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

536 V. TREATMENTS FOR ADDICTIONStherapist must, in the same session, “get across to the family that there is noissue more important at this stage of the work than the cessation of drinking,and that the family and the therapist must mobilize all resources toward thatgoal and that goal alone” (p. 354). Family therapists characteristically invitefamily members to become part of the solution to problems.A powerful, ecosystemic expansion of the above notion is to apply themethods of psychiatrist Ross V. Speck (2003; Speck & Attneave, 1973) andinvolve the family’s social network in the treatment endeavor. This can includeextended family, friends, work associates, and, commonly, other professionalsinvolved with the case. Callan, Garrison, and Zerger (1975) described such anapproach with adults who are addicted to drugs, while van der Velden, Ruhf,and Kaminsky (1991) have applied it with adolescents who abuse substances. Itis also regularly used in TFT (Landau & Garrett, 1998; Landau & Stanton,2000; Seaburn et al., 1995; Stanton & Landau-Stanton, 1990), in which amajor thrust of the first session or two is to attain consensus across the networkon what the primary goals of treatment are, and how change in each can beobjectively defined. Thus all members are working in accord, and (often unintentional)competing agendas among subsystems are minimized: Everybodyagrees both on what needs to be done and on how to know when that hasoccurred.By the second session, TFT also begins to build three graphic constructionswith the family, all of them printed with a marker on a large newsprint flipchart mounted on an easel. These are: (1) a list of the goals of treatment; (2) alist of the tasks to be performed toward meeting those goals, including who is todo them and, if applicable, by when; and (3) a three-generational genogram(Guerin & Pendagast, 1976; McGoldrick, Gerson, & Shellenberger, 1999) thatincludes all members, living and deceased. These graphics are brought to eachsession and hung on the walls (e.g., with masking tape) so as to be readily availablefor reference. Such techniques help to clarify, make more concrete, andprovide perspective on the problem(s)—both as to how they developed and theways the family has devised to contend with them.The therapist should also be aggregating information for a fourth graphic,the family “time line” (Stanton, 1992). This method clearly spreads out facts asto, for instance, when the substance abuse problem, and the latest relapse,began and what changes (e.g., illnesses, unemployment, relocation, immigration),losses (e.g., deaths, divorces, breakups of relationships), or other familystressors were occurring around those times. However, it may be too early atthis stage in therapy to construct the time line publicly with the family. Therefore,the technique is discussed at greater length below.Many families—in attempting to answer the question, “Why did this happento me?”—accept that genetics and/or a disease process is responsible forsubstance abuse, particularly when the problem is alcoholism (see below). Atbest, these theoretical explanations can reduce guilt, blame, and shame in fami-