICS OF A DYSFUNCTIONAL FAMILY/COUPLE -- Blurred boundaries. -- Shaming/Blaming -- Confused communication patterns. -- Punishing/Permissive -- Overprotection. -- Secrets -- Enmeshment, lack of autonomy or privacy. -- Compulsive/addictive -- Denial of conflict except as it involves the identified patient. -- Frozen feelings -- Inability to resolve conflict. -- Unhealthy competition -- Scapegoating. -- Parentified children -- Low toleration for stress and physical illness. -- Loss of freedom -- Fragmented, disjointed, isolated individuals. -- Closed system -- Noncohesive, noncommittal, pseudo-closeness. -- Approval and love must be earned -- Divisions and separations with alliances in conflict. -- Idealization of parents/ fantasy bond -- Skewed relationships, isolation of one family member. -- Perfectionistic -- Rigid positions. -- Roles assigned for family needs -- Lack of respect for individual differences.
  12. 12. Legacy of Shame Stigma Chronic fear Suppressed rage Self loathing Procrastination Low self-esteem False pride and grandiosity Vulnerability to use alcohol again as remission for suffering - past and present Chronic trauma over and over
  13. 13. Family Roles Addiction is a family disease seeking homeostasis The Dependent/IP The Mastermind The Enabler The Scapegoat The Hero The Problem Child The Lost Child The Mascot
  14. 14. Family Rules 1. Don’t Talk 2. Don’t Trust your feelings, intuitions 3. Don’t Feel 4. Don’t ask questions 5. Don’t share family secrets 6. Don’t admit what you don’t know 7. Don’t focus on yourself, only others 8. Don’t make problems and rock the boat
  15. 15. Permission for new rules Acceptance - we can’t control others Imperfection - It’s okay to be wrong or not know the answer It’s okay to feel your feelings, think your thoughts, have your opinion, want what you want, to talk openly, to resolve differences, to disagree, to see a problem Reliability - Learn to trust yourself and trustworthy people
  16. 16. Bader/Pearson Developmental Couples Model ● Bonding: initial honeymoon period, couples seek closeness, uncover their similarities, and begin falling in love. ● Differentiation: couples begin to acknowledge and address their differences. A central task of this developmental stage is finding ways to resolve conflict. ● Practicing: During this period, couples explore their independence, nurture outside friendships, and spend time developing their self esteem and competence in areas separate from the relationship. ● Rapprochement: This is a stage during which couples move away from and then return to one another. Often, a couple’s sex life will deepen during this phase. ● Synergy: This phase of development embraces true intimacy, recognizing a couple can come together and be stronger together than each member is alone. www.couplesinstitute.com
  17. 17. Couples Therapy addiction/high conflict Anxiety emerges when our attachment bonds are being threatened and when our needs are in danger of becoming unattainable. When a partner fails to respond to the other’s basic attachment needs for safety and security, PTSD like symptoms occur: States of hyper-arousal, clinging, and withdrawing. A negative model of self is experienced as being undeserving. The partner is seen as undependable. Small disappointments, and minor incidents, for the insecure spouse, echo back to early attachment injuries. “When your hysterical it’s historical”
  18. 18. Couples Therapy anxious needs defenses Non-committal individual Criticism and Complaints Defensiveness Anger Depression, in the relational context (disconnection) Judgement and blame Countertransference - therapist feeling disconnected
  19. 19. Basic Human Needs Attachment Needs: Acceptance, Acknowledgement, Affection, Attune, Appreciation, Belonging, Cooperation, Communication, Closeness, Companionship, Compassion, Consideration, Consistency, Empathy, Inclusion, Intimacy, Love, Mutuality, Nurturing, Recognition, Responsiveness, Respect, Safety, Security, Stability, Support, To know and be known, To see and be seen, To understand and be understood, Trust, Warmth Physical Well-Being Needs: Air, Food, Movement, Rest, Sleep, Sexual expression, Safety, Shelter, Touch, Water Autonomy Needs: Choice, Freedom, Independence, Space, Spontaneity
  20. 20. Basic Human Needs Play Needs: Fun, Joy, Humor Search for Meaning Needs: Achievement, Authenticity, Awareness, Celebration of life, Challenge, Clarity, Competence, Communion, Consciousness, Contribution, Creativity, Discovery, Efficacy, Effectiveness, Equality, Growth, Harmony, Hope, Inspiration, Integrity, Learning, Mourning, Order, Participation, Presence, Purpose, Self-expression, Stimulation, Understanding
  21. 21. Helping clients with their Unmet Needs ● Unrealistic needs and expectations ● The limitations of the partner ● The limitations of self ● The limitations of the environment Grief work towards acceptance Differentiation Affect Regulation Note: Maintain awareness of cultural diversity issues as they relate to feeling deserving of one’s needs, and to the communication of needs.
  22. 22. Initiator Focus on one issue Express your feelings and thoughts Avoid Blaming, accusing, name calling Be open to self discovery This is my problem – it’s an expression of who I am. It’s about me revealing myself and my being willing to express my thoughts and feelings.
  23. 23. Inquirer Listen calmly Ask questions Listen with openness. I do not own this problem. It’s up to me to manage my reactions Empathize Recap My partner is a separate person with their own feelings, thoughts, personality and family history. I only need listen, not look for solutions.
  24. 24. Family Counseling Techniques Sequencing. Ask questions like who does what, when? When kids are fighting, what is mother doing? Father? Hypothetical Questions. Who would be most likely to stay home if mother got sick? Which child can you visualize living at home as an adult? Reframing. Describe negative behavior in different ways. Acting out, for example, can be described as displaced anger from an unresolved family conflict. Empowering. Resiliance.
  25. 25. Family Counseling Techniques Tracking. How does a family deal with a problem. "What was it like for you when. . . ?" rather than "How did you feel when. . . ?" These kinds of questions help keep the focus on the family rather than on the individual. Sculpting. Create a still picture of the family that symbolizes relationships by having members position one another physically. This technique helps to cut through intellectualized defenses, and gets nonverbal members to express themselves. Eco-Map. Organize data about the family's total environment and their relationship to it.
  26. 26. Family Counseling Techniques Paradoxical Intervention. Instruct a family to do something they don't expect and observe how the family then changes by rebellion or noncompliance. This approach is not appropriate in crisis situations such as violence, grief, or suicide, or for families with minimal resistance. It is reserved for highly resistant and rigid families and is clearly an advanced therapeutic skill. Unbalancing. Support an individual or subsystem at the expense of others. This modifies family structure and introduces the possibility for alternative ways of living together.
  27. 27. Solution Focused Non Pathologizing Goal orientated, visualizing moving toward ideal Strengths based vs. weakness Solution based Seeks to understand client within their sociopolitical, cultural, and historical context
  28. 28. Solution Focused Family Therapy Looking for Previous Solutions - people have solved many, many problems on their own and have some idea how to solve the current one. “Are there times when this has been less of a problem” “What has worked in the past?’ Something the family tried. Looking for Exceptions - times the problem could occur but does not. Something that happened instead of the problem. “What is different about the times when this is less of a problem? Resources? Self care? Support? Threat?”
  29. 29. Solution Focused Family Therapy Present and future-focused questions vs. past focus - Problems are best solved focusing on what’s working. AA’s live in the solution. “What will you do this week that will indicate to you that you are making progress?” Compliments - esteem and strength building. Validate what clients did and are doing well. Normalizing past choices from a systems perspective. Shows the therapist has been listening and encourages change. “How did you do that?” “That was a life saving skill as a child.” Paradoxical Interventions - defiance based. Symptom Prescription, Restraining Strategies, Agreeing with dysfunction. Evidence based as helpful because clients attribute the change to themselves not the therapist.
  30. 30. Solution Focused Family Therapy The Experiment - once a positive frame is established, clients have been validated and normalized, previous solutions and exceptions discovered the therapist can invite the client to experiment and try to push the envelope and do more of what is working. Invites clients to drop their script and forge new neuropathways. Scaling Questions - Client self assessment, assess their situation, track their progress or evaluate how others might rate them on a scale of 0 to 10. Invites the therapist to talk about their motivation, level of hope or despair, wishes, confidence and progress.
  31. 31. Solution Focused Family Therapy Miracle Question - longest intervention, can almost be hypnotic. Brings about reframing, new ways of thinking, hope. Second part is to identify moment client experience some of this today. Small miracles. Coping Questions - Highlights a family’s coping skills even in the depth overwhelming difficulties. In despair many clients still get out of bed, feed their kids and do things that take major effort. “How have you managed to carry on?” “How did you survive that?” “How have you managed to prevent things from getting worse?” Opens up a channel for examining family’s resiliency and determination.
  32. 32. Solution Focused Family Therapy Highlighting choice - in a system that has over feeling of powerless, pointing out choices. Thanks for coming today even when court ordered is a choice. Minimizes victim stance. Increases responsibility and ownership. Family as expert - continue to consult and reassess “Is there anything that I did not ask that you think it would be important for me to know?” “Do you feel you got what you needed today?” “Is there anything you can tell me that you think will be helpful to me in working with your loved one or with this family?”
  33. 33. Solution Focused Family Therapy Using Countertransferece Joining the family system with permission by offering to give words to the situation. “Can I be you for a minute?” “Can I try to give this some words?” Speak as you imagine the family member wishes he could say or what another family member needs to hear. You are offering a new direction a new voice when they are stuck. Then process it with them. Helpful when BPD is detached so therapist is board or reluctant.
  34. 34. Virginia Satir Parts Party Write down three 1. People you admire, and what you admire them for. 2. People you detest, and what you detest them for. ● Have them party together, either externalized by a sculpt. role play, or imagination. ● Observe what happens. ● If and when, investigate clashes and conflicts, and the effects on the other parts. ● Resolve oppositions and conflicts by reclaiming valued, alienated, extruded, and/or unknown parts.
  35. 35. Virginia Satir Parts Party The purpose of a Parts Party is to integrate different aspect or facets of the personality, hence, “parts”. We regularly freeze the parts party to hear what particular parts have to say, especially those that the star or focal person recognizes. We freeze only those situations that seem to evoke powerful emotions in the star. Then we bring conflicting pairs together and ask which other parts they would like to assist them in dealing with and resolving the polarization or conflict. We can even make up new parts for that. The focal person can negotiate for conditions, or for more resolution before we move to integration.
  36. 36. Healing To get to the truth of the matter requires realistic and fearless confrontation with the ugly, destructive, and dangerous consequences of untreated alcohol abuse and dependence in society, as well as an awareness of the shame-based system of economic, social, psychological, religious, political and cultural denial that has evolved over the centuries to banish the problem from public consciousness. 60,000 French people die a year from alcoholism alone. Formal efforts to address the problem must be led by individuals whose fundamental understanding of alcohol abuse and dependence is based on personal recovery, and a broad knowledge of scientific advances in the field of addiction that now promise an excellent prognosis for recovery if treatment is followed. We must establish forums for recovery guided by principles of peace and honest reconciliation instead of shame, blame and punishment. We must be at the front line of ending the stigma and focusing on the solution and strengths in families and individuals to help end the suffering of addiction.

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