OBSERVING
SEQUENCES' AND "ENACTAMNT-DURING SESSIONS
Haley65 has placed particular stress on the
importance of symptoms in regulating sequences of behavior in the family. As
described in Chapter 1, drug taking and related behaviors often occur in response to parental conflict and
have the function of pulling the parents back together. The symptomatic
behavior of other family members (pa-rents, siblings, grandparents) also has an
important regulatory func-tion in these sequences. For example, a mother's
depression may serve as a signal that her son has become too independent, or the
father may begin to
complain about heart pains when conflict becomes too extreme.
It is best for the therapist to be able to
observe these sequences directly, in the session. Videotape is invaluable in
this effort, since subtle signals can trigger almost instantaneous
changes. Actual drug taking in sessions is rare, but there are
frequent examples of drug-related behavior. This includes various forms of
acting out, such as impulsive, angry outbursts, leaving the
sessions, or threats of shooting up heroin. Equally important is acting
incompetent (i.e., depressed, uncommunicative, helpless) or irrelevant.
Frequently, we have also
noted behavior by the
IP that serves to remind the family that he is a drug addict, such as nodding and scratching.
When these behaviors occur in a session, it is important to formulate hypotheses as to
the function they serve in the sequence.
The therapist might want to ask himself, ( I )
-What was happening prior to the symptomr (watching especially for
indications of parental
conflict, or pressure on a parent to change); or (2) -What new pattern of behavior is produced?” Often in such instances the parents become united against the addict ("detouring attacking-) or
attention is diverted into a
familiar and unproductive fight between the addict and one parent. Information about events outside the session can be helpful in confirming and elaborating
the hypothesized sequence. It is essential to collect factual data about the events both prior
to and following drug episodes, since it is unusual for families to be aware of their own sequences. Once a sequence has been tentatively identified, the thera‑pist can move
in the session to block its usual run. For example, he can elicit parental conflict and then prevent the
addict from interrupting and diverting the parents' attention. Finally, as
Hoffman" notes, all aspects of
the repetitive sequence may not have to be shifted, but only enough of them to cause the symptom to disappear.
It needs to be emphasized that this therapy is
concerned with the repetitive
interactional patterns that maintain the drug taking. The thrust of treatment is to
alter these sequences. Although
it is inter-esting to speculate about the etiology of drug abuse, it is
our experience that historical data are
generally of very
little utility in actually bringing
about change.
