Addiction is a family disease. Active addiction typically prompts families to make slow, incremental, adaptive changes over time in response to the steady progression of the disease. Unfortunately, those changes often exacerbate the problem. In his presentation as part of the Williamsburg Place Lecture Series, family therapist William Mock, Ph.D. explored some accepted techniques that can help reverse this toxic process. Dr. Mock is the executive director of the Professional Training Center, Inc., in North Ridgeville, Ohio, and chief trainer for the Ohio Institute for Addiction Studies in Lakewood, Ohio.
Throughout the lecture, Bill Mock presented a few axioms for family therapists. As a system, families function in a somewhat paradoxical matter. On the one hand, any family is like all other families around the world,” said Mock. “At the same time each family is like no other. One of the joys of working with families is getting them to teach me who they are.”
One way of finding out is a family choreography exercise. Mock asked volunteers from the audience to participate in an exercise representing a typical day in the family’s life. They went to different places in the room and every once in a while the therapist asked where they are and what they are doing. Family members remains silent throughout this exercise. “With a toxic family you don’t allow talking because they’ve already been talking and it hasn’t been good,” explained Dr. Mock. “When they tell you ‘we don’t communicate’ they mean ‘we don’t communicate in a loving and respectful way.’”
The next set of axioms informs family therapy sessions. Therapists bring knowledge of all families and how they work. Family therapists understand systems and the interrelatedness of issues. That is why families come to therapy among other reasons.
The second axiom in this set is that the therapist and the system form hypotheses. There are many possible reasons why a family may have come to see a therapist. It could be a chronic illness in our family, a pending divorce, toxic relations, or addiction. Family and therapist should come to a hypothesis or hypotheses about how things are working in that family. Mock offered a caveat here: “Don’t ask why or you’ll get a long and arduous answer.”
Thirdly, the family educates the therapist about the special nature of the family. “Families come to you thinking they are terminally unique,” said Mock. “They are not but there is a piece of them that is very special. I strive to find out what kind of family they are.” It is important to avoid making assumptions and let the family members explain who they are. “Too many family therapists are too pedantic,” warned Mock. “They lecture folks, telling them how they ought to act.”
Toxic families seeking help from a therapist typically present with a much diminished notion of what a normal family looks like. When therapists ask “what would be a good goal for you?” they would like to hear “I want to become an astronaut” or maybe “I would like to travel the world.” Toxic families will offer goals like “we won’t fight so much any more” or “the kids won’t be afraid anymore.” For such a family “normal” simply means the absence of a lot of grief. “They live in a world of serial crisis and they are just waiting for the next bad thing to happen,” said Mock. “For them normal is when nothing bad happens for the next couple of minutes.”
Part of therapist’s job is to get them to reframe that assessment and fill that vacuum with something positive. “Don’t say ‘stop doing that’, ask ‘what will you do?’ instead. Family members in treatment frequently say things like ‘if only so-and-so stops drinking we’ll all be happy,” Mock said. “They think they will turn into the Brady Bunch but they have no clue. All they know is the absence of pain.”
The Family is the Client
“Strategic error number one of family therapists is they don’t do family therapy,” warns Mock. “They come to the room, approach the ‘guilty’ member and say, ‘you’re the bad apple’—everybody else is a victim. The therapist then tries to fix family members individually, providing serial individual therapy instead of family therapy.” Mock’s axiom here is For the family therapist, the client is the family. “The family is the place where people are nurtured, the family is the place where people can grow and be,” he says. “The hallmark of good family therapy is a single word: respect! The therapist should try to engender respect between family members - for me that means I got to be respectful of that system sitting in front of me.”
Addiction as Serial Crisis
“One of the definitions of chemical dependency is serial crisis,” Mock said. “The usual methods to keep family member from harm become co-opted and become part of the process.” His axiom: Drug and alcohol addiction operates by hijacking the natural and caring processes and inclination of the family. That means, otherwise healthy and growthful processes are used to ensure the survival of the addiction and the system.
Addiction puts the family into crisis mode, forcing them to make changes. “An adaptation is a required change to a crisis,” Mock explains. “They make a quick adaptation because they don’t want to change too much. Change—no matter how desired—is highly anxiety provoking and they will resist it every way they can.”
Therapist should not be surprised. That’s exactly what they are supposed to do: resist dramatic change and maintain the status quo. But then the adaptations turn into a serial crisis. “A single adaptation is no big deal because it helps the family avoid a big upset,” Mock said. But with addiction the crisis goes on and on and on. “And after a while the changes are normalizing the abnormal. The adaptations stop being adaptations in the face of a crisis and become a way of life.”
What to do? Reframe the Issues
In healthy relationships, people are complimentary. They support and honor each other. In toxic relationships there is mostly blame to go around. “Toxic families speak to each other in terms of pathology on a whole range of issues,” says Mock. Therapists have to reframe the issues and should not be afraid to do it out loud.
They should start by asking ‘what is the family’s problem?’—what not who! “If they are really toxic, they will say, ‘she is the problem’ and if she is the problem, the solution is that she has to be something else.” Many families won’t even go as far as saying “her addiction is the problem.” They have to realize that they are not the family they want to be.
“Some clients are willing to say ‘this family is affected by drug and alcohol, by addiction.’ That’s pretty sophisticated and you probably won’t get that right away,” said Mock. “But you can coach them. Take the time it takes for them to find a statement they can all agree on.” Once there is agreement on the nature of the problem, the therapist should promote personal individual ownership of the problem, followed by a personal commitment to do something about it.
Finally, Dr. Mock offered a few bullet points for skillful interventions.
- Define normal: give the family a goal to move toward. They are coming to you trying to move away from something. It is healthier to move toward a more productive space than just move away from pain.
- Act as if: if this were a normal family, what would you be doing?
- Simple/complicated dichotomy: one of the things the family has been trying to do is make things easier but they ended up making things more complicated. The solution is usually very simple but also very hard.
- Start with whomever is ready to work: for years we insisted we can only move forward when the person who carries the prime symptoms for the system is ready to do something—don’t do that.
- Invite all the members: there is a school of thought that says “invite all the family members but leave ‘the drunk’ home”—don’t do that. We will all get well together.
Addiction affects many members of the family of the addicted individual. Spouses, life partners, parents, and children in a family with addiction can only truly heal if they become part of the therapy process. There is not need to wait until “somebody does something,” Dr Mock reassured his audience. “We don’t have to wait for anybody to do some work as a family.”