Reconstructing Family Dynamics in Addiction Treatment Presented by: Samuel Bierman and Cheryl caplan-zalis

The Importance of Family Involvement In Treatment Unresolved family of origin issues and multi-generational themes often play a central role in the relapse process Family beliefs of addiction and recovery are often distorted and education about the process can be life saving The addictive process will overwhelm the healthiest of families and create co-dependency, maladaptive behaviors, and put the whole family system at risk. Families normal position is to protect, defend, rescue their loved ones, which is counterintuitive in the recovery process. The identified patient has a much greater chance at long term recovery if the whole family is in recovery.

What does family treatment look like across the country No Family Involvement In Treatment Family Education Programs Comprehensive Family Involvement Programs Unfortunately, an estimated less than 30% of treatment center’s have any family involvement in treatment or family programs. Belief that the recovery process is solely the responsibility of the patient. Sometimes due to low reimbursement for family work Belief that getting the family involved is too difficult (HIPAA) or too much work for staff Traditionally, weekend family education programs with the goal of educating families on the disease of addiction Little to no process or actual family work with the patient Majority of education programs are conducted by part time staff with little knowledge of the family system Minimal family involvement besides the education program Involve the family throughout the entire treatment stay and continuum Educate, re-direct, inform, process, reconstruct the family system for the best desired outcomes Family support groups, family process groups, alumni family buddies, family recovery process Reconstructing family dynamics and roles from a dependent position to interdependent position

Examples of Best Practices of Treating Family Systems Treatment centers that engage the family before the treatment process begins and works with the family throughout the entire stay Separating the recovery process from the identified patient and the family members. Family members need to be on their own recovery process Residential Family Restructuring (Caron Renaissance) – Actually inviting the family into treatment to witness family dynamics and reconstruct in real time The family is the patient, and the patient is the family. Family follow up after treatment episode ends

How Do We Reconstruct Family Dynamics? Recovery for families often means going against one’s own instincts in order to allow the patient to experience the natural consequences of their own behavior Boundary setting (financial support, emotional support) Challenging dependent and enabling behavior and roles Educating families that they did not cause addiction, but their actions and behaviors can create barriers to recovery Re-defining roles in the family system, communication styles, boundaries. Identifying strengths and competencies of families in order to help them confront the issues that serve as obstacles to the recovery process

Boundaries – Setting Boundaries means that I will respect and protect myself from inappropriate behavior Guidelines Definition of Boundaries Format of Boundaries The purpose of setting a boundary is to take care of yourself Set limits that you are willing to follow through with Do not set boundaries to manipulate Lot of family members are fearful to set boundaries due to fear of abandonment. This is why the support of clinicians and the program is vital! Something that sets a border or a limit Sets a physical, emotional, intellectual, or spiritual space Boundaries can be spoken/unspoken Boundaries are a way to protect ourselves Be specific Be reasonable Enforce them Make them natural/logical

Vital Boundaries for Families I will not allow you to physically or verbally abuse me or the family I will not knowingly believe or support lies I will not allow active addiction, addictive behaviors in my home I will not rescue you from the consequences of your addiction or addictive behaviors I will not finance your addiction or addictive behaviors If you want to act crazy, that’s your business. You cannot do it in front of me. You must leave or I will walk away. You can ruin your fun, your day, or your life – that is your business. I will not allow you to ruin my fun, my day, or my life

Enabling Vs. Empowering Enabling – Doing for others what they CAN do for themselves Empowering – Encouraging and guiding others so they have the power over their own decisions Fix Problems Protect from consequences Carry and take on their feelings Control the situation Rescue Don’t Listen Doing it for them Dependence Caretaker Showing empathy Listening without reacting Encourage Share Confront Guiding Support Caregiver

What is the cause of families being over enmeshed and dependent in todays world? Pain tolerance of our youth NO MORE SKINNED KNEES Failure to Launch Average age children leave the home Pressure’s to succeed and “keeping up with the Jones’s” Instant gratification in the information and social media age Depletion of tolerance and patience in waiting for results

What should the results look like? The patient repeatedly experiences firm boundaries set by family, friends, peers, and the treatment team. The dissolution of rescue fantasies take form. The family begins to experience their own strengths and weaknesses rather than those of their love one. The family becomes oriented to their own family system and internal regulators. This is painful, but anxiety reducing and sobering. The family is now able to build a stable and functional self identity within the family system; which enhances feelings of positive regard, self worth, and genuine acceptance over the recovery process. The entire family system is able to lift each other up, on their own recovery process and support each other throughout life without sacrificing each other’s sanity.

Question and Answers Open Forum discussion