By William F. Northey, Phd

Centers for Children and Families

Did you know that family involvement has been shown to improve outcomes for people seeking behavioral health services? We have decades of research that shows the effectiveness of family treatment for substance abuse and mental health problems.

So why don’t we engage families more?

I think there are a number of reasons. Sometimes families can be “difficult.” Sometimes our clients are estranged or have strained relationships with family members. Sometimes rules, laws, policies, and our own beliefs get in the way. Often, we’re not comfortable working with families–as soon as you add more people to the therapy process things can get a bit dicey. And a good bit of the time I think it is just an oversight given our focus on individuals.

For those of you don’t know me I am a true-blue marriage and family therapist (MFT). Both my masters’ and doctoral degrees are in marriage and family therapy and I have been training MFTs around the world for over 20 years. For me, not including family members is like leaving money on the table — to borrow a gambling metaphor.

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To be completely transparent I actually don’t like working with individuals. Frankly I find them a bit boring. I love the energy that comes from having 3, 4, 5, or more family members in a room playing online casinos. For me, that makes doing therapy much easier. Sure I have to go for a ride with them every now and again, but if I can get them to go my way the impact can be tremendous. I often think of doing family therapy as white water rafting and I’m the guide. All of the people on the raft influence the direction it goes and it may go in a direction that might not be the one I would pick, but as long as I can keep them on the river (and in the raft) I can generally get them to their final destination, safe and sound.

Now you might be thinking to yourself, there is no way I’m getting in a raft with my clients and their families — and I completely understand that — but if we do not engage family members we are missing out on some great opportunities. That said, I’m not asking you to bring in families and start doing family therapy either. Instead I would like you to try a few things over the next couple of weeks that might help us recognize the influence that families have on our clients.

First, ask your clients about the people in their family or the people they live with. Do they have a spouse, domestic partner, children? Do they live with their parents or other relatives? If they don’t live with family ask them how often they have contact with family members. In cross-cultural research by Dr. Duke Stanton it was noted that 86% of substance abusing clients had regular contact with family, the highest among the countries studied, including England (62%) and Thailand (80%).

A second question you might ask your clients is, “How does your substance abuse (mental health problems, criminal history) and treatment for it impact your family?

As someone who thinks about things systemically, I know that a problem in one part of a system (i.e., a family) impacts other parts of the system–think of a mobile. Sometimes the impact might be negative, but there could also be benefits to family members at times as well. The type of impact is not necessarily the most important aspect, but recognizing that there is an impact can be both a powerful way to join with clients and potentially their families. Even if clients are estranged from their family they might want to think about what would happen if they became involved with them again.

Not every program needs to have family therapy available for its clients, but it does make sense to think about what kind of family involvement would make sense for your program. The Substance Abuse and Mental Health Services Administration (SAMHSA) put out a Treatment Improvement Protocol on Family Therapy (TIP 39) specifically to help programs think about how families can be involved in the treatment process. In the TIP they identify 5 levels of involvement from none (Level 1) to Integrated Family Therapy (Level 5).

It is rare program that a program can reach Level 5, but right now the Newark and Wilmington Outpatient Clinics do have MFTs who are providing integrated family therapy services (Belinda Porter and Chres Alicia). If you are not lucky enough to have an MFT on your staff, the next best thing is to refer your clients and their families to a family therapy program. Luckily the Bellefonte and Kent-Sussex Centers for Children and Families are actively working with Connections to provide such services (302-442-6620).

Program can also offer psychoeducation (Level 2) or emotional and educational support (Level 3).   This might include programs where the impact of substance abuse and mental health problems are presented to families to help them better understand what might be happening for their family member. Support and problem-solving groups can also be helpful. These groups help families negotiate the problems that often arise when they have a loved one who is suffering from a behavioral health issue. If you think your clients and their families might benefit from such a program let me know and we can help you get one set up.

So be aware of the power of families and use it whenever possible!