What Happens during a Family Therapy Session on Substance Abuse?

licensed therapist talking to family during in a family therapy sessionPsychotherapy is a form of intervention where a trained and licensed therapist uses techniques and principles based on psychological principles to help individuals change their behavior, thoughts, and feelings, or to adjust to certain issues in their lives.
Group therapy is a form of therapy where the therapist meets with one or more individuals at the same time and performs the same types of interventions. Therapy differs from social support groups like 12-Step groups in that these groups are not administered by trained and licensed therapists for the most part.

Family therapy is a subtype of group therapy where the members in the therapeutic group are all related. There is no one form of treatment intervention that is used in family therapy. A number of different types of family therapy treatment interventions exist, including cognitive behavioral techniques, psychoanalytic techniques, interpersonal techniques, etc. Some therapists who have received training in several different paradigms may use an approach that combines the techniques from these paradigms. The particular techniques used by the therapist depend on the therapist’s training and preferences, and on the types of clients that are in the group.

Family therapy concentrates on determining and adjusting how the overall structure, patterns of communication, aspects of relationships, power structure, and other aspects of the family system are affected by whatever issue is being addressed.

Family Therapy for Substance Abuse Issues

In the past, family therapists who treated issues that involved substance abuse most often treated families that had children or adolescents who were displaying substance abuse problems. As the techniques of family therapy evolved and more family therapists addressed issues regarding substance abuse with different family members, the research indicated that family therapy was indeed an effective intervention for both adolescents and adults with substance use disorders.

Family therapy has a number of stated principles, goals, and assumptions that guide the therapist; however, the actual treatment that occurs in family therapy sessions will differ from family to family and from session to session. There is no one standardized agenda that is followed for every issue, every family, or by every school of family therapy. This is because therapy is a dynamic process that adjusts based on the particular session and needs of the participants. There are, however, some general principles regarding the content of the sessions that can help one to understand how the treatment works.

The First Session and Early Sessions

During the first session, the therapist will typically have family members fill out paperwork. Then, the therapist will interview the family as a group, and the members of the family who will be involved in the treatment will typically outline the general problems. The therapist will often have the family members together for at least part of the first session in order to make introductions, get everyone’s viewpoint on the problems that are to be addressed in therapy, and observe how the different family members interact with one another. The goal here is to:

  • Identify the problems that will be treated
  • Observe each member of the family
  • Observe how each member of the family relates with one another
  • Observe how the family operates as a unit

In some cases, the therapist may interview different family members separately in order to get a broader perspective of the presenting issues and relationships. This helps the therapist to begin to put together a broad conceptualization of the issues and the treatment plan, and also to determine if everyone who is important to the presenting issue is present. Sometimes, the therapist may determine that some of the individuals who are present do not need to be part of the treatment, and other times, the therapist may determine that individuals not present in the initial session should be part of the treatment.

Most often, the therapist will explain the basic rules regarding therapy during the initial session, which include things like confidentiality, dates and times of meetings, a general description of what should be expected during sessions, a rough estimate of how long the treatment will last, rules for the sessions, etc. Some therapists may also have family members sign a contract stating that they will participate in treatment, defining their goals, stating that they will adhere to certain rules, etc.

If the therapist believes that a family member needs to seek medical treatment for some issue, the suggestion will be made. While some individuals may believe that the first session was “therapeutic” due to a type of cathartic effect as a result of disclosure, there is very little treatment that occurs in most initial sessions of therapy. Initial sessions are typically used by the therapist to assess the problem, get a feel for the individuals in treatment, and define the rules and limitations of the treatment. The therapist will continue to assess the situation throughout treatment and adjust care accordingly.

The next two or three sessions will continue to build on the assessment process and the identification of different patterns of communication, power structures, issues with substance abuse that affect the family, issues with the family that affect the individual who has a substance use disorder, etc. During these sessions, the therapist will continue to make observations and also begin to outline and implement specific interventions.

Middle Sessions

The format of subsequent sessions is really dependent on the dynamics of the members in treatment, the specific issues being addressed, and the actual treatment paradigm that the therapist follows. The sessions will typically last 60-90 minutes, and most often take place at the therapist’s office or at a treatment center. In some rare cases, therapists may have sessions at the family’s home. Sessions can vary in their intensity from being quite relaxed and low key to very emotional and demanding, depending on the situation.

Many things can happen during these sessions. Sessions can be devoted to having members explain how the issues affect them. The therapist will often spend time analyzing patterns of communication and power hierarchies, trying to increase effective communication strategies between members and pointing out how different members of the family exert their influence over one another in order to reach certain goals. The counselor may point out certain warning signs that family members are not communicating with one another and develop strategies for family members to more effectively communicate their feelings and needs to one another. The therapist may also discuss coping skills, such as how to deal with stress, issues with relapse, how to deal with anger, resentment, etc.

Issues with substance abuse can occur in one or more family members, and the therapist will typically help the family understand how the members of the family react to issues with substance abuse. This can include:

  • How the members of the family foster substance abuse in one or more members
  • How the member with the substance abuse problem affects the rest of the family
  • How the family can work together to help individuals with substance abuse issues overcome them

Sessions often include homework, such as having family members sit down and discuss the events of their day together, engaging in activities together, or eating a meal together

Other things that happen in sessions are outlined below.

  • The therapist attempts to consider the family from each member’s point of view. The therapist may attempt to get family members to look at themselves from the viewpoint of other family members. This develops understanding and empathy.
  • The therapist will most likely address the processes associated with how family members support one another, express and develop negative feelings toward one another, the parenting skills of the parents in the family, and how the family as a unit manages conflict.
  • The family therapist will also assess the understanding of each family member regarding substance abuse. Inevitably, family therapists will spend quite a bit of time educating family members about substance abuse and treatment.
  • In some cases, certain family members may benefit from individual therapy, and the family therapist will suggest this. Depending on the therapist, the individual members may be referred to different therapists for individual treatment, or the family therapist may provide individual treatment in separate sessions.

Final Sessions

family therapy final session

As the therapy evolves and the goals of the therapy are met, the family therapist will begin to slowly work on discontinuing treatment sessions. Eventually, the therapist will review the progress of the family with the group and discontinue treatment once the issues are resolved.  Members who suffer from substance use disorders will typically continue individual treatment, as these disorders are chronic and require long-term treatment.

Family therapists attempt to ensure that their clients have developed the skills needed to address future issues without formal intervention; however, the door is always left open if family members as a group or individually decide they need further treatment


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