Some people have a very strict definition of the word “family.” When they use this term, they are referring to those with whom they share blood ties. Parents, grandparents, siblings, aunts and uncles all fit this description. Other people have a much more loose definition of family, and they include their friends and members of their church within their inner circle. No matter whom you include in your family, the fact remains that the people who are members of that community have a huge impact on the choices you make, and they are, in turn, deeply impacted by your decisions. When you’re recovering from an addiction, your family can either help or hinder your progress.
Family therapy is designed to help you work with your family, building up a solid foundation for your long-term recovery. Through your sessions, you’ll all learn more about addiction, and you’ll learn to work together as a team to conquer that addiction, allowing you to move forward with your life.
*Choosing a Family Therapist
Sometimes, the counselor you use for your one-on-one addiction therapy will provide family counseling services as well. But, there are some addiction counselors who aren’t trained in family counseling techniques. In order to find the right family therapist to meet your needs, consider asking these questions from the Mayo Clinic:
- Are you licensed by the state?
- What is your experience with my family’s type of problem?
- Are you accredited by a professional family therapy organization?
- How much do you charge per session?
- Do you accept insurance payments?
- Are you available in an emergency?
It’s a common misconception that family therapy sessions are like extended holiday dinners, with all family members present, trying to make their voices heard above the others. This kind of environment might be familiar, but it also isn’t conducive to healing. Family therapy sessions are still therapy, not social gatherings, and as a result they tend to have a specific structure that is rigorously followed.
In the early part of therapy, you will meet with your counselor and discuss your addiction history and the impact of the addiction on your family. Some people enter treatment programs after a formal family intervention, where people close to the addict describe what they have noticed about the addiction and how those events have impacted them. In the first family therapy session, these people might describe the intervention, outlining who attended and what was said. This can give the counselor a good understanding of the major players, and how important they are to the addict.
When the counselor understands who should be involved, and how extensive the problems might be, a formal treatment plan can be designed. You will have an opportunity to give feedback on this plan, and you should understand exactly what is expected of you and how long the therapy might take. According to the Oklahoma Association for Marriage and Family Therapy, nearly 65 percent of family therapy cases are completed within 20 sessions, but your course of therapy might be longer or shorter depending on the issues you face.
*Attending Counseling Alone
In an ideal world, a person with addiction will willingly enter a family therapy program. In the real world, however, some people with addictions refuse to enter therapy. This doesn’t mean, however, that family therapy cannot move forward. Since family therapy focuses on family systems and family communication, it’s beneficial even if only a few members of the family attend. For example, according to an article produced by AARP, studies show that those who attended couples therapy together received no more benefit than those who attended couples therapy alone. Even if only one person attends counseling, that person can change the entire dynamic of the family in a positive way. Perhaps, this counseling could encourage the addict to attend addiction therapies at a later date.
The Fundamentals of Therapy
While your one-on-one counseling sessions for addiction focus on your addiction and how it can be effectively controlled, your family therapy sessions will focus on the dynamic relationships between the members of your family. The focus is on systems rather than individual problems. For example, in your counseling sessions, you might discuss how feeling stress at work tends to increase your cravings to use drugs. In your family therapy sessions, you might discuss how feeling stress at work translates into seeming withdrawn at home, which makes the entire family feel insecure and angry, which increases your stress. You’ll learn that the family is like a cobweb, and plucking on one string can cause ripples throughout the entire spread of the web.
Family therapy also includes a significant amount of education about the nature of addiction. As the addiction process moved forward, you may have experienced a significant amount of change in your life. The way you thought, felt and reacted to stress was likely influenced by your substance abuse. But your family may have changed as well. Perhaps your spouse began shielding you from addiction, calling in at work when you weren’t sober enough to go or handling all the childcare responsibilities, as you were absent. These changes can be persistent, and at the end of your recovery, they could cause you some problems. Your family, left unchanged, might expect you to play the same role you always played, but you’re a different person now with new capabilities and new ways of looking at the world. Family therapy allows the family members to change along with you, learning how the addiction process has modified the way they think and the way they behave. You’ll all heal together.
*Four Types of Family Therapy
While family therapy can take many forms, the Substance Abuse and Mental Health Services Administration reports that there are four predominant models in use today:
- Family disease model. Substance abuse impacts the entire family, and all members must change in order to halt the addiction process.
- Family systems model. Families become organized around the concept of substance abuse, and until this organization changes, the family might apply unseen pressure to keep the addict locked in addiction.
- Cognitive behavioral model. Substance use and abuse are reinforced through the interactions of the family, poor communication and lack of problem-solving skills.
- Multidimensional model. The family, as well as outside pressures such as work, school and society, all have a role to play in the addiction process and all of these factors must be addressed at the same time.
In some of your family therapy sessions, you’ll work in small groups with your therapist. You might attend sessions with your spouse, for example, or you might attend sessions with your parents. Other sessions will include members of your family and exclude you. It can be uncomfortable to think about members of your family going to counseling to talk about your addiction while you’re not there, but it’s important to remember that they have changes of their own to make and issues of their own to resolve. Your therapist is also firmly in charge of these meetings, so no one will be allowed to bash you or gossip about you in these sessions. They will be civil and constructive meetings.
Some sessions will include larger groups of people. You might have specific issues with your parents, for example, that are hindering your recovery and you might need to resolve past issues so you can all move forward more effectively. These larger meetings might allow you to clear the air, and you’ll all hear the same information at the same time. This might be an effective way to put old issues to rest.
Some forms of family therapy provide you with assistance in other areas of your life including your:
- Employment status
- Legal affairs
Your counselor might provide you with specific skills training in your sessions or information about community resources, and ask you to contact these groups directly and report back with results from those conversations.
*One Family’s Story
“When I started drug therapy, I thought I’d be doing most of the work. I was surprised that they wanted to bring in my kids and my wife for counseling, too. After all, they didn’t use drugs. I did. We all went to counseling together, and I learned so much. I learned how to talk to my kids without yelling, and they learned how to trust me again. My wife and I learned how to talk through our money troubles without getting mad, and we both learned how to create a home that would support my recovery. Now, we’re like a well-oiled machine, able to work together and really talk about our issues instead of fighting or avoiding each other. It’s been a very helpful part of my recovery.” – Monty
An Effective Treatment
Family therapy is used so often in addiction treatment programs because it’s been proven effective in study after study. In the early days, this form of therapy was primarily provided to adolescents with drug and alcohol addiction issues, but now, it’s used for almost everyone who is dealing with an addiction, since studies suggest that it’s helpful for almost everyone. For example, a review of research published in the Psychological Bulletin found that family therapy was more effective in treating drug addiction than individual counseling, group therapy or family education. This review is interesting, as it attempted to determine how effective family therapy is when it’s the only form of therapy provided. This is rarely what happens in addiction programs, as most combine family therapy with other forms of therapy. It’s likely that family therapy is even more effective when it’s supplied in conjunction with these other forms of therapy.
A very small study published in the Quarterly Journal of Studies on Alcohol found that families who were provided with family therapy were better able to relate, had healthier communication styles and improved mutual support. In other words, these families seemed to be able to heal, creating an environment that was loving and supportive. It seems like a worthy goal for any family to achieve.
Most research performed on family therapy has focused on traditional families that contain a married male and female couple. Many of these couples are Caucasian. There are many, many families in the United States that don’t fit these tidy descriptions, and these families might also need family therapy. For this reason, some family therapists have tailored their traditional approaches to provide specialized care to these nontraditional families. Some therapists include more family members, as dictated by the culture. Other therapists focus on the difficulties the whole family faces due to discrimination. These can be quite useful interventions for these families, both in the context of addiction and in the context of larger mental health.