CONTACTING THE FAMILY
It should be noted that not every family fought bitterly
against being involved in treatment. Some of
them were pleasantly surprised to be asked, and glad to participate.
They may have resented being excluded when
their son had been enrolled previously in a treatment program. These families were obviously not difficult to
enlist, so the remainder of this
discussion will deal with resistant families. It should be kept in mind that the therapist was working toward
involving both parents and any siblings living in the home or nearby. A problem
unique to
Principle 9: The therapist must get
past the index patient and directly contact each family
member, or at least both parents; if, prior to the first session, he can obtain from them an agreement to participate, the chances of their actually attending are increased
markedly. This is an extension of Principles 3 ancl 4 and
is our other cardinal rule. We cannot
emphasize enough the importance of getting the IP out of the middle in this task, so that the therapist can obtain individual contracts with each member. This takes
pressure off the IP for anything that
(it is feared) might happen later in therapy. The family members cannot charge him as readily with,
-You got us into this,- because each
of them shares responsibility for agreeing to participate. In other words, it allows the therapist to deal with, and counter, their fears firsthand, rather than
leaving this task to the IP. Also,
the IP is not put in a position of indirectly blaming them by stating that he wants them involved in treatment.
The two major vehicles for contact we have employed
are heavy use of the telephone and home visits. Once the therapist gets past
the IP, he should make as many calls
as necessary to other family mem-bers. This might entail calling parents
at home or work, in the day or evening. If
there are two telephones in the home, it is advisable for him to set up a conference call involving both
parents.
Upon making telephone contact, the therapist can
introduce himself to the family in a
friendly way by saying, -I guess by this time your son has had an opportunity to tell you a bit about our program.- It is best not to get into therapeutic issues over
the phone, but if they are presented,
to emphasize the importance of a family meeting around the problem. Where there is a difficult member to engage, it is
wise to ascertain which family member is crucial in excluding this member and
to find a way to put the responsibility for recruitment on the member who is supporting the exclusion. For
example, where the mother has an
interest in excluding father, it may be advisable to approach father through
mother. One way of doing this is to say to the mother, would like to discuss the program with your husband, but I would like you to discuss it with him
first.- This has the effect of respecting
mother's authority, but at the same time placing some responsibility for father's inclusion or exclusion
on her. It also pro-vides the
therapist with a clear understanding of how differences
between the couple are maintained. In cases where
there is a member of the extended family about whom the parents
differ, the therapist can approach the spouse who is allied with this
person and then negotiate this with the couple. For example, when
mother and father are divided about the maternal grandmother, it
is helpful to say to the mother (in the father's presence), "Well,
she is your mother, and you know her best, so why don't you try to contact
her first? If this doesn't work, the three of us will try another
approach.- This has the effect of hinting at the marital difference, while at
the same time develop-ing an atmosphere in which these differences can
eventually be worked out between the parental couple and the therapist.
Since it is quite easy to become involved in major
therapeutic issues over the telephone,
this should be avoided whenever possible. This is more difficult when a family is in acute crisis—for example, when the mother cannot come to a meeting because
the grandmother is in the hospital due to a heart attack. The therapist needs
to be seen not only as collaborating
with the parents in organizing session attendance,
but also as clearly in charge of the timing and content of such sessions. The resolution of issues that
maintain the presenting problem
should be orchestrated by the therapist, utilizing the de-veloping alliance
between himself and important members of the family. As the therapist contracts with the family for the initial session, other family issues may be acknowledged,
although, as noted in Principle 11,
the primary focus should remain on the presenting problem, usually the addiction, which is the
reason for bringing the family
together.*
In
about a quarter of our cases, home visits were made. Usually this was done when the parents were particularly
resistant or hard to get in touch
with. Sometimes the therapist would visit the home if he felt he was getting -stalled in the front office,-
for example, if he sensed the
parent(s) might be home, but the person answering the phone said they
were not. The home visit has the advantages of con-veying the therapist's true concern and interest and also in allowing direct, person-to-person contact. If the family
meets him and finds him to be personally acceptable, accepting, and
nonjudgmental, they might be more willing to attend. Fear of the unknown is
assuaged. They can be more assured
that the therapist is not out to -get- them.
