Family and Personal Recovery: A Parallel Process. Ryan Hanson, MA, CAP Executive Director Caron Renaissance

Transcription

1 Family and Personal Recovery: A Parallel Process Ryan Hanson, MA, CAP Executive Director Caron Renaissance

2 A Family Systems and Psychodynamic integrated treatment model The mental health (formerly Axis I), and the characterlogical or (formerly Axis II) make-up of the patient and related generational family themes are believed to pre-date the onset of addiction. Axis I, II and generational themes will contribute to the relapse process if not treated concurrently.

3 Family Systems Treatment Key premise: Changing one component, one family member, the entire system must seek a new equilibrium. Family systems inherently provide a sense of stability. This equilibrium depends on each member of the system and their respective tools. Individually and collectively members of the family system are geared toward reaching developmental milestones.

4 Family structures Family systems are designed to create stability and safety. Multi generational rules and roles are present in every family Rules are BOTH stated overtly and implied, and not always consistent Families seek stability and equilibrium

5 ADHD sidenote? How to have a healthy and stable workplace: HPPY HR / Engagement : 4 keys to a more stable work environment 1. Post workplace rules, policies and guidelines, as well as avenues to address concerns 2. Encourage work / life balance 3. Assign coaches and mentors specific to that employees need and goals 4. Encourage open communication

6 McGraw-Hill 2017 Why don t employees trust employee engagement surveys? Lack of trust and fear of retaliation Doubt that the system will change

7 Our Comparison Supportive Environment Open Communication Accepting Resiliency Support Network Experience Safe Environment Faith / Spirituality Coping Tools Addictive Environment Don t Talk Don t Trust Don t Feel

8 Emotional Messages Boys don t cry if you don t have anything nice to say, better not to say anything don t bring other people down why did you upset?.. its our responsibility to protect...its not nice to talk about that we don t air our dirty laundry in public what will the neighbors think what will your mother/father think you should have known better you asked for it we don t talk about your mother s drinking/your uncle s prostitutes/your aunt s scratch offs that s gay better to let it go emotion is a sign of weakness the worst thing for a man is to be seen as weak a woman s job is to care for others you don t want to disappoint

9 Some context about family treatment for addictive disorders: Samhsa doesn t have a family services category. They do list every facilities smoking policy The initial development of any level of family services was to increase outcomes for the IP. Almost all national programs center around education of the IP s problems

10 Families respond to their natural parenting instincts or natural love instincts to protect, defend and provide for their loved ones. Strategies learned during developmental stages. In family systems, there are parallel psychodynamics at play among primary family members and which are often rooted generationally and triggered through new stressors, trauma or loss.

11 Generational structures and strategies are present in every family. The defensive structures of a disrupted system are fueled by archaic defense mechanisms and of being trapped inside the system s own developmental deficits. Addiction is an autonomous process and while the family did not cause nor can they cure it, the family can influence the relapse process by addressing or ignoring the developmental and relational dynamics. Assessing / identifying the lens.

12 Some assessment strategies Genograms Individual biopsychosocial histories, including losses, sexual history, medical history (family medical history), addiction history, significant events, financial history, etc Emotional coping strategies Conflict resolution strategies Generational patterns Trauma history

13 This assignment is to help identify the way we see and cope with the world. All of us have an innate personality and we interact with the world (internal experience and personality plus environment) to develop our own coping strategies for life. Many times these strategies are formed in our developmental years and we continue using the same or similar strategies throughout our life. In each box, please list the following (please use bullet points, not narrative explanations): A significant event (these can be a loss, trauma, social issue, adjustment to changes in family or location, etc), your age at the time of the event, the thoughts you had about the event (again, at that time), your emotions at the time of the event, the behaviors (the things you did) to cope, and how specific family members responded to your behaviors. Please only list one event per box. The goal is for you to see your own pattern and identity how you respond and which strategies you use when you experience discomfort.

14 Big T and little t Research Dr. Revital Goodman : 70% of patients in substance use disorder treatment self identify as having experienced at least one Adverse Childhood Experience. Dr. Judith Landau has done amazing work looking at the generational impact of trauma and familial coping strategies

15 A nice Midwest family Intact farm family, 3 boys, father drinks heavily, both sides of the family have a history of addiction. Sexual history Legal history Messages from the system Generational traumas

16 Core Concepts The inability to manage one s emotional life, profound dependency needs, generational themes, distortions that the world will accommodate and failed attempts at self-care will create heightened states of anxiety and/or characterlogical depression.

17 Core Concepts The defensive structure of the addict is fueled by archaic defense mechanisms and of being trapped inside one s own developmental deficits. Addiction is an autonomous process and while the family did not cause nor can cure it, the family can influence the relapse process by addressing or ignoring the developmental and relational dynamics.

18 Core Concepts The family is not necessarily sick, but is responding to their natural parenting instincts to protect, defend and provide for their loved ones. In family systems, there are parallel psychodynamics at play among primary family members and which are often rooted generationally and triggered through new stressors, trauma or loss.

19 Family as Codependent Codependent is the natural position for a family member addiction distorts this. As family members focus their energy on the identified patient (IP), they can/do ignore their own issues and needs. This results in secondary gains for family members which need to be addressed. While the IP is the focus other family members needs are neglected.

20 Core Concepts Sobriety is the responsibility of the patient, however the family s responses to the patient can either strengthen recovery or influence the relapse process. The family or significant others must accept the challenge of looking into themselves and at their family histories in order to reverse generational themes and the dynamics that set the stage for family and individual relapse.

21 Back to the Midwest Resistance (missed calls, minimizing, not completing assignments, blaming) You ll have to ask her about that with wife answering / excusing for all the males Eldest son wanting to protect parents Resistance to discussing youngest son s drinking Genograms get us to the number of divorces, generational alcoholism, and more secrets gives the opportunity to deal with shame

22 Parallel Processes and Defenses Identified Patient 1. Steal / lie to obtain chemical, etc. 2. Avoid emotions through escape of addictive behaviors 3. Externalize blame on family/school/law/ society, etc. 4. Deal with shame through avoidance Family members / system 1. Lie, spend family funds to protect IP 2. Avoid emotions through focus on IP 3. Externalize blame on family/school/law/ society, etc. 4. Deal with shame through avoidance

23 Family Risk Factors / Risky Behaviors High Anxiety Enmeshed Systems (problem solving, coaching/lecturing, cheerleading) Entitlement Avoidance/Lack of Involvement Blaming / Excuse Making Refusal to follow recommendations Inconsistent Messages/Actions/Follow Through Abusive Behaviors Repeated Treatment History

24 How It Works Family members stop problem-solving for the patient. Family members begin to experience their own strengths and weaknesses and become oriented to their own insides painful, but anxiety reducing and sobering. The codependent position is weakened.

25 Stimulants, Sex, and Stigma Assessments with families need to include an understanding of their perception about addiction, sex, choice, morals, and responsibility Family members tend to take on parallel levels of shame they may respond with similar or different strategies to avoid the shame Shame = I m bad Guilt = My actions were inappropriate

26 Guilt Induction = Shame Reduction Ownership and Accountability of behaviors allows a patient/family member to reduce shame A behavior can be changed, control and empowerment happen when I focus on changing behaviors Needs a safe container (knowledgeable treatment, therapist, counselor, IOP, group, etc) Some notes about terminology are our labels pejorative?

27 Auntie Em, Auntie Em, It s a twister! Family Workshop: With an environment of safety, community and rapport (and some skilled push by the clinical team) the family lets all the secrets out. This helps to eliminate the negative contracts and allows new expectations to be developed The dependent role / blaming by the patient is challenged

28 Some accountability/ownership strategies Timeline of behaviors Timeline of consequences I never thought I would 20 ways I violated my beliefs 20 times my values and actions didn t match Shame spiral / shame collage Impact letters from family/school/work/etc Group / family work

29 Treating the family Increase Expectations Set Boundaries Demand Accountability reasonable and natural consequences Detach from problem solving Focus on self Adult/Adult Communication non avoidant conflict resolution Address splitting / secret keeping

30 Parallel Treatment Experiences Refer back to the assessment of the patient. Family members need the same level of assessment and most of the time the same level of treatment intensity. Residential level of care for families / family members Caron Renaissance/Ocean Drive, Onsight, Meadows, Bridge to Recovery

31 Resistance to Residential Identified Patient Denial (its not that bad) Blaming (I only do it because ) Blame shifting / distraction (Why aren t we talking about Dad s gambling?!) Avoidance of Responsibility Primary and Secondary Gains Family Member (aka Patient) Denial (Its not affecting me that much!) Blaming Blame Shifting (Sure I need to change, but they need to first) Responsibility (I love to, but someone has to pay for/keep doing ) Primary and Secondary Gains

32 Treating the Family Equilibrirm: e qui lib ri um noun: a state in which opposing forces or influences are balanced. - When one member of the family changes, the rest of the family must adjust. - This doesn t always happen the way families want, or in the time frame they desire!

33 How It Works Family members use appropriate internal and external resources to manage their own anxiety. Family members begin to perceive that it is they who are responsible to regulate their own internal affairs. The dependent and codependent position deteriorates.

34 How It Works The family members assume sober, adult relationships, sober social networks and activities, work/school tasks and adult-adult relationships and parenting. The family members experience the development of personal integrity and begin to practice the principles of recovery. The co-dependent position disintegrates and reintegrates as an inter-dependent position.

35 And Finally, back in Wisconsin - Patient has a weekly call with each member of the family every week for a YEAR. - Father reduces his drinking - Mother starts to manage some of her own health issues. Keeps seeing a therapist. - Oldest brother gets divorced for the third time, but does so amicably - Youngest brother keeps drinking his wife joins and remains in Alanon.

36 Q & A