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Family Addiction Case Study: The Sequential Family Addiction
Transcript of Family Addiction Case Study: The Sequential Family Addiction
A play written by Tracy Letts and turned into a screenplay directed by John Wells in 2013.
Family Members (see genogram handout)
The Family System's Current State
Identified Patient (reason for treatment)
Family Addiction Case Study:
Extended Family Systems Counseling
traditional and extended family (strong emotional ties)
substance abuse, infidelity, domestic violence, secrets
very loose boundaries with and between all members
Barbara is family hero (achieved and got away), Ivy is the chief enabler, Karen is the lost child/family mascot (making jokes to distract family problems, looks for love in all the wrong places), Violet is the scapegoat (addict)
dad and mom both addicts, to keep the peace, everyone turned a blind eye with hopes the abuse would subside. Addiction was allowed in order to keep the peace.
Barbara and Violet have a fused and abusive relationship
don’t expose family secrets unless to humiliate
Barbara is triangled in mom and dad’s relationship. Mom would triangle both Ivy and Barbara. Barabara is not able to be present in her marriage because she is so triangled with mother, father, sisters, and aunt.
patterns of domestic violence/neglect which often comes with substance abuse (Juhnke, & Hagedorn, 2006).
Family is ready for treatment now that fear of separation and change (Liddle, 2004) have been broken due to father’s death. His death invites an opportunity for everyone in the system to individuate.
Used to explore family dynamics, important addiction stories and patterns. This intervention changes focus from the present to the past, exploring how the past shapes now (Juhnke & Hagedorn, 2006) and addressing topics that are less emotionally charged.
Violet will deal with her past abuses and differentiate by turning outside of her daughters for support. All members will differentiate, becoming less reactive (emotionally regulated) to the system, while styling connected to family members.
Each member will mourn their father's death in their own unique way.
Use“I” language to promote self-differentiation (Juhnke, & Hagedorn, 2006).
Mom will seek help for herself, rather than triangulating her daughters for her emotional support. She will seek individual treatment to deal with past abuse, neglect, trauma, and grief.
Barbara will become non-reactive to mom’s drinking and become less emotionally reactive to other's choices (stop trying to protect everyone around her). She will allow her mother to get help on her own rather trying to force her to stop using. Once differentiated and detriangled, she will be available to work on her own marriage.
Ivy will stop enabling mother to use and no longer turn a blind eye.
Karen will become more a family member. Rather than being cut-off, she will be heard and valued by the rest of the family.
will become more rigid and flexible when necessary.
In heated conversations, the therapist can have family members speak to them, rather than to one another. This helps to avoid members become emotionally charged. (Juhnke, & Hagedorn, 2006).
The goal is to help family members talk about issues without getting into emotional turmoil.
Chosen Therapy Model
Juhnke and Hagedorn’s (2006) Sequential Family Addictions Counseling Model.
Stage Five: Extended Family Systems Counseling
Keep in Mind:
Models are simply a framework for conceptualizing and organizing treatment for families (Treadway, 1989).
Using one treatment model limits us from addressing the unique needs of each individual family system and specific addicted members. Juhnke and Hagedorn (2006) compare using one treatment modality as similar to a physician prescribing the same medication to patients who have various illnesses. When we treat families using only one theoretical framework, we ultimately limit our understanding of family system dynamics and needs.
Benefits of this Model
By addressing addiction through this lens, the family is able to come to terms with how the addiction cycles serve as a homeostasis, thus making changes that will no longer serve addiction (Stanton, Todd, Heard, Kirschner, Kleiman, Mowatt, Riley, Scott, Van Deusen, 1978)
Including all members of the family can take the focus off of the IP, recognizing how all family members are functioning in response to and with one another (Kaufman, & Yoshioka, 2004; Liddle, 2004).
Using this model invites all voices to be heard and validated (Kaufman, & Yoshioka, 2004), which is often lacking in addicted families.
Treating the whole system can lead to lasting change, rather than changing one part of the system and throwing them back into an unchanged family system.
Research reveals that when parents are involved in the treatment of substance abuse, it leads to a greater outcome (Liddle, 2004).
It encourages differentiation of members, while still maintaining relationships within the system (Juhnke, & Hagedorn, 2006).
It promotes emotional regulation, which may lead to an overall healthier life (Stanton, Todd, Heard, Kirschner, Kleiman, Mowatt, Riley, Scott, & Van Deusen, 1978).
A Model-Based Definition of Addiction
According to Kaufman and Yoshioka (2004), In the 1970s, counselors began to conceptualize alcohol abuse as a symptom of an underlying cause rather than a disorder of its own.
This new perspective has opened the doors for practitioners to work with families and the family system rather than merely treating the symptom barrier, the “alcoholic."
Clinicians now see substance abuse as a symptom of a deeper problem, rather than a problem in and of itself.
Juhnke, G. & Hagedorn, W.B. (2006). Counseling addicted families: An integrated treatment and assessment model. New York, NY: Routledge.
Kaufman, E. & Yoshioka, M. (2004) Substance abuse treatment and family therapy: A
treatment improvement protocol TIP 39. Center for substance abuse treatment. Rockville, Maryland: Substance Abuse and Mental Health Services Administration. Treatment Improvement Protocol (TIP) Series, No. 39. Retreived on November 28, 2014 from http://www.ncbi.nlm.nih.gov/books/NBK64265/pdf/TOC.pdf
Liddle, H. A. (2004) Family-based therapies for adolescent alcohol and drug use: Research
contributions and future research needs. Society for the Study of Addiction. 2, 76 – 92. Retreived on November 28, 2014 from http://www.med.miami.edu/CTRADA/documents/Liddle_2004.pdf
Stanton, D. M., Todd, T.C., Heard, T. C., Kirschner, S., Kleiman, J. I., Mowatt, D. T., Riley, P.,
Scott, S. M., Van Deusen, J. M. (1978). Heroin addiction as a family phenomenon: A new conceptual model. The American Journal of Drug and Alcohol Abuse. 5(2), 125-150. doi: 10.3109/00952997809027993
Treadway, D.C. (1989). Before it's too late: Working with substance abuse in the family. New
York, NY: W.W. Norton & Company.
Barriers to Treatment
Implications of Treatment
Violet needs medications to treat her cancer.
Recent death of father/husband.
Violet and Mattie Fae's past trauma, abuse from mother's boyfriends, and potential sexual abuse.
The big secret of Little Charlie being a brother is now out in the open.
Ivy and Little Charlie's incestuous relationship now exposed.
Prevention is a main goal of treatment (Kaufman, & Yoshioka, 2004), therefore the family has a strict prevention plan that includes support from outside of the family system.
There is now a strict plan in place for Violet's cancer treatment and regulation of her medications.
Ivy has stopped enabling her mother.
Barbara is working on differentiating and setting more rigid boundaries with mother and sisters. Her and her husband are seeking marital therapy together in Colorado.
Mother and three daughters attend therapy treatment, as well as seeking some of their own individual therapy.
Violet will need to explore her side of the family to reveal what kind of addiction and abuse was present (exploring her mother's life).