RESTRUCTURING
The most basic restructuring move in this therapy—and one empha-sized repeatedly in this volume—is to get the
parents or parent surrogates to work
together vis-a-vis the addict. If this is not done, the basic triadic conflictual pattern between the
IP and parents will persist and
treatment will probably fail.
In addition to obtaining parental
consensus on goals, there are other
restructuring moves that can be implemented, often concomi-tantly.
A number of these are demonstrated in the succeeding chapters. Usually they are used as intermediate moves en
route to getting the parents to work
together more directly. For instance, Haley" (see also Chapter 7) and the Milan group136 often have
parents alternate in taking
responsibility for the problem person; for example, each parent takes charge for a given period
such as a week, or they rotate between odd and even days during the same week. We
have not applied this method with any
regularity in our work with addicts' families, but it is an option worthy of
further exploration.
In cases
where, for example, a mother and son are overinvolved, a common strategy is to get the father to take
charge of the son (see Chapters
7 and 10). This requires that father and son relate differently in some way, and such an experience must usually be
engineered within
a session before it
can be generalized to the home situation. It may be possible to get them engaged in discussing some common interest, such as work, fishing, and so forth. The
mother should be present
during this exchange and may need the therapist's subtle support while her husband and son are engaged. For
instance, the therapist
might sit next to her, keep her from interfering in the father-son interaction,
and quietly comfort her with statements such
as, "They need this [talking
together"- or, -You know, you are right.
They don't get enough time to talk
together as father and son.-
Other tactics may also be used, depending on the
specific clinical situation. When it
appears that the mother endorses the drug be-havior of the IP, with the
father consistently more punitive, it may be possible to force the mother to
deal with the negative behavior of the abuser,
thus breaking the alliance with him. Alternatively, the thera-pist may meet only with the parents to formulate a
strategy to which both parents will
adhere.
Another approach is to shift the roles of the
parents to, for example, either those
of grandparents (rather than overinvolved parents), or of parents to any younger children they might have ("You can let him go because you have these
other kids to worry about").
Further, if the parents are retired or near retirement (Chapter 11), the therapist may want to work with them on
planning this stage
of their lives.
Because of the nature
of the AFP research design, most of our work has been with families in which two adults of different sex were involved, either as parents or in quasi-parental
roles. In cases where only one
parent is available—usually the mother—the process differs somewhat.'" Here, the therapist may
temporarily have to fill a parental
role toward the IP, and at other times must assume an almost spouse-like role toward the parent. Often
the latter is a way of substituting
for the pseudospouse role that has been played by the abuser. The next step is to develop alternative
structures and supports for the
parent through inclusion of relatives, friends, and so on—in other words, to establish or strengthen the natural
support system. In this way the parent will be less dependent on the IP
and able to move toward greater
disengagement, while the therapist will also be able to gradually disengage. When applicable, another
approach is to help the parent get a
job or develop more outside activities. Still another, stated above, is to transfer some of the attention
from the IP to any younger siblings
remaining in the family. Again, joining with the parent is a crucial part of the process, and under no conditions should the therapist become engaged in a direct power
struggle with the parent over separation with the IP.
