PARENT TRAP

THE DOUBLE INTERVENTION

Family and Personal Recovery

Sara Counes, CAP, ICADC

PARENT TRAP

Sara Counes

September 16th 2017

Name Commercial

Interests

Relevant

Financial

Relationships:

What Was

Received

Relevant

Financial

Relationships:

For What Role

No Relevant

Financial

Relationships

with Any

Commercial

Interests

Sara Counes Caron

treatment

centers

Salary from

Caron

National

Business

Manager

X

Glossary of TermsCommercial Interest - The ACCME defines a “commercial interest” as any proprietary entity producing health care goods or services, with the exemption of non-profit or government organizations and non-health care related companies.

Financial relationships -Financial relationships are those relationships in which the individual benefits by receiving a salary, royalty, intellectual property rights, consulting fee, honoraria, ownership interest (e.g., stocks, stock options or other ownership interest, excluding diversified mutual funds), or other financial benefit. Financial benefits are usually associated with roles such as employment, management position, independent contractor (including contracted research), consulting, speaking and teaching, membership on advisory committees or review panels, board membership, and other activities from which remuneration is received, or expected. ACCME considers relationships of the person involved in the CME activity to include financial relationships of a spouse or partner.

Relevant financial relationships - ACCME focuses on financial relationships with commercial interests in the 12-month period preceding the time that the individual is being asked to assume a role controlling content of the CME activity. ACCME has not set a minimal dollar amount for relationships to be significant. Inherent in any amount is the incentive to maintain or increase the value of the relationship. The ACCME defines “’relevant’ financial relationships” as financial relationships in any amount occurring within the past 12 months that create a conflict of interest.

Conflict of Interest - Circumstances create a conflict of interest when an individual has an opportunity to affect CME content about products or services of a commercial interest with which he/she has a financial relationship.

Objectives: Participants will be able to

• Recognize and describe the family system and assess

the needs of each individual in the system.

• Identify the dynamics that contribute to dysfunction

including sources of emotional dependence, family of

origin issues, secondary and tertiary gains of

dependency.

• Articulate the benefits of family recovery to the

sustainable change of the family system.

• Identify family systems likely to benefit from family

system intervention and treatment.

Treating the ENTIRE family system

Core Concepts

• The family is not necessarily sick, but is

responding to their natural parenting instincts to

protect, defend and provide for their loved

ones.

• In family systems, there are parallel

psychodynamics at play among primary family

members and which are often rooted

generationally and triggered through new

stressors, trauma or loss.

Core Concepts

• Sobriety is the responsibility of the patient,

however the family’s responses to the patient can either strengthen recovery or influence the

relapse process.

• The family or significant others must accept the

challenge of looking into themselves and at their

family histories in order to reverse generational

themes and the dynamics that set the stage for

family and individual relapse.

Family as Codependent

• Codependent is the natural position for a

family member – addiction distorts this.

• As family members focus their energy on

the “identified patient”(IP), they can/do ignore their own issues and needs.

• This results in secondary gains for family

members which need to be addressed.

• While the “IP” is the focus other family members needs are neglected.

Family Recovery

• Recognition of the depth of addiction and the parallel

impact.– effects on physical, mental, spiritual, interpersonal and emotional

well being

• Treatment is indicated for both patient and family

members. – therapy, similar assignments, on-site group process work with patient,

support/network development, family treatment planning/continuing

care planning.

• Misconceptions about relationships and history need to be addressed

– Failure to do so sets the stage for reenactments

An example:

• Sandy and Rob: Married, 3 “children”, Rob’s father died when he was 15, and Rob deals with

stress through focus on work, gets angry at times

when its ‘too emotional’. Sandy’s parents divorced when she was 12, she was the oldest

and she helped her 2 younger siblings through

custody issues. Their 24yo daughter is using drugs

/ going to school/not moving forward. 22yo

daughter is needy, anxious, lives at home/goes

to school. 18yo son finishing HS, no plans after HS.

Treatment: The family is the patient

and the patient is the family

• Addressing repetitive generational themes

• Family members begin to experience their own

strengths and weaknesses and become

oriented to their own insides – painful, but

anxiety reducing and sobering. The co-

dependent position is weakened.

• Family members stop problem-solving for the

patient.

Treating the family

✓ Increase Expectations

✓ Set Boundaries

✓ Demand Accountability – reasonable

and natural consequences

✓ Detach from problem solving

✓ Focus on self

✓ Adult/Adult Communication – non

avoidant conflict resolution

✓ Address splitting / secret keeping

Family Risk Factors / Risky Behaviors

• High Anxiety

• Enmeshed Systems (problem solving,

coaching/lecturing, cheerleading)

• Entitlement

• Avoidance/Lack of Involvement

• Blaming / Excuse Making

• Refusal to follow recommendations

• Inconsistent Messages/Actions/Follow Through

• Abusive Behaviors

• Repeated Treatment History

Parallel Processes and Defenses

Active using

Identified Patient

• Steal / lie to obtain

chemical, etc.

• Avoid emotions

through escape of

addictive behaviors

• Externalize blame on

family/school/law/

society, etc.

Family members / system

• Lie, spend family funds

to protect IP

• Avoid emotions

through focus on IP

• Externalize blame on

family/school/law/

society, etc.

Parallel Process and Defenses

Relapse

Identified Patient

• Angry/blaming/whining

• Demanding/entitled

• Inconsistency

• Poor Boundaries

• Breaking the rules

• Living in Crisis

• Irresponsibility

Family members/system

• Defending/protecting/r

escuing

• Losing perspective/self

centered thinking– “I have to”, “they cant

without me”,”I need too”

• Inconsistency

• Poor Boundaries

• Breaking the Rules

• Living in Crisis

• Irresponsibility

Parallel Process and DefensesRecovery

Identified Patient

• Gratitude

• Humility

• Perspective &

interdependent thinking

“I’m a part of”

• Sober social activities:

being with positive

people

Family members/system

• Confidence in self and

loved one

• Belief their loved one is

capable

• Appropriate perspective

“they are an adult and

can handle this

• Sober Social activities:

engaging in healthy

activities focused on self

and primary family unit

How It Works

• The family members assume sober, adult

relationships, sober social networks and

activities, work/school tasks and adult-adult

relationships and parenting.

• The family members experience the

development of personal integrity and begin to

practice the principles of recovery.

• The co-dependent position disintegrates and re-

integrates as an inter-dependent position.

A New Look at Relapse Prevention-Vocational/Colligate recovery

•Neuroscience is seeing that the relationship to

the future is a dopamine panel: Chemicals

aren’t the only things that release dopamine,

behavior do too

Relationship to the future and the

likelihood of recovery vs. relapse

•Dopamine helps recognize things that are

good for survival

Relapse prevention cont’d

• Decision making is dependent on thoughts or

ideas of the future

– The IP’s perspective

– The family perspective

How It Works

• Family members use appropriate internal and

external resources to manage their own anxiety.

• Family members begin to perceive that it is they

who are responsible to regulate their own

internal affairs. The dependent and co-

dependent position deteriorates.

When the family

changes….. the

patient changes

Q & A