Family Therapy

THE NEED FOR FAMILY THERAPY

Addiction-A “Family Disease”

  • Has an impact on each and every member of the family
  • Trust, love, respect and cooperation eroded
  • Healthy relationship between husband and wife, parent and child, siblings destroyed
  • Emotional, financial and social damage
  • Series of escalating crises intensifies over a period of time
  • Reality is denied by blaming, rationalizing
  • Respond to the problem inappropriately
  • Develop co-dependency traits

Family their problems therapy towards solving

  • To provide information about addiction and its effects on the family system
  • To provide a safe and acceptable environment for the family to discuss their issues
  • To help the family members express their shame, guilt, fear and hurt feeling
  • To recognize and grow out of their dysfunctional coping behavior and negative personality traits.
  • To help the family to understand their problems and set realistic goals
  • To guide the family to provide a more supportive environment for the recovery of the addict.
  • To make them understand the importance of follow-up for continued sobriety

    Therapeutic benefits of lectures/ classes and group therapy

Sr. No. Classes and Group Benefits
1 Addiction -a-disease Family understand the ‘disease concept’ and shifts her attitude positively towards the addict
2 Responses of the family members to his drinking Understand her ‘powerlessness’ over the alcoholic / addict. Realizes the need to
3 Feeling experienced Helps in identifying and sharing the feelings in an appropriate environment to get relief
4 Problems in recovery for the family Understand some of the problems she may face during recovery.
5 Co-dependency Understand her maladaptive / dysfunction behavior pattern.
6 Impact on children Realizes the impact of addiction on her children – emotional / physical damage – and plans methods to improve relationship.
7 Financial management Learns to manage her finances efficiently by proper budgeting.
8 Dealing with anger Learns to accept and express anger appropriately.
9 Disulfiram and the importance of follow Understand the need to provide disulfiram and importance of follow-up in the recovery of the
10 Relapse Understands the “relapse warning signs”; relapse intervention and relapse prevention methods.
11 Self-esteem Helps to identify her low self-esteem and learns ways of enhancing or strengthening self-esteem
12 Parenting Learns effective parenting skills and methods to raise children and adolescents as healthy individuals

Individual counseling

  • To help family members accept the disease concept of addiction which in turn will enable. Them to provide appropriate support to the client during recovery.
  • To assist in identifying ways in which they unknowingly enables the addict to continue with his inappropriate behavior and help them recognize the futility of their efforts.
  • To facilitate open expression of their negative feelings of anger, fear, self pity and guilt and offer methods to deal with them
  • To help them recognize their dysfunctional behavior patterns and negative personality traits and realize the need to make positive changes.
  • To assist them in identifying specific goals for the future in order to improve the quality of their lives.

What the family learns

  • Not to hide alcohol bottles and not search for drugs
  • Not to argue or quarrel with the addict while he is under the influence of drugs/alcohol
  • Not to ask him reasons for his drug use
  • Not to attempt to punish, threaten, bribe, preach or try emotional appeal with the addict
  • In the long run, none of these methods work

The family members learns

  • To accept that addiction is a serious problem which requires professional help
  • To calmly discuss addiction and related problems openly
  • To stop protecting him by covering up the consequences of his drug/alcohol use
  • Not to feel or give the impression that the addict is doing them a favour by not ‘using’
  • To start communicating honestly and openly to the other members in the family about their concern.
  • To plan one day at a time and start executing their plans
  • To start looking after their own needs and the needs of other members in the family
  • To accept that they are not alone and realize that help is available (through self-help groups)
  • To identify healthy leisure activities

The family members learn

  • To plan one day at a time and start executing their plans
  • To start looking after their own needs and the needs of other members in the family
  • To accept that they are not alone and realize that help is available(through self-help groups)
  • To identify healthy leisure activities

Changes that will help the family in recovery

  • Sharing responsibilities with the addict
  • Developing trust toward him
  • Overcoming the fear of relapse
  • Improving high expectations
  • Improving communication
  • Making efforts to overcomes one’s own short coming

DEALING WITH FEELING OF FAMILY MEMBERS

When an addict starts facing problems due to the abuse of alcohol/drugs, his family members also begin to experience various emotions. As the disease progresses, these feeling become intense. Unable to express these feeling appropriately, they eventually become self-damaging.

Some of the feeling experienced are:

  • Guilt
  • Anger
  • Fear
  • Shame
  • Grief
  • Self-pity & loneliness

Guilt

The emotional response to addictive illness in a family member frequently has its roots in guilt feeling. Our culture often implies that if a person drinks too much or takes drugs, Family members are to be blames. Sometimes the addict himself blames his wife for his drinking.

Anything can be stated as a reason for his excessive drinking; her family background, her education or the lack of it, her looks, or even the way she reacts to his drinking. If she is silent and does not protest too much, she is accused of not being concerned about him or seen as not being smart enough to control his drinking.

In case of unmarried persons, parents are blamed. If the mother is kind towards the addict she is blamed for being very kind. If the father restricts his access to money, he is blamed for being too strict with him. Decisions which were made keeping his welfare in mind in particular situations are now interpreted differently.

E.g. “You had sent him to a hostel. If he had studied here, he would not have picked up this habit”.

Society’s attitude and outlook automatically leads to self-blame and such self-blame only produces more guilt. Guilt of this proportion cannot be sustained or tolerated for long and thus the family members feel extremely depressed, sometimes to the point of contemplating or attempting suicide. Will the Suicide of the family member have any influence the addict’s drinking? All along the alcoholic would have mentioned several reasons for his drinking. The death of the family member will be given as yet another reason for his drinking.

Even after treatment, the blaming may continue especially when there is a relapse.

E.g. “You should have somehow convinced him to avoid drinking friends. You are not smart enough. That is why he has a relapse”.

The family members may blame themselves too. For example, if the patients starts drinking ten months after treatment. when the mother had gone to attend a wedding. she feels guilty that her absence was the cause for the relapse.

Staying sober is the responsibility of the patient and the family need not blame themselves for the relapse.

Family members try different ways to deal with alcoholism. None of these work. It is important to understand that family have no power or control over his addiction. As that cannot take the credit for his recovery, so also they need not take responsibility for his relapse.

Anger

When the family members’ opinions or feeling are not acknowledged or accepted they often experience anger and deep sadness. Initially this anger is focused towards the addict and his inappropriate behavior. As the disease progresses, the family members are unable to manage the enormous problems which in turn leads to utter helplessness. Now the anger has no focus at all, they are angry with children, friends, society – in short their anger is directed towards the entire world at large. At that Juncture, they find it difficult to accept words of care and concern. Words of consolation are receives only with anger. Even though they are extremely angry, the steam is often not let off completely. Hostility lurks just below the surface, waiting for an opportunity to come out in the open. This leads to physical problems such as migraine headaches, digestive disorders etc.

Anger causes constant fights at home. At night, the alcoholic shouts (because he is drunk) and the wife remains quiet. However in the morning when the alcoholic is abstinent the wife begins shouting and the alcoholic remains quiet. In their case the other person does not listen at all. The important fact is that no one feels guilty for shouting at the other. As the other. As both take turns at shouting, their anger seems to get “evened out”. Problems do not get resolved. Anger therefore does not subside. It continues to bubble

Do all these stop immediately after treatment? The answer is “no”. When the alcoholic continues to behave irresponsibly, is unwilling to go work, is lazy or spends too much money, the family tend to get more angry. They also feel that they should not express their anger because it may trigger a relapse for the addict. This leads to a lot of stress.

To handle anger we need to

1. Accept that we get angry

2. Recognize whom we are angry with

3. Why we are angry

4. Communicate anger appropriately.

Fear

Living in a problematic environment leads to constant fear – fear about the future, fear about the family life, fear about financial matters, about relationships, fear about arguments and loss of job or death due to accident or illness. There is a persistent fear that nothing is going to become normal. The constant fear keeps the family members are unable to function normally – eating, sleeping or even watching television becomes burdensome for them. Their thoughts are focused on the “ifs” of the future and they are unable to live in the present.

Fear continues even after he stops drinking such as “Would he have a relapse?” or “What if he drinks with esperal?” When the alcoholic comes home late or he receives a phone call from an alcoholic friend or his eyes are red, the family feels afraid and starts imagining things.

In the new life, these fears will only make their lives more miserable.

‘By worrying and getting afraid, are we going to avert a relapse? We need to learn to deal with fear, using the motto “one day at a time”. Taking strength from god to handle fear on a day- to- day basis would help.

Shame

Due to his drinking and drunken behavior, the family members experience a lot of shame. The inappropriate behavior of the addict in front of relatives and friends make them feel terribly embarrassed. The Slurred speech, the loud and illogical argument, the blood shot eyes, the disheveled look-everything is cause for shame. They wonder what the neighbor or friends would think of him as well as the family. The family feels ashamed, as if they have committed that act.

E.g. the wife hesitates to walk on the same read through which the alcoholic had gone home drunk.

They slowly avoid meeting others. They hesitate to visit others, because they may reciprocate the visit and they are not sure of the situation at home at that point of time they stop talking to neighbors for fear that they may question them about the noise at home or about his late coming. The fact that the young drug abuser has discontinued his studies or continues to be unemployed is also causes for shame. They stop attending wedding and other get-togethers.

Due to this, the family goes to the extent of totally cutting of all social communication. As the situation becomes worse, shame get multiplies- Ashamed of the alcoholic and ashamed of all other family members including themselves.

Even during recovery, they deprive themselves of happiness through avoiding all enjoyable activities. Now it is important to understand that the family has a right to live and also live happily. They should make conscious efforts to enjoy the pleasures of life spending time with children, going to temples, visiting supportive relatives, etc.

Grief

Addiction results in losses of many kinds loss of prestige, dignity, love, security. The list is endless. It is a chronic extended loss with no visible end. The most difficult part is that the family has no one to share their feeling with. By mourning for these losses and staying stuck in the past only increases their sense of despair.

After treatment, the grief has reduced, but the hurt continues to bother them. It takes sometime for the wound to heal- they are unable to forget certain past experiences resulting in retaliating in harsh and painful words. The patient retaliates with more wounding words.

The family constantly remind themselves of the losses and blame their fate. They mourn the loss of many years during which they could have been happy. They think of all the good times that the children have lost. They moan the fact their parents experienced pain and they could not keep them happy in their old age. All these losses make them more and more depressed.

It is essential to learn to forgive and forget – let go of the past.

Self-pity and Loneliness

The family members indulge in self pity and often feel that they are the only ones suffering in the entire world.

‘After attending classes, they understand that many people are in the same plight as they are. Talking about their feeling in classes and group therapy help them in overcoming self pity. They also learn to focus on the positive and the good things that they enjoy in spite of his addiction’.

When God closes a door, he opens many more windows to find happiness and the individual should be willing to look at the windows available.

E.g. “Even though our husbands are drinking, we might have bright and clever children or we might have jobs to concentrate on. Even attending therapy can be seen as an opportunity given by God to change our lives”.

‘To get over loneliness and self pity, they need to improve their relationships and begin to communicate with they can trust and share with someone who can understand exactly how they feel. Al-Anon is often the right place, offering them the comfort, hope and strength’.

How to deal with these emotions

Addiction brings with it emotional trauma. But the way in which family members deal with can make a difference between acting purposefully to limit the damage or reacting emotionally to deepen the pain.

Sharing and dealing with these emotions appropriately help in leading a positive life.