April 8th, 2022 
Working with Substance-Related Disorders, Domestic Violence, and Child Abuse
Chapter 18
Chapter 18
1
Substance-Related Disorders and Families
A significant challenge to families and society
Substance-related disorders are even more destructive
Alcohol use disorders
Alcohol abuse – “problem pattern where drinking interferes with work, school, or home life” in addition to other difficulties with the law and society (Stanton, 1999, p. 1)
Alcohol dependency – person is unable to control his or her drinking behavior even after trying
Pseudo individuation / Pseudo self
Chapter 18
2
Manifestations of Substance-Related Disorders in Couples and Families (1 of 2)
Shielding of the substance-related abuser by nonabusing members of the couple or family
Denial
Expression of negative feelings
Deterioration
Focusing energy on the substance abuser
Misusing family resources
Chapter 18
3
Manifestations of Substance-Related Disorders in Couples and Families (2 of 2)
Assuming survival roles:
Enabler: spouse or other family member on whom the substance abuser is most dependent and who allows a substance abuser to continue and become worse
Family hero: an adult or oldest child who functions to provide self-worth for the family
Scapegoat: a child who attempts to distract the family focus away from the substance abuser by acting out in a disruptive manner
Lost child: child who suffers from rejection and loneliness and offers a substance abuser family relief
Family clown: often youngest family member who provides the family with humor and thus reduces tension
Chapter 18
4
Individual Manifestations
Children
May behave in confused ways about their self-identity and self-worth
Those who lives with at least one parent who is an abuser of alcohol are twice as likely to develop social and emotional problems
May feel less attached and bonded
Adults
May spend lots of time and energy attempting to resolve issues related to the dysfunctional nature of their families-of-origin.
May struggle in relationships
Chapter 18
5
Substance-Related Disorder and Treatment
Family treatments are among the most effective approaches for helping those with substance abuse problems.
It is helpful to engage concerned significant others (C S Os) in the treatment process.
Also, it is important to engage the most disengaged member of the family, possibly through a direct conversation
Chapter 18
6
Approaches to Treating Substance-Related Disorder Families After Engagement
Use the Community Reinforcement Approach (C R A)
Consider environmental influences – the theoretical basis for assessing is multisystemic therapy
Help with emotional, social, and vocational issues
Address feelings and defense mechanisms
Consider prominent theoretical approaches: structural-strategic, Bowen, behavioral, Adlerian, and multifamily therapies
Chapter 18
7
Prominent Theoretical Approaches
Structural-strategic
Bowen
Behavioral
Adlerian
Multifamily Therapies
Use of Community Resources and Prevention
Chapter 18
8
Domestic Violence and Families
“Aggression that takes place in intimate relationships, usually between adults” (Kemp, 1998, p. 225)
“The willful intimidation, assault, battery, sexual assault, and/or other abusive behavior perpetrated on one intimate partner on another (Cobia, Robinson, & Edwards, 2008, p. 248)
Can take many forms: physical, sexual, psychological, and economic
Battering – “violence which includes severe physical assault or risk of serious injury (Kemp, 1998, p. 225)
Chapter 18
9
Prevalence of Domestic Violence
“Approximately one-third of all married couples experience physical aggression” (Crespi & Howe, 2000, p. 6).
An estimated one half to two thirds of couples seeking marital therapy have had some incident of aggression in the last year (Schact et al., 2009).
Although some men are the victims of abuse and violence by their mates, the large majority of those assaulted each yea are women.
Chapter 18
10
Those Who Batter
Come in “all shapes, sizes, classes, races, and sexual orientation” (Almeida, 2000, p. 23)
Pit bulls – heart rate increases as they become verbally aggressive with their partners
Cobras – heart rate decreases as they become verbally aggressive
13% of all murders involve husbands killing their wives
1.3 million wives are severely beaten by their husbands each year (Cobia et al., 2008)
Relationship between alcohol intoxication and domestic violence
Chapter 18
11
Assessment of Domestic Violence
Barriers
Legal
Psychological
Difficult to determine level and prevalence of violence
Levels of violence
Common couple violence (C C V)
Severe abusive violence (S A V) or intimate partner violence
Chapter 18
12
Open Assessment
Often results in obtaining the most information
Blame is not a primary emphasis and the therapist emphasizes that the expression of violence in the family hurts the entire family
Focus centers on dynamics within the family associated with family relationships, such as emotional expression, handling of money, sexuality and social connections
“Detection rates are increased when women are questioned directly, specifically, and alone (Schacht et al., 2009, p. 48).
Chapter 18
13
Treating Domestic Violence: Conjoint Therapy (1 of 2)
Involves seeing the couple together
Assessment of safety required
Three conditions must be met:
Man’s participation must be voluntary
Special agreement about confidentiality must be established
An optimal therapeutic stance must be achieved (Bograd & Mederos, 1999, p. 296)
Chapter 18
14
Treating Domestic Violence: Conjoint Therapy (2 of 2)
Couple therapy may work if the following criteria are met:
Only a history of minor and infrequent psychological violence or abuse has occurred
No risk factors for lethality are present
The man admits and takes responsibility for abusive behavior and also demonstrates an ongoing commitment to contain his explosive feelings without blaming others or acting out
Chapter 18
15
Treating Domestic Violence: Intimate Justice
The theory encompasses three ethical dimensions and nine ethical concepts (Jory & Anderson, 1999, p. 350).
It is akin to solution-focused approaches and confronts disempowerment and abuses of power in a partnership while challenging internalized beliefs about how one should treat one’s partner (Jory et al. 1997).
Through knowledge and insight, both behavioral attitudes and behaviors in couples may be modified.
Chapter 18
16
Treating Domestic Violence: Educational Treatment
Educationally, programs based on intimate justice theory and C B T have been employed with domestic violence families
The Duluth model is one approach
A C B T model of treatment
Holds the premise that people learn violent behaviors because they are reinforced for them in cultural and social circles
People can unlearn these behaviors and learn new ones through cognitive-behavioral means, such as education
Chapter 18
17
Child Abuse and Neglect in Families
Child Abuse (acts of commission)
Child Neglect (acts of omission)
Chapter 18
18
Child Abuse and Neglect Statistics
“In 2010, child protective services (C P S) received more than 3.3 million reports for alleged maltreatment of nearly 6 million children” (Juhnke, Henderson, & Juhnke, 2013, p. 57).
Each year more than 1 million children are victims of child abuse (U. S. Department of Health and Human Services, 2004).
Abuse is seldom of one type.
Chapter 18
19
Effects of Child Abuse
Aggression
Delinquency
Suicide
Cognitive, academic, and psychological impairment
Less satisfaction with life and increased likelihood of behavioral, cognitive, and affective disorders
Chapter 18
20
Child Physical Abuse
Resides on a continuum from mild to severe physical contact
Severe physical child abuse
Skin injuries to physical traumas and death
Psychological consequences, from fearfulness to posttraumatic stress responses
Chapter 18
21
Childhood Sexual Abuse (1 of 2)
Includes the following:
Unwanted touching
Making sexual remarks
Voyeurism
Intercourse
Oral sex
Pornography
Chapter 18
22
Childhood Sexual Abuse (2 of 2)
Boys
Least reported
Most commonly done by perpetrators outside of the family
12% to 18% are sexually abused during childhood or adolescence
Girls
Most reported
Most commonly done by a person within the family
1 in 3 is sexually abused by age 18.
Chapter 18
23
Treating Child Abuse and Neglect (1 of 2)
Involves legal, developmental, and psychological issues
All states require mental health workers and other professional helpers to report child abuse and neglect.
“Failure to report child abuse usually constitutes unprofessional conduct that can lead to disciplinary action by a regulation board, possible conviction of a crime, and a civil lawsuit for damages (Leslie, 2004, p. 48).
Chapter 18
24
Treating Child Abuse and Neglect (2 of 2)
Family therapists must deal with many current and historical issues in working with child abuse
Important to concentrate on the following:
Assisting the abuser in learning how to delay acting impulsively
Helping the abuser and the abused family members to recognize and select alternatives other than violence
Chapter 18
25
Working with Adult Survivors of Abuse
Treat not only issues from childhood but also adult behaviors associated with the past events
Understand the context in which the abuse occurred
Realize that children are rarely abused in only one way
Treatment approaches may vary from Bowen-based family-of-origin work to behavioral interventions
Chapter 18
26
Working with Children Who have been Abused
A variety of treatments have been used
Very important to focus on the safety of children living in potentially violent environments
Important to draw up a safety plan during the early stages of therapy, and should include the following:
Hotline or local police number
Identified safe internal and external locations in case of violence
Chapter 18
27
Posted in 