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"Alcoholic Treatment, Why Most Therapies Haven't Been Able to Help "
by Toby Rice Drews
by Toby Rice Drews
Chapter 4: Why Most Therapies Haven't Been Able to Help
Since many parents have gone to clergy, counselors, and general mental-health practitioners, and have become even more confused and despairing after doing so, this chapter is meant to clarify why the sessions may have been ineffective and why your kids' problems often got worse rather than better during the course of the therapy.
This chapter will be a beginning in helping you to make better choices about choosing counselors for your children, your spouses, and yourselves.
This chapter also will be helpful to the ever-growing number of therapists who are recognizing how pervasive all forms of alcoholism are in their caseloads, and are looking for addiction education and understanding to add to their expertise and enhance their effectiveness.
What are the basic myths all of us have been taught about therapy myths that pre vent the healing of alcoholic families, myths that do not take into account the disease concept of alcoholism and all that it implies?
Myth #1: Patients always tell therapists the truth about their drinking.
I have spoken with thousands of parents who took their children to see a therapist in an effort to bring some sanity back into their house holds. After the therapist posed a question or two to the child about his or her drinking, the matter was often dropped. Why? Let's look at a typical encounter:
Therapist: Do you drink?
Child: Yeah, some.
Therapist: How much?
Child: A couple of beers, at parties, with other kids. That's all. All the kids do it. My mother's paranoid.
Therapist: Why do you say that?
Child: I don't know. Ever since we moved, after my father got trans ferred on his job, my mom is really unhappy. She takes it out on all of us. My dad's always telling her she nags.
Therapist: Does she?
Therapist: Do you feel the same way?
Therapist: Let's talk about that, next session. Maybe we can find some ways for you to talk more directly to your mother about how you feel about the way she treats you.
The therapist has made her first mistake by believing the alcoholic's minizing of the drinking problem. The child's disease helped him divert the issue completely.
Alcoholics even child alcoholics will lie to pro tect their drinking. In coun seling, I've never had an alcoholic patient tell me that he or she drinks more than "a couple." Alcoholics are incapable of telling the truth due to a disease process that is extremely cunning in its efforts to protect its supply of alcohol. This is not a moral judgment. It is merely a fact of the disease. (See the list of questions at the end of this chapter to ask yourselves in order to crack through much of the child's denial and get at the truth. If you find a family history of alcoholism and if your child seems to have a problem, too, chances are your child does have a problem.)
If your child's therapy sessions pro ceed from the first myth that your child told the truth about his drinking then the next logical con clu sion in this erroneous thought process is to think that, instead of addic tion being the problem, "underlying mental-health issues" must be to blame.
Myth #2: These "underlying mental-health issues" can be re solved by teaching "good communications skills" to members of that alcoholic family.
This is impossible. Your alcoholic child can be very sincere and really want to co operate by trying to communicate better. But even after a terrific family therapy session, all his insight can go flying out the window with the next intake of alcohol. Furthermore, every day your child con tinues to drink, the disease is progressing. That means that in addition to ex periencing secondary physical problems, his or her ability to cope with life at all is pro gressively diminished.
If your child is going through with drawal, the severe agitation will be causing anger, anxiety, and overall, an in ability to have any "good communications."
Myth #3: Alcoholism is a result of un resolved conflicts, anxieties, and undealt-with anger. As soon as your child's ther a pist can "get at the root of the prob lem," the need to drink will wither away by itself.
I have personally seen terrible results from belief in this myth: Early deaths of children that could have been prevented; much confusion and despair for families; and the waste of lots of time and money in ineffective treatment sessions.
Putting it simply, problems do not cause alcoholism. Almost all of the time, after alcoholics stop drinking and attend AA regularly, their serious emotional problems disappear or at least diminish greatly with help. On the other hand, it is impossible for the still-drinking alcoholic to get well emotionally.
Myth #4: Even if the alcoholism is not dealt with as the primary issue, good therapy is being practiced if families are straight about feelings.
Even during therapy sessions where the alcoholic is acknowledged to be an alcoholic, many therapists have been trained to focus on asking parents how they feel about all this. On the surface, this may seem sensitive and caring. Unfortunately, such an approach often leads to fifteen, thirty, or even fifty sessions on how each family member "feels about" everybody else, and not much else is accomplished.
In this erroneous process, the next step for the therapist is to help everybody to improve their communications skills about how they feel! By that time, the drinking is no longer brought up on any regular basis. The drinking is merely discussed in terms of how everyone else feels about it.
When feelings rather than drinking or drugging are in the spotlight, then the onus is on parents to justify their over-reactive feelings (say, when their child may stop drinking for two or three weeks) and does not take into account the dynamic of the child's addiction and the constant tensions and crises it perpetuates on you.
More damaging, perhaps, is the prob ability that your therapist can get sucked into believing the charming facade that even an alcoholic child is capable of producing, thereby invalidating the credibility of your statements (that it is crazy, living in that household). The therapist thinks the alcoholism may be being exaggerated.
Myth #5: The alcoholic does not know how the family feels.
I'm also skeptical of counseling methods that assume your child does not know how you feel! It does not take three months of therapy sessions with Susie (who's con stantly truant from school) to let her know that her father and mother are angry!
Counselors wish from lack of knowledge about the dynamics of the disease process of alco holism, but it again subtly places the responsibility for the cause of the drinking on the parents, instead of on the alcoholism. (Parents often quit the counseling at this point, feeling even more depressed and despairing than when they entered counseling.)
I believe there is at least a partial ex plana tion for this lack of under standing and knowledge about the disease concept of alco holism. We all once believed alcoholism's lie that "the alcoholic wouldn't drink if all was right with his or her world." Unfortunately, no one's world can be just right.
Another partial explanation for this professional lack of knowledge about the disease concept of alcoholism is more hidden: many helping professionals are them selves adult children of alcoholics, spouses or former spouses of alcoholics, and parents of addicts. Since denial is the main symptom of alcoholism and addiction and since professionals are no more immune to the symptom than anyone else when coun selors are themselves un treated for their family disease symptoms, they bring this denial symptom to their work. Thus, we have a client whose main problem is a disease that may remain un diagnosed be cause the therapist's own family disease remains undiagnosed, be cause the therapist's main symptom, too, is denial around even seeing the disease!
Myth #6: When parents are told they are "enablers," it leads them to stop the enabling.
"Enabling" is meant to describe the res cue opera tions that the spouse or parent of an alcoholic carries out, when he can't stand watching the alcoholic suffer the con se quences of the disease. When that hap pens, he "cleans up" the alcoholic's messes (lies to the school that his son has the flu when the child was actually picked up for drunk driving). That way, the alco holic doesn't suffer the real conse quences of his behavior.
A parent must learn, eventually, to get some detach ment on watching these crises happen in order to stop cleaning up after the child. The idea is to allow the disease to hurt the child so much that he or she wants to get sober. Of course, it takes a parent a lot of time in a healing group such as Al-Anon in order to be able to do this. And this detach ment can't be forced or rushed by counselors. It is a slow process, and very frightening.
When a mother rescues her alcoholic child and I label her an enabler, she ob viously is still doing the rescuing behav iors and is not yet unafraid enough to give them up. She knows I am being judgmental when I use this term. Even when I say it lovingly, I seem to be admonishing her to go faster than she is capable of doing at that time. And she feels des pairing, because she is doing her best. She may get so discouraged and frustrated and overwhelmed that she stops treatment.
More specifically, the term enabler implies that while the parents did not cause the drinking, their rescue operations con tributed to the perpetuation of the drinking. Such thinking is dangerous; it leads alcoholics, who are already looking for a way to blame others for the drinking, into again placing responsibility for the drinking on the family.
Alcoholics do not need any encourage ment to blame others! Alcoholism coun selors spend most of their time trying to crack through the blame-systems of alco?holics. It is considered to be a major break through in the wellness process of alcoholics when they begin to acknowl edge that nothing "got them drunk." In contrast, alcoholics who have had relapses and are re-entering treatment are now often heard saying, "I wouldn't have gone out that time if I hadn't been enabled!"
The alternative to being labeled enablers is to teach you to end the rescue operations through the simple but effec tive process of detachment. For, de tach?ment will help end your fears and it is your fears that origi nally caused you to rescue. And even though, in this book, we are primarily talking about parents and kids, the detachment process is espe cially important if you also are married to an alcoholic. It is important for you to lose your fears of that adult alcoholic so you can get on with your life and become more able to deal with your children-alcoholics.
How does detachment work? How does it help you to lose your fears of your alcoholic child or spouse? The general process goes something like this:
1) When you begin to learn ways to stop watching the alcoholic in order to begin the healing process of seeing to your own needs, the alcoholic has radar and senses this switch in focus.
2) Much of the "games" stop then, be cause the alcoholic child knows that less attention will be paid to him or her.
3) By continuing to focus on yourself in stead of the alcoholic, you get an even greater distance (detach ment) from the threats, and begin to lose your fears of them. You begin to see how you gave the alco holic so much of his or her power. You can take it back!
4) Again, the alcoholic senses this. He or she begins to threaten even less.
5) You see that detachment works! You gain more confidence. Many of the illusions in your household are begin ning to end.
6) You lose much of your preoccupation with the alcoholic. Your pre occu pa tion was based on your needing to stop him or her from hurting you. You now see they are much less capable of hurting you than you thought. They've already done most of the damage they can do. But the game has been to keep up more of the same junk, to keep up the illusion that the alcoholic is powerful. This no longer works. You have learned not to look at him or her; to walk out of the room; out of the house to not beg.
7) The alcoholic now stands alone with his or her disease. They've lost their audience, and therefore drop much of the bullying. You are not watching it.
8) The alcoholic can no longer get you to believe you are responsible for his or her drinking and for the craziness in that house.
9) The alcoholic has a chance to grow up and make a decision to get help.
10) You are free.
When I teach parents the dynamic of what I have just described, they begin to naturally let go of the disease to detach because they are losing their fears of the alcoholics. All of us stop manipu lating and controlling people when we lose our fears of them.
* * *
As a therapist, I try to let parents know that I will gently help them along the not-straight road toward freedom from their fears. I let them know that they do not have to meet a timetable. In fact, I let them know that I am aware that I do not walk in their shoes, that they must be comfortable to make even a small step; that what I will do is love and accept them, even when they vacillate in their ability to detach from the disease.
I let the parents know that I know they will be ready some day. I try to give them the same hope that Al-Anon holds out that my acceptance of them will be part of the healing and will help move them along toward health and the choices that they now can only dream of.
And then, gently, naturally, interventions do happen, because with one hand I provide the healing embrace and com fort of total acceptance and without pressure; while with the other hand, I hold up the mirror of reality and nudge them along ever so gently toward reality.
Is There A Family History of Addiction or Alcoholism?
Twenty questions for family members. Answering yes to any two of these often indicates alcoholism. Ask these questions about yourself, your spouse, parent, grandparent, uncle, aunt, sibling, cousin, and any other family member.
Have/do you or the other relative . . .
1) Ever talked about switching from liquor to wine or beer?
2) Have idiopathic epilepsy?
3) Have adult onset diabetes?
4) Have essential hypertension?
5) Ever complain or "nag" about a rela tive's drinking?
6) Have adult children who are tee totalers?
7) Did anyone ever talk about a rela tive's drinking? Did that relative . . .
8) Seem to drink a bit too much?
9) Fall a lot?
10) Fall asleep on the sofa a lot?
11) Have a lot of arguments?
12) Seem to be able to drink more than most people and not feel it?
13) Have any liver problems?
14) Go from job to job?
15) Have credit problems?
16) Ever get stopped for drunk or reckless driving? Or ever have a single-vehicle accident on a weekend night?
17) Frequently have a red nose? Red eyes?
18) Have a beer breath?
19) Seem to be either the life of the party or a loner?
20) At the mention of alcoholism, bristle and get defensive, or abruptly leave the room?
1) Describe how you may have needed an Al-Anon meeting to recover from a family therapy session.
2) Describe the ways you believed your ineffective communications with your child caused the addiction.
3) Describe your feelings when you read or hear that you are an enabler.
4) Using the process of detachment just described, visualize a scenario in which you can see yourself no longer reacting to the alcoholic in one of the situations you find chronically troublesome.
1) Make a list of family members who were probably alcoholic (use the twenty questions as a guide).
2) If your current therapy is not address ing the alcohol or drugs as the primary problem, con sider getting a second opinion or evaluation for your child at an Alcoholic Treatment center.
3) Make a call to a treatment center and ask for a brochure to be sent to you.
The following is excerpted from the "Getting Your Children Sober" book--- (this material is also applicable when there are no alcoholic children involved...only alcoholic adults)
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