SOCIAL MANAGEMENT
FAMILY THERAPY
Family therapy began with the finding that many people who had – shown
marked clinical improvement after individual treatment – often in institutional
settings – had relapse when they returned home. The family-based treatment
approaches are designed to reduce high levels of criticism, and family tension
have been successfully reduced, decreasing relapse rates in patients with various
disorders.
One of the important approaches to resolving the family disturbances is called
structural family therapy. This approach can hold that if the family context can
be changed, then the individual members will have altered experiences in the
family and will behave differently in accordance with changed requirements of
the new family context. Thus, an important goal of structural family therapy is
changing the organization of the family in such a way that the family members
will behave more supportively and less pathogenically towards each other.
Structural family therapy is focused on present interactions and requires an
active but not directive approach on the part of a therapist. Initially, the therapist
gathers information about the family – a structural map of the typical family
interaction patters – by acting like one of the family members and participating
in the family interactions as an insider. In this way, the therapist discovers
whether the family system has rigid or flexible boundaries, who dominates the
power structure, who gets blamed when things, go wrong, and so on. Armed
with this understanding, the therapist then operates as an agent for altering the
interaction among the members, which often has transactional characteristics of
overinvolvement, overprotectiveness, rigidity, and poor conflict resolution
skills. The identified client is often found to play an important role in the
family’s mode of conflict avoidance.
BASIC ASSUMPTION
If we hope to work therapeutically with an individual, it is critical to consider
him or her within the family system. An individual’s problematic behavior
grows out of the interactional unit of the family as well as the larger community
and societal systems.
FOCUS OF FAMILY THERAPY
Most of the family therapies tend to be brief because families who seek
professional help typically want resolution of some
problematic symptom. Changing the system can stimulate change quickly. In
addition to being short-term, solution-focused, and action-oriented, family
therapy tends to deal with present interactions. The main focus of family
therapy is on here-and-now interactions in the family system. One way in which
family therapy differs from many individual therapies is its emphasis on how
current family relationships contribute to the development and maintenance of
symptoms.
ROLE OF GOALS AND VALUES
Specific goals are determined by the practitioner’s orientation or by a
collaborative process between family and therapist. Global goals include using
interventions that enable individuals and the family to change in ways that will
reduce their distress. Tied to the question of what goals should guide a
therapist’s interventions is the question of the therapist’s values. Family therapy
is grounded on a set of values and theoretical assumptions.
Ultimately, every intervention a therapist makes is an expression of a value
judgment. It is critical for therapists, regardless of their theoretical orientation,
to be aware of their values and monitor how these values influence their
practice with families.
HOW FAMILIES CHANGE
An integrative approach to the practice of family therapy includes guiding
principles that help the therapist organize goals, interactions, observations, and
ways to promote change. Some perspectives of family systems therapy focus on
perceptual and cognitive change, others deal mainly with changing feelings, and
still other theories emphasize behavioral change. Regardless of the lens that a
family therapist operates from, change needs to happen in relationships, not just
within the individual.
Contributions of Family Systems Approaches
One of the key contributions of most systemic approaches is that neither the
individual nor the family is blamed for a particular dysfunction. The family is
empowered through the process of identifying and exploring internal,
developmental, and purposeful interactional patterns. At the same time, a
systems perspective recognizes that individuals and families are affected by
external forces and systems, among them illness, shifting gender patterns,
culture, and socioeconomic considerations.
Family therapy redefines the individual as a system embedded within many
other systems, which brings an entirely different perspective to assessment and
treatment.
An advantage to this viewpoint is that an individual is not scapegoated as the
“bad person” in the family. Rather than blaming either the “identified patient or
a family, the entire family has an opportunity
(a) to examine the multiple perspectives and interactional patterns that
characterize the unit and
(b) to participate in finding solutions.
GROUP THERAPY
Group Therapy has been shown to be effective for many clinical problems
especially substance-related disorders. In the confrontational give and take of
group therapy, alcohol abusers are often forced to face their problems and their
tendencies to deny or minimize them. These group situations can be extremely
difficult for those who have been engrossed in denial of their own
responsibilities, but such treatment also helps them see new possibilities for
coping with circumstances that have led to their difficulties. Often their paves
the way for them to learn more effective ways of coping and other positive steps
toward dealing with their drinking problem.
Working in groups is a counseling activity that is often effective in helping
individuals resolve personal and interpersonal concerns. Organized groups
make use of people’s natural tendency to gather and share thoughts and feelings
as well as work and play cooperatively. “Groups are valuable because they
allow members to experience a sense of belonging, to share common problems,
to observe behaviors and consequences of behaviors in others, and to find
support during self-exploration and change” (Nims, 1998, p. 134). By
participating in a group, people develop social relationships and emotional
bonds, and often become enlightened
THE PLACE OF GROUPS IN COUNSELING
A group is defined as two or more people interacting together to achieve a goal
for their mutual benefit. Everyone typically spends some time in group activities
each day (for example, with classmates or business associates). Friendliness is
part of human nature, and many personal and professional skills are learned
through group interactions. It is only natural, then, for counsellors to make use
of this primary way of human interaction.
Most counselors have to make major decisions about when, where, and with
whom to use groups. In some situations, groups are not appropriate ways of
helping. For instance, a counsellor employed by a company would be unwise to
use groups to counsel employees with personal problems who are unequal in
rank and seniority in the corporate network. Likewise, a school counselor would
be foolish to use a group setting as a way of working with children who are all
behaviourally disruptive. But a group may be ideal for helping people who are
not too disruptive or unequal in status and who have common concerns. In such
cases, counselors generally schedule a regular time for people to meet in a quiet,
uninterrupted setting and interact together.
Groups differ in purpose, composition, and length. Basically, however, they all
involve work, which can be described as “the dynamic interaction between
collections of individuals for prevention or remediation of difficulties or for the
enhancement of personal growth/enrichment”
Groups have a number of general advantages in helping individuals. Yalom and
Leszcz (2005) have characterized these positive forces as therapeutic factors
within groups. For counseling and psychotherapy groups, these factors include
the following:
• Instillation of hope (i.e., assurance that treatment will work)
• Universality (i.e., the realization that one is not alone, unique, or abnormal)
• Imparting of information (i.e., instruction about mental health, mental
illness, and how to deal with life problems)
• Altruism (i.e., sharing experiences and thoughts with others, helping them by
giving of oneself, working for the common good)
• Corrective recapitulation of the primary family group (i.e., reliving early
family conflicts and resolving them)
• Development of socializing techniques (i.e., interacting with others and
learning social skills as well as more about oneself in social situations)
• Imitative behavior (i.e., modeling positive actions of other group members)
• Interpersonal learning (i.e., gaining insight and correctively working through
past experiences)
• Group cohesiveness (i.e., bonding with other members of the group)
• Catharsis (i.e., experiencing and expressing feelings)
• Existential factors (i.e., accepting responsibility for one’s life in basic
isolation from others, recognizing one’s own mortality and the unreliability of
existence)
The group may also serve as a catalyst to help persons realize a want or a need
for individual counseling or the accomplishment of a personal goal.
They have definite limitations and disadvantages. For example, some client
concerns and personalities are not well suited for groups. Likewise, the
problems of some individuals may not be dealt with in enough depth within
groups. In addition, group pressure may force a client to take action, such as
self-disclosure, before being ready. Groups may also lapse into a groupthink
mentality, in which stereotypical, defensive, and stale thought processes become
the norm and creativity and problem solving are squelched. Another drawback
to groups is that individuals may try to use them for escape or selfish purposes
and disrupt the group process. Furthermore, groups may not reflect the social
milieu in which individual members normally operate. Therefore, what is
learned from the group experience may not be relevant. Finally, if groups do not
work through their conflicts or developmental stages successfully, they may
become regressive and engage in nonproductive and even destructive behaviors
such as scapegoating, group narcissism, and projection.
Group Size and Duration
A group’s size is determined by its purpose and preference. Large groups are
less likely to spotlight the needs of individual members. Therefore, outside of
group guidance there is an optimal number of people that should be involved. A
generally agreed-on number is 6 to 8 group members, although Gazda (1989)
notes that if groups run as long as 6 months, up to 10 people may productively
be included. Group size and duration affect each other. Corey (2016) states,
“For ongoing groups with adults, about eight members with one leader seems to
be a good size.
Groups with children may be as small as three or four. In general, the group
should have enough people to afford ample interaction so it doesn’t drag and yet
be small enough to give everyone a chance to participate frequently without …
losing the sense of ‘group’”.
Open-Ended versus Closed Groups
Open-ended groups admit new members after they have started; closed groups
do not. Lynn and Frauman (1985) point out that open-ended groups are able to
replace lost members rather quickly and maintain an optimal size. Many long-
term outpatient groups are open ended. Closed ended groups, although not as
flexible in size, promote more cohesiveness among group members and may be
productive in helping members achieve stated goals.
Confidentiality
Groups function best when members feel a sense of confidentiality—that is,
what has been said within the group setting will not be revealed outside. To
promote a sense of confidentiality and build trust, a group leader must be active.
In the prescreening interview the subject of confidentiality should be raised. The
importance of confidentiality needs to be stressed during the first meeting of the
group and on a regular basis thereafter.
Furthermore, it is the group leader’s role to protect his or her members by
clearly defining what confidentiality is and the importance and difficulty of
enforcing it. Whenever any question arises about the betrayal of confidentiality
within a group, it should be dealt with immediately.
Otherwise, the problem grows and the cohesiveness of the group breaks down.
Olsen (1971) points out that counselors must realize they can guarantee only
their own adherence to the principles of confidentiality. Still, they must strive to
ensure the rights of all group members.
Physical Structure
The setting where a group is conducted is either an asset or a liability. Terres
and Larrabee (1985) emphasize the need for a physical structure (a room or a
setting) that ensures the safety and growth of group members. Groups within
schools and community agencies need to be conducted in places that promote
the well-being of the group. The furnishings of the space (attractive) and the
way the group is assembled (preferably in a circle) can facilitate the functioning
of the group.
In some instances, the spouses of alcohol abusers and even their children may
be invited to join in group therapy meetings, in other situation, family treatment
in itself is the central focus of therapeutic efforts. In that case, the alcohol
abuser is seen as a member of a disturbed family in which all members have a
responsibility for cooperating in treatment. Because family members are
frequently the people most victimized by the alcohol abuser’s addiction, they
often tend to be judgmental and punitive, and the person in treatment, who has
already passed harsh judgement on himself or herself, may tolerate this further
source of devaluation poorly. In other instances, family members may
unwittingly encourage an alcohol abuser to remain addicted.
ENVIRONMETNAL INTERVENTION
Environmental support has been shown to be an important ingredient of an
alcohol abuser’s recovery. People often become estranged from family and
friends because of their drinking and either lose or jeopardize their jobs. As a
result, they are often lonely and live in improvised neighborhoods. Typically,
the reaction of those around them is not as understanding or as supportive as it
would be if the alcohol abuser had a physical illness of comparable magnitude.
Simply helping people with alcohol-abuse problems learn more effective coping
techniques may not be enough if their social environment remains hostile and
threatening.
The macro-level physical and social environmental influences on the
development of substance use. Of course, these physical and sociocultural
environmental influences alone may not determine behavior, but they help
define the communities within which social learning is shared. Macro-level
physical and sociocultural environments help determine the diffusion of
knowledge, which is affected by social interactions among individuals within a
common culture. Physical structures tend to identify the types of
communications that occur within them (e.g., consider conversations occurring
in a library, at a church, at a bar, or in an adult Internet chat room). Culture,
including shared language, norms, contexts, and beliefs often direct the daily
behaviors of individuals, including communication contents within different
locations. Cultural contexts, as well as
drug use patterns, have spatial and temporal aspects, which can be evaluated
with newer methods of network analyses that will increase our understanding of
drug use patterns across communities.
Adolescents and adults are routinely exposed to a variety of environmental
contexts meshed with cultural norms communicated in a range of experiences
with others, as well as through exposures to the media and the World Wide
Web. These contextual influences direct whether, where, and how one will use
drugs. In terms of drug abuse, however, multiple experiences or active
participation in a drug use subculture ultimately may eclipse the influences of a
more general cultural background.
Prevention with help of Social and Environmental Factors
There are a variety of programs that make use of micro-level social groups that
can help prevent one from drug misuse and aid in prevention programming
There are several strategies of prevention programs that involve social
interaction and the group, including school-based prevention programming that
involves social influence instruction, instruction in conscientiousness,
community unit-based involvement, and family-based involvement. One could
speculate that the closer one approximates real-world social situations in
prevention interventions, including addressing family and peer group dynamics,
the more likely program information will translate to high-risk situations in real-
life settings that include pressures from family members, peers, and the
community. Clearly, the micro-level social group impacts an individual’s
behavior and choices, and the group is a key point of intervention. Multifaceted
prevention approaches that target the individual within peer groups (e.g.,
school-based programming), family members, and the community (e.g.,
physicians and legislators) may be most effective in preventing the onset of
drug use and misuse, assuming sufficient implementation fidelity.
The larger social and physical environment appears to have a significant impact
on constraining drug use prevalence and drug availability through anti-drug use
policies and resources allotted for communicating prevention messages.
Involvement of schools, the home, businesses, mass media, and local
government, working together to plan more favorable social and physical
environments appear to be key to a molar impact on prevention of drug abuse.
Not only constraining youth from engaging in drug use but also providing the
availability of and access to environmental resources that encourage more
prosocial activities and self-efficacy in positive life management is a means to
facilitate entry into new directions. Access to jobs, education, recreation,
transportation, and other health and community services may assist in directing
them to seek out other means to spend their time or improve their options. In
conjunction with other social and environmental strategies, supply reduction
strategies such as raising the age of legal use, limiting access, and limiting use
locations are ways in which tobacco and alcohol use have been controlled.
The larger socioenvironmental climate “sets the stage” for culturally expressed
group and individual perceptions and attitudes that impact licit and illicit drug
use policy change and the resources available for the prevention and treatment
of drug misuse.
Nevertheless, access to substance abuse treatment programs is increasing (e.g.,
in the prison and juvenile justice systems). In terms of cost, public and self-help
settings are generally less expensive than private settings, and in terms of
convenience, self-help and some public settings (e.g., the work site and school
settings) generally are more convenient than many private settings.
Mass media campaigns should not be ruled out as effective wide-reaching
cessation programs or as having the potential to reinforce sobriety messages for
those in recovery. Early detection through drug education and awareness in a
variety of larger social settings, access to a variety of treatment options –
including community-based residential treatment – for those in need, continued
refinement of program components, and increasing insurance treatment stay
limits may all contribute to better treatment outcomes. Finally, being aware of
the geographic context of drug abuse may assist in designing environments in
which drug abuse is relatively less likely.
