What is Family Therapy for Addiction, & How Can It Help MY Family?

You may have heard of counseling, or psychotherapy, to help someone with an addictionFamily Therapy is just that, except that the one going to therapy is not just the individual struggling, but the entire family.

While individual therapy focuses on the thoughts, behaviors and emotions of one person, family therapy focuses on the relationships, and aims to understand and validate the experiences of all family members. The goal of family therapy is to bring clarity to all relationships, and to foster repair and closeness if family members choose. Family therapists believe that problems exist between people, not within people.

In the addiction context, a family therapist will explore with the family how substance use is embedded in a cycle of interaction within the family. For example, many young adults and parents are in what we call a fugitive/detective dynamic. The more the young adult acts like a fugitive (hiding, lying) the more a parent acts like a detective (snooping, chasing) – and visa versa. In addition, family therapists can provide additional education about substance use for the whole family and support family members in reducing their unhelpful behaviors and increasing their effective behaviors.

Family therapists help identify new skills and then coach family members in the practice of these new skills.

Anxiety, anger, frustration and a deep worry often interfere with parents renovating their approach to family life. Family therapists can also put the substance use in a different context by addressing other challenges and highlighting other resiliencies in the family – for example, understanding what is working in the teen’s life, or asking, “If we weren’t here to talk about this person’s substance use, what would we be talking about as a family?”

Many research projects demonstrate that Family Therapy is very helpful, although there are time-based and/or economic barriers as to why it’s often not offered, implemented or practical.

In our work at CASA, we’ve been engaged in a research project attempting to distill the core elements of family therapy from evidence-based therapies, and have identified four of the most important components of these family therapy models: Family Engagement, Relational Reframing, Family Behavior Change, and Family Restructuring.

Family Engagement

The first element is Family Engagement, as enhancing family members’ involvement and investment in the therapy of the young adult who is struggling is key.

  • For example, for a parent who feels reluctant to engage in therapy, a therapist might share something like: “You and I together are trying to help her not go under. This isn’t going to be easy, but I’m going to push you to hear her point of view and you’re not always going to agree. I’m going to help her bring things to you, and to help you hear her.”
  • For a teen who is feeling unsure about the value of family therapy for them, a therapist might share something like: “Your mom seems upset about your grades dropping. That’s important and we will spend time talking about it, but I’m just as interested in hearing how you feel things are going for you. I want therapy to be a place where you can talk about what you think is going well, going not so well, and what you would like to be different.”

Family Engagement interventions typically take place during the initial phase of treatment, though investment and goal setting are continually revisited in family therapy.

Relational Reframing

The second element, Relational Reframing, consists of interventions designed to move away from individual ways of defining problems and generating solutions, and toward an understanding focused on relationships. These interventions also aim to remove irrational descriptions and attributions for family members’ behaviors, and instead focus on understanding motivations for behavior based on those relationships.

  • For example, a family therapist may want to expand a description of a parent from someone who is critical and judgmental to one who is simply worried by sharing, “I take it that when you are yelling at your daughter about her coming home late, you are actually worried about her safety and well-being, rather than just being angry with her.”
  • A family therapist may also want to transform an understanding of a teen’s substance use from one that blames them to one that’s a more meaningful understanding of their problem by saying something like, “I wonder if because of what has happened in the past, everyone in this family is a little bit anxious, and everyone has different ways of dealing with that anxiety, and a lot of the ways aren’t really working for you. Maybe you are using substances and staying in your room a lot, but I bet you’re all feeling pretty scared.”

Family Behavior Change

The third core element, Family Behavior Change, aims to shift the behavior of family members. These interventions aim to teach concrete new skills and encourage individual behavior changes that will allow for improved family relationships. New skills and behaviors are positively reinforced and coached, for both individuals and the entire family.

  • For example, new skills that a family therapist might teach a family could include assertive communication skills, enforcing limits, negotiation of rules and boundaries, expressing feelings more effectively, and others.

Family Restructuring

The fourth element, Family Restructuring, aims to change the way the family system is governed; that is, to shift underlying beliefs, premises and family rules.

  • For example, there may be a trend in the family that when someone is upset, they don’t talk about it and are meant to handle it alone. A family therapist might help the family become aware of this premise, and might introduce new beliefs about the value in speaking with each other about difficult feelings. There may also be beliefs about different roles two different parents occupy, and family therapists can help identify a shared way that both parents can respond to their child.

Family members are encouraged to understand the dynamics of their family, and how these dynamics are linked to the problematic behavior. It ends up prompting shifts in attachment and emotional processes between family members.

Even without formal family therapy, parents can begin to think about how they can be resources for their teen, and how relationships could shift in their families to better support a teen who is struggling with substance use. Parents should be curious about their son or daughter and his/her life in a non-judgmental manner.

  • What is your child thinking and feeling?
  • What is your child hopeful about or worried about?
  • What does your child think is good about using drugs?
  • Is there anything your child worries about related to drugs, or about risks of the behavior?
  • What does your child believe that you do not properly understand or value?

We know that engaging in these conversations can be very difficult, so parents shouldn’t be afraid to seek support on their own to do so, or be discouraged if it at first it doesn’t feel successful when they aim to engage in a more skillful conversation with their teen.

If a parent’s approach to substance use is based on punishment, the teen is less likely to talk about their substance use and whether they are worried about themselves or a friend. This does not mean that behavior doesn’t have consequences, but that parents should position themselves as resources for their teens rather than act as probation officers. Limit setting is important, and consistency is the most important part of limit setting — for example, if your child misses curfew and the consequence is a week of being grounded, it’s very important to follow through as opposed to just grounding him or her for a day or two. We also know that the most effective way to change behavior is through positive reinforcement, so in addition to boundaries and consequences for less healthy choices, parents can look for opportunities to positively reinforce the healthy choices the teen is making in their everyday life.

Because we know some teens do use substances, parents should encourage their teens to avoid drugs but also talk about reducing risk if they or people they hang out with do use drugs. Also, providing fact-based and honest drug education makes parents more credible and again more likely to be someone their teen comes to for advice or help.

The relationship with your child is the most important thing to attend to – don’t lose sight of this core value when you’re legitimately concerned about your son or daughter’s substance use. Stay focused on the positive relationship and your lifelong bond with them, and offer compassion and love. It is truly the most important thing and has the biggest positive influence on their behavior.

Many thanks to the National Center on Addiction and Substance Use for their insight for this post.