Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

24. Family-Based Treatment 533called transitional family therapy, or TFT (Horwitz, 1997; Landau & Stanton,2000; Landau-Stanton, Clements, & Stanton, 1993; Landau-Stanton, Griffiths,& Mason, 1982; Seaburn, Landau-Stanton, & Horwitz, 1995; Stanton, 1981a,1984; Watson & McDaniel, 1998). Based both on structural-strategic (Stanton,1981a; Stanton & Todd, 1992) and intergenerational (e.g., Guerin & Pendagast,1976) methods, it integrates (1) the management of the substance abuse problem,(2) the larger psychosocial environment (ecosystem and network)—inline with Henggeler and Borduin (1990), Liddle and Hogue (2001), and Speckand Attneave (1973; Speck, 2003)—and (3) exploration and interventionspertaining to how the problem originated in the family’s history. TFT’s“geodynamic balance” theory of change (Stanton, 1984) posits that all therapeuticinterventions can be subsumed within a complementary dichotomy of“compression” and “diversion” techniques. Compression (e.g., strategic, paradoxical)methods push a family interaction sequence further in the way it normallyunfolds, that is, exaggerating it so as to get a counteraction—and thus anew sequence—among family members. Diversion (e.g., structural, behavioral)methods introduce competing behaviors that block the family’s typical sequenceand induce it to experience, and then to practice, a different and morefunctional pattern.Stage 1: Problem Definition and ContractingThe first stage of family therapy begins when someone contacts a therapist andrequests help from the full range of service settings and treatment providers.Family therapists also work in therapeutic communities, where families oncewere excluded. By making family therapy available, such therapeutic communitiesbring the “real world” into the center and help each family prepare for itsreunion.The therapist’s first step is to convene enough of the family to gain adequateleverage to initiate change in family interaction regarding the substanceabuse. As previously discussed, this may involve 1, 2, or 30 family members, andmay include other members of the substance abuser’s community. Family therapistsgenerally start by working with the most motivated family member ormembers, convening other family members as necessary (Berenson, cited inStanton, 1981b).Next, family therapists attempt to understand and define the problem.When substance abuse is suspected, many therapists ask simple questions, suchas “Who drinks?” or “What medications are used in your family?” We ironicallyrefer to these as loaded questions and ask them of all our clients.To assess the degree of substance abuse, particularly with adult clients,Davis (1987) suggests the use of a standardized questionnaire, such as the MichiganAlcoholism Screening Test (Selzer, 1971). History of the abuse, degree ofphysiological addiction, organic consequences of long-term addiction, prior