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Host: Dr. Dawn-Elise Snipes

Cheap CEUs are available for this presentation at

What is a Family
~ Families are uniquely defined by each individual
~ Not always blood related
~ The significant others (SOs) the Identified Patient (IP) considers important in their lives.
~ Families are systems characterized by self-regulation & Homeostasis
~ Each members has a function in maintaining the balance
~ Enabler, scapegoat, hero, lost child, mascot
~ When a person or the situation changes, everyone else has to adapt to maintain “status quo”

Family Risk Factors & Interventions
~ Disrupted attachment
~ Emotional or physical enmeshment or disengagement creating a lack of safety
~ Mental illness or addiction in caregivers
~ Lack of effective caregiver interpersonal skills including boundaries (CRAVES)

Family Risk Factors & Interventions
~ Disrupted attachment
~ Lack of effective skills to nurture a high-needs child  environment of invalidation
~ What causes high-needs
~ Genetic predisposition to emotional dysregulation
~ Fetal exposure to
~ Substances
~ High levels of cortisol
~ Grief or anger at the child
~ Birth defects / disabilities
~ Unplanned pregnancies  interpersonal and tangible losses
~ Long NICU stays
~ Family violence
~ Low parental supervision

Consequences of Addiction & Mental Health Issues on the Family
~ Lack of trust
~ Anger
~ Frustration and feelings of helplessness as they watch the IP suffer
~ Resentment at the IP for their behaviors and “refusal” to change
~ Guilt
~ Feeling responsible for the IPs condition
~ Abandonment
~ Embarrassment

Consequences of Addiction & Mental Health Issues on the Family
~ Anxiety that the IP will experience harm
~ Pessimism & cognitive distortions
~ Isolation
~ Social withdrawal or “lack of time” for outside activities
~ Withdrawal from the IP
~ Family conflict over how to deal with the IP

Where to start…
~ Examine behaviors in terms of communication
~ Recognize that resistance means the IP
~ May not have the skills and ability to make the change
~ May feel overwhelmed by the prospect of change
~ May have tried before and failed and believe the situation to be hopeless
Counselor Tasks
~ Engage family members, including reluctant ones
~ Structure a conference such that all members have a chance to express themselves
~ Systematically assess the family’s level of functioning
~ Support individual members while avoiding coalitions
~ Help the family see problem behaviors as a form of communication and an adaptation to stay safe
~ Reframe the family’s definition of its problem in a way that makes problem solving more achievable
~ Help family members explore new forms of collaborative efforts to cope with problems (How can I help you? / You can help me by…)
~ Help family members generate alternative, mutually acceptable ways to cope with difficulties
~ Help the family balance coping efforts while calibrating roles (enabler to supporter)

~ Family approaches recognize the reciprocal impact of every individual and every relationship on the functioning of the whole system
~ Family systems resist change in favor of homeostasis
~ It is important to assess
~ The health and wellbeing of all members of the family
~ The PACER needs of each individual and their readiness for change for every treatment goal.
~ Develop a unified vision of what health and happiness look like and each person’s tasks in helping the family move toward that goal.