Uncovering the Power of Total Family Intervention | Recovery Month '24

Foreign. I'd like to welcome everybody today's presentation on the overview of total family intervention. I'm your host, Dr. Donnelly Snipes. In this presentation, we're obviously not going to learn everything there is to know about interventions. My goal is to help you understand what, what it is so when you hear about it happening, you know what's going on and you can formulate some ideas. We want to identify who typically does an intervention and for what reasons and explore the basic steps of an intervention. Now we do have a class at all CEUs. We have a track that has over 100 hours that helps train people to do interventions because there is a lot to know. Interventions or approaches like in sbirt. If you look up SBIRT online or go to SAMHSA and look it up, it stands for screening, brief intervention and referral for treatment. This is your most basic form of intervention and SAMHSA has really promoted it as a tool for primary care physicians to do interventions in office when they have identified that somebody that they are treating is, has a problem. So interventions are approaches or meetings designed to facilitate entry into the, into treatment by a person with an addiction or a mental health issue who is not yet in the action phase of change. Now remember, with our phases of change, we've got pre contemplation. The person says I don't have a problem, leave me alone. Contemplation. They recognize they've got a problem, but it's overwhelming to even think about moving on Preparation. They know they've got a problem. They're starting to look around at their options to think about what they might do and action is when they actually start treatment. And obviously if an intervention is necessary, the person hasn't actually started treatment yet. And interventions can be a useful tool to help people who feel overwhelmed and they just, they know they have a problem, but it's. They just can't even begin to think about where to start or put one foot in front of the other towards that goal. Interventions are based on motivational interviewing approaches and the basic framework that we use is frames Feedback. We want to provide the person feedback about what we observe in their behavior and how that behavior may be impacting others and what our feelings are about what's going on. Responsibility for change is put squarely on the shoulders of the person with the mental health issue or the addiction. We can't force them to do anything. We're giving them options, which is where we get down to advice and a menu of options. In a well planned intervention, the person who's doing or people who are doing the intervention have options for the people up and, up to and including the availability or the ability to enter residential treatment right now. And, and if the person agrees to treatment, then they can, you know, start acting on it right away. Empathy is the next thing we need to recognize. And, and I talked so many times about resistance. Resistance is not about a person trying to be ugly, trying to be troublesome. 99.999% of the time, I'm optimistic there. Most of the time, resistance means that the person feels overwhelmed or they don't know what the options are. Maybe they've tried before and failed, failed. So they're scared to do it again. There is something that is blocking them from making that next step. So empathy is really important. We need to empathize. We need to try to walk, you know, half a mile, even in that person's shoes and say, what is it that's holding this person back? What is it that's preventing them from taking the steps to have a rich and meaningful happy life? And the final phase is self efficacy. And that's where we provide the encouragement. We, you know, we've handed out the options. We've said, we've said, this is what's available. We really want you to get help. We know you can do it. And self efficacy is increasing this person's belief that if they start to do the plan and in recovery, oftentimes we call that the next right thing. If they start to do the next right thing, then they actually can achieve sustained sobriety and recovery or sustained positive mental health. Who does interventions? Well, unfortunately, and this is one of the things that really frustrates me. Anybody can do an intervention, which is why it's so important to screen your interventionists ahead of time. Doctors can do interventions. Usually they use that sbirt model. Okay, cool. Doctors have a lot of training. Counselors and social workers can do interventions. If they have training in substance abuse, then they are more equipped to do substance abuse interventions. Obviously, with their general background, they're already equipped to do mental health interventions. And when we think about mental health interventions, you may be kind of scratching your head going, huh, well, think about somebody who has bipolar disorder. This is one of the most common issues that families seek interventions for in, in terms of mental health. Because when people have bipolar disorder, those highs are really awesome. And they love that euphoria. And the lows, I mean, the lows suck. The lows can be really, really low. But when they start taking medication, they, they don't have the extreme lows anymore, but they don't have that euphoria. So medication compliance, treatment compliance for people with bipolar disorder can be a challenge. Getting people to enter treatment can be a challenge. If they've got bipolar two, so they're only, you know, hypomanic, and they may have persistent depressive disorder, they may have difficulty seeing what. Where there's even a problem. And this is where counselors and social workers can provide that feedback about what they observe in terms of the person's behaviors and reactions and life functioning. Family members and friends can also do interventions. To the best of my knowledge, there is no state in the United States that requires that interventionists have any form of formal training. They, they don't require any form of certification. And that can be really, really dangerous because interventions can also be very triggering for the person with the mental health or substance abuse issue. If they feel attacked, if they feel threatened, it could push them in a very dark direction. So it is important to know if you're recommending an intervention, make sure that the interventionists that you're referring people to have adequate training in whatever issue that that person is dealing with. If they have sex addiction, gambling addiction, alcohol addiction, bipolar disorder, eating disorders, you know, there's a whole range of stuff, and each one of those things has their own. Has its own unique issues associated with it. It's really important. Now the interventionist is not doing, but understanding how those issues develop, what maintains those issues, what sort of treatment is available, and how those issues, whatever those issues are, impact the family system is really important. An eating disorder is going to affect the family differently than alcoholism, for example. Total family intervention. When a family lives with a person with an addiction or mental illness, thoughts, behaviors, and relationships are influenced by the problem, and they also influence the problem. So everybody in the family, their thoughts, behaviors, relationships, may start revolving around the identified patient, the person with the addiction, or the mental health issue, which may cause them to feel frustration, anger, anxiety, stress. You know, happiness usually doesn't come up a lot when people feel that way. It creates sort of a negative, chaotic environment which can negatively influence the identified patient and make the problem inadvertently worse. So they, they work with each other or against each other, depending. If it's a positive situation, then it'll probably motivate and support the person. If it is a negative situation, it. If it has negatively impacted the family, which is generally where you're at when people contact you about interventions, then there's going to be some work to do. Total family interventions recognize the impact of the addiction or mental illness, not only on the identified patient, but also on the entire family system. Communication styles, boundaries, anger, grief, resentment. There's lots of stuff. Guilt that comes up really high, too. Most people in the family may have some elements of any or all of those issues that they're going to need to deal with. One of the things that used to frustrate me so much when I did residential treatment was having a person come in and go through 30, 60, 90 days of residential makeup. Huge strides in their thinking, their health behaviors, their, you know, addressing their problems, their coping skills. Oh, they were just. They were really going strong, but the family hadn't budged. The family was still thinking the same way. The family was still expecting the same things. The family was still holding on to resentments and anger and suspicion. And yes, it takes a while to work through those trust issues and, you know, all of the hurt and devastation that's been done. But it's important because if you take a person who is, you know, doing great in recovery and you put them back into that same dysfunctional environment, which one do you think has more power? Someone with really new skills that's really trying to learn a new way of life or this whole environment with multiple people and multiple old ways of behaving and reacting? So TFI really insists the whole family be involved. Now, not all interventions require the whole family to be involved, but with tfi, that is one thing that is. Is certainly recommended. TFI recognizes the impact and loosely defines family as those significant others who are most prominent in the individual's life and relies on the agreement of all family members to participate not only in the intervention. It's not just about getting that person into treatment, but also the treatment process. Now, they may be parallel. The family may see outpatient therapists or something. Well, the identified patient is in residential or seeing different therapists. But it's important that everybody starts working on their stuff so they can start developing healthier relationships and boundaries and communication skills and, you know, all that stuff. Think about a person with an addiction. What are some of the most common problem behaviors? Lying, avoiding, anger, resentment. You know, those are just some that come out. Maybe staying out all night, losing jobs, being unpredictable. In what ways does the family possibly support, encourage, or maintain those behaviors? If you've worked with people with addictions, you know that there is generally at least one person in the family that that has tried to make excuses for, justify, rationalize those behaviors. They may have also tried to get the person into treatment. They may have actually gone overboard in Caretaking for that person. And enabling is the word we use generally enabling that person. How is supporting, encouraging or maintaining the problem behaviors in the identified patient easier or more rewarding than maintaining healthy boundaries? And I will speak from pseudo personal experience. My cousin had a really bad drug addiction. And I remember the anxiety and stress and I mean sleepless night after night after night that my aunt and uncle would have when my cousin was, was out on the street and they were so worried about her. So you know, was it better for them to set boundaries and say, okay, if you're going to use, you can't live here or was it better for them to let her continue living there and feeding her and everything so hopefully she would come home? You know, this is a quandary that a lot of families face. How are family members influenced by the addictive behaviors such as denial, blaming, avoiding, justifying and gaslighting? You know, a lot of people with addictions are very good at trying to make you believe that what you're thinking is, is crazy. They make you think that you're overly paranoid. They are good at manipulating and protecting their addiction. These behaviors tend to create barriers and resentments and anger and lack of trust between family members. So those relationships start to become more tense. They, they still love one another, there's still a love there, but they almost can't like each other at this point. In what ways do the dysfunctional behaviors from the addicted family system impact each family members other social relationships and their mental and physical health? Now this is important to think about. In what ways is the person impacted? And I'll, you know, go back to my aunt and uncle. My aunt has diabetes and even before all this it wasn't well controlled. And during this process her diabetes just went haywire because her HPA axis was over activated, her blood sugar was all over the place, she wasn't sleeping. My uncle had cancer. And obviously you can hypothesize that it may have negatively impact his response to the chemo treatment because he was under so much stress. But aside from that, you know, they were as, as husband and wife. They were arguing and fighting with each other about what the right thing to do was. They were angry all the time, they were irritable. They had more difficulty getting their jobs done at work because they were so exhausted and so drained and so worried. So you can see that addictions and, and the same thing. If you plop in somebody with a mental health disorder or plop in somebody with an eating disorder, there are going to be similar issues that pull at the heartstrings of the loved ones. And they are so fearful, but part of them is also so frustrated that the, the identified patient isn't seemingly willing to get help at that point. And that's where we need to educate a lot about resistance. And look at why is this person not making these steps? What's holding them back? Instead of thinking, why are they pushing us away? Think about what's holding them back and envision maybe this image of whatever the issue is, is a great big monster pulling the person back. There's something holding them back. The same thing can be said about a person with a mental illness. You know, think about some of the most common problem behaviors. Maybe somebody with bipolar disorder doesn't take their medication. So you never know which person is going to show up. Somebody with major depression, somebody with who's in a manic episode, or somebody who is asymptomatic. So there's a lot of question about, you know, how to handle things on a day to day basis. Now, most people don't cycle super rapidly, but you don't know when an episode is going to happen. And with bipolar, for example, it doesn't go from asymptomatic to depression to manic. There's no linear progression. You can have three manic episodes in a row and then a major depressive episode or vice versa. It can be really challenging. And when the person is clinically depressed, you know, they don't have energy to do the things that they want to do often, and sometimes the things that they need to do. When identified patients begin the recovery process, they need support and to learn new ways of acting, reacting and interacting. The family system has been organized around dysfunctional patterns and may not know how to react unless the family also participates in treatment. So when Johnny starts, you know, sleeping a little bit later, you know, that may be a old behavior that indicated that Johnny had relapsed and was staying up partying all night. Now, it may mean that Johnny stayed up too late watching tv. It doesn't necessarily mean the same thing. But the family, based on their prior learning, says, oh, I remember what this means. And they start becoming suspicious. And at a certain point, identified patients start to get frustrated and they're like, well, if I'm going to be blamed for it, you know, what's the point in not doing it? And it's really important to increase communication and open communication and talk about how to redevelop trust in the treatment process. In the intervention, the goal is to help people see why they all need to address their issues. While other intervention approaches focus primarily on getting help for the identified patient, Total family intervention recognizes that improvements will be short lived if the family does not also engage in the recovery process. By addressing the whole system, it also helps the identified patient feel less attacked. If everybody in the family is saying, okay, I got stuff, then the identified patient doesn't feel like everybody's pointing a finger at them saying, you did this, you broke us. You need to get better. When you get better, we'll all be better. That is a lot of daggone pressure to have to carry around. If you know, I have to get better in order to heal my family, well, that's part of it. But the family needs to heal as well. The steps in a total family intervention follow the standard steps of most interventions with the obvious difference that each person in the process, not just the patient, is asked to recognize their need for physical, affective, cognitive, emotional and relational recovery. So physical we're really talking about basic health. You know, a lot of times family members, blood pressure has gone up, they haven't been taking care of themselves, they haven't been sleeping well because they've been so stressed out. They need to start taking care of that so their HPA axis can get reregulated. They need to start learning to do things that make them happy. They need to start learning how to set emotional boundaries so they can be happy. And even if some things are going poorly, even if the identified patient is, isn't doing exactly what they want, they can, they can still have happiness in their life. Cognitively addressing some of those thinking errors that we always talk about, those cognitive distortions like all or none thinking and the recency bias and environmental. We want to help the family address things that are going on in their environment. You know, if they, what, what do they need to do to make their environment happier, healthier and less stressful. And relationship is really, when we're talking about communication styles and boundaries and you know, all that. So the initial contact in an intervention, generally somebody is generally not the entire family. Generally somebody reaches out and they're often desperate at this point. They feel like they've tried everything and they're terrified for their loved one. They often have a myriad of emotions from love to anger, guilt, fear. And because they're contacting you, somewhere down in there, there is a kernel of hope and we want to help them find that hope. It's important that in this initial contact that the interventionist is appointed as the primary contact for the team. So everybody that ends up on this intervention team knows who they're going to call. They're not calling one another, going, when's the meeting? Da, da, da. They know that if they need information, they call the interventionist. The next step is to identify who will be on the team. It's vital that the main people involved in the person's life are willing to, to join the identified patient in the recovery process. If only a few people join the recovery process, then the person with the addiction can split family members and continue the problem behaviors. For example, if you've got a mom who is on board and a dad who is, you know, still giving the person money under the table, that may not work. You know, there's going to have to be a united front. And it may not be a mom and dad. Maybe they've got a united front, but grandma and grandpa think that, you know, they have a better way to do it. So they're the ones that are letting the person stay with them, giving them money, whatever. So it's really important that everybody who the person could potentially manipulate is willing to participate to, to a reasonable extent. Obviously they're going to have friends and stuff that aren't going to be involved. But we want to get the main people who would be willing, you know, who, who are more susceptible to be manipulated. The second contact, you know, first you're just identifying what's going on. The second contact, we're getting everybody together. We're going to educate them about what an intervention is and what it is not. You know, this is not treatment. This is not a guarantee the person is going to go into treatment. This is a process to try to help increase the person's motivation and readiness for change. We need to educate them about what will be required of them in the process, including personal counseling and support. This is a really stressful time, and leading up to it is stressful. The intervention can be stressful. And afterwards, especially if the person doesn't accept help, it can be extremely stressful. We want to talk about what the possible outcomes are and, you know, how the person, how the family is going to handle those possibilities. Not inevitabilities, but possibilities. You know, the person could, the identified patient could say, hey, you know, treatment sounds good, you know, just, just help me. I, I just don't know how to take the first step. Or the person could say no and probably with some expletives included and, and storm out. So we need. And there are all kinds of options in between. They could go to treatment, stay there for three days, and then Leave against medical advice. We want to talk about what those possible outcomes are. We want to educate them about the types of treatment and resources that are available to help them. Not just the identified patient, but the whole family, and then talk about what the next step might be. So they're getting an idea. They're deciding whether this is something they're, you know, all in on. We also provide hope and informed consent. And this is really important because, like I said, they're making a decision about whether they're all in or not on this process. We want to develop hope that an intervention can help them move in the right direction by having them envision what life will look like when the person is in recovery. This is what somewhere in the back of their mind they've been thinking about, they've been dreaming about. So let's start articulating what it looks like so they have a. A goal. Provide information about the success of interventions in general as well as, you know, the interventionist's own personal success rate. You know, if you are only successful one out of every 15 times, it's ethical to tell them that if you're only successful one out of every 15 times, it's probably also important to get more training, but that's a whole different issue. We also want to educate them about the risk factors they can reduce and protective factors they can enhance to support their loved one. So, for example, let's stay with somebody with alcoholism. One of the risk factors that they can do is eliminate alcohol from the house if the person is living there. They can encourage the person to come over for dinner every evening, and that enhances support. That's a protective factor because the person's not going to be drinking in when they're coming over to the house, hopefully, and they also won't have access to alcohol at that point. So there are things that can be done to start making the environment and the relationships more supportive and less, less risky, Motivate them to commit to, to the process and take the next step in setting up the intervention. All PACER sources of motivation so when we're motivating the family, we want to help them see the physical sources of motivation. How will doing this intervention protect the health of their loved one and reduce their stress and related physical symptoms effectively? How will the intervention ultimately lead to improved happiness for the whole family and reduced distress? Cognitive sources how does doing an intervention right now make sense? Because they've already tried what they perceive to be everything else, and they really believe that the person is in objective danger right now. Environmental sources of motivation. How is it going to make their whole household less stressful? You know, sometimes you walk into a house, especially if families fighting, and you can cut the tension with a knife. Nobody wants to live in that environment. How is an intervention potentially going to make the household less stressful so you don't have that tension? And relational sources of motivation. How is the intervention going to improve relationships among all family members as they support each other and how it may help the person with the addiction or mental health issue take necessary steps to improve their relationships with the rest of the family? So we want to focus on the fact that this intervention is not just about, again, the identified patient. This is about helping the identified patients, mom and dad, start getting along better, reduce some of the tension there. This is about how helping the rest of the family eliminate some of those barriers or elephants in the room that have been plaguing them, that relate to this addiction, start helping them support one another in this process. They're going to form a team. They're going to have to present a unified front, so they're all going to have to be coming from the same playbook. During the first face to face meeting, the interventionist also gathers information about the stage of readiness for change of the identified patient, as well as each person on the intervention team. Now, obviously, the identified patient isn't there, so we're going to have people hypothesize about that person's level of readiness for change. So we have an idea about whether the person, the identified patient, has no desire to change. They don't think they've got a problem, or whether they just need some. Some guidance. They're preparing. They really want to make a change, but they don't know the first step. You know, there's very vastly different approaches based on, on where that person is pre contemplation. I don't have a problem. Other people need to change, but not me. Contemplation. Maybe I got a little bit of a problem, but my behaviors are not having a significant negative impact in the preparation phase. The identified patient or the people realize that they have problems or are contributing to the problem, and they're considering what they may need to do to address it. And they're getting ready to make the change. And then in action, they're doing it. Now, remember, everybody on the team is in some level of readiness to change. What are they changing? They're having to be ready to look at themselves and think about changing their own behaviors, their own responses to the situation at hand, because the family Dynamics are probably going to change markedly. The Readiness for Change assessment. Really simple. Ten questions on one to four people. Rate it. How much do you agree with this statement? And that'll just give you an idea about where people are in terms of readiness for their own change versus still believing that the identified patient is the root of all problems. And if that person gets better, then everything will be sunshine and roses during the second contact. Ideally, everyone on the team will be in the action phase of readiness for change prior to the initial intervention. So there may be some motivating that we need to do over the next couple of weeks. It's important to continually reinforce the notion that recovery is possible and identify changes that they make will improve their health, their energy and their happiness. Part of it is about them getting happier and healthier. In order to create a healthy, supportive environment for the identified patient. In some cases, because of the threat of overdose or suicidality, or because it's impossible to find a time in which the identified patient is sober or mentally stable, it may be necessary to help the intervention team pursue involuntary commitment. Currently there are 37 states that allow some form of involuntary commitment for addiction treatment. And nearly every state has laws for involuntary commitment for mental health issues. The process requirements and how long a person can be committed will vary by each state. Once the identified patient has been stabilized, then the intervention can take place, ideally before the person is discharged. So if they're in crisis stabilization, ideally before they're discharged, there there is a discharge meeting where the intervention takes place. It is important to realize though, if, you know, I probably don't need to say this. Involuntary commitment does a lot to make the person feel attacked and does a lot to break down trust. So it's not something that we want families to go into lightly. It's not something that we want to recommend routinely. We really want to be looking out for the safety of the identified patient. The third through the sixth contact is planning. During this phase, it's vital to help the family see how the behaviors of the identified patient have impacted them as well as the identified patient. Physically, affectively, cognitively, environmentally and relationally. You know, we're going to keep going back to that because we want them to see the broad scale scope and see the, the tentacles of, of how the problem has impacted the family. It'll be more important for everyone to start taking care of their physical and mental health through proper nutrition, adequate sleep and management of all health conditions like diabetes or high blood pressure or autoimmune issues which are made worse by stress, by the way they need to learn or enhance their stress management skills. Deal with anger, grief, guilt and anxiety issues surrounding the patient's situation. You know, maybe they feel guilty for setting boundaries. Maybe they feel guilty for not setting boundaries. Soon enough, you know, there's always guilt. Begin giving themselves permission to be happy every day. And this is so important. You know, you can worry and fret and stress over the identified patient. 247 it's not going to do any good. And it's important for people to develop some distress tolerance skills so they're able to find some moments during the day. I'm not saying it's easy but it's important for them to give themselves permission to be happy. Yes, my child, my spouse, my, my, whatever is, you know, struggling right now. But that setting those healthy boundaries and saying that hurts and that, that really sucks. However, it doesn't mean that I have to be miserable. 24 7, 365 matter of fact, it's important for the support team to be able to experience some happiness other otherwise they're going to descend into a place of darkness and depression and hopelessness. And that's not where we want them to be. It's important that they also evaluate their relationships and enhance boundaries and communication where necessary. That means between everybody talking openly, honestly and assertively. Assertiveness is one of the first skills that is important for them to start learning with one another. So if they start having a concern about something instead of holding on to it and waiting and maybe nurturing a grudge, it's they're able to ask one another about it and have calm conversations. They need to learn about the addiction or mental health issue and the extent to which it is impacting the person, the identified patient. How is their depression, how is their bipolar, how is their eating disorder impacting them physically? How is it impacting them emotionally, cognitively and interpersonally? It's important to screen during this time. Now anybody can do screenings. This is not assessment or diagnosis. It's screening. And there's lots of screening instruments out there. You can go on the APA website. The DSM has a online, has a lot of free screening tools you can use. It's important to screen for any addiction or mental health issues in the identified patient. Obviously through secondhand reports from their family as well as the people on the intervention planning team. We want to make sure that if people may have an issue that they are referred to appropriate resources, you know, counseling, medication, whatever that is. It's vital to ensure identification of the most appropriate treatment placements as well as to ensure the safety of all involved, including the identified patient. Not everybody, not, not everybody is going to be appropriate for every treatment situation. So we need to know that if we're going to set up a potential treatment admission that when the person gets there that they will be likely accepted, not rejected on, on the basis of co occurring issues or medications that they're on. Explore the impact of the identified patient's behaviors on the family, how they impact the patient, behavioral changes that the family will need to make to support the recovery process. Maybe not jumping to conclusions, maybe not giving the person money every time they come to the house. That's just one of the big things that typically comes up. Changes or issues they will need to address for their own health or mental health and how they will do that. Not everybody's down with seeing a counselor. That's cool. Some people want to work on self help books, some people want to see their religious leader, whatever it is that they're going to do to address it. It's important for them to make a plan plan and start exploring what's maintaining the behaviors for the identified patient. And this is where education can come in helping them understand that any of these issues, mental health or addiction can be caused by or result from or both disruptions in the neurotransmitter system. There is a physiological basis to what is going on. Now that's not the only thing that's going on. There are probably also interpersonal issues, cognitive issues. There's a lot of stuff that may be there. But it's important for the family to understand that there, there is a physiological element to it that the person's body will need to heal and rebalance, develop a unified message that change needs to happen. The types of changes expected, what support is available for change related behaviors and consequences for refusal to accept treatment. These may include the identified patient having to move out, being cut off from further financial support, not being able to see their children when they're under the influence, maybe having to take a drug test whenever they come over for visitation. Depending on what's going on with the person, there are going to be different consequences. Now you don't want to have them set the consequences, you know, sky high. We want to set things that are reasonable, such as and. And they have to be related to what's going on. So if the person is, when they're in a manic episode, if they come to the house and they create all kinds of chaos and they scare their children, you know, then it may be important to demonstrate that they are actively taking their medication. And before visitation, you know, thinking about minimizing the negative consequences of the identified problem. Explore prior attempts, the person, the family has made to get the person into treatment and what happened. You know, by the time they get to you, they've already tried to get that person into treatment. So why didn't they go? Or if they went, why didn't they stay? That's going to provide oh so much in, in terms of nuggets of information about what may be holding this person back. And I still want you to have that image in your head of something or someone holding the identified patient back. They're trying to run forward, but there's something restraining them. Find an appropriate initial placement which will be able to admit the person the day of the intervention. Now, you want to generally have multiple different levels. They may not be ready to go to residential. So an outpatient therapist that would be able to start seeing them today or tomorrow, or an intensive outpatient program that they could start tomorrow, sometimes they can't start that very same day. There has to be a transition plan until the person can get into treatment. That's less than 24 hours. You don't want this to drag on. But sometimes in that first eight to 24 hours, until the person actually can start the treatment, they will need to be with someone. Whether it's a recovery coach, sometimes the family wants to step back, or a family member or the. Or the team. It's going to be important to decide how that's going to look. If the person says, okay, I'll get help, how can we make sure that happens? And how can we make sure that they continue that momentum into treatment as quickly as possible? Ensure the family is versed on family medical leave. A lot of times the person may have to take time off from work or school insurance benefits, options for child care if needed, somebody to watch their pets, somebody who can make sure that bills get paid while the person's in treatment, etc. You know, they are going to be sort of plucked out of their life if they go into residential for a month or maybe only a week, But a period of time where somebody is going to have to, you know, make sure that the basics can get done. And some of these are some of the most common reasons why people say, I can't do that right now. I can't leave my job, I need the paycheck. I can't do this, that or the other. And it's going to be important to know what their typical rationale is that is holding them back and have solutions available to them. The family is also going to have to at this point, start writing personal narratives and they can take on different forms. One is a letter template and it starts out with something like I love you, I care about you, and truly believe that it's possible for you to get better. There's that self efficacy piece. Acknowledge the person's fears about entering treatment. You know, I know you're afraid that we can't afford it right now or you're afraid you'll lose your job. But we've all come together and identified some workable options. The next step or part is why is it important that the patient make these changes right now? Why is it important to you? And using those I statements, I feel that it's really important for this to happen right now because the person also then goes on to talk about how it makes them feel to see the patient struggling. Still using I statements, it's really important that everybody owns their stuff. I feel helpless when I see you struggling so much. I feel, you know, and there's probably going to be a lot of stuff there. And how does the patient's behavior impact the person in general? So in general, your I feel and keep going back to I feel, however they feel when the person does this, when you disappear for 48 hours or, or 72 hours at a time and I haven't heard from you, I feel terrified and I. I'm not getting enough sleep. And talking about helping the person, the identified patient really see the objective impact of their behavior on the person. The letter goes on, giving three specific examples of things the person has done that let the per. Let the talker know that the identified patient had a problem and how it's impacted them. So when did it happen? Last Christmas? You know, assuming this is, you know, March last Christmas, when you showed up to the Christmas Eve gathering and you were stoned. Yeah. Okay, so that was what happened. What specifically happened? And talk about exactly what happened that day. The person may not really remember it. So kind of go over it briefly. How did it impact you, the speaker physically? Did it cause you insomnia? Were you not able to sleep that night? Did it raise your blood pressure, give you a stomach ache? You know, what happened? How did it impact you emotionally and how did it impact other people that were there? You know, maybe the person's grandchildren were there and they got really scared or they weren't sure what was going on. So encouraging the person to get a wide understanding of their behavior. And this Is all in that feedback section, the final couple parts. I recognize that we all have to make some changes in this process. And then the person identifies what they have committed to doing for their own recovery. I've agreed to start going to counseling or I've agreed to start seeing the pastor once a week. Once everybody has their letters written, they're educated about the problem, we know what stage of change the person is in and everybody else is in. We have options identified for, for treatment. Then it's important to get together and rehearse the intervention process, anticipate the person's objectives, and have calm, rational responses prepared for each reason the person may give to avoid treatment or taking responsibility for their behavior. Especially in addictions, there's often a lot of blaming. You made me do this. If you wouldn't have. If you wouldn't nag me all the time, I wouldn't have to drink. There's a lot of blaming, minimizing, rationalizing. It's helpful as an interventionist to keep a running list of objections that people have to treatment. So if a family's having difficulty coming up with objections, you might say, well, has the person ever used this as a reason to not go and give them prompts so they can make sure that they're prepared for as many possible objections as possible, Even though the entire family has participated in the process until now. And remember, I'm using that term family really loosely. It's anybody who's really important to the identified patient. It's often suggested that the person, the identified patient, be confronted at first by just one person with or without the interventionist present. And that'll depend entirely on the patient, the situation. That's going to be a family to family thing. If that fails, or if it seems the family has already tried that, then a group intervention may be the next step. During the intervention, whether it's one or one on one or in a group, ensure the person, the identified patient, is not under the influence of drugs or alcohol at the time. Present the message with love, respect, support and concern. It's going to be important to keep that anger under control. It's going to be important, hopefully, to have dealt with some of that anger and resentment and be more on the side of compassion and empathy. Set ground rules in with yourself, with the person that's doing the intervention with the team that prohibit name calling or angry accusing statements and insist on objective presentation of facts using I statements, saying something like, you completely destroyed last Christmas Eve. That's not objective. You know, that doesn't tell the person, what they did. It's important to say, I felt humiliated when you showed up at the family Christmas party and you were stoned and you did this, that and the other. That's objective. That's something that can be sort of verified. It's important to use those objective examples. Stay on track during the intervention. Remember that the person with the addiction or mental health issue will likely feel very threatened. Make sure team members are prepared to remain calm in the face of the person's accusations, hurt or anger, which is often meant to deflect or derail the conversation. They've learned that if they can bow up enough, generally people will back down. So it's going to be important to be prepared for that. This is why one on one is usually the best way to start. And a lot of times if it's done well, the family doesn't have to move to that next step. Sometimes it can be, you know, like I said, a person and the interventionist counselor person and the identified patient. So there is a moderator there and you know, that can be super effective in many cases. A lot of times it doesn't get to that full intervention group intervention like you see on television. During the intervention, it's important to express concern and present treatment and recovery options using the frames method. Let them know that, okay, these are your options. You don't have to go to residential. If you would agree to start going to 12 step meetings or smart recovery meetings every day and you know, whatever the other demands are, then you know, that's cool. But it's important to have a minimum requirements for what the person needs to do as well as up to and through the highest level of treatment that they may need. So, okay, they're not ready to go to residential. What are they willing to do? What we want to see is forward movement. You're not going to take somebody who's in the pre contemplation or contemplation stage and likely get them to jump into residential treatment. That's not super realistic. You may get them to agree to start going to 90 meetings in 90 days and you know, going to work every day and whatever those minimum requirements are. So it's important to have that minimum ask for an immediate decision. Don't give the person time to think about whether to accept the treatment offer because it just gives them time to continue denying the problem, go into hiding or go on a dangerous binge. We want to know that they've agreed to do something and then we've got a plan. And part of that plan Involves safety, making sure that if they're going to start doing the next right thing that they have their basic needs met. We know they have safe, stable housing, we know they have access to medical care and nutrition, et cetera. It's recommended that the interventionist have a licensed therapist or the person's physician as part of the team in the event that the person goes into crisis during the process. For cost containment reasons, this professional may only need to be present if a phase two intervention, a group intervention is required. Total family intervention Best practices require the participation of a licensed medical or mental health professional if the person has a history of depression, suicidality, physically aggressive outbursts, or is physically vulnerable in some way. If you're working with somebody who has anorexia and they are at a weight that they are physically compromised, it may be important to have a licensed clinician involved. So if the person decompensates or refuses treatment and needs to be involuntarily committed, you know, that's, that's there. But we really want to try to empower the person. Follow up is essential after the intervention is recommended for someone, either the interventionist, a coach, or a clinician that's involved in the process, to have brief 30 minute follow up meetings with the family on a weekly basis for 12 weeks, regardless of whether the person went into treatment. If the patient accepted treatment, follow up focuses on adapting to all of the new changes. You know, what progress is the person making. It's important to encourage the family to focus on the positive steps the person's taking because they're often used to looking at all of the things the person's not doing. We want to help them start looking at the positive steps. If the patient refused treatment, follow up often focuses on maintaining the united message, you know, not giving extra money, not giving them a job, not doing things that are going to support their continued unhealthy behavior and preventing further splitting and destruction of the family. You know, if a person identified patient splits the family and gets, you know, mom to give them money under the table, then not only is that enabling the the behavior, but it's also going to cause conflict within the family system. It's also important to look at how everyone is managing to adhere to the rec, their recovery plan. Regardless of whether the patient chooses to begin the recovery process, they need to start changing patterns of everyday living to make it easier for everybody to avoid destructive behavior behavior, seek counseling or recovery support for themselves and know what to do if a relapse occurs. This is essential for every team member not Just the patient. And when we talk about relapse, that's for everybody. If they notice they're falling back into old ways of thinking and behaving, that's a relapse and they need to know what to do. Altogether, a well constructed intervention will take between 15 and 25 hours from the initial contact determination and that includes those 30 minute follow up sessions. And why do I, why did I say for 12 weeks? Well, 12 weeks usually gets people in recovery to a place where they are feeling okay. They feel like they've got their land legs, so to speak. They are not in the reintegration process yet, but they have made a lot of changes. And the first three months can be really hectic and chaotic. And this is the time where it is most likely for people to discharge against medical advice or, or relapse. So during those first three months, we really need to make sure we're still touching base with that family and helping them do what they have decided to do. The interventionist needs to be aware of not only addiction, but also mental and physical health issues which may need to be addressed and could complicate the intervention or treatment process. For example, if the identified patient has Hepatitis C or tuberculosis or is pregnant, you know, that may alter the places that they can go for treatment. It may alter a lot of things about the intervention process. So that was a really obviously really fast overview of what an intervention is. It doesn't have to be this adversarial meeting where somebody feels put on the spot. It can be a very loving, caring meeting. Can't find another word to do to use for it that where empathy is really expressed instead of anger and the person feels supported and empowered to start making that next step. Are there questions? If this podcast helps you help your clients or yourself, please support us by purchasing your ceus@allce.com or getting your agency to sponsor an episode. 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