September 19, 2020
An adage in recovery circles regarding family therapy says, “The patient is the family, and the family is the patient.” This phrase is often used to describe the therapeutic relationship between therapist and client. Though it's not an exact parallel to family therapy, it also points out the need for an understanding of the family in addiction recovery.
Family therapy is a multilevel treatment focusing on the family's relationships, patterns, and interactions. Family therapy usually involves multiple family members and a variety of treatment options. It can assist families when they are having problems and help promote family cohesion.
In addition to addiction-related issues, family therapy can help families deal with a wide range of topics that include but are not limited to the following:
Grief and loss
Mental health issues
Behavioral problems in children and adolescents
We who work with people recovering from substance and alcohol abuse disorders know that their families are often just as much in turmoil as the person with the issue. The reality is that the person in recovery often points out that something is wrong in the family. Their drinking, using, or unwanted compulsive habits are usually a warning signal that there might be more significant problems at home that go unaddressed.
Unfortunately, many families approach taking a loved one to rehab as though they are dropping off a car to be overhauled and hope to pick it up in twenty-eight days and all will be “fixed.” We've been in these situations and know it doesn’t exactly work that way. What is often even more surprising to families is that a suitable treatment plan will include them and integrate family therapy sessions at some point into the care plan of their loved one.
Families and family members have often taken on roles during years of dysfunction that must be identified and challenged through a good family therapy program. The enablers, the fixers, the over-achievers, and the person who sets the emotional thermostat all have to be helped in letting go of their old paradigms to allow the recovering person to merge back into the family in a healthy way without returning to unhealthy family dynamics.
Several types of family therapy can help those in recovery and their family to fix dysfunctional relationships and heal from the damages of substance use. Cognitive therapy, interpersonal therapy, behavior therapy, and other forms of individual therapy may all be adapted for this kind of group therapy. Some therapists may only use one particular approach when working with families. On the other hand, others may choose a more flexible, holistic strategy that blends elements of several therapies.
The goal of supportive family therapy is to provide a secure space in which family members may express their feelings and receive understanding and acceptance from one another.
Family systems therapy is a method that emphasizes building on the positive aspects of interpersonal connections to treat mental and behavioral health issues.
Psychoeducation is a therapy that focuses on educating loved ones about substance use and mental disorders. Family members may be a more cohesive support structure if they have information about available treatments, drugs, and methods for helping themselves.
Narrative family therapy is a method of therapy in which family members are encouraged to share their narratives to gain insight into how their upbringing has shaped who they are and their relationships with others. By engaging with this story, the individual may broaden their perspective and look at issues from other angles.
Short-term treatments like functional family therapy are often used to help young people having difficulties with reckless conduct, aggression, or drug use. Even if the person identified as a user is an adult, this therapy works on the belief that building mutual trust and appreciation between family members and patients is beneficial in looking for resolutions to the issues.
The Bowenian approach to family therapy is ideal for cases in which patients are unable or unwilling to include other members of their immediate family in their care. The foundations of Bowenian therapy are triangulation (the inclination to release emotions by talking to an outsider) and differentiation (the practice of learning to react less passionately in family interactions).
This method of psychotherapy is quicker and more to the point than others, with the therapist giving the family assignments to complete outside of sessions. This assignment's goal is to improve communication and decision-making within the household by having members evaluate and make necessary changes. With this type of treatment, the therapist assumes a position of authority, paving the way for improved communication amongst family members who would not otherwise be able to assert themselves.
Family therapy has many different practices and goals for a loved one's addiction, but the two most common are strengthening family relationships and solving communication problems. Family therapists often use problem-solving, role-playing, and communication exercises to help families improve their relationships and resolve conflict. The ultimate goal of family therapy is to help families function more effectively and improve the quality of their lives.
All family members must feel a sense of closeness and connection to heal and maintain a healthy family. In addiction recovery, this is often the first step for family members. During the early stages of family therapy in the recovery process, a family may need to heal from broken trust and communication issues. In some cases, there may be a need to break destructive patterns of communication that lead to discord and distance. To regain a sense of family togetherness, family members may need to go back to the basics of communication. This may mean listening to each other and making eye contact during conversation. It may also mean setting clear boundaries in how serious talks are handled, avoiding defensiveness, or communicating respectfully.
In family therapy, relational reframing is the practice of shifting the lens through which family members view one another. It is a way to help family members change their perceptions of each other and the dynamics within the family. For example, a child may see her parent as being an irresponsible addict. In family therapy, the child may learn how her negative perception of her parent is a self-fulfilling prophecy. She may also learn how her behavior contributes to her parent’s addiction. Parents may see themselves as victims, but in family counseling, a family member may discover how their child’s perception is a self-fulfilling prophecy. She may also learn how her behavior contributes to her child’s feelings about addiction.
Family restructuring is the idea that the therapist and the family members will restructure the family to be functional and healthy. Family restructuring is done during family therapy when the family has agreed to work together to change the dynamics in the family. Family restructuring may involve creating boundaries, exploring family rules, and setting expectations for the family. It may also include taking a look at the family roles and finding new ways to shift these roles so that they better reflect each family member’s needs.
A crucial part of family therapy is exploring behavior changes, individually and as an entire family unit. Behavior change may be directed toward healing from addiction and reducing the impact of substance abuse on the family. This may include attending 12-step meetings, seeking therapy for oneself and others in the family, and connecting and communicating better as a family unit. Behavior change may also involve changing destructive communication patterns, setting boundaries, and finding healthy ways to resolve conflict.
Family days in a substance abuse treatment program can be emotional, fearful, and even enlightening as past experiences are exposed and discussed. Resentments have been used to justify all kinds of addictive and manipulative behaviors that may be going on apart from the person with the identified problem. There may even be more than one addict in the home. There may be multiple addictions, mental illnesses, trauma, or abuse. Even rage, inappropriate emotional enmeshments, and various relational alliances must be identified and called out. Ultimately, the addict realizes that they are not the only problem in the family and are a part of a larger dynamic in need of guidance and insight.
Secrecy and emotional bargaining within families are inevitably going to be addressed as well. Addiction flourishes in secrecy and silence. Good family therapy realizes that exposing our secrets is the beginning of living healthily. We are only as sick as our secrets as they say, and that goes for families, not just people with substance use disorders.
The best way we can care for the ones we love is to be willing to take the vulnerable journey into restoration with them. Allowing ourselves to hear the tricky things about ourselves is the beginning of being able to own our part in the bigger problem. A good family therapist can help gently nudge and guide loved ones down the path together without focusing on blame and shame but rather on the hope that a close, solid family system is in place at the end of the process.
The Wish Recovery treatment center offers families the support they need to be understanding and empathic witnesses to the needs of their loved ones as they embark on a new life together, leading them across the bridge of fear navigating through the darkness of substance use disorder into a place of light, hope, and trust.
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