Ideally, the initial interview should end on a
positive and hopeful note, with a
clear strategy defined with the addict on how to contact the family for the first family interview. The
therapist works out a time with the
addict to contact his family, preferably when all members of the family (including the addict) will
be present. It is also important to
allow the addict sufficient time to discuss his knowledge of the family-treatment program with them.
There
will, of course, be situations where this ideal outcome cannot be achieved and the therapist cannot get the
patient to budge in the initial
session. -Stalemate" encounters are usually the result of the patient denying the therapist access to
information needed to construct the
framework for placing the drug problem in a family context. The interview structure presented may not
elicit all relevant facts in any area, but its application does ensure that the
questions of
patient off' to therapy.
If these strategies
are not effective, the therapist can postpone further discussion, possibly even
for a week or two, while the patient -thinks
things over.- Or, the patient might be told to return -when he's ready to make a move.- This last tactic is
most workable when the therapist has
some form of leverage with the patient, such as control over medication or liaison with the physician who has this control. In such instances he can withhold small
changes or privileges until the
patient complies. However, it is best to reserve use of this tactic, making it a last resort when all else fails
to work. It should not be used more
than once, and care must be taken that it does not fall into the category of
denying the patient treatment to which he is entitled.
CONCLUSION
In conducting an in tial interview with a
drug-dependent individual, a therapist
must deal with three major concerns. First, he must demon-strate his understanding of drug dependency in
general, and this patient's drug
problem in particular. Second, he must show a willing-ness to help the patient formulate and realize
concrete plans for a better future.
Third, and most important, he must be able to convey throughout the course of the interview a sense that
he is competent in this work.
Unwillingness by the patient to involve his family in the task of getting him drug-free is minimized when
these concerns have been dealt with
in the context of the initial session. The general structure of the interview process is schematized
in Table 1.
The model described here structures the contents of
the session in a manner that maximizes
the likelihood that these concerns will be brought out and discussed. It should be noted, however, that all the model actually provides is a form of technical
assistance. We are not suggesting that
it supplies answers in itself, or that it in any way reduces the responsibilities of the therapist. Each
patient will have unique aspects to
his problem. He will discuss these in unique ways, and the therapist should respond uniquely.
We
have used this model successfully throughout the life of the AFP in recruiting families through the IP.
Although it was developed with heroin
addicts, there is no reason why the procedures described could not be applied to other kinds of family
problems. In fact, adult
We
have dealt, here, with the first interview and have not discussed the next step of actually contacting and
personally re-cruiting family
members; this is covered in Chapter 5. When the therapist is allowed to contact the family, the question of why they need
to be involved in treatment will become an important issue. The initial, individual contact is crucial, however,
in helping the patient to shift from
perceiving his problem solely within the traditional treat-ment setting to viewing it as part of a family
context.
