Approaches to Fathers

Approaches to Fathers

As might be expected, fathers were the most difficult family members to recruit. However, the lore in the field may be exaggerated on this point. We have heard other therapists complain, 7We can't get the fathers in,- when they never contacted these men directly and left the recruiting to someone else. What these therapists may really mean is they cannot get other family members to bring fathers in. As other authors have stated," 86 contacting fathers directly can make a dif-ference.

Even granting the above, however, the fathers in our sample presented special problems. At least 72% of them had drinking problems1" and did not want this brought to light in a therapeutic situation. Some were rarely at home, and asleep when they were. Still more common was a family pattern in which the father was shut out from communications about the IP or his treatment. The family structure was tight and rigidly channeled. It was not unusual for the rest of the family to agree to participate and then come in without  telling the father where and when they were going, or for what reason. On more than one occasion a therapist called a father to confirm an appointment, only to get a -What are you talking about?”

response. Again, preappointment contact with fathers became a necessity.

Engaging fathers was one of our more demanding tasks and often one requiring the most creativity. At one time or another we used all of the guidelines (summarized earlier) that L'Abates6 has presented for enlisting fathers. The following vignettes give some

idea of the latitude and innovation that can be applied to this endeavor.

Vignette 5. The therapist (Paul Riley) tried numerous times to reach a

father at home, but to no avail. Finally, he made a visit to the father at

his place of work in order to foster trust and explain the treatment program.

Vignette 6. Three home visits were made. On the first, the therapist (Jerry I. Kleiman) commiserated with the mother while she cried and talked about how things were. The next night he returned to the home and sat with the father in the den, where he had numerous pictures on the wall of his son as a Marine. The father lamented about what his son "could have been." The two of them talked and drank beer together. The following morning Kleiman went over and brought the family in for treatment.

Vignette 7. In this case the therapist (Paul Riley) sensed that the father was suspicious and jealous because this strange man (Riley) had come to his house to talk to his wife. Consequently, Riley brought his own wife along for the next visit. This reduced the threat, because now Riley had his woman and the father had his.

Vignette 8. In a case seen by Sam Kirschner, PhD, the father was adamantly against coming and said his son didn't deserve the effort. Drawing upon his clinical knowledge and experience, Kirschner sized up this situation as one in which, unless change occurred, the addict was in danger of "going off the deep end." He sensed that the young man was feeling desperate and that something had to be done to avert a tragedy. It became clear that a harsh reality was being ignored and that the father's (and family's) denial had to be con‑fronted directly. Because the stakes were so high he decided to take a gamble, which required two steps. First, he moved to counter the father's resistance by referring to a pattern that is typically seen in addicts' families and one that was suspected in this particular family: he made a joining pitch by connoting positively that the father really cared more about his son than he let on, and that if something happened to the son, father would be the flrst to help him out. The second move was to confront the denial. Kirschner left the father with the prediction that if he did not come into treatment, his son would either be dead or in jail within 2 weeks. The son obliged by getting arrested 3 days later, and the father took out a second mortgage on his home to raise the bail money. These events ob-viously gave Kirschner considerable power from that point on.

While Kirschner's prediction might seem extreme, or even absurd, it should not be mistaken for a paradoxical intervention. Rather, he was rubbing in a harsh reality. The probability for disaster was high, and this was not being recognized by the father. It needs to be emphasized that these addicted young men die or become im-prisoned at rates that are many times higher than for similar men in their age group (see Chapter 1). From our own data (see also Chapter 17) 10% of a matched group of clients (who were not assigned to family therapy) died over an 18- to 48-month follow-up period (average 31 months). This mortality rate was five times higher than the 2% of deaths that occurred during the same period for cases that engaged in family therapy. Our therapists were aware of the threat to life or other dangers extant when the addictive process was allowed to continue unchecked, and Vignette 8 presents one response to this exigency. In this context a sense of -mission-was hardly inappropriate.

Vignette 9. Therapist Samuel M. Scott encountered a case where the father worked two full jobs and was only at home and awake for 15 minutes of each day. Father's routine was to arrive home, wolf down a meal, and go immediately to bed. Scott made several telephone attempts and missed the father by 5 or 10 minutes. When he finally did catch him, he opened by being extremely contrite, recognizing how busy the father was and how hard he worked, and apologizing for interrupting his schedule. He was so apologetic that the father's curiosity was aroused, and the conversation turned into one with the father asking Scott questions about his son's program and about how he and the family could help.

An important ingredient of this vignette was the way Scott intuitively responded to signals from the father about the latter's personal space. He let the father know immediately that he was sensitive to issues of -turf,- in a sense saying, respect your boundaries and your privacy.- Establishing such respect early allowed rapid joining and a smooth transition into the matters of treatment.

Vignette /O. This was a situation in which the mother and siblings agreed to participate, but they claimed that there was no way the father would become involved. Mother said she had petitioned her husband about it several times without results. She conveyed to Sam Kirschner, the therapist, the pain and frustration she felt at her husband's intransigence—she could not move him. She noted how badly things were going, both in general and with her husband. It was clear to Kirschner that she hoped he would do whatever was necessary to budge her husband from his position, and that the information she conveyed might provide Kirschner with momentum. After several attempts, he finally reached the father by the telephone. The following is a reconstruction of that conversation.