ALCOHOLISM TREATMENT TECHNIQUES AND APPROACHES: WORKING WITH FAMILIES OF ACTIVE ALCOHOLICS
The most important thing the counselor needs to keep in mind is that the client being treated is the person in the office. In this case it is the family. The big temptation for the counselor may be to try treating the alcoholic in absentia, through the family member. This may be the family member’s wish, too, but it would be futile to attempt it.
What does the family need? One important need is for education about alcoholism, the disease, including its impact on the family. Another is aid in sorting out their own behavior to see how it fits into, or even perpetuates the drinking. Also, they need to sort out their feelings, and realistically come to grips with the true dimensions of the problem and the toll being exacted from them. As well, there is the need to examine what their options are for dealing with the problem. Most importantly family members require support to live their own lives despite the alcoholic. Paradoxically, by doing this, the actual chances of short-circuiting the alcoholism are enhanced.
Family assessment Just as all alcoholics do not display the identical symptoms or have the same degree of chronicity and extent of impairment, the same is true of family members. In the assessment process many of the same questions the counselor asks in dealing with the alcoholic should be considered. What has Caused the family member to seek help now? What is the family’s understanding of the problem? What supports do they have? What is the economic, social, and family situation like? What coping devices do they use? What are their fears? What do they want from you? Where the counselor goes in working with the family will depend on the answers to these questions. Treatment plans for family members might include individual counseling, support groups, Al-Anon, or other agencies.
You will notice that we have been speaking interchangeably about families and family members. Contact with a counselor is typically made by a single individual. Efforts to include other nonalcoholic members of the family (or the alcoholic) usually fall to the counselor. In some cases all it takes is the suggestion. In other cases, the family member may resist. This resistance may be due to a sense of isolation, that no one else in the family cares. It may instead be fear of the other family members’ disapproval for having “spilled the beans” about the family’s secret. Although the ideal might be having the family member approach the others, as the counselor, you (with the client’s permission) can contact other family members to ask them to come in for at least one session. Almost universally others will come in at least once (and this includes the alcoholic), if you tell them you are interested in their views of what is happening.
Family intervention. The initial focus has to be working with the family or family members on their own problems. Nonetheless, the indisputable fact is that the alcoholism is a central problem and that the family would like to see the alcoholic receive help. It is important to recognize that, ineffective as their efforts may have been, still much of a family’s energy has gone into “helping.” Now, as a result of education about the disease, plus assistance in sorting out their own situation, they in essence have become equipped to act more effectively in relation to the alcoholic. At the very least the family has been helped to abandon its protective, manipulative, enabling behavior. However, more is possible. A very successful technique, developed by the Johnson Institute in Minneapolis, consists of an intervention that involves the family and can be used to help move the alcoholic into treatment. This intervention technique and the rationale underpinning it was first described in I’ll Quit Tomorrow.
The intervention process involves a meeting of family, other concerned persons, and the alcoholic, conducted under the direction of a counselor. Each individual, in turn, provides the alcoholic with a list of specific incidents related to drinking that have caused concern. These facts must be conveyed in an atmosphere of genuine concern for the alcoholic. In so doing, the alcoholic is helped to see both the true nature of the problem and the need to seek assistance. Each person also expresses the hope that the alcoholic will seek treatment. By cutting through the denial, by providing the painful details, the intervention process can be thought of as precipitating a crisis for the alcoholic.
The counselor who is involved in family work is well advised to become skilled in conducting interventions, either by attending workshops or by “apprenticing” to someone trained in this technique. We should be clear that conducting an intervention is not something you do on the spur of the moment. It is not something to be done impromptu, just because you happen to have the family together. Nor is it something you describe to the family and suggest they do on their own after supper some evening!
The effectiveness of intervention depends on the participants’ ability to voice a genuine concern and describe incidents that have caused concern in an objective, straightforward manner. This takes briefing and preparatory work. Typically, this will entail several meetings with the family. The family members must become knowledgeable about the disease of alcoholism, so that the behaviors that previously were seen as designed to “get them” can be seen for what they are, symptoms. The preparation will usually involve a rehearsal during which each of the participants goes through the things that they would like to convey to the alcoholic. The participants also need to discuss what treatment options are to be presented, and the actions they will take if the alcoholic does not seek help. Is the spouse ready to ask for a separation? Is the grown daughter ready to say she will not be comfortable allowing Mom to babysit for the grandchildren anymore. Beyond preparing the participants, a successful intervention also requires that the counselor be supportive to all present, equally, and deflect the alcoholic’s anxiety and fears, which may surface as anger.
*128\331\2*

ALCOHOLISM TREATMENT TECHNIQUES AND APPROACHES: WORKING WITH FAMILIES OF ACTIVE ALCOHOLICSThe most important thing the counselor needs to keep in mind is that the client being treated is the person in the office. In this case it is the family. The big temptation for the counselor may be to try treating the alcoholic in absentia, through the family member. This may be the family member’s wish, too, but it would be futile to attempt it.What does the family need? One important need is for education about alcoholism, the disease, including its impact on the family. Another is aid in sorting out their own behavior to see how it fits into, or even perpetuates the drinking. Also, they need to sort out their feelings, and realistically come to grips with the true dimensions of the problem and the toll being exacted from them. As well, there is the need to examine what their options are for dealing with the problem. Most importantly family members require support to live their own lives despite the alcoholic. Paradoxically, by doing this, the actual chances of short-circuiting the alcoholism are enhanced.Family assessment Just as all alcoholics do not display the identical symptoms or have the same degree of chronicity and extent of impairment, the same is true of family members. In the assessment process many of the same questions the counselor asks in dealing with the alcoholic should be considered. What has Caused the family member to seek help now? What is the family’s understanding of the problem? What supports do they have? What is the economic, social, and family situation like? What coping devices do they use? What are their fears? What do they want from you? Where the counselor goes in working with the family will depend on the answers to these questions. Treatment plans for family members might include individual counseling, support groups, Al-Anon, or other agencies.You will notice that we have been speaking interchangeably about families and family members. Contact with a counselor is typically made by a single individual. Efforts to include other nonalcoholic members of the family (or the alcoholic) usually fall to the counselor. In some cases all it takes is the suggestion. In other cases, the family member may resist. This resistance may be due to a sense of isolation, that no one else in the family cares. It may instead be fear of the other family members’ disapproval for having “spilled the beans” about the family’s secret. Although the ideal might be having the family member approach the others, as the counselor, you (with the client’s permission) can contact other family members to ask them to come in for at least one session. Almost universally others will come in at least once (and this includes the alcoholic), if you tell them you are interested in their views of what is happening.Family intervention. The initial focus has to be working with the family or family members on their own problems. Nonetheless, the indisputable fact is that the alcoholism is a central problem and that the family would like to see the alcoholic receive help. It is important to recognize that, ineffective as their efforts may have been, still much of a family’s energy has gone into “helping.” Now, as a result of education about the disease, plus assistance in sorting out their own situation, they in essence have become equipped to act more effectively in relation to the alcoholic. At the very least the family has been helped to abandon its protective, manipulative, enabling behavior. However, more is possible. A very successful technique, developed by the Johnson Institute in Minneapolis, consists of an intervention that involves the family and can be used to help move the alcoholic into treatment. This intervention technique and the rationale underpinning it was first described in I’ll Quit Tomorrow.The intervention process involves a meeting of family, other concerned persons, and the alcoholic, conducted under the direction of a counselor. Each individual, in turn, provides the alcoholic with a list of specific incidents related to drinking that have caused concern. These facts must be conveyed in an atmosphere of genuine concern for the alcoholic. In so doing, the alcoholic is helped to see both the true nature of the problem and the need to seek assistance. Each person also expresses the hope that the alcoholic will seek treatment. By cutting through the denial, by providing the painful details, the intervention process can be thought of as precipitating a crisis for the alcoholic.The counselor who is involved in family work is well advised to become skilled in conducting interventions, either by attending workshops or by “apprenticing” to someone trained in this technique. We should be clear that conducting an intervention is not something you do on the spur of the moment. It is not something to be done impromptu, just because you happen to have the family together. Nor is it something you describe to the family and suggest they do on their own after supper some evening!The effectiveness of intervention depends on the participants’ ability to voice a genuine concern and describe incidents that have caused concern in an objective, straightforward manner. This takes briefing and preparatory work. Typically, this will entail several meetings with the family. The family members must become knowledgeable about the disease of alcoholism, so that the behaviors that previously were seen as designed to “get them” can be seen for what they are, symptoms. The preparation will usually involve a rehearsal during which each of the participants goes through the things that they would like to convey to the alcoholic. The participants also need to discuss what treatment options are to be presented, and the actions they will take if the alcoholic does not seek help. Is the spouse ready to ask for a separation? Is the grown daughter ready to say she will not be comfortable allowing Mom to babysit for the grandchildren anymore. Beyond preparing the participants, a successful intervention also requires that the counselor be supportive to all present, equally, and deflect the alcoholic’s anxiety and fears, which may surface as anger.*128\331\2*

THE SELF-MANAGEMENT OF PAIN: THE USE OF PSYCHOLOGICAL REACTIONS THAT REDUCE PAIN AND THE PRACTICE OF RELAXING MENTAL EXERCISES

According to circumstances, and according to our own individual personality, at different times we can use various psychological reactions to reduce our pain. We can do what we can to deny it, and use various distractions to forget it. If our personality is such that we can do it, we can

dissociate ourselves from the pain and stand apart from it or even make the painful part numb. We can all practise autosuggestion, and most of us can get some help from it provided we do it in a really relaxed state of mind.

The Practice of Relaxing Mental Exercises-This of course forms the basis of this approach to the management of pain. It allays anxiety, wards off distress, allows the effective use of autosuggestion, and of itself reduces our threshold of pain.

Any system that is successful in the self-management of pain is based on a calm and relaxed state of mind. The system described here is simple and effective, and can be mastered by almost anyone who sets his mind to it.

*133\57\2*

LEISURE AND STRESS

We feel we must get on in the world. So don’t let us waste our time. Well, what is waste of time?

Sleep is not waste of time. It is a biological necessity. It is the same with rest. What of leisure? We must sleep. We must take a rest. But with leisure there is a matter of choice. We can take it or not as we please.

If we sleep, we sleep. If we take a rest, we rest. But leisure is different in that there are so many ways we can take our leisure.

In matters in which we are able to make a choice, we can either choose well or choose badly. So it is with leisure.

Too much or too little. Too much breeds the feeling of purposelessness. Too little and we deny ourselves those important moments of allowing our mind to run easily. If we do something which is consistent with our biological needs, we call it ‘common sense’. If we apply this kind of wisdom to leisure time, we provide a background which will reduce our vulnerability to stress. The crucial factor is that we should enjoy our leisure in such a way that we have moments in which our brain runs easily in a way that allows it to integrate all the messages it has been receiving.

I am not suggesting that all our leisure should be spent sitting quietly in the garden or in some beautiful park. Nor do I suggest that we should spend most of our leisure lying in the sun on the beach, or sitting with a book by the fire. No. Not that at all. These activities may be useful ways of letting our brain run quietly. But we can still let our brain run quietly while we are actively doing things.

We play games. If we play for the game, for the exercise, the companionship with our fellows, and the fun of it, at the end of the day our brain will be further on the way to coping with the problems that beset us. But if we play the game in highly competitive fashion, at the end of the day we may feel exhilarated from a win, but our stress situation will remain unchanged.

Play, romp, have fun and our stress is reduced. And laugh, particularly if we can laugh at ourselves.

Leisure often involves going out, parties, socializing. A part of this is eating and drinking. We are gregarious animals. Over past generations we learnt the hard way that it was safer to stay in the group. In primitive times, those who wandered off by themselves became the victims of enemies, either human or animal, and did not survive to have children. So the tendency to be gregarious has been bred into us. And this tendency is reflected in the behaviour patterns of our leisure time.

The relaxation of our mind in the friendly company of others does something to help our brain towards the full integration of stimuli, and so works to prevent stress.

In contrast to our gregarious need we have more recently evolved a tendency to have some time by ourselves. This is a much more recent development of human kind, and comes about through our increasing awareness of our own being, and an awareness of our relationship with the world around us. This need is manifested more strongly in the introverted people among us. This is so because their habitual way of dealing with anxiety and nervous tension is to withdraw from the problems around them. So they have the tendency to withdraw into themselves, and this becomes a feature of their leisure activity. In this quiet withdrawal into the self, the introvert gains some inner tranquility in being by himself. He likes to ponder things. Not the problem that is the basis of his stress, but rather the wonder of the natural things around him. His mind runs quietly, and stimuli arising from his problems are better integrated.

A few moments’ daydream may do more to relieve stress than an hour’s discussion of its causes.

*65/98/5*

MAJOR PROBLEMS, WHICH MAY CAUSE STRESS: THREAT OF BUSINESS FAILURE

“We are a castle of playing cards. Someone shakes the table and everything collapses. It does not need a storm, just the slightest puff and we are gone.

Put up the interest rate. Just a few points. Gone. That which was steadily balanced falls to pieces.

I’m not a magician. How could I tell they were going up? My whole business. All that I have worked for threatened.”

He is clearly under stress, and the threat to his business is his major problem. In his mind, the only problem. But it so happens that his wife’s father was a successful businessman. She is given to comparing her husband to her father. In fact, her urging him to greater success had provoked him into taking unwise risks. His reaction is, ‘What will she say? What will she think?’ This is the associated problem resulting directly from the major one. If someone could lead her into supporting him instead of criticizing him, he may well be able to cope with the major problem without stress.

And how does she give this support that will allow his mind to run free? No advice. No working it out logically with him. And certainly not, ‘My father would do it this way.’ Reassurance is little help. The real help comes by the wordless expression of support. If she curls up closely in bed that night, nothing need be said.

*28/98/5*

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