The Holistic Solution To Addiction and Emotional Upsets - Page 2

By Cathy Cassata 06/06/14

Family therapist Doreen Maller shares her innovative approach to treating families challenged by addiction or trauma. A Fix interview.


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What happens after you identify a problem?

I approach these situations from a family system perspective, and I try to answer the question, “what is this family going to do next?” I agree with the notion that you can’t do anything that the person with the problem doesn’t agree to, but I also believe that most people lack the intrinsic knowledge of know how to navigate their health insurance, and what is available in different step levels and programs for detox and substance abuse. Sometimes I’m just informing patients about their options like AA, or outpatient and inpatient programs, and helping them find what’s right for them.

For example, people can land in programs that don’t seem to be helping. Helping a family  understand that systemically there are protocols to follow because insurance often covers the lowest levels of intervention before they fund more intensive levels. The therapist can help reframe this experience to explain that when an approach doesn’t work, it isn’t exactly a failure, but rather a mismatch, and then give support to the client or family to navigate the insurance system toward a more appropriate level of care. 

What specific approaches do you use with families in crisis?

As a family therapist, I am often the first contact a person or family has when they initially realize that they, or someone in the family, has a problem. So a lot of my work is helping with the realization of the issues and finding other community resources for people as they move toward recovery solutions. If I’m talking to someone in the family who isn’t perceived to have the problem but is looking for help, I use Elisabeth Kubler-Ross’s stages of grief model quite a bit. Denial, anger, bargaining, depression, and acceptance can provide a road map of what the journey might entail. When I explain to an individual or other family members that they’re not the first people who have dealt with an addicted family member, and that people have really thought hard about the processes around getting through this, sometimes the idea that they’re in a process makes the whole thing less isolating. 

I also use the change wheel. Before I tell people “this is what you can do” and “this what interventions look like,” I explain the wheel. In many families, the person they are concerned about is not even considering change, even though others in the family are growing impatient. Using a visual tool like the change wheel explains that. There is a whole process of preparing to make changes in your life which is about the first half of the wheel, and then making the change is the rest of the wheel.

Once, I worked with parents whose child was serving a two-year sentence at a therapeutic boarding school. I was going through the cycle of change with the mom and she said, “I’m ready for change, my daughter’s not even thinking of change, my husband is saying ‘how come we all haven’t changed yet?’ and my other kid is just frustrated. So here we have this wheel of change, but everyone in the family is managing it differently.” I thought that was brilliant. When treating one person, it’s easier to tell where they are on the wheel of change, but in a family system, everyone is in different places. It adds to the complexity of the problem. 

How do you get family members to connect when they’re in different stages of change?

As a relationship expert, the challenge is to teach people how to communicate with each other, because often when you’re dealing with families in crisis, people aren’t talking to each other, and there may be a lot of manipulation, anger and resentment going on. Getting people to talk about how the family is in crisis is the first step. We can start the conversation with one person or more.

Using a systems approach, if you change one person, you change the whole system. If you start with one person and that person begins to change, there is this hope and possibility that the whole the system can change because one person is changing. If you raise consciousness and awareness in one person, this opens up the possibility that things can be managed differently. If everyone can admit that the family has a problem then you can begin the process of addressing the problem. This may involve sending the family to AA meetings or codependency meetings, or helping to change their ways of socializing. 

Have you ever had a child come to you about an addicted parent?

When I was an intern, I ran a drug and alcohol rehabilitation model for juveniles after their first arrest. Instead of going to juvenile hall, they came to me for 10 sessions. I did this for about two years and met with about 90 kids. I’d ask them questions like “who was the first person who turned you on to drugs?” It was eye-opening. What was most interesting though was that many kids who I talked with were telegraphing for the family system.

We call this the “identified patient,” meaning that sometimes a kid is pulled into therapy because of misbehaving or failing in school, and it turns out the kid is having a problem because the family is having a problem. In these cases, a child is the family’s gateway into the mental health world, and a gateway into a system of care for the whole family. Working with a family to understand the impact of the parent’s behavior on the child is a critical component of family work.

How do you uncover family issues in these situations?

If you’re only addressing the child’s behavior, you could miss the much bigger issues. In my early years as a therapist, I had many kids who were expressing violent behavior in their classrooms. I noticed that everyone was melting down around 11:00 AM, and I hypothesized that it was because they were hungry. I started digging into the family system and trying to understand why the kids might be hungry. I learned many different reasons. Some weren’t eating breakfast because their parents were in jail for substance use, and no one in the family was feeding them regularly. Others lived with a grandparent who was busy taking care of other grandkids, too. Some were living with a parent with a substance issue.

Managing a family that is affected by use and addiction is very difficult. In many cases, we had to involve a larger system such as family services. While working with a child on behavioral issues is necessary, deeper systemic change can only happen by including the whole family and working with the parents to understand the impact of their choices on their kids. Working through the feelings and emotions of this takes time. 

It seems that you truly believe in the holistic approach. Can you explain why?

Issues of addiction, emotional distress, trauma and family issues are very complex. I believe that complex problems require complex interventions. The holistic approach challenges the care provider to consider many aspects of care, compassion and connection. It encourages the therapist and the family to work together as a team toward family stability and strength.  Working this way allows me to continue exploring options with families and promote hope in their road to recovery.

Cathy Cassata is a regular contributor to The Fix. She last wrote about John Norcross and video game addiction.

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Cathy Cassata is a freelance writer who writes about health, mental health and human behavior for a variety of publications and websites. She is a regular contributor to Everyday Health and Healthline. View her portfolio of stories at Connect with her on Twitter at @Cassatastyle.