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Heal Your Addiction by Making a "Constellation" of Your Family System

By Karen Carnabucci LCSW TEP 01/21/16

The innovative family constellation technique uncovers and addresses dysfunction and trauma within families.

The Family Constellation Approach to Healing Addictions

When we think of family constellations, the image that might come to mind is a family tree, or a photograph of the extended family posed around the Thanksgiving table. But for many clients in addiction treatment, there may also be a deeper constellation, often unconscious, comprised of relationships and sometimes traumatic events that continue to exert a deleterious impact on the client. Some clinicians believe that such constellations can continue to exert power for generations, as the unfinished business that has become part of the family psyche remains operational. Innovative treatment approaches can illuminate these powerful patterns to bring insight and relief, as Karen Carnabucci describes below…Richard Juman, PsyD

The world of addiction treatment has seen a revolution in the past 25 years, with a wider acceptance of what have been broadly known as experiential therapies, including psychodrama and its derivative of role-play. Now addiction treatment is adding a newcomer to the mix: Family Constellations Therapy, which is just beginning to make inroads in addiction treatment in the United States, although it is highly popular around the world. Family constellations were developed about 30 years ago by Bert Hellinger, a German philosopher and psychotherapist, originally to address the trauma of World War II. The method is widely accepted in Europe, Russia, Asia and Latin America and is rapidly growing in the United States.

This approach not only identifies the reality of multi-generational trauma but also gives a proven method to address and release what are usually considered intractable problems. In a constellation session, the work typically takes place in a group, with group members seated in a circle. A simple introduction begins the group; for instance, the facilitator may ask each person to say what he or she is feeling, in a few words. 

When a group member is chosen to address a personal issue, other group members are asked to represent people in the person’s family system. 

When the selected group members stand, the client positions each person in the open space of the circle. When all are positioned, the client returns to his or her seat to watch. Representatives are asked to become open to whatever feelings, insistent thoughts or strong impulses become apparent, then report or respond to their movements or inner experiences. There is no role-playing or acting, just direction to follow the body experience.

When a vision of the distorted dynamics is discovered, the facilitator directs specific changes in the grouping—sometimes moving a person from one place to another or repeating a short healing sentence—to release trauma and create a greater sense of peace and resolution.

Alcohol, Violence and Fathers

One of my clients, “Darrell,” was distraught after violently pushing and shoving his wife during an argument. His wife had threatened to leave and take their three children with her, and he arrived in the treatment room contrite, ashamed and scared. He acknowledged that he had been drinking prior to the argument. He didn’t approve of violent behavior toward women, and he didn’t want to relapse. But he said that he felt no option other than to strike out when she started the argument.

The pattern showed that his drinking, or thoughts of drinking, escalated when he was angry with his wife; he could not control his temper.

Later, in the set up in “the field,” Darrell placed himself and his father. The man representing his father looked off to the side, seemingly distracted from his son. Asked about his paternal grandfather, Darrell admitted that he was not sure who his grandfather was – there had been a family rumor that the man he called grandfather may not have been his biological grandfather.

I pulled in a man who was identified simply as “biological grandfather” and positioned him behind the father representative, lightly touching the father representative on his shoulders. The father reported that he felt numb and could not feel the hands. After several minutes, however, he reported that he felt his back slowly warming, becoming more at ease.

Darrell was then brought into this three-dimensional picture, standing in front of the father. His father was instructed to place his hands on Darrell’s back.

Darrell was encouraged to take in the experience. He admitted the experience felt “odd” at first. After some moments, he relaxed and became more comfortable.

When Darrell returned for his next weekly appointment, he reported that he was surprisingly able to stand firm when his wife started to bait him during an argument, telling her calmly that he did not want to discuss the topic.

Marijuana and the Lost Brother

“Monique” used alcohol publicly and marijuana secretly. She dipped occasionally into her son’s ADHD medication, and confessed that she relished her appointments to get Botox treatments, probably more often than most women she knew.

“I just have an addictive personality,” she claimed, before finally admitting that marijuana seemed to have a special hold on her.

In her first constellation session, she agreed to set up her relationship with marijuana. She picked one group member to represent herself, and a second group member to represent marijuana. 

Each was placed quite close to the other. As Monique watched from the side, the two began to embrace, almost tenderly holding each other.

Monique’s genogram, taken earlier, showed that Monique’s mother delivered her first child, a stillborn boy, one year before Monique’s birth. I directed another group member to join the scene, standing in for that stillborn brother.

For a long time, the brother stood at the edge of the group space, appearing lost and disoriented. He slowly moved closer until he stood in front of Monique, gradually taking her attention.

As she and her brother looked at each other, the representative for marijuana slowly loosened the hold, and then faded back. Monique embraced this lost brother. Later, she made a new commitment to her recovery, beginning to attend a 12-step meeting regularly and speaking more honestly in her individual sessions.

Father and Son

“Ben,” a 58-year-old artist, had been struggling with chronic alcoholism for years and could not stop his drinking despite multiple rehab stays. He seethes with anger at the mention of his emotionally abusive father who disowned him before his death several years ago.

During the constellation session, Ben faced the representative for his father, backed by a long line of male ancestors. Ben and the father representative look at each other in silence for a time. The father is prompted to say, “I am your father and you are my son. And you always will be my son.”  

There follows a deep breath on Ben’s part, taking in the truth of the relationship. He bows his head; the facilitator prompts him to say something very different from that boy with the seething chip on his shoulder: 

“You are my father, I am your son. For whatever else you failed to give, you gave me my life, and from now on I will honor you for that gift.” 

The son bows again, bending to the degree that he can experience his humility, respect and proportionate smallness to the bigger father.  

The father says, “Whatever you have gotten from me is yours to take. It will have to be enough.”

The son responds, “It is enough, and I will make something of my life in your honor. Father, I will carry you in my heart, from this day forward.”

Feeling the energy of generations of men, Ben sobbed for his sister who had suddenly died months before. He had been unable to feel the loss, but it seemed that the strength in the line of men opened this tenderness of feeling. When he returned home, Ben spontaneously produced an artwork honoring his father, which he turned into a shrine. There was no prescription to make this art; it simply happened as he felt appreciation for the father he now experienced as solidly behind him. As he began to speak daily to his father’s spirit at the shrine, Ben filled that emptiness that haunted him as long as he could remember. He stopped his excessive drinking for the first sustained time in his life.

Many clients who struggle with addiction are initially skeptical of this approach, sometimes because they are disconnected from their bodies and have difficulty “feeling into” the representation. Others have gone through years of traditional therapy and feel discouraged or are resistant to a modality which is phenomenological rather than theoretical.

The 2015 North American Systemic Constellations Conference, which took place Nov. 12-15 in San Diego, Calif., put a big spotlight on the use of this approach to treat addiction.

Ingala Robl, a leading constellations trainer in Mexico and one of four keynote speakers for the conference, addressed “Addiction as a Post-Traumatic Stress Response” in her keynote address. 

Robl considers trauma—in the addict’s early years or from a previous generation—as leaving “profound marks” on the soul of the person, and addictive behavior—whether from smoking, sniffing, injecting or drinking—is viewed as a kind of self-soothing of such deep-seated fears and trauma. 

In addition to this keynote address, the workshop titled, “In the Field of Addiction: Running a Family Constellation Program in an Addiction Rehab,” shared ways that Dina Ostrovsky, a constellations facilitator based in New York City, has seen great changes in clients.

Ostrovsky has successfully used family constellations at a treatment center in Costa Rica, first as a therapist-coach and later as one of the organization’s directors. Now she works with addicts in her private practice in New York City. She, like other constellation practitioners, considers constellations as a ground-breaking method for dealing with addictions to drugs, alcohol, sex, nicotine and food.

“The idea is that addiction is not only a personal problem, but belongs to the family system is known in classical psychotherapy,” says Ostrovsky. “Family constellations provide powerful tools to address this aspect of addiction in a rehab environment.”

Mark Johnson, LMFT, founder and director of the Seattle Constellations Institute, has been teaching and facilitating this work since 2003. He facilitates constellations sessions at a Native American clinic which offers intensive outpatient treatment, some taking Suboxone for opiate addiction.

Like other practitioners, he observes little tolerance for feelings; sometimes there are cognitive deficits due to heavy drug use.

“Constellation work needs to be introduced carefully,” he says. “Although not unique to this population, there are usually significant trauma and attachment issues underlying. What there is, is a deep lack of trust in new people and processes, so the ability of the facilitator to develop trust, connection and rapport is critical.”

Many believe that it is trauma that’s at the root of addiction. Ostrovsky recalls that patients with Native American heritage often discovered that their addictions were linked to the trauma of the indigenous peoples losing their land, culture and lives with the influx of the conquering Europeans and European Americans. Another discovery has been the correlation between the type of addictive substance and a broken relationship with the lineage of the father or mother.

“As an example, most cocaine addicts had a disconnection with their fathers and used cocaine as a bridge to access their male power,” reports Ostrovsky.

Johnson, working with Native Americans, lists multi-generational and historical trauma, multi-generational attachment issues and significant losses such as suicide, homicide, early death, adoption and foster care.

Sometimes, the trauma is subtle. “It is always a systemic issue of some sort of dysfunctional or abusive attachment break from one or both parents,” says Cefalu. “If not with the parents, then their parents were very neglected or abused and they are carrying for the grandparents.

“The client just doesn't realize he or she did not get nourishment; they did get basics met at times, but they are searching for the nourishment they didn't receive as children."

Ultimately, clients feel empowered to step into a co-healer role because of the collaborative nature of the work. With practice, clients with addictive disorders are able to become more attuned to their bodies and emotions by helping others.

Karen Carnabucci, LCSW, TEP, is a board-certified psychodrama trainer, psychotherapist and certified constellations facilitator. She presented at the 2011 and 2015 Systemic Constellations Conferences and writes frequently on ancestral healing and the safe use of experiential methods. She is the author of Integrating Psychodrama and Systemic Constellation Work: New Directions for Action Methods, Mind-Body Therapies and Energy Healing with Ronald Anderson, Healing Eating Disorders with Psychodrama and Other Action Methods: Beyond the Silence and the Fury with Linda Ciotola and Show and Tell Psychodrama: Skills for Therapists, Coaches, Teachers, Leaders. Learn about her programs, books and retreats at

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Karen Carnabucci, LCSW, TEP, is a board-certified psychodrama trainer, psychotherapist and certified constellations facilitator. She writes frequently on ancestral healing and the safe use of experiential methods. She is the author of several books, including, Integrating Psychodrama and Systemic Constellation Work: New Directions for Action Methods, Mind-Body Therapies and Energy Healing and Show and Tell Psychodrama: Skills for Therapists, Coaches, Teachers, Leaders. Learn about her programs, books and retreats at You can also find Karen on Linkedin and Twitter.

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