IMMEDMCY AND PRIMACY OF CONTACT

IMMEDMCY AND PRIMACY OF CONTACT

One of the difficulties encountered in engaging addicts' families in a

program described by Ziegler-DriscolV" was that family treatment could not begin until the IP had completed a therapeutic community (inpatient) program. This had the double disadvantage of starting -treatment- when the client was supposed to be "cured,- and also of reinforcing the idea that the problem was the patient's, not the family's. Another hindrance, noted with nonaddicts' families by Sager and associates,126 and others, was the frequency with which clients were passed from one agency or treater to another. This reduced the chances for family engagement. We ran into these problems also, albeit to a lesser degree. Of central importance is the immediacy with which both the IP and family are engaged.

Principle 5: The closer the family therapist's first contact with the index patient is to the time of intake. the greater are the chances for recruiting the family. We discovered early that this was a critical variable. If the family therapist cannot see the client on the day of intake, he should set an appointment for no later than 2 or 3 days afterward. At the very' least he should be able to manage a brief telephone conversation with the client prior to the actual meeting. We were sensitive enough to this issue to eventually equip therapists with beepers. In this way we increased the chances of contacting them immediately and having them talk to the IP over the phone, should they have been unable to come to the drug-treatment clinic that day. This procedure added to the urgency of the situation and was a sign to the client that the therapist was sensitive to his need for help.

Principle 6: The earlier the family therapist enters the chain of -treaters" encountered by the client, the better are chances for family recruitment. As noted in Chapter 3, we observed that a kind of -imprinting- process occurs during the intake period, whereby the client attaches strongly to the first person (or persons) offering him help; this person appears to have much more leverage with him than do those who deal with him later. Consequently, if the therapist does not want his influence diluted, he should try to be among the first in the line of treaters with whom the client will come in contact.

Principle 7: The sooner the family is contacted, the more likely they are to be engaged. This conclusion is obvious from the above discussion, and has also been emphasized by Davis.37 In addition, it speaks to the possibility that the family may be in crisis (see below, and also Chapter 4) and more amenable to help at the time of intake than later on; the therapist has greater leverage because defenses are most vulnerable and the family is more in a posture of requiring help. This is the best time to expect everyone to come in.