When individuals are in recovery, they need support and encouragement to strengthen their resolve. The strongest forms of support and nurturing come from those closest to us. Family members often represent our closest connections, and even in instances where there is tension and strife between family members, the bonds often remain very salient.
Maintaining strong family bonds or reinforcing bonds that are stressed or damaged is extremely important for an individual in recovery. Research indicates that strong family support is one of the most important aspects of recovery. Strong family bonds reinforce the notion that the recovering individual is not alone and can rely on others to help them through the rough times.
Instilling a Sense of Respect
Strong family support for an individual who is undergoing treatment for a substance use disorder can help to alleviate many of the negative effects of their substance abuse, such as shame, guilt, vulnerability, and even debilitating emotional states or potential disorders, such as anxiety and depression. This can help maintain the recovery program and give the person confidence.
Unconditional Positive Regard
One of the important general factors of successful outcomes in psychotherapy is the expression of positive regard for the person in therapy by the therapist without instilling any conditions regarding this acceptance. Family support for the individual in recovery also translates as a sense of unconditional positive regard to the person.
Unconditional positive regard refers to the fact that the person is still loved and respected despite their shortcomings. This is not to say that unconditional positive regard accepts or approves of an individual’s behaviors, but that the person is still loved and regarded as important despite whatever shortcomings they have. When this attitude can be instilled in an individual, it is very therapeutic and can give the individual the determination to deal with potential uncertainty. Family members who are grounded can display love, affection, and acceptance without criticism for the individual recovery, and this, in turn, can help the individual develop more confidence in their recovery program.
Part of a Unit
Family members are often very sensitive to the needs, feelings, motivations, etc., of each other. This sensitivity can result in positive support for individuals in recovery who have difficulty understanding what they are feeling or thinking. Family members can help these individuals sort out these confused feelings, prioritize tasks, communicate with others better, and improve their decision-making abilities.
Family members will often inherently be more patient and understanding with members of their family than other individuals. This can advance the healing process and reduce frustration on the part of the recovering individual. This can also help to ground the individual in other activities, such as the spiritual side of recovery that many have difficulty understanding. Just being part of a concerned family group can help individuals get a sense that there is something beyond themselves, more powerful than themselves, that can help them recover (often considered to be one of the spiritual aspects of recovery).
Detrimental Aspects of Family Involvement
While family support can be crucial to success in recovery, it can sometimes have the opposite effect and even contribute to relapse. It is important to understand that family members should not be considered to be the “cause” of an individual’s relapse, the same way that they cannot “cause” an individual to be successful in recovery. They can, however, be contributing factors to either outcome. Family members who are angry, resentful, aloof, or uninvolved may exacerbate an individual’s confusion or anger, and this may contribute to the success or failure of an individual’s recovery program.
In addition, while it is important for family members to be involved with the recovering individual, it is also important for them to not become so enmeshed in the individual’s recovery that the individual feels trapped, burdened, or suffocated. Individuals in recovery need a balance between strong social support and autonomy to allow them to successfully negotiate the recovery process. Sometimes, the boundaries between too much involvement and too little involvement are fuzzy, and the family needs to approach the situation with a trial-and-error strategy until a successful medium of support is reached. The recovery process often requires that individuals need significant close support in the early stages of recovery, but as they become successful and time goes on, they need less and less formal support or supervision from family members.
The family can also become an active part of the therapeutic treatment process that individuals in recovery undergo. This may occur out of necessity for families that have certain dysfunctional aspects of their relationships or out of pure support to assist the individual in the recovery. One of the best options for direct involvement in the therapeutic process of an individual in recovery from a substance use disorder is family therapy.
What Exactly Is Family Therapy?
Not all members of the family need to be involved in family therapy. Family members who are directly involved in the situation being addressed are the only ones who need to be involved in the therapeutic process, and sometimes, not all of these family members are involved. There is no one particular type of family therapy, and the particular therapeutic approach depends on the orientation of the therapist. Most forms of family therapy that address issues with substance use disorders have some type of cognitive-behavioral approach to them; however, this is not always true.
The basic goal of family therapy is to identify and correct dysfunctional processes that contribute to problems within the family unit or with family members. This could include a number of different focuses including communication patterns, family structure, different types of family alliances, substance abuse, etc. The basic underlying philosophy behind use of family therapy is that individuals are strongly affected by their family environment and also affect the family environment. Treating the family as a unit can help to restore balance in the family and to the members of the family.
The General Focus of Family Therapy for Issues with Substance Abuse
Despite the particular approach used, all family therapies have a set of assumptions that can be traced back to the innovators of family therapy treatment. Briefly, this basic set of assumptions includes the following notions:
- Families are made up of different components, and an issue that occurs with one component will affect other components of the family structure. One can view the term component to refer to each different family member, the hierarchy of power within the family, the patterns of communication within the family, etc.
- A family member with a particular issue may also affect a number of different components in the family structure (e.g., an individual’s substance abuse).
- The effect of having one or more individuals with a substance use disorder can affect the different components in a number of different ways. These components can act to worsen the issue, make the issue better, result in isolation, or cause any number of other effects.
- Stress from one situation can affect more than one component of the family.
- The reaction can result in unhealthy patterns of behavior for both the family as a unit and the members of the family separately.
- Substance use disorders result in an unbalanced family system.
- Treating the family system can help restore balance to the family and to the individual with the substance use disorder.
Family therapy attempts to resolve issues by bringing the members together, dealing with the specific issues that the substance use disorder has created within the family, instilling trust in the family members, and instilling cooperation within the family unit. It is important to understand that family therapy is a specific type of psychotherapy that requires specialized training. Families can get together to try and talk about their issues, attend social support groups such as Al-Anon or other 12-Step groups, or try other forms of intervention; however, unless the family is treated by a formal therapist, the intervention is not family therapy. Family therapy is delivered by psychologists, counselors, social workers, licensed family therapists, and other individuals who are formally trained in the theoretical approaches of this discipline.
The professionals who practice family therapy require special training, as family therapy approaches are different than approaches used for other forms of groups or individual therapy. The family therapist treats all the members of the family as active and equal members who participate in treatment. The therapist is trying to maintain an objective approach to treatment while understanding the subjective issues of the family members. This requires specific training and practice because members of the family often become very emotional during sessions.
The sessions may focus on helping the individual with the substance use disorder, the attitudes of other individuals in the family structure toward that individual, how different alliances have formed as a result of one person’s substance use disorder, etc. Family therapists often attempt to have all family members who are in the treatment sessions develop and sign a contract that specifies the expectations from everyone in the treatment. This way individuals can commit to working on the issues at hand and remain focused.
There are often a number of other issues that occur within the family structure that can distract from the particular goals of the therapy. It is important that the family therapist keep the goals of the treatment sessions in sight and not deviate from the goals of therapy. If other issues need to be addressed, family members can participate in other family sessions to address those.
Family therapy sessions are typically longer than individual sessions because of the need to allocate more time to a number of different individuals. For the most part, group therapy sessions typically last about 90 minutes.
What Family Therapy Is Not
It is important in a discussion of family therapy to clear up some misunderstandings regarding this form of treatment intervention.
- Family therapy is not limited to use for married couples or families with children. Family therapy can be used for a number of different issues, including substance use disorders, and it is not only designed for parents and children.
- All members of the family do not have to be present for the sessions in order for the therapy to be effective. It is certainly desirable to have all family members who are directly involved in the issue or who live together in treatment; however, it is mistaken notion that everyone must be actively involved in treatment for it to be effective.
- Family therapists do not blame any particular individuals for the issues being addressed. There is a mistaken notion that family therapists blame parents for situations that they bring into the sessions. This is not true. Competent family therapists objectively try to solve issues within the family structure and do not place blame on any one individual.
- There is a notion that family of therapy is not an effective approach to treat substance use disorders. Nothing could be further from the truth. Research regarding the utility of family therapy for the treatment of substance use disorders shows that it offers a number of advantages because it can involve all family members, can foster a support system for individuals with substance use disorders, and can address issues that fuel substance abuse. It is true that individuals with substance use disorders will often be instructed to attend both individual substance use disorder therapy and group therapy, such as family therapy.
The involvement of the family in assisting an individual with a substance use disorder is often crucial in the effectiveness of the person’s treatment outcome. While family involvement can influence an individual in recovery, it is mistaken notion that family can cause an individual to be successful or unsuccessful in recovery.
One professional form of intervention for individuals with substance use disorders is family therapy. Family therapy treats both the family unit and the individual with the substance use disorder. It has solid research to support its use.