FAMILY NETWORKING WITH
ALCOHOLIC AND CHEMICALLY DEPENDENT FAMILIES
William L. Mock, Ph.D., LISW, LICDC, SAP
Director, Ohio Institute for Addiction Studies
34650 Capel Rd
Columbia Station, Ohio
(216) 2299506
drmock@ymail.com
Like any system, the family is a complex array of structures and processes
which are inextricably intertwined.
A change in one of the family's
processes results in a complimentary change in other processes and related
structures. Similarly, a change in one of the family's structures may
result in modification of an existing process, institution of new styles,
or loss of a previously used process. For example, much has been written
about the family which changes its executive sub-system from a two parent
to a one parent configuration and vice-versa. There is recognition that
communication, emotional support, and physical maintenance processes go
through a variety of changes as a result of this structural change.
Active alcoholism/chemical dependency represents an ongoing change process
for the family. The family makes slow, incremental, adaptive changes over
time in response to the steady progression of the disease. These changes
help the family to survive the continuing crisis that alcoholism/chemical
dependency represents. They allow the system to maintain a tenuous
homeostasis. They further serve to support (enable) the development of
the disease. Common intuition suggests that these changed processes and
structures may not be appropriate for living a drug and alcohol free life
style in the real world. Indeed, available research and clinical evidence
support that intuition. The family may wish devoutly for and applaud
loudly the cessation of drinking/drugging and recovery of the
alcoholic/chemically dependent member(s). However, that change presents
the family system with the prospect of reversing changes in being that
have accumulated over years in response to the illness. Some families do
that more successfully than others as evidenced by the heightened divorce
rate in newly sober/dry couples. Our job as therapists is to aid the
family to make process and structural accommodations needed to make those
changes that are functional for family and individual growth.
BORDERS
Among the structures that are of concern to family therapists is the
border which surrounds the family. While not made of bricks or wood or
other solid stuff, it is as vital to the functioning of the family unit as
the wall of a cell is to the proper, continuing functioning of the cell.
In fact, the family border functions and operates in ways similar to the
cell wall. It serves to define the family unit. Inside is family and
outside is others, such as other family cells, units, agencies,
organizations, etc.
Like the cell wall the family border is semi-
permeable. It allows the selected passage of resources, information,
emotional support, and energy into the family. Through this border, the
family can eject toxic wastes as well as the energy, resources, etc. which
we commonly see as the family's invaluable contribution to society. In
the functional family the border is tough but flexible, able to withstand
assault.
Families suffering from alcoholism/chemical dependency have markedly
different borders. As a result of successive crises and continuing pain
for members and threats to the family unit, the border undergoes a
metamorphosis. It shrinks, becomes rigid, dense and impermeable. In some
cases the border also becomes brittle. When bumped by every day hazards
it may crack or shatter, spewing family members in many directions.
At a time when the system and each of its members need support from
outside, they are least able to acquire it. In the alcoholic/chemically
dependent family, the border becomes more rigid, more impermeable. There
is a progressive isolation of the family unit behind a dense wall of
denial, rationalization, and shame. Extended family members, friends, coworkers professional helpers are all excluded from the inner life of the
family. The strength, energy, and support they used to bring to the
family are cut off.
A number of strategies are available to the therapist who wishes to help
the family return to or acquire a more functional state. Al anon and al
ateen involvement on the part of family members stretches and flexes the
border. It punches small holes in the border through which energy may
flow. Whether they are the prime symptom bearer (i.e. the
alcoholic/chemically dependent) or not, members should be encouraged to
work their own personal recovery program. Bringing to awareness the
nature of their isolation will often result in individual members deciding
to reach out for sources of support and help. The therapist may help
members to identify those persons and things outside the border that had
previously been important to them. People, hobbies, volunteer work,
church, extended family may all have been cut off by the changing border.
The therapist can help them to return to these resources and thus mend the
border.
In some cases the border is so rigid, inflexible, and impermeable that
more dramatic measures are needed to restore the family's connection to
its network of supports.
FAMILY REGENERATION NETWORKING
Such an approach is family regeneration networking. Support for change
and resolution of crises can often come from the broader system of
extended family, friends, clergy, schools, and work associates. Family
regeneration networking attempts to tap the potential of this system in
the service of crisis resolution. Rueveni (1979) offers the following
definition of family networking which is relevant to family regeneration
networking:
"Family network intervention is an attempt to mobilize the social network,
support system in a collaborative effort to solve an emotional crisis. It
is a time-limited, goal-oriented approach that will help family members in
crisis to assemble and mobilize their own social network of relatives,
friends, and neighbors; this network will become collectively involved in
developing new options and solutions for dealing with a difficult crisis.
This intervention process includes an intervention team that rapidly
involves networking of the family members with its extended social support
system in a process that can result in modifying destructive relationships
and in the development of support systems for one or more of the ailing
members."
If as you read the above description, you think he is describing the
Johnson Institute's style of Intervention, you're nearly correct. There
are three notable differences between the Johnson Institute style of
Intervention and Family Networking. First, the Johnson style intervention
requires that the symptom bearer (i.e. alcoholic or drug abuser) be
present. In family regeneration networking, this is not so. Second, the
focus of the Johnson style intervention is on getting the
alcoholic/chemically dependent person into treatment. In short the
family's chances for success or failure in this endeavor are solely or
largely dependent on the actions of the symptom bearer. The primary
symptom bearer does not have to be present in order to conduct a family
network. This is not substantially different from some old patterns where
the feelings of the members of the family were oriented around the
behaviors of the primary symptom bearer. The aim of family regeneration
networking is much broader. It is to reduce stress and pain in the family
and to mobilize resources to solve every member's problems. Often times,
the symptom bearer seeks help as a direct result of the family
regeneration network efforts. In any case, the family stops responding to
the alcoholism/chemical dependency in its acquired traditional
dysfunctional way. What results is less pain for members and an
atmosphere where change in all members including the primary symptom
bearer in is more likely. Third, family regeneration networking generally
entails a great many more people. Each member of the family is encouraged
to involve persons in the networking who can have impact on his or her
problem. For example, the son of an alcoholic father may see his problem
as feeling lonely and isolated as a result of his dad's alcoholism.
People he involves and/or reinvolves might include friends, school peers,
scout leader, etc. These are the very people who were progressively
excluded from the system as a side effect of the developing serial crisis
we call alcoholism/chemical dependency.
Family regeneration networking is both a general strategy and a discrete
event. It serves as a template for guiding all our short term and long
term interventions. As a discrete event it walks the family through all
the stages of the process in a very short period of time. This helps the
whole family system become oriented to the process and provides for
support for change for all from the beginning. Ultimately the goal is for
the family’s supra-system to be reconnected in a more functional fashion.
Fullest general implementation of this approach requires that all the
helping agencies involved coordinate their efforts in concert with this
model.
We will explore the process of an event as a way of illuminating the
general approach. The processes that are defined for the event are the
same as processes used in longer term family therapy. They are just more
compressed and intense. With so many people involved in the event,
several staff are typically needed. Set up time for the networking event
is great and the family's investment in the set-up process is fairly high.
Also, a family networking event is often a full day in length. Clearly,
this is not a routine procedure. Therefore, it is imperative that
criteria for the approach be clearly understood and met.
CRITERIA
The criteria for using a family networking approach to the resolution of
the crisis of a family harmfully involved with alcohol or drugs include:
1.
the nature and severity of the crisis,
2.
the degree of anxiety and desperation about the crisis
exhibited by the family,
3.
many previous unsuccessful attempts to solve the problem,
4.
the availability of sufficient numbers of potential members,
and
5.
the willingness of family members to call on those others for
help.
PHASES OF THE FAMILY NETWORKING PROCESS
Speck and Attneave (1973) have identified six distinct phases through
which a successful networking of a family system passes. The phases are
marked by tasks required of family members, tasks required of the
therapist(s), and goals for each phase. Space does not permit intensive
examination of each phase. What follows is a brief summary of the phases.
In some cases the Speck and Attneave definitions have been edited or
elaborated on to make them more directly relevant to alcoholism/chemical
dependency.
1. RETRIBALIZATION (a title contributed by Attneave who is a native
American)
This is the phase where family members call together network members and
provide the setting for the event. This may in some cases require that a
hall be rented. In effect, the family, member by member, is redefining
the social/emotional support network in which it resides and with which it
interacts. This is the beginning of the building and rebuilding of ties
between network members. The therapist(s) must explain the rationale for
this approach and help the family members to see its importance and
potential value. Typically, the family members feel anxious about
approaching potential network participants. The therapist(s) helps by
reducing anxiety levels through structured exercises and by coaching the
family members on ways they might invite others.
2. POLARIZATION
The previous stage dealt with assembly of the network, this is the stage
where it gets to work. The family presents to the network the problems as
perceived by each member. The therapist(s) must be careful to keep
blaming behaviors to a minimum and to enhance assumption of personal
responsibility by each member for personal feelings. During this time,
network members react individually to the presented problems. Therapeutic
confrontations are promoted which help family members form new perceptions
of each other and of their respective problems. It is time to leave this
phase only after each member has identified and defined how
alcoholism/chemical dependency has been in their lives.
3. MOBILIZATION
At this stage, the therapist(s) sets the network upon two tasks. The
first is the generation of possible solutions to the identified problems.
The second is the identification and mobilization of the networks
resources. The network can be broken up into small task groups each of
which is organized around one of the family member's problems.
Periodically these small groups should be brought back together to share
and consolidate work already done and to allow for cross fertilization of
ideas. Members can change from one group to another as they see the need.
It is especially important at this stage to keep the network focused on
solution generation and not "awful-izing".
4. DEPRESSION
At this point, the network members become discouraged with the difficulty
of the task before them and the lack of "quick fixes". By building
feelings of cohesiveness and fortifying the ties between members,
depression can be offset. Structured group techniques can help the system
become "unstuck" at this point.
5. BREAKTHROUGH
Solutions are chosen here and plans for implementing changes coalesce.
Included in the planning process is the development of contingency plans.
Each family member has identified sets of supports, resources, and
plan(s). This phase is marked by the emergence of informal leadership.
6. ELATION, EUPHORIA, EXHAUSTION
This is the termination phase of the networking event. The members of the
network should be helped by the therapist(s) to celebrate their successes.
It is a good time to reinforce for members the value of their individual
contributions and the network. Future connections between members of the
network are planned with the aim of attaining or maintaining the solutions
selected or developed earlier.
OTHER CONSIDERATIONS
Clearly family networking is a complex, difficult task. The preceding
description only hints at the power and complexity of the process. In
addition to the tasks described, there are also the tasks of set up and
aftercare. The therapy team needs to exercise care in selecting this
technique and skill in preparing the family for it. They also need to
recognize that the family networking event is only a beginning. Provision
for follow-up and aftercare of the family needs to be made. Given the
power of this technique, the therapy team has to be highly expert.
Expertise in family therapy, group work, and alcoholism/chemical
dependency treatment must be represented in the therapy team. They must
be experienced in family networking and be able to work smoothly with each
other.
IN CONCLUSION
The family's structures are an appropriate target for intervention by the
therapist dealing with alcoholic/chemically dependent families. The
family networking technique is a powerful way of dealing with families
with rigid or otherwise dysfunctional borders. It has benefits to the
family. It provides the family with an emotionally validating experience.
They can have a success after a series, perhaps a lifetime, of failures.
They feel less alone, less horrible and less powerless in their isolation.
They learn that their problem is not so heinous that they need hide it or
themselves from the world. Their power to be, to feel, to act independent
of the controlling effects of alcoholism/chemical dependency is
demonstrated to them in sure, concrete terms. Unlike some other
techniques, family networking allows the family the belief that they are
the agents of their change.