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COUNSELING FAMILIES WITH AN ALCOHOLIC PARENT.
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Discusses various therapeutic models: Psychoanalytic, Client-centered, Rational-Emotive, Cognitive Behavior, Family therapy, Groujp therapy, Gestalt.... More...
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Paper Abstract:
Discusses various therapeutic models: Psychoanalytic, Client-centered, Rational-Emotive, Cognitive Behavior, Family therapy, Groujp therapy, Gestalt.
Paper Introduction:
Counseling with Families with an Alcoholic Parent
Introduction
Given the high incidence of alcoholism in this country and the havoc that disease wreaks on families and communities, there is a need for understanding how various therapeutic approaches can assist family members with an alcoholic parent to heal and grow. The intent in the following pages is to explore some therapeutic approaches, think about their applicability to this situation, and illustrate how they might be utilized in working with clients.
Therapeutic approaches
Psychoanalytic
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It emphasizes developing the potentially autonomous individual(Hersher, 197 ). and McInerney, J.F. (1999). He againemphasized that clients could attend psychoanalysis for years without everachieving any healing or resolution. Oaklander (1988) provides the best discussion because sheincludes not only techniques, but transcripts, case examples, anddiscussions of the cases designed for use by therapists in schools, mentalhealth centers, and private practice.Conclusion: In exploring the literature, it is apparent that each of these modelscan be utilized in working with families with alcoholic parents, althoughsome seem to be preferred by contemporary psychotherapists. Journal ofFamily Psychology, 12(4), 557-577. (1988). Thiswas an intensive group focused on specific issues identified as common toACOAs and the authors discussed group processes and techniques thatappeared to be effective for group members.Gestalt Therapy One form of group therapy that was particularly popular in the 197 sand early 198 s was gestalt therapy, developed by Fritz Perls. Psychoanalysis is a long-term,several times a week, depth process that is focused on bringing theindividual to insights about their situation. Contemporary clinical psychology. and Moir, R. Thus, it would seem that elements of both cognitivebehavioral and family systems therapy would be more fruitful.Family Therapy The preceding have primarily been individual approaches in which oneclient works with a therapist. It would not be a top choice for working with familymembers with an alcoholic parent. This, then, is a therapeutic processthat is not generally recommended.Client-Centered Therapy On the other hand, client-centered therapy seems more appropriate tothe situation. It isalso not particularly suited to work with families, or individual membersof families, in which one parent is an active or recovering alcoholic. Wormer, K.V. He believed that people held erroneous beliefs aboutthemselves and others that trapped them in negative patterns of feeling,and behavior. Efron, D.E. They worked with 63 couples with a male alcoholicpartner, with each dyad attending up to 2 sessions of either form oftherapy. It also focuses on teaching clients how to modify theirbehavior in specific situations in order to be more successful. The rational-emotive therapist does not worry about exhibitingempathy or unconditional positive regard; instead, this is more of a toughlove approach which uses several different techniques to push clients intochanged behavior. NY:International Universities Press. harm reduction: ComparingAmerican and British approaches to drug use. (1998).Demand-withdraw couple interaction moderates retention in cognitive-behavioral versus family-systems treatments for alcoholism. It is suited to the client who is verbally adept, somay not be appropriate for all cultures or for clients who speak English asa second language. (1995). Yet, the approaches are very different.Gestalt therapy also uses psychodrama and dreamwork. They learned that attributes of couples, and family attributes,or types of relationships seem to influence response to treatment in termsof retention. Carl Rogers (1961) was the founder of client-centered orperson-centered psychotherapies which emphasize the client's presentsituation, his or her ability to change that situation, and creating atherapeutic environment of unconditional positive regard that enables theclient to change. Burney (1995) looked at psychoanalysis in terms of the concept ofcodependence, finding it useless in working with recovering people. Counseling with Families with an Alcoholic Parent Introduction Given the high incidence of alcoholism in this country and the havocthat disease wreaks on families and communities, there is a need forunderstanding how various therapeutic approaches can assist family memberswith an alcoholic parent to heal and grow. There is an extensive literature dealing with the gestaltapproach for children and adolescents, including techniques for workingwith this population have the special problem of one or more parents whoare alcoholics. This involves four phases from drinkingthrough transition to early recovery and ongoing recovery. (Ed.). Boston, MA: Houghton-Mifflin. The entirefamily is considered to be part of the process, but needing first to beinvolved in individual groupwork through Al-Anon, Alateen, or AlcoholicsAnonymous. (1961). Burney, R. For example, he explored the self-talk of depressed peopleand found that it was unwarrantedly negative, tending to reinforce negativebeliefs about the depressed individual and the hopelessness of theirsituation. On becoming a person: A therapist's view ofpsychotherapy. (1999). Goldenberg, H. Rogers' emphasis on personalresponsibility and personal choice-making is more congruent with thismodel, in which the client is assumed to be an autonomous individualcapable of making choices. However, with family therapy, the family isseen as a whole system, with every member playing a part in the problem andin the solution. In this particular case, an alcoholic mother had an only childin a residential treatment facility. Social Work with Groups, 19(3-4),117-129. For a group approach that is peer-supported, rather than led by atherapist, Brown and Lewis (1999) suggest what they call a "developmental"model for the family in recovery. Thisis a fairly confrontational form of therapy which actually might fit inwell with 12-step approaches, such as Alcoholics Anonymous and Al-Anon orAlateen. Rational-emotive therapy withalcoholics and substance abusers. Short term co-led intensive groupwork with adult children of alcoholics. References Beck, A.T. The therapist, like the Rogeriantherapist, is focused on helping the whole person to develop and becomeautonomous and self-fulfilling. and Kern, R.M. One interesting approach to using family therapy with an alcoholicparent is that in which the identified patient becomes the helper (Odom etal., 1999). NY: Guilford. The problem, according to Ellis, is thatmost people hold erroneous beliefs about themselves and others that trapthem in ineffective behavior patterns. The enabler is generally the spouse of the addict,although children can also be enablers. Shoham, V., Rohrbaugh, M.J., Stickle, T.R., and Jacob, T. Brown, S. (1996). It has been particularly successful with clients who are anxiousand phobic. According to Ellis,the client is responsible for his or her situation in the present, nomatter what happened in the past. Therapeutic approachesPsychoanalytic The psychoanalytic approach is, of course, the first and classic typeof psychotherapy. It focuses on earlychildhood trauma, but it is not focused on rapidly changing the client'spresent situation. Humanistic psychotherapy: The rational emotiveapproach. (1988). This is an Adlerian family therapy approach in which thealcoholic family is seen as discouraged and in need of information andassistance. This was passed through the child to themother through role-playing, increasing the mother's knowledge of parentingand also increasing her levels of self-esteem. and Lewis, L. Only after this individual work is finished do the authorsrecommend family intervention and marital and family reintegration. Like rational-emotive therapy, cognitive behavior therapyemphasizes helping people change their way of thinking about a particularlife situation. NY: Pergamon. It isanother therapy that is present-oriented, rather than looking to the past,and a confrontational therapy. Windows to our children: A gestalt approachto children and adolescents. NY: Appleton-Century-Crofts. Family Journal, 7(2), 181-184. Monterey,CA: Brooks/Cole. Cognitive therapy and emotional disorders. (1976). Ellis, A. Lafayette, CA: PeoplePress. However,there are some problems with this. Ellis discussed workingindividually with the enabler using traditional RET behavioral techniquesin order to help the individual think more rationally about the situationand change their enabling behavior. Albert Ellis (1988) himself contributed to a book on the use ofrational-emotive therapy with both the substance abuser and the enabler ofthe substance abuser. Hersher, L. Therapists from this school of thought are basicallynondirective, assuming that individuals have the capacity within themselvesfor making decisions and for understanding their behaviors and changingthem. The attribute they emphasized was the demand-withdrawdynamic in couples which had a negative impact on retention of information,and changed behavior. Thisbook has the advantage of being a 1 -year study of 52 recovering alcoholicfamilies, but the disadvantage of being biased toward the 12-step approachand drawing volunteers from that community for that study. Least utilized is psychoanalysis. This seemsparticularly suitable for working with families of alcoholics. It is generally done in a group settingwith an active and directive therapist. Family therapy holds that if one person in the system ishaving a problem, this means that the entire family needs help. Oaklander, V. Even gestalt therapy has been used in working with families ofalcoholics. Again, this is not an empathic, but aconfrontational approach that requires the enabler to see how theirbehavior has contributed to the problem.Cognitive Behavior Therapy Cognitive behavioral therapy is a melding of two approaches thatinvolves helping clients to change both their thinking and their specificbehaviors. The intent in the followingpages is to explore some therapeutic approaches, think about theirapplicability to this situation, and illustrate how they might be utilizedin working with clients. (1973). Codependence: the Dance of wounded souls. Beck (1967) is one familiar theorist in this field, with afocus on depression. Yet, it is also similar to the 12-stepapproach of Al-Anon or Alateen, except that those were designed to be peersupport groups, rather than groups controlled and facilitated by experts. NY: Julian Press. Gestalt theory verbatim. It tends to be a psychotherapy, at this point, of theelite. Four psychotherapies. The family therapist used birth orderdynamics to accentuate the child's over-responsibility, presenting thatchild with parenting material. Harm induction vs. Itdiffers from family therapy in that members of the group come fromdifferent families and situations. This typeof therapy has been used with alcoholics and with depressed or anxiouspeople. The decision to drink or not to drink is seenas free choice, rather than as the result of being addicted or not addictedto alcohol (Wormer, 1999).Rational-Emotive Therapy In contrast to Rogerian methods, rational-emotive therapists are verydirective. (1998) performed astudy exploring differences in response to cognitive-behavioral therapy andfamily systems therapy. However, it no longer holds an exclusive place among thepsychotherapies and is not the most popular of the psychotherapies. Goldenberg (1973) noted that familiesmay not benefit if members are uncooperative or absent, if one familymembers dominates, or if the problem seems to be long-term and entrenched.This, then, seems to make family therapy problematic for situations inwhich alcoholism has been a long-term issue or in which the alcoholic isnot in recovery and not interested in recovery. Rogers also emphasized empathy for the client and trying tounderstand the world from the client's point of view. Rogers approach does not mesh well with the standard abstinence modelof treatment of alcoholics, nor with thinking of alcoholism as a disease.Instead, the Rogerian approach is effective in harm-reduction programs inwhich the emphasis is on teaching individual drinkers how to modify theirbehavior to create less harmful consequences. (1973). The alcoholic family in recovery: Adevelopmental model. For example, Shoham et al. Highland, NY: The Gestalt Journal Press. Odom, M., Snow, J.N. There seem to be other factors that affect the effectiveness of thistype of approach, however. (1979). Perls, F.S. Journal of OffenderRehabilitation, 29(1/2), 35-48. Most of thefamilies also were Caucasian. The task of the rational-emotivetherapists is to show clients their misinterpretations and to help clientslearn to think more rationally about themselves and their behaviors. This is an interesting useof the family systems model, with the intervention taking place through theidentified "problem" member.Group Therapy Group therapy involves one or more therapists with several clients,sometimes with the same problem, sometimes with disparate problems. NY. Rogers, C.R. Use of the identifiedpatient as the helper in family therapy. Henoted that psychoanalysis dealt only with the intellectual issues involved,rather than the emotional healing that needed to be accomplished. Efron and Moir (1996) described a more traditional co-led grouptherapy model, although modified for adult children of alcoholics. Thus, someform of family therapy seems to be a preferred mode, as does cognitivebehavioral therapy. Ellis, A. There are several reasons for this. (1999). Albert Ellis (1973) was the founder of this school ofpsychotherapy, which is also very present-oriented.
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