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Family Therapy in Addictions Treatment

From the earliest days of Alcoholics Anonymous, the role of the family in addictions and recovery has been a hot topic of conversation. In the earliest experience of AA, most of the addicts worked with already had families of their own, that they had been busy destroying through the effects of the addiction! The pioneers of AA leaned heavily toward the alcoholic removing himself from the family as much as possible in order to minimize the ongoing damage to the family; and for those families it was often a relief to not have so much toxic effect coming at them!

From the earliest days of AA, family groups met together informally to support each other as their alcoholic loved one began the journey into sobriety. In 1951 Alanon was formed; this organization more than any other movement contributed to the foundations of understanding addiction as a family disease, noting that the behavioral patterns of the family members were often as repetitive and unhelpful as those of the alcoholic.

In the 1960s two emerging movements expanded the awareness of these interactive patterns. Codependents Anonymous (CODA) came into existence based on the premise that the dysfunctional patterns of behavior that become stylized in the alcoholic family occur, in fact, in many dysfunctional family systems, if not all. They recognized that not only the “identified patient” needs support in changing and healing, but the families of those individuals need such support as well.

The second movement was the development of family therapy. Growing out of theory related to communication and to computer systems, family therapy has brought into very clear focus for both the professional and recovery communities that one family member’s life is always influenced by and influential on all other family members’ lives. As a result, for the past 25 years addictions treatment has nearly always included a family therapy component. There are two primary formats in use today. The weekly family support group is most commonly used by outpatient and intensive outpatient programs. This activity is a combination of education about the disease of addiction and consciousness-raising about the family’s roles in both addiction and in recovery, with multiple families sharing experience, strength, and hope with each other. The family week model is used nearly universally in inpatient and residential treatment settings. This family week is usually a process that parallels the 12-Step process. It uses a communication model and focuses on generational family patterns, trauma, family dynamics, and other contributing factors that may be root issues for addiction. Usually these therapy experiences in no way contradict the principles of 12-Step recovery, but do not include or integrate 12-Step material or information.

In general terms, there are two goals for family therapy: one is to effect change in the functioning and way of life of the family and to support such change in an ongoing fashion. This goal is more achievable in an outpatient setting; therapy sessions may be briefer, involve single families, and work toward change in incremental steps. The second goal can be to lead the family in experiencing moments in which their perceptions, values, and emotions reflect a profound shift in their world view, a moment that provides a long-lasting anchor for remembering their commitment to the new way of life. This goal is capitalized on in family weeks and family workshop setting in treating the addicted family: in the weeks and months following such an experience, all participating members of the family can say, “Remember when we committed to…?”

Family therapy that parallels 12-Step recovery rather than being integrated with 12-Step recovery is an unfortunate circumstance. For the individual to use the 12 Steps for recovery, but for the family therapy to not fully embrace that paradigm is neither necessary nor beneficial. A family therapy format that mirrors the Step work of the individual and provides the framework for family healing can be developed that builds on the strengths of both 12-Step recovery and the best of family psychology. The process can be utilized in either the traditional one-week time span of addictions family weeks, or in stages over the span of multiple family workshops such as is utilized at Gatehouse Academy.

Donald Durham, Ph.D., Licensed Psychologist
Clinical Director

For information on the Gatehouse Academy Family Therapy, click here

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