Supporting Treatment
Welcome to the Family Support Group Program.
Here you can download the session PDF below by clicking on the button or continue scrolling to the online version. The videos password is craft.
Session Online Version
CHECK-IN SECTION – Maximum time 20 minutes
Mindful Minute -- take a break from what you have been doing, breathe deeply, relax and recharge.
Step 1: Find a comfortable seated position with both feet grounded on the floor. Put a hand on your stomach. Close your eyes.
Step 2: Take a deep breath in through your nose and out through your mouth. Notice your thoughts and feelings and any tensions in your body.
Step 3: As you inhale and exhale, breathe deeply so your belly fills and empties with air. The hand on your stomach helps you practice belly – not chest breathing.
Step 4: or the next minute make breathing in and out your only focus. Let your thoughts come and go without trying to control them. If you find an area of tension in your body, relax it and let the tension go.
Step 5: At the end the minute slowly open your eyes. Gently bring your presence back to your surroundingsOur Purpose
Our Purpose
CRAFT Connects’ Family Support groups are for parents, partners, families and other Concerned Significant Others (CSOs) who have a loved one that is struggling with a substance use or mental health disorder. We know from first-hand experience that loving someone with these challenges can be a difficult, lonely journey. To create a safe place for honest sharing of our lived experience we use appropriate language and behavior. We are empathetic, nonjudgmental, genuine, respectful, steer clear of confrontation and imposing our own solutions. We encourage hope and compassion for all. CRAFT Connect helps to reframe and energize connections between you, your loved one and behavioral health professionals into a “therapeutic alliance” that leads to progress and healing. There is a lot we can learn from one another.
Last week we studied the “FS13. Invite Your Loved One to Enter Treatment” session.
A. Were you able to follow through on these commitments?
· Complete the “Windows of Opportunity Worksheet”.
· Use the “PIUS Communication Worksheet” to write down and practice how to invite my loved one to enter treatment.
B. What experience did you have practicing or sharing last session’s principles and skills?
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C. What did you do to purposefully take care of yourself?
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LEARN SECTION – Maximum time 30 minutes
1. Well supported scientific evidence shows that you, your loved one and their therapist or program all benefit when you make the effort to develop a “therapeutic alliance” and not engage in Therapy Interfering Behaviors. For your loved ones’ therapist or program’s perspective, this kind of collaboration can lead to an over 50% improvement in your:
· Loved ones’ relationship with their therapist
· Loved ones’ willingness to discuss and be more “open” about their personal lives
· Better “adherence” or “compliance” with mutually determined treatment goals
· Loved ones’ focus on their recovery-oriented goals
· Loved ones’ overall quality of life
· Loved ones’ mental/behavioral health conditions
Think: When your loved one accepts the invitation to enter treatment how do you think you fit into their treatment team? What are your expectations for involvement?
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2. Your involvement in your loved ones’ treatment is based on their needs, preferences and goals – not yours. Addressing treatment related issues in an open, collaborative and caring manner can help strengthen the relationship between you, your loved one and their therapist or program. The “Treatment Collaboration Handout” included with this session highlights five building blocks that have proven to contribute to treatment’s success:
· Mutual respect for each other
· Two-way sharing of information
· Honest and clear communication
· Mutually agreed upon goals
· Shared planning and decision-making
3. Adopting the following mindsets will also help you support your loved ones’ treatment as effectively as possible.
A. Have realistic expectations. Your loved one isn’t broken and needs fixing. Treatment isn't about fixing; it's about helping your loved one find their most effective and healthy way to live.
B. Your loved one is an individual and an adult. They are not extensions of you. Their desires, dreams and goals, even when you disagree with them, even if they are objectively wrong, are still valid to them.
C. Even when your loved one acts in ways that are scary, your response, when based on fear, is unlikely to help improve the situation. Be as encouraging and positive as possible.
D. You're changed behavior can be a key element in helping your loved one make their own changes. It is naive to think that your loved one can achieve recovery if your family system doesn’t include some level of intentional support around their recovery.
E. Your loved one is doing the best they can and wants to improve. At the same time, they need to do better, try harder and be more motivated in order to reach their goals and function better. Both of these ideas can be true at the same time.
F. Treatment is a system with rules, expectations, limits and boundaries – one step in a longer journey. Expect setbacks, mistakes and slipups while your loved one is in treatment. Be understanding and willing to ‘walk away’ and revisit these situations later.
Discuss: What other mindsets have you found helpful in supporting your loved ones’ treatment? Share how have you been able to help build a collaborative relationship between you, your loved one and their therapist or program.
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4. Therapy-Interfering Behavior (TIB) is anything that your loved one or you do that is incompatible or interferes with your loved one’s ability to successfully participate in treatment. A TIB is defined by the outcome of the behavior. They can be intentional or unintentional, strategic or automatic, calculated or absent-minded. TIB’s are typically ongoing patterns of behavior by us or our loved one, not isolated events. For example, when discussing the nature of their problems or their treatment plan our loved one argues with their treatment team, dismisses the things they say or lectures them. If we get upset during every family therapy session that behavior interferes with our loved one’s treatment because they didn’t get the care they needed during that session. This pattern of our getting upset would be considered a TIB, no matter what may be upsetting us.
THERAPY INTERFERING BEHAVIOR ACTIVITY
Step1: While your loved one has been in treatment have you repeatedly engaged in any of the common Therapy-Interfering Behaviors listed below?
Step 2: If you answered yes, please write down what you think caused your behavior.
A. Not engaging in or accepting treatment strategies that your loved one’s therapist or program believes are essential. (Y/N)
Cause of your behavior?______________________________________________________________________________________________________
B. Phoning or emailing the therapist or program too much, needing reassurance that treatment is “worth it” and working. (Y/N)
Cause of your behavior?______________________________________________________________________________________________________
C. Demanding solutions, assistance or resources that the therapist or program cannot offer. (Y/N)
Cause of your behavior?______________________________________________________________________________________________________
D. Being distrustful, hostile or critical towards the therapist or program. (Y/N)
Cause of your behavior?______________________________________________________________________________________________________
E. Extremes in your behavior, e.g., acceptance or change, flexibly or rigidity, nurturing or withholding, vulnerability or irreverence towards the therapist or program. (Y/N)
Cause of your behavior?______________________________________________________________________________________________________
F. Using your loved ones’ treatment to work on your own personal problems. (Y/N)
Cause of your behavior?______________________________________________________________________________________________________
G. Being so grateful that your loved one is in treatment that you emotionally “check” out. (Y/N)
Cause of your behavior?______________________________________________________________________________________________________
Step 3: If you answered yes for more than one TIB, select the one that you feel you could address first in changing your behavior. (Y/N)
Discuss: Share the TIB you selected with the group and how you are going to change.
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BARRIERS TO TREATMENT ACTIVITY
Despite scientific evidence and having the right mindset there may currently be barriers to your involvement in your loved ones’ treatment. Write those barriers below.
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Discuss: Share what you wrote with the group.
5. Treatment of behavioral health disorders can be hard on your loved one as well as on your family. There are a number of concerns you may have about your loved one while they are in treatment -- finances, childcare, school, employment, staying in contact, etc. To help your loved one achieve recovery here are some things you can do while they are in treatment.
· Do educate yourself on their mental health and or substance use disorder. (https://www.craftconnectfs.com/family-support-resources contain accurate information about the prevalence, symptoms, causes and basic disease concepts of your loved one’s disorder.)
· Do not negatively “enable” your loved one. If they can do something for themself let them do that. It's okay to let them struggle sometimes and have natural consequences.
· Do set and respect boundaries and limits with your loved one. Hold yourself and your loved one accountable to those boundaries and limits.
· Do get support for yourself – self compassion and self-care.
· Do ask before you act. Ask your loved one if they want advice or help.
· Do celebrate little victories. Be encouraging and positive.
· Do use your loved ones’ time in treatment to “do your own work” to prepare for their graduation or discharge.
· Do show love, care and patience.
Discuss: What other things you can do to support your loved ones’ treatment?
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WHAT I CAN DO ACTIVITY
Step 1: Look at the “do” list above. Circle what you can do now to support your loved one’s treatment.
Step 2: Start to plan on how, when and where will you show your support.
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Step 3: What is one thing you can do right now.
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Discuss: Share the beginnings of your supporting treatment plan with the group.
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6. Will the group please repeat the following with me. “God, Grant me the serenity to accept the things I cannot change. Courage to change the things I can, and Wisdom to know the difference.” These words adapted from a prayer by ethicist Reinhold Niebuhr and known as the “Serenity Prayer” can help you understand the barriers you may need to accept and what you may be able to change. You can accept with serenity the current reality of your situation when you trust in your Higher Power’s ability to help you. You can accept with serenity that although you cannot control the choices and actions of your loved one, you can decide how you will act in each situation you face. Change is a process, not an event. Look at the “Cycle of Change Handout” accompanying this session. You've helped your loved one enter treatment with the expectation that they will remain long enough to "graduate”. Do not be caught unprepared if your loved one quits. Dropping out of a treatment program is not the end. Your loved one may need multiple rounds of treatment before they achieve a stable lasting recovery (Meyers and Wolfe, 2004).
Discuss: What can we do to prepare for changes in our loved ones’ feelings about being in treatment?
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GROUP SHARING SESSION – Maximum time 30 minutes
7. We will now begin the sharing portion of the meeting. You are invited to share from 3 to 5 minutes about your experience as it relates to your loved one’s recovery, this week’s session or what you are currently working on. Please focus your sharing on potential solutions rather than the problems. We will conclude the sharing five minutes before the end of the meeting. Who would like to begin?
MY COMMITMENT SECTION – Maximum time 10 minutes
8. Please remember that what has been shared here is confidential and that the opinions expressed are of the individuals who shared them. These are our group commitments, we will start the next CRAFT Connect session by reporting on them. This week I will:
A. Do the in-between session assignments:
· Follow the five building blocks highlighted in the “Treatment Collaboration Handout”.
· Develop a plan on how, when and where I will you show my support.
B. Share what I am learning with my family, friends and community.
C. Show kindness for myself by self-care.
As you listen to this “Song About Connection”, please take a few minutes to quietly think about what you learned in this session. Write your thoughts and personal commitments below.
Watch: “You've Got A Friend” video.
What are the most important things I learned?
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What will I do differently because of what I learned?
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Treatment Collaboration Handout
Remember, your involvement with your loved ones’ treatment is based on their needs, preferences and goals – not yours. Parents, spouses, siblings, children, friends, co-workers, members of the community and other Concerned Significant Others (CSOs) are crucial collaborators in their loved one’s recovery from mental health and substance use disorders. These are five building blocks of collaboration between therapist or programs (providers) and CSOs. (Portland Research Institute, 2018 Bogart & Solomon, 1999; Zipple, Langle, Spaniol, & Fisher, 1997)
1. Mutual respect for each other.
All members of the relationship have equal value and worth. CSOs and providers need to recognize and acknowledge the strengths and expertise that each possesses. CSOs are indeed experts on their loved one. Providers should highlight CSOs strengths, even amid challenges. They may have a vast repertoire of skills and wisdom concerning what 'works' and what does not work with their loved one, how services help or hinder, and what needs clients have. Providers using specialized skills offer CSOs opportunities to obtain new knowledge about their loved one’s condition and behavior, adapt or change methods and behaviors to be more successful, and try new ways to assist CSO functioning
2. Two way sharing of information.
Information exchanged between CSOs and providers is extremely important. CSOs want to understand their loved one's condition, the nature and course of their disorder, treatment strategies, and its long-term consequences. Providers sensitivity and responsiveness to the information needs of CSOs and the CSO's reciprocal sharing of information greatly facilitate the collaborative process. HIPPA regulations are often cited as the primary reason for not sharing information with CSOs. Even its strictest interpretation does not prohibit providers receiving information from CSOs.
3. Honest and clear communication.
Partners are honest in their feelings and expectations and clear and open in how they communicate their thoughts. CSOs and providers need to examine the biases and preconceptions they have towards each other and how those biases may inhibit communication. Truthful input and feedback is essential for CSOs and providers to be able to understand the needs of clients, generate strategies for help, and evaluate progress. Communication conducted in an atmosphere of respect and sensitivity to the other person, will provide a basis for mutual understanding and action between CSOs and providers. Accurate and timely information sharing, openness to questioning and clarification, and a desire to share knowledge will help overcome many barriers in working together.
4. Mutually agreed upon goals.
Too often, CSOs and providers relationships are characterized by a dominant professional role and a passive recipient role. CSOs provide information to the provider, who then, often after consultation with other providers, develops a plan of action. The goals of the plan may not be made clear to the CSO, and may or may not be seen of any value by the CSO. By working together to set goals, CSOs and providers also can be better assured that their efforts will represent a shared commitment that made use of the knowledge and expertise each has.
5. Shared planning and decision-making.
Whenever possible broaden treatment and recovery to include their CSOs. Joint decision making between CSOs and providers affirms a primary role of the ‘family’ in what services are received and how they are provided. A commitment to shared responsibility implies that CSOs should be involved in all phases of service provision, including treatment and discharge planning. This commitment helps to ensure that services are responsive to CSO and client needs and that gaps in services are identified while clients are still in treatment.
Cycle of Change Handout
For over 35 years researchers have found that individuals move through a series of six stages (precontemplation, contemplation, preparation, action, maintenance, relapse) in the adoption of healthy behaviors or cessation of unhealthy ones. Research on a variety of different problem behaviors has also shown that there are certain predictors of progression through the stages of change (e.g., Prochaska & DiClemente, 1983), including decisional balance (Prochaska, 1994); self-efficacy (e.g., DiClemente, Prochaska, & Gibertini, 1985); and the processes of change (Prochaska & DiClemente, 1983).
Where do you think your loved one is at in the Cycle of Change, and why?
Precontemplation, not yet acknowledging that there is a problem behavior that needs to be changed. The stage in which an individual has no intent to change behavior in the near future, usually measured as the next 6 months. PR contemplators are often characterized as resistant or unmotivated and tend to avoid information, discussion, or thought with regard to the targeted health behavior (Prochaska et al., 1992).
Contemplation, acknowledging that there is a problem but not yet ready or sure of wanting to make a change. Individuals in this stage openly state their intent to change within the next 6 months. They are more aware of the benefits of changing, but remain keenly aware of the costs (Prochaska, Redding, & Evers, 1997). Contemplators are often seen as ambivalent to change or as procrastinators (Prochaska & DiClemente, 1984).
Preparation, getting ready to change. The stage in which individuals intend to take steps to change, usually within the next month (DiClemente et al., 1991). Preparation is viewed as a transition rather than stable stage, with individuals intending progress to Action in the next 30 days (Grimley, Prochaska, Velicer, Blais, & DiClemente, 1994).
Action, changing behavior. An individual has made overt, perceptible lifestyle modifications for fewer than 6 months (Prochaska et al., 1997).
Maintenance, maintaining the behavior change. These are working to prevent relapse and consolidate gains secured during Action (Prochaska et al., 1992). Maintainers are distinguishable from those in the Action stage in that they report the highest levels of self- efficacy and are less frequently tempted to relapse (Prochaska & DiClemente, 1984).
Relapse. Returning to older behaviors and abandoning the new changes.
This Transtheoretical Model (TTM) of change in health psychology explains or predicts a person's success or failure in achieving a proposed behavior change, such as developing different habits. It attempts to answer why the change "stuck" or alternatively why the change was not made. TTM — currently, the most popular stage model in health psychology (Horwath, 1999) — has proven successful with a wide variety of simple and complex health behaviors, including smoking cessation, weight control, sunscreen use, reduction of dietary fat, exercise acquisition, quitting cocaine, mammography screening, and condom use (Prochaska, et al., 1994).