Structured Family Recovery™ Addressing ASAM’s Six Dimensions
As a foundation for the Structured Family Recovery™ (SFR) Counselor Training and all subsequent advanced SFR trainings, students will explore how SFR addresses ASAM’s Six Dimensions in a way we have not done in our field before. The book It Takes a Family: A Cooperative Approach to Lasting Sobriety (Hazelden, 2014, foreword by Robert L. DuPont, MD) has created a framework for family recovery teams that actively impacts all six dimensions. (The first two being primarily physical in nature also require patient willingness, which is often a factor of a well trained, family team’s influence.) As Robert L. DuPont writes in the foreword to the book:
“In this book, Debra Jay unlocks the secrets of this revolutionary new approach to addiction [i.e., The New Paradigm]. She adds a significant new dimension by focusing on the role of the family both in creating this system of care management and making it work long term.”
Understanding Success in Terms of Intervention, Treatment, and the Continuum of Care: Professional Limitations and Questioning the Rubrics Used to Measure Success.
It’s long been understood that relapse has been a enduring issue in the alcohol and drug treatment field. Unable to measure accurately the relapse rates post-treatment, the statistical spread commonly used is a relapse rate of 50- to 90-percent in the first year after treatment. Students will review the different ways, as a field, we have tried to improve these numbers, but without consistent and dependable results. Exercises will include ways we have attempted to change definitions of success and expectations of what happens after treatment, and how these efforts do not match what families want and what they think they are paying for. We will then compare results for the general-public with results for impaired professionals engaged in diversion programs.
Physician Health Programs and the Eight Essential Elements: Lasting Sobriety for a Small Subset of Addicted People
Receiving exceptional support that includes eight essential elements, 78 percent of doctors have a zero relapse rate over five years post-treatment (“Setting the standard for recovery,” DuPont, et. al.). Students will learn about the eight essential elements and how SFR creates a pathway for people to implement these elements into their families, which includes the newly recovering person. DuPont writes in the discussion section of the study on PHPs that these elements can be successfully used as a chronic care model for the general population of addicted people. Students will learn the process of implementing these eight essential elements in a palpable manner to the entire family through the SFR process. As Dr. DuPont wrote: “On the basis of these findings, there is reason for renewed optimism for individuals with [addictions] and their families.”
The Basics of Structured Family Recovery™
Students will discover the ways myths and misconceptions about families of the addiction have served to hinder professionals from engaging the most important people in the lives of most alcoholics and addicts: The family. Students will then do a metacognition study to examine their own biases about family and then discuss these finding in a small group (3 or 4). Having examined and challenged their own thinking, students will begin building new conceptions about families in the recovery process by learning the basics of SFR and the results families are experiencing. Part of this process is examining several case studies, all demonstrating how SFR addresses disparate family dynamics.
A Misunderstood Disease: Cognitive vs. Emotional Understanding
Students will learn about and deliberate the various ways to identify different needs among different people in their understanding of the nature of addiction. Students will learn that cognitive and emotional understanding can be incongruent within an individual. Having a congruent understanding of the disease of addiction is key to reaching a state of empathy. Students will work in small groups as they learn to look deeper at the needs of family members and how this work lays groundwork for work to come.
Family Denial: How Necessary Is It to Address Denial?
Students will learn to define denial as an action-stopper and how trying to educate families out of their denial before moving forward stalls the recovery process, sometimes indefinitely. Instead, students will learn how to handle denial as an SFR counselor, how to move past it quickly, and engage the family in recovery-based actions. The class will develop a practical understanding of how to use action to quickly dismantle denial.
What Is Correlated to Lasting Change and What Is Not.
Students’ beliefs about lasting change will be challenged by 40 years of studies by social scientists and, more specifically, the work done in the Stanford Behavior Lab. Many things that are not correlated to lasting change are widely accepted as tenets in the addiction field. We will examine what these tenets are good for accomplishing, but why lasting change is not among the benefits. We will then examine what correlates to lasting change and exactly how SFR has incorporated this clear understanding of what is required for lasting change into the fabric of the process.
A New Look at Relapse and Enabling
Students will participate in a metacognition exercise about relapse and enabling as part of looking at both differently. We have long been ineffective at getting family groups to consistently end enabling behaviors. Students will examine the different blocks for families, how we have systematically ignored the deeper reasons for enabling, and how to view enabling in a way that allows us to offer families what they need to let go of enabling behaviors.
Actions that Help Sustain Behavior Change
Students will learn how to implement the tools developed by the Stanford Behavior Lab to sustain behavior change long term. This will be an experiential process with students using these tools themselves to directly experience how they work to change or initiate behaviors in a lasting manner. They will then examine how these tools work for families engaged in SFR and how to teach families to use them.
The Science Behind the Effects of Addiction on Family Members and SOs
As neuroscience advances, we discover the extent the body and the brain are changed by relentless stress. Harvard has done advanced studies on the ways children are affected and how these changes appear to affect mental and physical health throughout a lifetime. Students learn the latest in psychosomatic medicine (behavioral medicine) and research – the various aspects of the relationships among social, psychological, and behavioral factors and bodily processes when in a close relationship with an alcoholic or addict.
It Takes a Family: The SFR Team
Students learn the nuts-and-bolts of transforming a family into a family recovery team and, once accomplished, how the action steps of SFR begin creating a strong recovery culture within the family. Students learn how they can facilitate and foster this process, but also ways they can interfere and even unwittingly sabotage the process. Students will break into small groups to discuss pre-determined case studies and what choices they would make if they were working with these families. The entire class will review and discuss choices made by each small group.
How Do I Talk to My Addict? How Do I Talk to My Family?
Coming out of treatment, addicts don’t know exactly how to talk to others closest to them, and their families and friends usually feel an equivalent problem with communication. Students will learn the way SFR opens up an appropriate transparency in communication, which quickly increases the comfort levels of all parties involved.
The Ethics of Proper Training and Adhering to the Process
Using as a text, The Elements of Ethics for Professionals, by Johnson and Ridley (Palgrave Macmillion, 2008), students will discuss the ethics of being properly trained prior to claiming expertise in any area of an endeavor; staying true to their training when executing this new area of expertise; and engaging in supervision and follow-up training as necessary. Additionally we will look at the matters of non-maleficence vs. beneficence especially important to SFR: Do not blur roles; resist coercion; prevent misuse of the work; plan for illness, incapacity or other times away from your practice; establish win-win solutions; clarify expectations; communicate clearly; refer cautiously; resolve conflict flexibly; create positive social norms. Students will also engage in discussions about the following in terms of ethics: Honor human differences; respect values; behave professionally at all times; confront irregularities; never undermine other people; avoid conflicts of interest. This work on ethics will be done under the umbrella of SFR counseling.
A Deep Look at SFR and Twelve-Step Programs
At the heart of SFR and family recovery is 12-step recovery for the family and the newly sober person. Students are all required to be actively engaged in any of the many 12-step programs available. Students will learn why working as an SFR counselor requires an intimate and personal experience with a 12-step program. We will also examine, in small groups, the reasons we have historically had difficulty engaging family members, let alone entire family systems, in 12-step recovery and how SFR is changing that experience. We will discuss case studies showing entire families quickly go from resistance to action.
Putting Structured Family Recovery into Place
Students will learn the necessary steps and skills for putting SFR into place. This includes the necessary preparation for both the family and the SFR counselor. Students will learn the order of involvement of family and addict, and the rationale for how the SFR counselor moves the family forward in this early stage. Students will learn how to select and work with a family SFR chairperson as well as other roles family members play in the SFR process. Students will learn about the whys of the SFR format and their role in facilitating. Students will learn the philosophy of using well-designed checklists and why they are key in creating lasting change with SFR. Students will walk through scheduling SFR meetings with families and learn why using the right process can be the difference between success and failure. This is were students will discover the many details that must be put in place to create the greatest probability that families will adhere to SFR long term.
Family Guidance for Creating an SFR Recovery Plan
The workhorse of SFR counseling is the SFR Recovery Plan, which puts all the elements together in a plan that serves to formalize a recovery program for each family member, including the newly sober member of the family. Students learn why it is essential that all family members create an SFR Recovery Plan and the issues for family members and the newly sober person, with a special focus on complacency. Students will learn in depth how to facilitate the following elements of the SFR Recovrey Plan:
- Writing a personal Recovery Goal
- Creating a Recovery Commitment Statement
- Eight Essential Elements work
- Identifying Relapse Warning Signs & Symptoms (family and addict)
- Writing a Relapse Agreement
- Writing a Conversation with My Future Self (letter format)
- Planning a Rapid Relapse Response
Students will also learn how to facilitate the use of the following checklists to help keep the SFR family team on track:
- SFR Overview Checklist
- Daily Recovery Checklist
- SFR Chairperson Checklist
- SFR Secretary Checklist
- Red Light, Yellow Light, Green Light Decision-Making Checklist
- Recovery Plan Checklist
Creating SFR Boundaries: Red Light, Yellow Light, Green Light
Students will learn how to implement the Red Light, Yellow Light, Green Light system of decision-making. This prevents families from “dropping bombs” in the middle of SFR meetings and hijacking the process. Students will learn how to teach SFR family teams this system for bringing concerns to the attention of the SFR counselor and how to then decide together what is and isn’t appropriate for SFR meetings. Students will learn how to use case management outside the usual weekly SFR meetings to deal with important issues that are not appropriate for these meetings. Also, students will work in small groups to discuss making proper referrals for issues outside the bounds of SFR and will revisit the ethics of avoiding dual relationships.
The Negative Brain: Choosing Kindness and Gentleness
Students will analyze the neuroscience of the brain’s retention of negative and positive experiences and how therapy often reinforces the negative brain. They will learn how SFR requires that families work together and how to avoid engaging the negative brain that is often the source of conflict, splitting families apart. Anger and resentment are not ignored, but redirected to an appropriate place for dealing with these negative and sometimes distorted emotions: the Twelve step programs for alcoholics, addicts, and families. Students will do some metacognition and role-playing work on how to check their own tendency to “do therapy” and mine the negative experiences and emotions vs. facilitating SFR as a positive, action-based program that uses the 12-steps to manage and eventually dissipate anger and resentment. Students will learn and then discuss the pros and cons of engaging in therapy early in recovery, when it is and isn’t recommended, and how to refer cautiously. Also, students will learn how to dialogue with therapists so they understand – and won’t undermine – the SFR work the family is doing.
Understanding Rebuilding Trustworthiness in the Addicted Family
Students will examine the loss of trustworthiness within the family holistically. While we typically focus on the addict in terms of lost trust, students will learn how trust is eroded among and between most family members. Students will discuss the language families use that ultimately translates into describing lost trust. Students will learn to direct families in what they need to do to rebuild trust, and how to do it effectively. We will examine using the Eight Essential Elements as trust builders. Students will do short exercises on trust and rebuilding relationships.
Fun as a Serious Matter in Recovery
Students will acquire the latest knowledge on the importance of play and having fun in recovery. The class will see a short video by Stuart Brown M.D. discuss his research on play and how it positively affects the brain, our moods, trust of others, and, ultimately, our sense of belonging. Students will break into small groups with assignments that lead them into discussions of the importance of play for the entire family during early recovery and beyond. We will also brainstorm novel ways families can have fun with spending much or any money.
Interwoven throughout the training, the trainers will work on special issues that students usually struggle with in their early work as SFR counselors. The following highlights these issues:
- Speaking in plainspoken language rather than “therapy talk.”
- Knowing where to set professional boundaries
- Understanding working with families from a holistic viewpoint
- Unwittingly splitting family teams and sabotaging the SFR process by reverting to a therapist role with individual family members
- Properly dealing with objections from individuals on the SFR family team
- Identifying issues that require case management and separating these services from the actual SFR meeting
- Developing the self-awareness and discipline not to complicate the SFR process
- Learning to maintaining the process while still bringing individual personality, wisdom, guidance, and energy into the process
- Listening well to families to get to know them in terms of their family values and worldview
- Knowing when the desire to be helpful is actually harmful, but disguised as beneficence.
- Understanding the primary role of the SFR counselor and avoiding cross-purposes
- Communicating with professionals prior to referring to clearly state the purpose of the referral and to educate them on the SFR process, so that goals between professionals remain complimentary.
- Knowing to call second meetings (other than the SFR meeting) to deal directly with case management issues.
Structured Family Recovery Simulation
Students will participate in a simulation of the first 6 weeks of SFR meetings. This is not a role-play, but a very sophisticated, real-to-life simulation. It includes a fully developed family, with thorough biographical information for each family member. Scripts are written as guides for the approach each family member will take to the SFR process. Each student will have an opportunity to play the SFR counselor during one SFR meeting; the rest of the time they will stay in role as their family member character. Students will learn by experiencing SFR from the family perspective, by being the SFR counselor and by witnessing how other students play the role of family member and SFR counselor. All SFR simulation meetings will be observed and reviewed by a trainers for this SFR training.