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# The Role of Family in Addiction & Recovery

Creative Ways to Help Families Heal Through Recovery

Estimated watch time: 49 mins

Available credits: none

Objectives and Summary:

Jasmyne Kettwick has been working in psychiatric treatment with children, adults and families for more than 11 years. In her presentation on family therapy strategies, she shares some helpful approaches to treating the family unit as a whole, including how to determine which roles family members take on and how to help them communicate effectively.

After watching her presentation, the viewer will be able to:

Understand the roles that family members typically take on during active addiction and recovery.
Learn strategies for fostering effective communication, overcoming roadblocks within families, and helping individuals feel heard.
Find ways to frame talking points in less judgmental ways using Enneagrams and similar approaches.

Presentation Materials:

PowerPoint Presentation:

Transcript:

Welcome to the Community Education Series hosted by The Recovery Village and Advanced Recovery Systems. Hi, I’m Jasmyne Kettwick from Relate Family Therapy in Centennial, Colorado, and today I’m going to be presenting on creative ways to help a family heal through recovery. I have been working with kids, families, and adults for about 11 years now in different outpatient and inpatient pieces. I helped run a residential facility. I worked in outpatient psychiatry. I worked in in-home case management, and I’ve been running a private practice for several years now where we have an entire team that can help all members of the family.rnrnDuring today’s presentation, we’re going to go over a little bit about who Relate is and what’s different about our private practice as opposed to other ones, and kind of talking through the different roles in a family and ways to engage the family system. Because when we know there’s an identified patient (IP), a lot of times, people want to just work on the IP. I want to help transition and work on the entire family system to help the IP as we move through.rnrnRelate is a very client-centered practice. We have several offices designed for the client instead of for the therapist. So if you come in to Relate, you don’t come into a therapist office — you come into your space. So we have a young child playroom. We have an older teen/tween space. We have several offices that are just for individual and couples therapy, and we hope to keep those offices very comfortable and inviting because we want people who are experiencing high trauma to feel safe and less stressed.rnrnThere’s also already so many reasons that they have to be overwhelmed that being able to come into a clean space that’s really dedicated to them, I thought, was just a nice way for them to feel more centered and grounded. Relate has three waiting spaces for families that maybe are experiencing divorce, or the parents are in some sort of high conflict. So when the kids come in, they don’t feel like their parents have to sit together, or one of them can’t be present and has to go to the car or can’t come to the therapy sessions at all.rnrnAll of our therapists specialize in different areas. So we have some people that will work in DBT, CBT, parent-child interaction training, play therapy specific for young children or older children, family dynamics work. We have a lot of different specialties in order to help an entire family come together, and we want to be a one-stop-shop for therapies. So if you have experienced a family trauma or addiction piece, you would come to Relate and we hopefully could see the kids and you at the same time, or we could have staggered sessions so you wouldn’t have to be in therapy all week long. You can have a certain time when you’re there and hopefully get the work that you need, and hopefully we can help find the best people for what you’re looking for.rnrnWe’re going to get started talking about family systems work. Family systems work is something that started in the ‘50s because, at that point, there was a lot of pathology towards an individual person. They had decided that working with an individual was the way to make change and kind of motivated that person to go ahead and work, but what they found was as they moved that individual person back into their home or back into the relationships that they were in before, that person regressed. They recognize that family systems and relationships and connections really was the piece that created the long-term change for a lot of cases.rnrnThere are different paths, like schizophrenia and that sort of thing, that that’s not necessarily true, but when we’re really working with that family systems piece, we’re working on changing the relationship and the connections in order to create a new sense of homeostasis. Because homeostasis is that piece where you’re going back to that original point. You’re where you’re most comfortable where that family lies, and oftentimes, that carries a lot of trauma. And so they might recognize, “Where we’re at is not necessarily good, but it’s what we know. It’s where we’ve always been, and this is the way we function.”rnrnSo there becomes this piece where they’ve identified one certain patient in that family or one person that holds the trauma and carries it likely the most. They’re the ones that exhibit the symptoms, and so as they do that, the rest of the family pushes off the problem onto them and then identify them as the problem. There are a lot of times when that person does have a lot of great concerns, like addiction, and some of these pieces that all of you can work with outside of the family system individually. But as they start to heal, what we want to do is we want to take a look at the whole system and work on how to help them change as well so that the person who’s individually changing isn’t just changing to go back into the same system and then work back into their old patterns of behavior.rnrnA lot of times, the identified patient is the one who makes the waves in the family. They are often the black sheep. They’re emotionally unregulated. Everyone might be to some degree, but you feel this person’s emotions — their ups and downs make the entire family’s ups and downs, and they can sense that when that person isn’t around, there’s more comfort in the family because they’re used to staying in that homeostasis position. You often see that the dysfunction manifests itself through that individual, and the family doesn’t like it.rnrnSo, the rest of the family. Many times when people have identified the problem and then that person, for whatever reason, leaves the family system for a while, they calm down. They feel like, “Hey, even though this isn’t necessarily great — the way we’re behaving — it’s way better than it was when that IP was involved and was there.” So sometimes, it’s difficult to get the rest of the family on board. They might not want to work together and come together to change because, for them, they believe wholeheartedly that that IP is the problem, and if you could solve their problems, then they would be better. And they can cite the fact that when that person’s gone, things do often seem a little bit better.rnrnSo we have to find a way to engage them and help them feel like they’re part of your work by saying, “How can we learn about you? How can we just learn about your family? It will help that identified patient if we learn about you.” The first way to do that is to talk about some of the roles in the family. So, there are often a lot of roles within a family system, and some people might play more than one role. We’re wanting to look at that from just that outsider perspective. Who’s the caregiver? Who’s the clown? Who becomes the savior when you’re in different situations?rnrnWho’s that intellectual mind, the one that can create a space between their emotions and what they’re thinking? They can give you, “These are the things that are going on, this is what I’m seeing,” and they really don’t necessarily relate them back to emotions the way that maybe the clown or the black sheep would. Being able to talk to the family about the roles is kind of the first step in just addressing what’s going on within the family system and understanding roles for yourself. So you can see as they’re coming up that, “Oh yeah. This person is playing the role of the caregiver — they’re the most parentified,” or, “This person has been the black sheep, and that’s how they become the identified patient.” Being able to work with that is a really nice start in family systems because you can get a sense of where they are, and then you can start to formulate your plan around that.rnrnSpecifically within families that have addiction, there are roles that have been identified that are really good to go over. Many people that have studied addiction have already kind of talked through the roles, like the family hero and the rescuer and the mascot, but I wanted to go through some of these roles that maybe are just a little more specific that you hadn’t heard of or maybe thought about for a while. One of them is the adjuster; this is the person who never seems like they’re bothered by what’s happening. They know things are wrong and they find ways to cope, but they just go from one chaotic piece to the next and they find a way to just fulfill what’s needed in the moment. They don’t really have that strong sense of identity. They’re just somebody who will help in the moment and then say, “Well, that’s over. We’re moving on to the next thing,” and they just learn to adjust. They don’t become too attached to things because they know things are chaotic and they’re going to keep changing.rnrnThe next one is the doormat, and this is a pretty obvious one. It’s typically someone who’s been abused or has experienced some high stress and trauma, and they’ve just learned to survive by just letting people do what they want. They sense that if they end up confronting them, it could become very dangerous. So they’ve decided they would just go through the pain and let others walk on all over them in order to avoid the potential of having something dangerous happening to them. They recognize that someone has injured them, but they don’t really relate to the feelings of it. They don’t say that it’s painful or shameful or they’ve hurt them or there’s a lot of guilt there — there isn’t really that connection to the feelings. They just recognize that there’s been a negative behavior and that they don’t want to confront it.rnrnThe rebel: This person is someone who has that up-and-down sense. If there’s an action, they have a reaction, and it’s often shifting the pendulum, right? They go from calm and fine and something happens within the system and they have a very strong reaction to it. This is the person who is very visible to the outside and can be part of the IP, depending on the family system, because they’re the one who makes a lot of noise. Sometimes other people, like in schools or like family members like grandparents and that sorta thing, might recognize the child who’s the rebel because the school might sense they’re doing really well and then all of a sudden they’re doing so poorly in class. They might then try to talk to the parents, or things might come out about this family because the rebel has been acting out and they’ve had these mood swings or had some big actions that have happened that other people have taken notice of.rnrnThe scapegoat: This child takes the blame and shame of the other members. This is kind of an obvious one too. The members of the family recognize that something’s wrong, but they often decide that it’s because of that specific person. That person is dysfunctional, and as long as their dysfunction is highlighted, that means the rest of us are okay. So, we’re okay as long as that person can get help and get out of there. It’s very similar to the black sheep in a lot of ways because everyone else is okay if that person is okay. But when they’re not okay, everyone else feels like, “Gosh, that person is not okay again, so it’s making us have to wonder, worry, think about things again. But if they were okay, we’d be fine.”rnrnThe bully: This is often someone who’s been the victim of the most abuse, the most trauma. In terms of the parents, maybe they’ve decided that they focus the physical, sexual or emotional abuse on this person, and then they find ways to create an outlet for themselves by becoming a bully for others. They often really regret that because they know the shame and the pain of being the bully, but they continue to abuse others because it’s easier than facing the trauma that’s come to them. So this could be someone over their lifetime who ends up being the bully because they haven’t received that acknowledgment and been able to be vulnerable to their own pain.rnrnThe lost child: This is often the youngest child or someone that maybe has the personality where they just want to stay out of the way. They expect nothing, they want nothing, they sneak quietly out of the picture. They often end up at friend’s house all the time, they don’t want to come in and do family work, they just would rather ignore things, they don’t want to talk. Oftentimes when you’re doing family work, they will not talk. They will pretty much refuse to talk, and you sit there and wait and wait for them to talk and they just do it. So the lost child will just be the least threatening and stand back.rnrnThe last hope is the caretaker for the family, and they want to make sure that things are right; they want to make sure that family feels right. Whatever’s happening in there, they will feel like it’s going right. “I want to do best for my family, I know they’re all struggling, I know this is hard for them, but I want to do what’s right.” So they often are good students. They often find jobs. They often take on a lot of burdens in the household because they want to make sure that they are doing their part, but they can create that imbalance where they really do too much, and they do so much to help the family because they feel like that is their role. That’s the way that they were going to have success within that system.rnrnSo now that we’ve kind of gone over some of these roles within addicted families, I want to talk about ways to engage the family, because this really is at the heart of the work, right?rnrnWe so often can recognize the roles and kind of see what’s going on in the system. We’ve talked to maybe the IP, and maybe we’ve gotten a sense through assessments of what we see that’s going on, but we have to find a way to motivate that family for change. And one of the big pieces is that there’s often so much resistance to that.rnrnI wanted to use this platform as a way to talk about some more creative ways to get that work started, so people feel like they’re connecting to something new and something different. An Enneagram is a great way to get started in that. This is something that’s coming up more and more. You’ve heard of many personality tests, but the Enneagram is nice because it really works around a framework to talk about personality in segments. There’s nine segments, and each one of those segments has a different type. There’s the helper, the achiever, the individualist, the investigator, the loyalist, challenger. So there are nine of them, and everyone, when they take this test, will be assigned numbers. They’ll have like their strongest personality type and then they’ll have a couple of sub-personality types.rnrnWithin that, there’s kind of some similarities between these other pieces that we were talking about — specifically, around the rules within the family. So you’re able to address the challenger in a way that’s around the Enneagram and not so much about being in an alcoholic or addicted household. You can say, “Based on the test that you took and that Enneagram, your personality is going to say that these are some of the things fears that you have. So you’re a number three; you tend to fear failure.” Being able to say that is a nice, indirect way to say to that achiever number three style, “You really do feel fear of failure. Since you fear failure, this is hard for you. Doing the work in this system probably feels like you could fail. This person has relapsed before. There have been feelings before where you failed, and working on your family now feels like something you don’t want to do because you really do fear that failure, once again, coming up.”rnrnThat’s a great way to align the current concerns that you’re seeing in the therapeutic setting with this personality test — by externalizing the problem and putting it in the Enneagram and saying, “This is what this test is about your personality.” You’re not pinning yourself into a place where you say, “I can tell you’re the striver,” or, “You’re a high achiever in this family and you’ve recognized this failure before.” Somebody might create a defensive stance from that, but if you talk about it in terms of their Enneagram, they might be more open to sharing some of that.rnrnIn addition to the fears that come up, you can also sense people’s values. The fears and the values are two big parts of this Enneagram test, and being able to recognize what somebody values is also a nice way to segue in family therapy. So if somebody is a type six, they really value predictability. So that loyalist comes up as someone who is committed and then they want security, so they want things to remain predictable. Just as number three, fears failure and doesn’t want things to not succeed and is very shy and standoffish about doing the therapeutic work. Number six might feel that too because they sense so much up and down in the work, and that there’s a lot of regressive behaviors when you address them head on, and that makes their feelings more unpredictable. So being able to say, “As a six, you really value predictability. Maybe we can set up some things to make this more predictable to you, and I can help you and kind of talk through what we’re going to go through in a session and that sort of thing.” That might help them sense that, “Yeah, she’s working on what my personality says as opposed to judging me or coming from a negative place.”rnrnAnother great tool to use creatively is the brain dump. There are lots of different brain dumps that can come up. Brain dump is an exercise where someone just writes out all sorts of different things on the paper that just come to their heads. So there, they can often be set up in like four sections on a paper, or maybe it’s like past, present, future, would, should, what you need, what you want, what you’re hoping for. They can even be as simple as, “What are your worries for today? What are you going to address or work on today?” Basically, finding a way to organize the thoughts within the mind through a piece of paper and just some simple scribbling of thoughts.rnrnThis is nice because that current worry can come up for you, and maybe if you have the entire family do a brain dump exercise, you’ll see some parallels that are coming up. And it’s something that they’re just quickly writing out and not really putting a lot of thought into, and they’re just getting themselves out on that paper. So you don’t really have to have them talking and processing; it’s just a chance to just write what they feel. Come at it from that perspective of, “Let’s just go through what you’re thinking right now,” and you can then see what matches up and what’s different on these different brain dumps and process from there. And that’s a nice black-and-white way to organize, “These are the thoughts of dad, these are the thoughts of child or spouse,” and comparing and contrasting them as a way to just creatively say, “These are the thoughts that are coming up for you in some of the first things that you’re thinking of.”rnrnThe biggest things that you want to work on with creative interventions is you want to present some problem-solving exercises. A lot of times when we have addicted families, problem-solving is not necessarily a strength. Looking at how the family works together without intervening can be a challenge as a therapist, but you can learn a lot. Give them an exercise, give them a game, give them something where you just sit and watch them. I’ve had families that I’ve done this with, with a variety of tools I’ve used — taking playing cards and having them build a house of cards. I’ve just given them the cards, and I’ve said, “I really want you guys to work together to build a house of cards,” and I’ll make it just that non-directive to start with. Like, just build one. And then, as they work, some families will set up expectations like, “It needs to be three cards high to be a house,” or some families will just work to make a box and then they’ll just quit and say they’re done. Using that intervention, you can kind of go from there.rnrnYou can make it more challenging or you can just continue to watch if they really are struggling to kind of talk through, “What’s going on here, why isn’t this working? How can we create a better structure, some parameters around this?” But sometimes within it, I might just switch it up and say, “Okay, now I want only the child to touch the cards,” because maybe the parent is doing too much of the work themselves, and that I want to see how the parent will give directions to the child doing the exercise. Or I might say, “Okay, so now you’ve built one that’s really nice and there’s maybe four cards stacked. Now, I want you to make one where you only have the faces facing out.” So only if you have like the spades or the diamonds, so every side has to face out. So just some kind of silly directive really, but seeing how they follow it and how they piece it together is a nice way to see how they problem-solve in the system, and it’s a very indirect way to see how they work together.rnrnThe other piece that can be important is just sitting in the room and sitting in silence, letting them kind of lead, see who speaks and see who talks for whom, being able to be within that system and sort of sitting there and letting them own this space. You’re kind of outside of it a little bit more — that can help you watch and see how they problem-solve within something that’s kind of uncomfortable just naturally. Another piece that’s kind of fun to do is family representations. How do they see each other? I really like to use the styles of communication presented by Satir for this. They are placating, blaming, computing, distracting and congruent communication. So, looking at the way that this family sees each other communicating.rnrnYou would ask them, “What are some things you really value about your dad,” or, “What are some things that you would like me to know about your relationship with your mom? What are some of their strengths? What are some of the stories that you share from your past that are stories that you felt afraid, stories where you felt happy or proud?” Having these family members represent their experience of each other to you can help you get a really good backbone on how they communicate, how they connect, how they repair their relationship and where they go for help within the system. That’s a nice way to say, “I’m watching you and I’m learning about you and I’m gaining the tools that I need in order to help you as we move forward.” There are things that they value about each other. There are things that they might like about each other, and if they can’t name those, there might be some sort of piece that is working towards self-sabotage.rnrnSelf-sabotage is just a huge piece of working with highly traumatized families, particularly ones that have had addiction in their household. Self-sabotage is something that we as therapists often run into, and when we do, we aren’t always sure what to do with it. We don’t know if it’s time then to stop therapy or if it’s a way that we need to seek outside consultation on it, or maybe I feel like we’re not the best fit for that family, and I really want to challenge you to look at self-sabotage and figure out where this family’s at and what their block is to achieving that success. Once the family has some tools and there’s not really any logical or rational explanation for why they’re not reaching their goals, there is some sort of sabotage in play. So being able to address that means looking at all the members of the family and why they’re not meeting the expectations that have been set, and it may or may not have even been by you. It may have been set by them in the recovery process, or even within their own home. Maybe they’ve already had times where they’ve set up strong boundaries and they didn’t follow through with them.rnrnSome of the ways that self-sabotage comes up, or self-defeating behaviors, are that they look for immediate results. And when I say immediate, I mean they’re coming into the first session naming, “You know what? We’re not going to be here for long. We’re not going to be able to stay in therapy for long,” or, “I’m not going to be able to pay for this,” or, “I can’t take off work, so I’m thinking I’m only going to be able to come here for two or three times.” When they’re already coming in with that sense that we need to get this over with, they’re setting themselves up for failure. Another way is the classic way, and the reason that we’re doing this presentation in the first place is because they’ll often name that identified person and they will just sit there and tell you reason after reason after reason why that person is the problem and how I’m not getting it — I don’t understand, I’m not seeing that person for who they are, they’re manipulating me — and they won’t consider their own role in the system.rnrnThe second you go towards talking to them about their place or that they have something to do with it, they immediately shut you down and talk about that IP. Really, they feel like that person has pulled the wool over your eyes and that you are being manipulated by them like so many before have. Because, especially in addiction, they often are manipulating the system, right? They are wanting to make sure they can feed their addiction, and so they have manipulated the system. So that person is coming in with something that is a genuine fear of theirs — that you also, as the therapist, are being manipulated by somebody who has done so much in their lives to manipulate others. But to some degree, we have to work in that idea of trust and that, “I understand, and we’re going to have ways to hold that IP accountable,” or, “They’re working their program where they’re doing these things. I’m looking at this other piece as well.” So you have to name for them that yes, there is an accountability here for that person and we want to get there, but you are also part of this, and I want to make sure that your life feels better or that things that are coming up for you are addressed.rnrnAnother way that self-sabotage comes up is that they avoid those underlying issues just to push that first order change. So they might come in and say things like, “My child’s now going to bed on time, so this is better. I really don’t think we need to be here anymore. My kid’s doing well in school now, so the issue is gone.” They find something in a behavior that’s shifted as you’ve done some work, and they immediately then want to cut off the therapy because to them, it’s like, “Well, it’s easier. Now the kids go into bed, they’re doing better in school. We don’t really need to address any of these really hurt feelings or get really vulnerable because things are good enough, like maybe they’ll never be perfect, why do you keep pushing that things need to change?” That’s a way for them to avoid that underlying issue they pushed the therapist to triangulate in others. And this doesn’t just have to be the IP. We often are very savvy about recognizing when they’re pushing in the IP’s agenda, but sometimes we miss that piece where they’re pulling in other members like step-parents or grandparents, or even other children.rnrnWhen you sense that they’re talking more about someone else outside of the system, or potentially even in the system that you’re not naming, they’re triangulating them in. You need to redirect them and get them into a place where they’re addressing the relationship, whatever that is, as you, them and the person that you’re talking about. Not somebody who says that, “Oh, my mom always tells me how Johnny, blah, blah, blah,” or, “You really should talk to my mom about this because she watches him and she tells me the same thing. And these are some of the things that are coming up for her, and she wants me to do this and that.” Well, that’s great, and I’m willing to address some of those things maybe with your mom, if that’s necessary, but right now I’m talking with you and how you feel about it or what do you do with him.rnrnThey guard family secrets in the name of lack of rapport and supports. Okay, this is a really tough one. They’ll come in and they’ll say, “You don’t know the half of it,” or, “There are things you don’t understand,” or, “There are things that I can’t tell you yet,” or, “I don’t really want to tell you because I don’t know you well enough.” And this is something where if that comes up for them and it’s consistent, you have to put into play some sort of boundary around you. Either need to share this with an individual therapist, and there has to be some sort of form of communication where, “I can talk with them if it’s too difficult for you,” or we need to figure out a way to work around this piece and work on the other traumas that are coming up. Because stopping in the name of a family secret is part of the reason we’re here in the first place, right?rnrnThere are things that are being guarded. There are ways that this family has been keeping up this homeostasis, and family secrets is often one of them. There is a person within the system sometimes that can get highly emotional. They will get so emotional in a session, they will be angry and screaming, they will be crying the whole time, they really can’t regulate themselves emotionally in your family sessions and you often have to kind of spend that time really focused on them. That person may need their own individual therapy and their own work. The other way that you can kind of work through it is maybe you can kind of start with them and say, “I recognize how emotional this is, and I know that this is difficult for you.” Maybe they can have a notepad and they can just write things down and do some of their part that way, because we don’t want to avoid people because they become stoic and they don’t engage and they disengage when you’re talking or because they’re so highly emotional that the rest of the system kind of becomes standoffish and doesn’t know what to do.rnrnLike a child who might say, “I don’t want to talk about this because it’s going to make my mom cry.” We have to hold that space for the child and say, “If your mom cries, I’m going to help take care of her in this session. I’m going to work with her and we’re going to figure that out, but you have to be able to talk about your feelings too.” And that child needs to be able to self-advocate their needs while this parent is having that emotional reaction and reactivity. So we’re holding space for both people and we’re showing them that we’re emotionally ready to be neutral to whichever way it’s going and allowing for everybody to have the floor and have the room and space to feel like they can connect and talk, as opposed to self-sabotaging the situation and saying, “Every time we come in here, mom cries and cries. Maybe this isn’t good for her anymore.”rnrnOne of the largest ways I’ve recognized self-sabotage within a family is confusion. People will start to express confusion when they’ve been in therapy with you and they start to sense things are going okay. They will do it through things like, “I don’t get it. I don’t get their point of view. We’re never going to understand them. I’m never going to understand what they’re saying. I’m just so confused about what we’re doing here. I don’t even know why we come here. I have to come here because my son wants me to, I don’t understand. We’re not getting anywhere. We are not on the same page. I want something, he wants something, you don’t understand as the therapist — either one of us or our point of views. You weren’t there. You weren’t part of this until a couple months ago. How do you think you can understand us? We are not on the same page. I am completely lost to what we’re doing here.”rnrnI’ve heard this many times when someone is getting to that place where they have to do some work. Where they’re not holding down their end of the boundaries or we’ve set up rules — we’ve set up ways that they can hold to them. “You cannot give the addict money.” Both parents: “Great. We’re not going to give him any more money.” The mom comes back and she says, “Oh, I gave him a hundred bucks. He really needed to cover his rent.” The dad gets upset about that, and mom comes back and says, “Well, I’m confused. I didn’t know we couldn’t pay for his rent. I thought I couldn’t give him just money to pay for alcohol or that sort of thing.” And then everyone’s like, “Well, no, we really agreed that we were not going to give him any money,” and so this parent then is suddenly very confused about what the rule was. “I can’t change unless you can tell me why.” So that comes up for people because they sense they can’t trust you. So there’s this communication of like, “Unless you can tell me why it’s important to do this,” or, “What are your qualifications to give me these rules or to tell me to do this? Do you have kids?”rnrnThey come up with a lot of excuses as to why you can’t help them change because you can’t tell them exactly why or what to do with it in a way that they trust, or that they believe that, yes, this is the right thing to do. And that can become very frustrating from a therapist’s point of view, because you might be working with the whole family and you’ve really built rapport with all of them, and there might be this one person who just keeps questioning it and who just keeps feeling like maybe they’re the one who’s the holdup. Maybe they’re the one sabotaging the system and you can’t get them to move, and the rest of the family just feels defeated because that person will not hold up their end of the bargain. Those connections and having the expectations just are explained away with their confusion.rnrnWe can work on this by using connection. It can be so tough to stay present and to have that family sit in that pain. Oftentimes, people within the system just don’t want to do that. They’d rather disengage. They’d rather not be able to share their whole experience of it because it is really painful, and being vulnerable can be scary. They have these injuries that have been built up over years and years of behavior, and so not being able to name them is just part of the defense that has come up. The way that they cope is that, “I’m not going to be part of this, I’m not going to work on this,” but finding ways for those clients and that family to stay present in that pain is going to be a huge part of your work in reconnecting this family system. And one of the most basic ways is to allow the space for the shared events that have gone on and for everyone’s perspective of those events and getting to that place where there’s the communication around what we’re going to change in the future so those hurt feelings and that pain doesn’t come up. What are you willing to do? That’s a tough question. That’s one of those questions that you’ve had to build strong rapport, you have to have a deep connection with that family system, and you’ve had to sit with them and slow down a little bit.rnrnSome of the big blocks to this connection are the fears of the unknown. We often fear the unknown in everyday situations, and people recognize that there is relapse. We could be setting ourselves up for failure and being played the fool again. People don’t want to feel like they’ve done all this hard work and their family member hasn’t, and we need to acknowledge that for people — “You’ve put in so much effort, you’ve put in so much money, you’ve put in so much time and you don’t want to feel like this fails again.” Being able to do that and acknowledge that for somebody can be a really big floodgate opener, because seeing them for what they’ve put into this whole situation, it might just feel like a relief. Someone’s validating their position. Someone’s validating the fact that they’ve worked so hard to help somebody who really has to help themselves. That’s built up in resentment of the past. That past is just such a big piece and it’s a huge block. Your identified patient has got to work through acknowledging they’re hard and making amends is a big piece, whether or not you use a 12-step program.rnrnMaking amends within the system comes in three different ways. The first way is direct: They need to understand and repair. They need to put themselves in a position where they take responsibility for their previous actions. That is a huge way to heal and move forward. The next way is indirect amends. It’s that you recognize that you’ve done some irreversible damage here. You’re not going to get back those years of your child’s childhood. You’re not going to be able to replace the car that you wrecked of your parents. You might not be able to do some of these things that your family had done before, and saying, “I know you can’t get that back and I’m really sorry about that,” is a great way for them to acknowledge the past. And the third way to make amends is just by living, and living their best life now and choosing the positive pieces. That will help this system heal, saying, “I know I didn’t do that well before, but I’m doing better now,” and actually showing the family how they are doing better now is a good way to help erase some of the wounds that can come up in that period piece, where they’re building pain and pain and pain on top of each other.rnrnThe last piece is recognizing that they’ve always had problems and this is just making them feel worse. “Fixing this doesn’t make our family better.” They have assimilated to their problems, and we’ve talked about it before. Their sense of homeostasis is there. When someone’s assimilated and said, “You know what? We don’t need to really work on this. You are bringing up our pain. You’re making us come in here and talk about stuff we don’t want to, you’re not fixing us. You’re making us worse. We go home and we feel bad. We don’t like being here.” There is so much of that that can come up with that, and part of that is trusting that therapeutic relationship and building on it and saying, “I know that this is really hard work. This hour that you’re in here is like exercise for your head and your heart. We are exercising these emotions and these muscles, and you’re lifting a lot of weight. It is one hour. And I believe that if we do this consistently, this is going to get easier, but I know right now it is really hard for you and I can see that.”rnrnSo that’s a big piece: empowering them. All members of the system have a part, and saying, “Your part’s important. You have strengths in the system. You also have some weaknesses, but your strengths really outweigh those as we work forward and move into a place where you have some things that you’re giving this IP and that you’re giving each other that are so important.” And being able to look at a family and hear them laugh together when they haven’t done it for a long time — that is just one of my favorite parts of family therapy. When we’ve gotten to a place where some of that hurt has moved out just enough where they can connect again, and they can sense their family system for what it is. There are things that come up that are kind of funny, and they have their inside jokes and the way that they look at things. And when they’re willing to laugh together, you can feel some of the strength of that system coming through, and that’s a very powerful moment for all of us.rnrnWhen you start the work with the family, we have to look at what their first goal is and what our first goal is. Being able to meet some of their needs while you’re meeting some of the system’s needs from the therapeutic standpoint can really work with best results, and for that partnering piece. If you go back and do some of that work that we talked about earlier — where you’re using those creative interventions, you’re seeing what all the family members really want, what they’re hoping for, what they’re working towards, what they’re wanting to get out of therapy — if you can make sure that you’re tandemly addressing it with some of the pieces that you think are most important to start with, your partnership will be stronger because they’ll sense that they’re getting what they came to therapy for. They might really want to be able to use some things that are coping skills for them and that sort of thing, and you might really be wanting to focus on something that maybe they aren’t seeing as important, but partnering by making both things part of your initial treatment plan will help keep them on board and help those family members sensing that their input is really important. Of course, we have to address unsafe behaviors first, and I think that most people recognize and understand that, but from there, working on that partnership is really important.rnrnThe way we do that is finding that balance between you as an expert and you as a partner. Having clear goals that have a real check-in date that are often strengths-based. We don’t have to have every goal of these strengths-based, but making sure that we have some that are. We know that evidence-based treatment relies on strengths-based goals, and that can help people sense that they are moving in a more positive direction. So really, having clear goals with a measurable piece and an end date can help those clients recognize that we’re working towards something. Have knowledge that helping the goals might be part of the plan, but they might not always understand the entire way to get there. They have to build trust with you, and that takes time, especially in highly wounded relationships and systems.rnrnSlowing down and recognizing that there’s a healing process to growing that relationship can be very important through the therapeutic work. You might not reach the same goals as quickly as you want to. You might have to spend more time in that rebuilding and repair piece for you because you’re mirroring this system. You’re helping them progress into a place where they can trust, and that might be on their time — not yours. The last part is just being consistent with checking in on those goals, staying black and white and using those goals as the pillar and helping them see we are working on the things that you find important and that I think are going to help heal you to get you to where you need to be. Staying on track with that, not allowing them to sabotage, for them getting off and talking about and triangulating someone else, not putting in additional plans and additional work before we’d solve some of these pieces that we’ve come up with initially. These are all ways that they might get out of the hard work that you guys have set in place through these goals. Goals are a key piece to this, and recognizing what they are is a nice way to hold people accountable and to show your accountability to your work.rnrnSo finally, if you have any additional questions or things that come up around this presentation, feel free to reach out to me to chat a little bit more. This is my email address, the phone number and the website for Relate. Thanks for coming to this presentation. I really appreciate your time, and I hope you learned something.rnrnThank you for watching this video. We hope you enjoyed the presentation.

PowerPoint Presentation:

Creative Ways to Help a Family Heal Through Recovery(PDF)

Articles:

Resources for Friends and Family with an Addicted Loved One

Support Groups for Families

Family Therapy

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Healing Families from Addiction

Transcript:

During today’s presentation, we’re going to go over a little bit about who Relate is and what’s different about our private practice as opposed to other ones, and kind of talking through the different roles in a family and ways to engage the family system. Because when we know there’s an identified patient (IP), a lot of times, people want to just work on the IP. I want to help transition and work on the entire family system to help the IP as we move through.

Relate is a very client-centered practice. We have several offices designed for the client instead of for the therapist. So if you come in to Relate, you don’t come into a therapist office — you come into your space. So we have a young child playroom. We have an older teen/tween space. We have several offices that are just for individual and couples therapy, and we hope to keep those offices very comfortable and inviting because we want people who are experiencing high trauma to feel safe and less stressed.

There’s also already so many reasons that they have to be overwhelmed that being able to come into a clean space that’s really dedicated to them, I thought, was just a nice way for them to feel more centered and grounded. Relate has three waiting spaces for families that maybe are experiencing divorce, or the parents are in some sort of high conflict. So when the kids come in, they don’t feel like their parents have to sit together, or one of them can’t be present and has to go to the car or can’t come to the therapy sessions at all.

All of our therapists specialize in different areas. So we have some people that will work in DBT, CBT, parent-child interaction training, play therapy specific for young children or older children, family dynamics work. We have a lot of different specialties in order to help an entire family come together, and we want to be a one-stop-shop for therapies. So if you have experienced a family trauma or addiction piece, you would come to Relate and we hopefully could see the kids and you at the same time, or we could have staggered sessions so you wouldn’t have to be in therapy all week long. You can have a certain time when you’re there and hopefully get the work that you need, and hopefully we can help find the best people for what you’re looking for.

We’re going to get started talking about family systems work. Family systems work is something that started in the ‘50s because, at that point, there was a lot of pathology towards an individual person. They had decided that working with an individual was the way to make change and kind of motivated that person to go ahead and work, but what they found was as they moved that individual person back into their home or back into the relationships that they were in before, that person regressed. They recognize that family systems and relationships and connections really was the piece that created the long-term change for a lot of cases.

There are different paths, like schizophrenia and that sort of thing, that that’s not necessarily true, but when we’re really working with that family systems piece, we’re working on changing the relationship and the connections in order to create a new sense of homeostasis. Because homeostasis is that piece where you’re going back to that original point. You’re where you’re most comfortable where that family lies, and oftentimes, that carries a lot of trauma. And so they might recognize, “Where we’re at is not necessarily good, but it’s what we know. It’s where we’ve always been, and this is the way we function.”

So there becomes this piece where they’ve identified one certain patient in that family or one person that holds the trauma and carries it likely the most. They’re the ones that exhibit the symptoms, and so as they do that, the rest of the family pushes off the problem onto them and then identify them as the problem. There are a lot of times when that person does have a lot of great concerns, like addiction, and some of these pieces that all of you can work with outside of the family system individually. But as they start to heal, what we want to do is we want to take a look at the whole system and work on how to help them change as well so that the person who’s individually changing isn’t just changing to go back into the same system and then work back into their old patterns of behavior.

A lot of times, the identified patient is the one who makes the waves in the family. They are often the black sheep. They’re emotionally unregulated. Everyone might be to some degree, but you feel this person’s emotions — their ups and downs make the entire family’s ups and downs, and they can sense that when that person isn’t around, there’s more comfort in the family because they’re used to staying in that homeostasis position. You often see that the dysfunction manifests itself through that individual, and the family doesn’t like it.

So, the rest of the family. Many times when people have identified the problem and then that person, for whatever reason, leaves the family system for a while, they calm down. They feel like, “Hey, even though this isn’t necessarily great — the way we’re behaving — it’s way better than it was when that IP was involved and was there.” So sometimes, it’s difficult to get the rest of the family on board. They might not want to work together and come together to change because, for them, they believe wholeheartedly that that IP is the problem, and if you could solve their problems, then they would be better. And they can cite the fact that when that person’s gone, things do often seem a little bit better.

So we have to find a way to engage them and help them feel like they’re part of your work by saying, “How can we learn about you? How can we just learn about your family? It will help that identified patient if we learn about you.” The first way to do that is to talk about some of the roles in the family. So, there are often a lot of roles within a family system, and some people might play more than one role. We’re wanting to look at that from just that outsider perspective. Who’s the caregiver? Who’s the clown? Who becomes the savior when you’re in different situations?

Who’s that intellectual mind, the one that can create a space between their emotions and what they’re thinking? They can give you, “These are the things that are going on, this is what I’m seeing,” and they really don’t necessarily relate them back to emotions the way that maybe the clown or the black sheep would. Being able to talk to the family about the roles is kind of the first step in just addressing what’s going on within the family system and understanding roles for yourself. So you can see as they’re coming up that, “Oh yeah. This person is playing the role of the caregiver — they’re the most parentified,” or, “This person has been the black sheep, and that’s how they become the identified patient.” Being able to work with that is a really nice start in family systems because you can get a sense of where they are, and then you can start to formulate your plan around that.

Specifically within families that have addiction, there are roles that have been identified that are really good to go over. Many people that have studied addiction have already kind of talked through the roles, like the family hero and the rescuer and the mascot, but I wanted to go through some of these roles that maybe are just a little more specific that you hadn’t heard of or maybe thought about for a while. One of them is the adjuster; this is the person who never seems like they’re bothered by what’s happening. They know things are wrong and they find ways to cope, but they just go from one chaotic piece to the next and they find a way to just fulfill what’s needed in the moment. They don’t really have that strong sense of identity. They’re just somebody who will help in the moment and then say, “Well, that’s over. We’re moving on to the next thing,” and they just learn to adjust. They don’t become too attached to things because they know things are chaotic and they’re going to keep changing.

The next one is the doormat, and this is a pretty obvious one. It’s typically someone who’s been abused or has experienced some high stress and trauma, and they’ve just learned to survive by just letting people do what they want. They sense that if they end up confronting them, it could become very dangerous. So they’ve decided they would just go through the pain and let others walk on all over them in order to avoid the potential of having something dangerous happening to them. They recognize that someone has injured them, but they don’t really relate to the feelings of it. They don’t say that it’s painful or shameful or they’ve hurt them or there’s a lot of guilt there — there isn’t really that connection to the feelings. They just recognize that there’s been a negative behavior and that they don’t want to confront it.

The rebel: This person is someone who has that up-and-down sense. If there’s an action, they have a reaction, and it’s often shifting the pendulum, right? They go from calm and fine and something happens within the system and they have a very strong reaction to it. This is the person who is very visible to the outside and can be part of the IP, depending on the family system, because they’re the one who makes a lot of noise. Sometimes other people, like in schools or like family members like grandparents and that sorta thing, might recognize the child who’s the rebel because the school might sense they’re doing really well and then all of a sudden they’re doing so poorly in class. They might then try to talk to the parents, or things might come out about this family because the rebel has been acting out and they’ve had these mood swings or had some big actions that have happened that other people have taken notice of.

The scapegoat: This child takes the blame and shame of the other members. This is kind of an obvious one too. The members of the family recognize that something’s wrong, but they often decide that it’s because of that specific person. That person is dysfunctional, and as long as their dysfunction is highlighted, that means the rest of us are okay. So, we’re okay as long as that person can get help and get out of there. It’s very similar to the black sheep in a lot of ways because everyone else is okay if that person is okay. But when they’re not okay, everyone else feels like, “Gosh, that person is not okay again, so it’s making us have to wonder, worry, think about things again. But if they were okay, we’d be fine.”

The bully: This is often someone who’s been the victim of the most abuse, the most trauma. In terms of the parents, maybe they’ve decided that they focus the physical, sexual or emotional abuse on this person, and then they find ways to create an outlet for themselves by becoming a bully for others. They often really regret that because they know the shame and the pain of being the bully, but they continue to abuse others because it’s easier than facing the trauma that’s come to them. So this could be someone over their lifetime who ends up being the bully because they haven’t received that acknowledgment and been able to be vulnerable to their own pain.

The lost child: This is often the youngest child or someone that maybe has the personality where they just want to stay out of the way. They expect nothing, they want nothing, they sneak quietly out of the picture. They often end up at friend’s house all the time, they don’t want to come in and do family work, they just would rather ignore things, they don’t want to talk. Oftentimes when you’re doing family work, they will not talk. They will pretty much refuse to talk, and you sit there and wait and wait for them to talk and they just do it. So the lost child will just be the least threatening and stand back.

The last hope is the caretaker for the family, and they want to make sure that things are right; they want to make sure that family feels right. Whatever’s happening in there, they will feel like it’s going right. “I want to do best for my family, I know they’re all struggling, I know this is hard for them, but I want to do what’s right.” So they often are good students. They often find jobs. They often take on a lot of burdens in the household because they want to make sure that they are doing their part, but they can create that imbalance where they really do too much, and they do so much to help the family because they feel like that is their role. That’s the way that they were going to have success within that system.

So now that we’ve kind of gone over some of these roles within addicted families, I want to talk about ways to engage the family, because this really is at the heart of the work, right?

We so often can recognize the roles and kind of see what’s going on in the system. We’ve talked to maybe the IP, and maybe we’ve gotten a sense through assessments of what we see that’s going on, but we have to find a way to motivate that family for change. And one of the big pieces is that there’s often so much resistance to that.

I wanted to use this platform as a way to talk about some more creative ways to get that work started, so people feel like they’re connecting to something new and something different. An Enneagram is a great way to get started in that. This is something that’s coming up more and more. You’ve heard of many personality tests, but the Enneagram is nice because it really works around a framework to talk about personality in segments. There’s nine segments, and each one of those segments has a different type. There’s the helper, the achiever, the individualist, the investigator, the loyalist, challenger. So there are nine of them, and everyone, when they take this test, will be assigned numbers. They’ll have like their strongest personality type and then they’ll have a couple of sub-personality types.

Within that, there’s kind of some similarities between these other pieces that we were talking about — specifically, around the rules within the family. So you’re able to address the challenger in a way that’s around the Enneagram and not so much about being in an alcoholic or addicted household. You can say, “Based on the test that you took and that Enneagram, your personality is going to say that these are some of the things fears that you have. So you’re a number three; you tend to fear failure.” Being able to say that is a nice, indirect way to say to that achiever number three style, “You really do feel fear of failure. Since you fear failure, this is hard for you. Doing the work in this system probably feels like you could fail. This person has relapsed before. There have been feelings before where you failed, and working on your family now feels like something you don’t want to do because you really do fear that failure, once again, coming up.”

That’s a great way to align the current concerns that you’re seeing in the therapeutic setting with this personality test — by externalizing the problem and putting it in the Enneagram and saying, “This is what this test is about your personality.” You’re not pinning yourself into a place where you say, “I can tell you’re the striver,” or, “You’re a high achiever in this family and you’ve recognized this failure before.” Somebody might create a defensive stance from that, but if you talk about it in terms of their Enneagram, they might be more open to sharing some of that.

In addition to the fears that come up, you can also sense people’s values. The fears and the values are two big parts of this Enneagram test, and being able to recognize what somebody values is also a nice way to segue in family therapy. So if somebody is a type six, they really value predictability. So that loyalist comes up as someone who is committed and then they want security, so they want things to remain predictable. Just as number three, fears failure and doesn’t want things to not succeed and is very shy and standoffish about doing the therapeutic work. Number six might feel that too because they sense so much up and down in the work, and that there’s a lot of regressive behaviors when you address them head on, and that makes their feelings more unpredictable. So being able to say, “As a six, you really value predictability. Maybe we can set up some things to make this more predictable to you, and I can help you and kind of talk through what we’re going to go through in a session and that sort of thing.” That might help them sense that, “Yeah, she’s working on what my personality says as opposed to judging me or coming from a negative place.”

Another great tool to use creatively is the brain dump. There are lots of different brain dumps that can come up. Brain dump is an exercise where someone just writes out all sorts of different things on the paper that just come to their heads. So there, they can often be set up in like four sections on a paper, or maybe it’s like past, present, future, would, should, what you need, what you want, what you’re hoping for. They can even be as simple as, “What are your worries for today? What are you going to address or work on today?” Basically, finding a way to organize the thoughts within the mind through a piece of paper and just some simple scribbling of thoughts.

This is nice because that current worry can come up for you, and maybe if you have the entire family do a brain dump exercise, you’ll see some parallels that are coming up. And it’s something that they’re just quickly writing out and not really putting a lot of thought into, and they’re just getting themselves out on that paper. So you don’t really have to have them talking and processing; it’s just a chance to just write what they feel. Come at it from that perspective of, “Let’s just go through what you’re thinking right now,” and you can then see what matches up and what’s different on these different brain dumps and process from there. And that’s a nice black-and-white way to organize, “These are the thoughts of dad, these are the thoughts of child or spouse,” and comparing and contrasting them as a way to just creatively say, “These are the thoughts that are coming up for you in some of the first things that you’re thinking of.”

The biggest things that you want to work on with creative interventions is you want to present some problem-solving exercises. A lot of times when we have addicted families, problem-solving is not necessarily a strength. Looking at how the family works together without intervening can be a challenge as a therapist, but you can learn a lot. Give them an exercise, give them a game, give them something where you just sit and watch them. I’ve had families that I’ve done this with, with a variety of tools I’ve used — taking playing cards and having them build a house of cards. I’ve just given them the cards, and I’ve said, “I really want you guys to work together to build a house of cards,” and I’ll make it just that non-directive to start with. Like, just build one. And then, as they work, some families will set up expectations like, “It needs to be three cards high to be a house,” or some families will just work to make a box and then they’ll just quit and say they’re done. Using that intervention, you can kind of go from there.

You can make it more challenging or you can just continue to watch if they really are struggling to kind of talk through, “What’s going on here, why isn’t this working? How can we create a better structure, some parameters around this?” But sometimes within it, I might just switch it up and say, “Okay, now I want only the child to touch the cards,” because maybe the parent is doing too much of the work themselves, and that I want to see how the parent will give directions to the child doing the exercise. Or I might say, “Okay, so now you’ve built one that’s really nice and there’s maybe four cards stacked. Now, I want you to make one where you only have the faces facing out.” So only if you have like the spades or the diamonds, so every side has to face out. So just some kind of silly directive really, but seeing how they follow it and how they piece it together is a nice way to see how they problem-solve in the system, and it’s a very indirect way to see how they work together.

The other piece that can be important is just sitting in the room and sitting in silence, letting them kind of lead, see who speaks and see who talks for whom, being able to be within that system and sort of sitting there and letting them own this space. You’re kind of outside of it a little bit more — that can help you watch and see how they problem-solve within something that’s kind of uncomfortable just naturally. Another piece that’s kind of fun to do is family representations. How do they see each other? I really like to use the styles of communication presented by Satir for this. They are placating, blaming, computing, distracting and congruent communication. So, looking at the way that this family sees each other communicating.

You would ask them, “What are some things you really value about your dad,” or, “What are some things that you would like me to know about your relationship with your mom? What are some of their strengths? What are some of the stories that you share from your past that are stories that you felt afraid, stories where you felt happy or proud?” Having these family members represent their experience of each other to you can help you get a really good backbone on how they communicate, how they connect, how they repair their relationship and where they go for help within the system. That’s a nice way to say, “I’m watching you and I’m learning about you and I’m gaining the tools that I need in order to help you as we move forward.” There are things that they value about each other. There are things that they might like about each other, and if they can’t name those, there might be some sort of piece that is working towards self-sabotage.

Self-sabotage is just a huge piece of working with highly traumatized families, particularly ones that have had addiction in their household. Self-sabotage is something that we as therapists often run into, and when we do, we aren’t always sure what to do with it. We don’t know if it’s time then to stop therapy or if it’s a way that we need to seek outside consultation on it, or maybe I feel like we’re not the best fit for that family, and I really want to challenge you to look at self-sabotage and figure out where this family’s at and what their block is to achieving that success. Once the family has some tools and there’s not really any logical or rational explanation for why they’re not reaching their goals, there is some sort of sabotage in play. So being able to address that means looking at all the members of the family and why they’re not meeting the expectations that have been set, and it may or may not have even been by you. It may have been set by them in the recovery process, or even within their own home. Maybe they’ve already had times where they’ve set up strong boundaries and they didn’t follow through with them.

Some of the ways that self-sabotage comes up, or self-defeating behaviors, are that they look for immediate results. And when I say immediate, I mean they’re coming into the first session naming, “You know what? We’re not going to be here for long. We’re not going to be able to stay in therapy for long,” or, “I’m not going to be able to pay for this,” or, “I can’t take off work, so I’m thinking I’m only going to be able to come here for two or three times.” When they’re already coming in with that sense that we need to get this over with, they’re setting themselves up for failure. Another way is the classic way, and the reason that we’re doing this presentation in the first place is because they’ll often name that identified person and they will just sit there and tell you reason after reason after reason why that person is the problem and how I’m not getting it — I don’t understand, I’m not seeing that person for who they are, they’re manipulating me — and they won’t consider their own role in the system.

The second you go towards talking to them about their place or that they have something to do with it, they immediately shut you down and talk about that IP. Really, they feel like that person has pulled the wool over your eyes and that you are being manipulated by them like so many before have. Because, especially in addiction, they often are manipulating the system, right? They are wanting to make sure they can feed their addiction, and so they have manipulated the system. So that person is coming in with something that is a genuine fear of theirs — that you also, as the therapist, are being manipulated by somebody who has done so much in their lives to manipulate others. But to some degree, we have to work in that idea of trust and that, “I understand, and we’re going to have ways to hold that IP accountable,” or, “They’re working their program where they’re doing these things. I’m looking at this other piece as well.” So you have to name for them that yes, there is an accountability here for that person and we want to get there, but you are also part of this, and I want to make sure that your life feels better or that things that are coming up for you are addressed.

Another way that self-sabotage comes up is that they avoid those underlying issues just to push that first order change. So they might come in and say things like, “My child’s now going to bed on time, so this is better. I really don’t think we need to be here anymore. My kid’s doing well in school now, so the issue is gone.” They find something in a behavior that’s shifted as you’ve done some work, and they immediately then want to cut off the therapy because to them, it’s like, “Well, it’s easier. Now the kids go into bed, they’re doing better in school. We don’t really need to address any of these really hurt feelings or get really vulnerable because things are good enough, like maybe they’ll never be perfect, why do you keep pushing that things need to change?” That’s a way for them to avoid that underlying issue they pushed the therapist to triangulate in others. And this doesn’t just have to be the IP. We often are very savvy about recognizing when they’re pushing in the IP’s agenda, but sometimes we miss that piece where they’re pulling in other members like step-parents or grandparents, or even other children.

When you sense that they’re talking more about someone else outside of the system, or potentially even in the system that you’re not naming, they’re triangulating them in. You need to redirect them and get them into a place where they’re addressing the relationship, whatever that is, as you, them and the person that you’re talking about. Not somebody who says that, “Oh, my mom always tells me how Johnny, blah, blah, blah,” or, “You really should talk to my mom about this because she watches him and she tells me the same thing. And these are some of the things that are coming up for her, and she wants me to do this and that.” Well, that’s great, and I’m willing to address some of those things maybe with your mom, if that’s necessary, but right now I’m talking with you and how you feel about it or what do you do with him.

They guard family secrets in the name of lack of rapport and supports. Okay, this is a really tough one. They’ll come in and they’ll say, “You don’t know the half of it,” or, “There are things you don’t understand,” or, “There are things that I can’t tell you yet,” or, “I don’t really want to tell you because I don’t know you well enough.” And this is something where if that comes up for them and it’s consistent, you have to put into play some sort of boundary around you. Either need to share this with an individual therapist, and there has to be some sort of form of communication where, “I can talk with them if it’s too difficult for you,” or we need to figure out a way to work around this piece and work on the other traumas that are coming up. Because stopping in the name of a family secret is part of the reason we’re here in the first place, right?

There are things that are being guarded. There are ways that this family has been keeping up this homeostasis, and family secrets is often one of them. There is a person within the system sometimes that can get highly emotional. They will get so emotional in a session, they will be angry and screaming, they will be crying the whole time, they really can’t regulate themselves emotionally in your family sessions and you often have to kind of spend that time really focused on them. That person may need their own individual therapy and their own work. The other way that you can kind of work through it is maybe you can kind of start with them and say, “I recognize how emotional this is, and I know that this is difficult for you.” Maybe they can have a notepad and they can just write things down and do some of their part that way, because we don’t want to avoid people because they become stoic and they don’t engage and they disengage when you’re talking or because they’re so highly emotional that the rest of the system kind of becomes standoffish and doesn’t know what to do.

Like a child who might say, “I don’t want to talk about this because it’s going to make my mom cry.” We have to hold that space for the child and say, “If your mom cries, I’m going to help take care of her in this session. I’m going to work with her and we’re going to figure that out, but you have to be able to talk about your feelings too.” And that child needs to be able to self-advocate their needs while this parent is having that emotional reaction and reactivity. So we’re holding space for both people and we’re showing them that we’re emotionally ready to be neutral to whichever way it’s going and allowing for everybody to have the floor and have the room and space to feel like they can connect and talk, as opposed to self-sabotaging the situation and saying, “Every time we come in here, mom cries and cries. Maybe this isn’t good for her anymore.”

One of the largest ways I’ve recognized self-sabotage within a family is confusion. People will start to express confusion when they’ve been in therapy with you and they start to sense things are going okay. They will do it through things like, “I don’t get it. I don’t get their point of view. We’re never going to understand them. I’m never going to understand what they’re saying. I’m just so confused about what we’re doing here. I don’t even know why we come here. I have to come here because my son wants me to, I don’t understand. We’re not getting anywhere. We are not on the same page. I want something, he wants something, you don’t understand as the therapist — either one of us or our point of views. You weren’t there. You weren’t part of this until a couple months ago. How do you think you can understand us? We are not on the same page. I am completely lost to what we’re doing here.”

I’ve heard this many times when someone is getting to that place where they have to do some work. Where they’re not holding down their end of the boundaries or we’ve set up rules — we’ve set up ways that they can hold to them. “You cannot give the addict money.” Both parents: “Great. We’re not going to give him any more money.” The mom comes back and she says, “Oh, I gave him a hundred bucks. He really needed to cover his rent.” The dad gets upset about that, and mom comes back and says, “Well, I’m confused. I didn’t know we couldn’t pay for his rent. I thought I couldn’t give him just money to pay for alcohol or that sort of thing.” And then everyone’s like, “Well, no, we really agreed that we were not going to give him any money,” and so this parent then is suddenly very confused about what the rule was. “I can’t change unless you can tell me why.” So that comes up for people because they sense they can’t trust you. So there’s this communication of like, “Unless you can tell me why it’s important to do this,” or, “What are your qualifications to give me these rules or to tell me to do this? Do you have kids?”

They come up with a lot of excuses as to why you can’t help them change because you can’t tell them exactly why or what to do with it in a way that they trust, or that they believe that, yes, this is the right thing to do. And that can become very frustrating from a therapist’s point of view, because you might be working with the whole family and you’ve really built rapport with all of them, and there might be this one person who just keeps questioning it and who just keeps feeling like maybe they’re the one who’s the holdup. Maybe they’re the one sabotaging the system and you can’t get them to move, and the rest of the family just feels defeated because that person will not hold up their end of the bargain. Those connections and having the expectations just are explained away with their confusion.

We can work on this by using connection. It can be so tough to stay present and to have that family sit in that pain. Oftentimes, people within the system just don’t want to do that. They’d rather disengage. They’d rather not be able to share their whole experience of it because it is really painful, and being vulnerable can be scary. They have these injuries that have been built up over years and years of behavior, and so not being able to name them is just part of the defense that has come up. The way that they cope is that, “I’m not going to be part of this, I’m not going to work on this,” but finding ways for those clients and that family to stay present in that pain is going to be a huge part of your work in reconnecting this family system. And one of the most basic ways is to allow the space for the shared events that have gone on and for everyone’s perspective of those events and getting to that place where there’s the communication around what we’re going to change in the future so those hurt feelings and that pain doesn’t come up. What are you willing to do? That’s a tough question. That’s one of those questions that you’ve had to build strong rapport, you have to have a deep connection with that family system, and you’ve had to sit with them and slow down a little bit.

Some of the big blocks to this connection are the fears of the unknown. We often fear the unknown in everyday situations, and people recognize that there is relapse. We could be setting ourselves up for failure and being played the fool again. People don’t want to feel like they’ve done all this hard work and their family member hasn’t, and we need to acknowledge that for people — “You’ve put in so much effort, you’ve put in so much money, you’ve put in so much time and you don’t want to feel like this fails again.” Being able to do that and acknowledge that for somebody can be a really big floodgate opener, because seeing them for what they’ve put into this whole situation, it might just feel like a relief. Someone’s validating their position. Someone’s validating the fact that they’ve worked so hard to help somebody who really has to help themselves. That’s built up in resentment of the past. That past is just such a big piece and it’s a huge block. Your identified patient has got to work through acknowledging they’re hard and making amends is a big piece, whether or not you use a 12-step program.

Making amends within the system comes in three different ways. The first way is direct: They need to understand and repair. They need to put themselves in a position where they take responsibility for their previous actions. That is a huge way to heal and move forward. The next way is indirect amends. It’s that you recognize that you’ve done some irreversible damage here. You’re not going to get back those years of your child’s childhood. You’re not going to be able to replace the car that you wrecked of your parents. You might not be able to do some of these things that your family had done before, and saying, “I know you can’t get that back and I’m really sorry about that,” is a great way for them to acknowledge the past. And the third way to make amends is just by living, and living their best life now and choosing the positive pieces. That will help this system heal, saying, “I know I didn’t do that well before, but I’m doing better now,” and actually showing the family how they are doing better now is a good way to help erase some of the wounds that can come up in that period piece, where they’re building pain and pain and pain on top of each other.

The last piece is recognizing that they’ve always had problems and this is just making them feel worse. “Fixing this doesn’t make our family better.” They have assimilated to their problems, and we’ve talked about it before. Their sense of homeostasis is there. When someone’s assimilated and said, “You know what? We don’t need to really work on this. You are bringing up our pain. You’re making us come in here and talk about stuff we don’t want to, you’re not fixing us. You’re making us worse. We go home and we feel bad. We don’t like being here.” There is so much of that that can come up with that, and part of that is trusting that therapeutic relationship and building on it and saying, “I know that this is really hard work. This hour that you’re in here is like exercise for your head and your heart. We are exercising these emotions and these muscles, and you’re lifting a lot of weight. It is one hour. And I believe that if we do this consistently, this is going to get easier, but I know right now it is really hard for you and I can see that.”

So that’s a big piece: empowering them. All members of the system have a part, and saying, “Your part’s important. You have strengths in the system. You also have some weaknesses, but your strengths really outweigh those as we work forward and move into a place where you have some things that you’re giving this IP and that you’re giving each other that are so important.” And being able to look at a family and hear them laugh together when they haven’t done it for a long time — that is just one of my favorite parts of family therapy. When we’ve gotten to a place where some of that hurt has moved out just enough where they can connect again, and they can sense their family system for what it is. There are things that come up that are kind of funny, and they have their inside jokes and the way that they look at things. And when they’re willing to laugh together, you can feel some of the strength of that system coming through, and that’s a very powerful moment for all of us.

When you start the work with the family, we have to look at what their first goal is and what our first goal is. Being able to meet some of their needs while you’re meeting some of the system’s needs from the therapeutic standpoint can really work with best results, and for that partnering piece. If you go back and do some of that work that we talked about earlier — where you’re using those creative interventions, you’re seeing what all the family members really want, what they’re hoping for, what they’re working towards, what they’re wanting to get out of therapy — if you can make sure that you’re tandemly addressing it with some of the pieces that you think are most important to start with, your partnership will be stronger because they’ll sense that they’re getting what they came to therapy for. They might really want to be able to use some things that are coping skills for them and that sort of thing, and you might really be wanting to focus on something that maybe they aren’t seeing as important, but partnering by making both things part of your initial treatment plan will help keep them on board and help those family members sensing that their input is really important. Of course, we have to address unsafe behaviors first, and I think that most people recognize and understand that, but from there, working on that partnership is really important.

The way we do that is finding that balance between you as an expert and you as a partner. Having clear goals that have a real check-in date that are often strengths-based. We don’t have to have every goal of these strengths-based, but making sure that we have some that are. We know that evidence-based treatment relies on strengths-based goals, and that can help people sense that they are moving in a more positive direction. So really, having clear goals with a measurable piece and an end date can help those clients recognize that we’re working towards something. Have knowledge that helping the goals might be part of the plan, but they might not always understand the entire way to get there. They have to build trust with you, and that takes time, especially in highly wounded relationships and systems.

Slowing down and recognizing that there’s a healing process to growing that relationship can be very important through the therapeutic work. You might not reach the same goals as quickly as you want to. You might have to spend more time in that rebuilding and repair piece for you because you’re mirroring this system. You’re helping them progress into a place where they can trust, and that might be on their time — not yours. The last part is just being consistent with checking in on those goals, staying black and white and using those goals as the pillar and helping them see we are working on the things that you find important and that I think are going to help heal you to get you to where you need to be. Staying on track with that, not allowing them to sabotage, for them getting off and talking about and triangulating someone else, not putting in additional plans and additional work before we’d solve some of these pieces that we’ve come up with initially. These are all ways that they might get out of the hard work that you guys have set in place through these goals. Goals are a key piece to this, and recognizing what they are is a nice way to hold people accountable and to show your accountability to your work.

So finally, if you have any additional questions or things that come up around this presentation, feel free to reach out to me to chat a little bit more. This is my email address, the phone number and the website for Relate. Thanks for coming to this presentation. I really appreciate your time, and I hope you learned something.

Thank you for watching this video. We hope you enjoyed the presentation.

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The Recovery Village aims to improve the quality of life for people struggling with substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare providers.

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