Approaches to Wives

Approaches to Wives

In our experience with this population, wives of the clients were perhaps the most willing participants of all family members. For the most part, if the IP would cooperate, his wife was easy to bring in. For whatever reasons, they just did not give us much trouble, and some-times even helped us recruit their husbands' parents.* The only exceptions to this were cases in which the wife and the IP's family of origin were openly antagonistic toward each other. In such instances our research design dictated that we concentrate on involving the family of origin (since they, but not the wife, were required to attend the evaluation session), and bring the wife in after treatment began.

THE NONBLAM1NG MESSAGE

When these families are approached they often feel frightened, de-fensive, and guilty. At some level they know they are to a great extent to blame for the problems of the IP. Thus they are ready to hear blaming from the therapist. They anticipate it, and often attempt to deny or avoid the blame they fear the therapist will place on them by diverting it to external influences such as peers, the neighborhood, or the treatment program. The therapist's task is to get beyond this stumbling block and reduce resistance arising from fear of blame.

Principle 10: The therapist must approach the family with a rationale for treatment that is nonpejorative, nonjudgmental, and which in no way blames them for the problem. This requires skill. Some responsibility is being ascribed to the family by the very fact that they are being asked to become involved. There is an implicit message that the family has not resolved something with one of its members. Consequently, the therapist must approach them in a nonconfronting way, which gets them off the hook, thereby re-ducing resistance and making them more amenable to hearing what he has to say. Our experience is consonant with that of Vaglum's" that family members should not be treated as -patients,- but as "healthy- people who, themselves, are without problems. Under no circumstances should the therapist become involved in a struggle with the family over whether they are the problem or not. Instead, he should allow them to become acquainted with him in order to remove mystery and fear; if they sense that he is both genuinely concerned

and not out to put them on the "hot seat,- they will be more agreeable to his requests.

Vignette 12. In this case the therapist (Jerry I. Kleiman) underscored the parents' martyrdom, talking about all they had been through and how their son never listened to them. He emphasized repeatedly that the son did these things despite "all they had done so far." He empathized with the father's plight—nobody listened to him, people kept secrets from him—and told him it was time for this to stop. He talked to the parents as victims, telling them that there was a need for them to be in control of the situation.

Principle 11: Primary focus should be on helping the index patient rather than the family. This approach stems from the work of Haley, and is described in Chapter 6. It has also been applied by others with these families."' '8" Again, the emphasis is on joining the parents in helping their son to "be the kind of person he can be.- To the extent that the therapist ever takes a blaming stance, it would be in this context. He might join the parents in mildly blaming the IP for the problem. Alternatively, he could state, -No one is to blame.- Or, he might emphasize how difficult it is to get off drugs, and, -Your son needs all the help he can get." The family is then redefined as a group that can help the IP, rather than one that causes his problem. Vignette /3. In this family the therapist (Jerry I. Kleiman) empathized and shared with them. He got them to admit that with all they had done so far, they had not been able to help. He suggested that maybe this was an opportunity for them to teach their son what the world is all about.

Vignette 14. The therapist (Jerry I. Kleiman) talked to the father about his goals for his son. The discussion had a kind of "reparenting" flavor, as the father talked about his lack of success both with his son and in general. Kleiman suggested that perhaps this program would give him a chance to succeed in a new way.

Principle 12: The rationale for family treatment should be pre-sented in such a way that, in order to oppose it, family members would have to state openly that they want the index patient to remain symptomatic. While not necessarily easy to do, succeeding at this task can greatly facilitate the recruiting effort. If nothing else, the family may come in to disprove an implication that they do not want change. It sometimes helps to begin by -ascribing noble intentions- to the family (see Chapter 6): -Of course, your goal is to see him straighten out.- In fact, the therapist ought to operate under the assumption that the family wants to help and desires to see the IP get better. He has to believe that, in the end, the parents really do not want a drug addict for a son. If he implies that they do want an addicted son, he will have a battle on his hands. If he is able to avoid such an altercation, the therapist can instead proceed with establishing his case for family treatment, using strategies of the sort described in other sections.