1. CHAPTER 15: Working with Substance-Related Disorders, Domestic Violence, and Child Abuse Family Therapy: History, Theory, and Practice 6 th Edition Samuel T. Gladding Developed by Nathaniel N. Ivers, Wake Forest University © (2015, 2011, 2007) by Pearson Education, Inc. All Rights Reserved

2. 15-2 Gladding, Family Therapy: History, Theory, and Practice, 6 th Ed. © (2015, 2011, 2007) by Pearson Education, Inc. All Rights Reserved Overview The nature, manifestation, and treatment of substance-related disorders Domestic violence and families Child abuse and neglect in families

3. 15-3 Gladding, Family Therapy: History, Theory, and Practice, 6 th Ed. © (2015, 2011, 2007) by Pearson Education, Inc. All Rights Reserved Substance-Related Disorders and Families A significant challenge to families and society Substance-related disorders are even more destructive Alcohol use disorders Alcohol abuse Alcohol dependency Pseudo individuation / Pseudo self

4. 15-4 Gladding, Family Therapy: History, Theory, and Practice, 6 th Ed. © (2015, 2011, 2007) by Pearson Education, Inc. All Rights Reserved Manifestations of Substance-Related Disorders in Couples and Families Shielding of the substance-related abuser by nonabusing members of the couple or family Denial Expression of negative feelings Deterioration Focusing energy on the substance abuser Misusing family resources

5. 15-5 Gladding, Family Therapy: History, Theory, and Practice, 6 th Ed. © (2015, 2011, 2007) by Pearson Education, Inc. All Rights Reserved Manifestations in Couples and Families Continued Assuming survival roles: Enabler Family hero Scapegoat Lost child Family clown

6. 15-6 Gladding, Family Therapy: History, Theory, and Practice, 6 th Ed. © (2015, 2011, 2007) by Pearson Education, Inc. All Rights Reserved Individual Manifestations Children May behave in confused ways about their self-identity and self-worth Those who lives with at least one parent who is an abuser of alcohol are twice as likely to develop social and emotional problems May feel less attached and bonded Adults May spend lots of time and energy attempting to resolve issues related to the dysfunctional nature of their families-of-origin. May struggle in relationships

7. 15-7 Gladding, Family Therapy: History, Theory, and Practice, 6 th Ed. © (2015, 2011, 2007) by Pearson Education, Inc. All Rights Reserved Substance-Related Disorder and Treatment Family treatments are among the most effective approaches for helping those with substance abuse problems. Engage concerned significant others (CSOs) in the treatment process. Engage the most disengaged member of the family, possibly through a direct conversation

8. 15-8 Gladding, Family Therapy: History, Theory, and Practice, 6 th Ed. © (2015, 2011, 2007) by Pearson Education, Inc. All Rights Reserved Approaches to Treating Substance-Related Disorder Families After Engagement Community Reinforcement Approach (CRA) Environmental influences Multisystemic therapy Help with emotional, social, and vocational issues Address feelings and defense mechanisms Prominent theoretical approaches: structural- strategic, Bowen, behavioral, Adlerian, and multifamily therapies

9. 15-9 Gladding, Family Therapy: History, Theory, and Practice, 6 th Ed. © (2015, 2011, 2007) by Pearson Education, Inc. All Rights Reserved Prominent Theoretical Approaches Structural-strategic Bowen Behavioral Adlerian Multifamily Therapies Use of Community Resources and Prevention

10. 15-10 Gladding, Family Therapy: History, Theory, and Practice, 6 th Ed. © (2015, 2011, 2007) by Pearson Education, Inc. All Rights Reserved Domestic Violence and Families “Aggression that takes place in intimate relationships, usually between adults” (Kemp, 1998, p. 225) “The willful intimidation, assault, battery, sexual assault, and/or other abusive behavior perpetrated on one intimate partner on another (Cobia, Robinson, & Edwards, 2008, p. 248) Can take many forms: physical, sexual, psychological, and economic Battering – “violence which includes severe physical assault or risk of serious injury (Kemp, 1998, p. 225)

11. 15-11 Gladding, Family Therapy: History, Theory, and Practice, 6 th Ed. © (2015, 2011, 2007) by Pearson Education, Inc. All Rights Reserved Prevalence of Domestic Violence “Approximately one-third of all married couples experience physical aggression” (Crespi & Howe, 2000, p. 6). An estimated one half to two thirds of couples seeking marital therapy have had some incident of aggression in the last year (Schact et al., 2009).

12. 15-12 Gladding, Family Therapy: History, Theory, and Practice, 6 th Ed. © (2015, 2011, 2007) by Pearson Education, Inc. All Rights Reserved Those Who Batter Come in “all shapes, sizes, classes, races, and sexual orientation” (Almeida, 2000, p. 23) Pit bulls Cobras 13% of all murders involve husbands killing their wives 1.3 million wives are severely beaten by their husbands each year (Cobia et al., 2008) Relationship between alcohol intoxication and domestic violence

13. 15-13 Gladding, Family Therapy: History, Theory, and Practice, 6 th Ed. © (2015, 2011, 2007) by Pearson Education, Inc. All Rights Reserved Assessment of Domestic Violence Barriers Legal Psychological Difficult to determine level and prevalence of violence Levels of violence Common couple violence (CCV) Severe abusive violence (SAV) or intimate partner violence

14. 15-14 Gladding, Family Therapy: History, Theory, and Practice, 6 th Ed. © (2015, 2011, 2007) by Pearson Education, Inc. All Rights Reserved Open Assessment Often results in obtaining the most information Blame is not a primary emphasis and the therapist emphasizes that the expression of violence in the family hurts the entire family Focus centers on dynamics within the family associated with family relationships, such as emotional expression, handling of money, sexuality and social connections “Detection rates are increased when women are questioned directly, specifically, and alone (Schacht et al., 2009, p. 48).

15. 15-15 Gladding, Family Therapy: History, Theory, and Practice, 6 th Ed. © (2015, 2011, 2007) by Pearson Education, Inc. All Rights Reserved Treating Domestic Violence Conjoint or Couples Therapy Intimate Justice Educational Treatment

16. 15-16 Gladding, Family Therapy: History, Theory, and Practice, 6 th Ed. © (2015, 2011, 2007) by Pearson Education, Inc. All Rights Reserved Child Abuse and Neglect in Families Child Abuse (acts of commission) Child Neglect (acts of omission)

17. 15-17 Gladding, Family Therapy: History, Theory, and Practice, 6 th Ed. © (2015, 2011, 2007) by Pearson Education, Inc. All Rights Reserved Child Abuse and Neglect Statistics “In 2010, child protective services (CPS) received more than 3.3 million reports for alleged maltreatment of nearly 6 million children” (Juhnke, Henderson, & Juhnke, 2013, p. 57). Each year more than 1 million children are victims of child abuse (U. S. Department of Health and Human Services, 2004). Abuse is seldom of one type.

18. 15-18 Gladding, Family Therapy: History, Theory, and Practice, 6 th Ed. © (2015, 2011, 2007) by Pearson Education, Inc. All Rights Reserved Effects of Child Abuse Aggression Delinquency Suicide Cognitive, academic, and psychological impairment Less satisfaction with life and increased likelihood of behavioral, cognitive, and affective disorders

19. 15-19 Gladding, Family Therapy: History, Theory, and Practice, 6 th Ed. © (2015, 2011, 2007) by Pearson Education, Inc. All Rights Reserved Child Physical Abuse Resides on a continuum from mild to severe physical contact Severe physical child abuse Skin injuries to physical traumas and death Psychological consequences, from fearfulness to posttraumatic stress responses

20. 15-20 Gladding, Family Therapy: History, Theory, and Practice, 6 th Ed. © (2015, 2011, 2007) by Pearson Education, Inc. All Rights Reserved Childhood Sexual Abuse Includes the following: Unwanted touching Making sexual remarks Voyeurism Intercourse Oral sex Pornography

21. 15-21 Gladding, Family Therapy: History, Theory, and Practice, 6 th Ed. © (2015, 2011, 2007) by Pearson Education, Inc. All Rights Reserved Childhood Sexual Abuse Boys Least reported Most commonly done by perpetrators outside of the family 12% to 18% are sexually abused during childhood or adolescence Girls Most reported Most commonly done by a person within the family 1 in 3 is sexually abused by age 18.

22. 15-22 Gladding, Family Therapy: History, Theory, and Practice, 6 th Ed. © (2015, 2011, 2007) by Pearson Education, Inc. All Rights Reserved Treating Child Abuse and Neglect Involves legal, developmental, and psychological issues All states require mental health workers and other professional helpers to report child abuse and neglect. “Failure to report child abuse usually constitutes unprofessional conduct that can lead to disciplinary action by a regulation board, possible conviction of a crime, and a civil lawsuit for damages (Leslie, 2004, p. 48).

23. 15-23 Gladding, Family Therapy: History, Theory, and Practice, 6 th Ed. © (2015, 2011, 2007) by Pearson Education, Inc. All Rights Reserved Treating Child Abuse and Neglect Family therapists must deal with many current and historical issues in working with child abuse Important to concentrate on the following: Assisting the abuser in learning how to delay acting impulsively Helping the abuser and the abused family members to recognize and select alternatives other than violence

24. 15-24 Gladding, Family Therapy: History, Theory, and Practice, 6 th Ed. © (2015, 2011, 2007) by Pearson Education, Inc. All Rights Reserved Working with Adult Survivors of Abuse Treat not only issues from childhood but also adult behaviors associated with the past events Understand the context in which the abuse occurred Realize that children are rarely abused in only one way Treatment approaches may vary from Bowen- based family-of-origin work to behavioral interventions

25. 15-25 Gladding, Family Therapy: History, Theory, and Practice, 6 th Ed. © (2015, 2011, 2007) by Pearson Education, Inc. All Rights Reserved Working with Children Who have been Abused A variety of treatments have been used Very important to focus on the safety of children living in potentially violent environments Important to draw up a safety plan during the early stages of therapy, and should include the following: Hotline or local police number Identified safe internal and external locations in case of violence