POTENTIAL TRAPS
AND PITFALLS
Many of the potential traps
and pitfalls in this treatment, such as
getting
diverted by side issues or dealing prematurely with the parents'marriage, have been
delineated. At the risk of repetition, several of them are emphasized and
embellished here.
Avoiding
Power Struggler
At all times the therapist should avoid power
struggles with the family, for he will always lose in the end and
treatment will falter. One way of preventing this is by going through the appropriate hierarchy—usually the parents—when moving toward
change. For instance, in Chapter 10
the therapist first gets mother's tacit approval (father is not present) before challenging the addict about his
con-tinued use of illegal drugs; the therapist makes sure that mother will not oppose him on this. In Chapter 11, the
therapist takes a different tack and
waits the parents out; rather than goading them into taking a stance against the addict, or confronting the
addict himself while the parents are still tentative, he gives the
addict enough rope to hang himself—through a
series of dirty urines—and lets the parents finally rise up in protest against their son's conning
behavior.
Before the family
becomes involved in treatment, the therapist may have to exert some effort in joining the addict on a one-to-one basis
(see Chapters 3 and 4). At such times it is not usually fruitful to strongly challenge the addict about the goals of
therapy or get locked in some other kind of rigid stance with him, partly
because this will usually make him
less willing to include his family in therapy. How-ever, once the family is engaged, the therapist
should be much more hesitant to see
the addict individually, especially before progress has been made toward becoming drug-free. It is our
experience that parents are usually
more in favor of the addict's stopping his use of drugs and methadone than is
the addict himself. Since the therapist wants them on his side and wants to shift responsibility to them, the move toward stopping drug taking will be much more
potent if they (and he) unite against
the addict on this issue. On the other hand, if he sees the addict individually he will not have this major source of leverage available and can be more easily drawn
into a one-to-one struggle over
medications, goals, and so forth. This is a divide-and-conquer move by the
addict, and the therapist must remain alert and wary in order to anticipate and neutralize it.
It
may help the therapist avoid the pressure to see the addict individually if he
remembers that the addict's behavior is protective of the family and is not just an attempt to
manipulate him. Many of the addict's actions seem to be based on the
assumpt on that the therapist will criticize and upset other family
members without ac-complishing anything worthwhile. However, if the
therapist is em-pathic to the family members, and joins well, he can obviate the family's need to be
protected by the addict. In this way he nullifies many of the addict's
attempts to triangulate (such as screening and distorting communications
between therapist and parents, making himself overly central,
etc.). He engages each member directly, making of the status quo.
it more difficult for the
addict to serve as a go-between or as defender
Avoiding Increased Resirtance
We have emphasized repeatedly that there must be
no blame of the parents in this therapy, and that resistance can
often be neutralized through noble ascriptions and, as in Chapter 12,
by eliciting and gradually increasing parents' competencies.
Blaming parents usually results in swift and premature termination of
therapy.
A major strategy for avoiding resistance is to
stick with the presenting problem. When side issues are raised
by family members—as they often are—the
therapist can avoid getting lost by reorienting the therapy and returning
to the primary symptom. In fact, there may be points in therapy when
the therapist is deluged by a flood of competing agendas from
equally vocal family members. At such times
the symptom may provide the only lifeline
preventing him and the therapy from getting swept away.
When secondary or superfluous side issues are raised, it is i in -
portant for the
therapirt to raire the question, -flow does thir relate to his drug
problem.2- before the family does. If he gets enticed into a
side issue and a family member beats him to this question, he will look foolish and may lose ground in his effort to bring about change. His credibility may be questioned, resulting in erosion of their respect
and slippage in his base of leverage.lt should be remembered that if they entered therapy to
deal with the drug problem, they will be distracted from this goal. much less cooperative with
a therapist who waffles or is easily -Spreading the problem" is another pitfall the
therapist must avoid. This technique was particularly prevalent in family
therapy's early days, when therapists tended to emphasize, for
example, that an
IP's siblings had problems, too. However, Haley65 has cautioned against such an intervention because it usually
succeeds in making the parents feel worse. They might think, -We went
into therapy with one problem and we came out with three!" Consequently, they may end up by increasing their
attack upon the IP because he has caused them to be put in a situation in which
they are accused of being even more "awful" for fostering a second, or
even a third, problem child. Further, spreading the problem to include a
parent (e.g., for drinking too much), in addition to the IP, is also
fruitless, as has been discussed
earlier.
Another practice that frequently engenders
resistance is when a therapist works toward developing
"insight" in family members. The methods normally used to
invoke insight often appear demeaning to family members, as if the
therapist is trying to undress them emo-tionally or get inside their
psyches. Thus they respond with irritation and defensiveness. Addicts'
families are usually much less concerned with intellectual insight
than they are in seeing the presenting prob-lem alleviated. They cannot
readily explain ''why'' they do things—especially the kind of
"whys" that many therapists prefer. Conse-quently, they see this tack
as a subtle form of blaming or putting them down in which the therapist, with
his advanced education and -knowl-edge,- comes across as a smarty-pants who
makes them feel inadequate and guilty. Since change can come about through
directly altering the family structure and sequences—much of which
occurs outside the members' awareness—we do not consider insight to be a
worthwhile goal. In fact, the first author (Stanton) has noted elsewhere
'5" that intellectual insight, if it occurs at all in therapy, not
infrequently lags about 3 months behind actual change, and thus is
obviously not necessary for transformation in such cases.
