USING CRISIS INDUCTION

THIS CHAPTER is a clinical presentation of brief family therapy with a case in which the index patient (IP) had used heroin for 9 years and been chronically addicted for 7 years. It emphasizes ways the therapist can prepare and use crisis induction to bring about  change. The rationale for using crisis inductionm2 rests upon the observation that family patterns of interaction are often stabilized by one member of the family acting in an extremely dysfunctional, life-threatening manner, such as shooting heroin. The recurring pattern

  of the addiction cycle has been described in Chapter I ; basically, it is a process in which the addict creates a crisis related to drug usage as a way of distracting family members from more threatening inter- personal conflicts within the family. As noted in Chapter 6, the therapist can get this pattern -unstuck- with some families through basic restructuring moves within sessions, such as blocking dysfunc-tional interactions between the parents and refusing to allow typical unproductive patterns of focusing on drugs. However, some families are more staid or homeostatic than others, remaining relatively un-moved by standard interventions. In such cases the therapist may have to intensify his interventions in order to get the family beyond their impasse-like stability and allow them to progress. Thus he intentionally induces a crisis, thereby temporarily unbalancing the family system. In this way he -opens the system up,- providing the opportunity to make significant changes in the way parents align themselves in the family hierarchy.

 CASE MATERIAL

The IP in this case, Jim, was a 23-year-old male of Italian-American extraction whose father was a repairman and whose mother was a homemaker. Jim had an Ilth-grade education and had served 2 years in the Army. Prior to treatment he had been arrested once for burglary, but the charges had been dropped. Although he had not been otherwise apprehended, he occasionally engaged in shoplifting and drug selling to sustain his habit.

Most of the transcriptions in this chapter are taken from the ninth session, in which a crisis was planned and implemented. To assist in understanding the context of this session, excerpts from the initial meeting between the addict and the therapist are first pre-sented. The dialogue below takes place when the two of them are alone, having just met for the first time. Earlier in the day, Jim had been told by personnel at the Veterans Administration Drug De-pendence Treatment Center (VA DDTC) that the therapist would be his drug counselor and would be in charge of his methadone. As this session continued, Jim became more agitated and com-plained of feeling sick. He gave permission for the therapist to phone his home and both parents were home. The therapist introduced himself and explained to the parents that their son had entered a new drug-treatment program that involved participation of the entire family. The parents were asked if they would come to the clinic immediately. The parents agreed, but said that only they were coming, not the daughters or grandmother.