WORKING WITH ELDERLY PARENTS

14 Haziran

IN PREVIOUS CHAPTERS it has been made clear that the course of drug addiction is strongly linked to certain characteristics of family life experience. Age is one such factor. A drug problem frequently emerges at the time in life when a passsage is anticipated from the dependency of youth into the self-reliance of adulthood. The integrity of the family of origin may be threatened by a member's shift toward autonomy. In such families, the onset of a symptom that postpones this passage may constitute a -solution,- postponing or avoiding the greater family crisis (see Chapters 1 and 4).
An addicted eldest child presents a powerful example to his younger siblings of the -dangers" that lie beyond the family circle. On the other hand, should the first child manage the transition to adulthood responsibly, increased pressure might come to bear on the second and later children. The youngest child may be forced to travel the hardest route of all, becoming the final link in making or breaking the future viability of the family—now reduced to the husband-wife
dyad.
While the age configuration among siblings is an important factor in determining which child becomes addicted, the effect is mediated by the age of the parents. Parental age warrants deeper consideration in clinical diagnosis and treatment than it has received from many family therapists. Any strategy adopted by the therapist will either support or undermine the plans and ambitions of the parents for their children, the children for their parents, the parents for themselves, and the children for themselves. If the therapist is insensitive to the fact that not only the addict but the entire family experiences critical life cycle transitions, his approach may blindly  ignore the relative needs of some family members, or set off their needs against those of others (see Chapter 4).
In contrast to the extensive clinical material of the other cases in this book, the present chapter is more narrowly focused. Emphasis is predominently on issues pertaining to parents who are elderly and the difficulties involved with the addict's leaving home under such conditions.
Implicitly or explicitly, parents who are left with an addicted adult child at home usually indicate discomfort at the prospect of that child's departure, despite his age. The operations of the therapist must give credence to the parents' hesitancy, without giving them the impression that their reluctance is right or wrong. While their ex-pressed concern is for their offspring, the underlying issue is com-monly protection of their own interests. However, this is usually outside of their awareness and they focus instead upon the addiction. The parents' point of view is that it would be irresponsible for the child to leave home before he is fully "responsible- for his behavior.
The parents' position constitutes a contradiction, or paradox, that severely limits the child's chances of attaining independence, though it is rarely recognized as such by any member of the family. In effect, the admonition keeps the child from acquiring the conditions or status needed to exhibit responsible behavior, or to have the parents perceive it as such. The addict is in a bind in which it is impossible to leave home responsibly or to demonstrate responsibility at home (see Chapter 1). Therapy with families of this sort must seek to change the conditions that keep the child and parent bound in interdependent positions. The paradox must be broken before a new manner of relating can be established between family members. Following one case through the course of therapy, we can see how the therapist moved toward this objective of breaking the paradox, and how the factor of the parents' advanced age was handled in relation to this task.  
CASE EXAMPLE INDUCTION
The addict, Paul, was the only son in this Black, middle-class family.

He was age 25, had served in Vietnam, and lived at home with his
mother and father. An older sister was not living at home, but had 


regular contact with her brother and parents. The addict had begun drug use as a business venture (i.e., dealing) after leaving the service. He was successful, and increased his personal use of heroin. After several years, he began to see the habit as harmful and tried twice to detoxify, unsuccessfully. He had had several arrests, one of which was pending trial at the time that therapy began. He said that he was now motivated to detoxify and intended to enter school and find a job as
soon as he finished.
In the first interview between the client and therapist (Peter Urquhart) the client indicated that his home life was good. He felt his parents were a strong, positive influence on him, and saw no problem in having them enter therapy. Throughout this interview the client presented a tone of cooperation. Urquhart did not attempt to persuade; rather, he conveyed the idea that the requirements of therapy were few and obvious to both him and the client. These were: the manage-ment of medication, gradual detoxification, and active involvement of the family. The therapist's manner dovetailed with the client's stance of cooperative, responsible participation: there was no confrontation, no question that the therapy should proceed any differently than the therapist had described it. Following through on this continuity, the therapist obtained the client's assurance that he would be responsible for bringing his parents in for the first family session—which he did
within the week.*
FIRST FAMILY SESSION
The therapist began therapy with the family by asking the client to discuss his personal goals (described to the therapist the previous week). The client specified two goals: (1) detoxification, and (2) completion of a correspondence course, to obtain a decent job. In keeping with the earlier spirit of cooperation and responsibility, the client said that he believed he could finish the course ahead of schedule and be employed within several months. At the outset of therapy, then, he was already presenting a fairly specific set of goals. However, means for accomplishing these goals remained undeveloped at that point. (Getting the client to articulate such goals will take more work in many families, but needs to be accomplished as early as
possible in the therapy.)
When the therapist asked the client's father and mother, respec‑
tively, what their goals were for the family, neither could respond other than to say that they wanted to see their son -straighten up-and stop "sliding back." They clearly had not thought or talked about what life on their own would be like after their son left home. Their attention had become fixed upon the son and his drug problem. Yet, they had difficulty defining this problem in terms that could be adapted by the therapist into goals supportive of the client's own
plans.
Two key transactional problems were manifested during the
parents' discussion of goals. First, it was learned that the father had recently retired. He was presently spending 4 to 6 hours a day in the company of his son, even driving him to the drug-treatment pro-gram to pick up medications.* Second, the therapist observed that the mother cut in on the father's communications with the son (in the session and at home), redirecting it toward the drug problem. The therapist asked the client how he felt about these tendencies of his parents. The client responded that he saw them as positive—as signs of concern and caring in a close-knit family. This clarified that, at least on the surface of their relationship, the mother, father, and son had evolved a durable status quo with one another since the onset of the son's drug problem. The son recalled that his parents had been
steady and helpful all through his life.
Further inquiry by the therapist brought out that the household
rules were set by the mother: both the father and son stated that she permitted no fighting or other bad habits in the house. The mother confirmed this, and indicated pride in having maintained order at home. There is an irony implicit in this statement, given the nature of the client's drug problem, that became explicit slightly later in the session, when the therapist asked the parents how they adjusted to life without children when the son was in the service. It seems that the father at that time worked two shifts daily. He was almost never at home during the day, and the mother was quite lonesome. She indicated that the experience was not at all pleasant. To establish a base for the client on the issue of leaving home in the future, the  therapist stated that he assumed this would be a goal after the detoxification was completed, something the parents would have to consider more carefully. The client agreed, adding that he wanted to get married, too. The father's response was critical; he indicated that the son needed to be able to take care of himself before he could even think about leaving. The father recalled that in his own life he had carried this kind of responsibility for 35 years.
The paradoxical nature of this criticism is apparent: the son should not be permitted to take care of himself, says the father, until he is able to take care of himself. Yet, the father gives no indication of how the son could demonstrate this competency. Nor does the father indicate that he should offer guidance to the son in this matter, despite his own wealth of experience.
Mother's statements in this same discussion revealed further aspects of the paradox and its function in family relations. When the therapist asked if the closeness among family members would present a problem in the client's leaving, she stated that she saw her son's goal as fine, that she would do everything she could to help him leave: give him money, food, clothing, and so forth. The strings implict in her -good will- were not apparent to the mother or the father. The parents revealed that the client did not presently have to pay them room or board, just -take care of himself- (another facet of the paradox). This arrangement effectively deprived the client of any opportunity to demonstrate responsibility: the parents' accommoda-tion of their son was warm and loving, yet it provided no area where independence or personal success was sanctioned, and placed no obvious values on autonomy. So long as the son cooperated with this complacent ethos of the parents, the status quo would remain. Neither he nor they would grow, and the family system would remain at its
present life cycle stage.
The atmosphere of the discussion changed sharply when the therapist informed the client that his urinalysis for the past week had come up dirty (indicating illicit drug use). The parents did not under-stand what this meant and the therapist asked the son to explain it to them. The client equivocated—blaming it or, the treatment system. Since his own urines were surely clean (he asserted in a "cooperative-tone), another patient's urine specimen must have been confused with his. Here, the theme of goodness and cooperation, so carefully nurtured elsewhere in the client's relationship with his parents and  the therapist, was breached. If appropriately followed through, this topic area could be used by the therapist to demonstrate to the parents that the son's expression of good intentions is not always to be believed, leading them toward a better grasp of how to evaluate his problems and how to respond to them. The therapist, working from the strength of the cooperative spirit developed up to this point in the therapy, could now be explicit without being confrontative. In this first session, however, he merely indicated the discrepancy between the urine report and the client's story, and let the client's explanation stand. In later sessions, should the urines remain dirty, he would still be able to come back to this discrepancy and use it further.
JOHN M. VAN DEUSEN PETER URQUHART

Artikel Terkait

Next Article
« Prev Post
Previous Article
Next Post »

Disqus
Tambahkan komentar Anda

Hiç yorum yok