iStock_000016965781XSmallI have a client who is in treatment as an outpatient with our clinic, for the third time. We’ve never been able to get the client’s family involved in treatment. The wife and mother did come to a family session once, during the initial treatment, but were visibly nervous the whole time. I asked them why and the client’s mother explained they were afraid of being seen by people they knew. They live in a small community, mostly families that have lived there for generations, and there’s still quite a bit of shame attached to drug abuse. What would you suggest?”

I’ve run into this in other communities with similar demographics, and it’s a powerful barrier. In my experience, it’s mostly psychological — the family is operating under the misconception that folks in their town don’t know, when they already do. Or in some cases there’s status involved — the family has achieved a level of respect in the community that they believe is threatened by open acknowledgment of one member’s addiction. It’s a cultural stigma of the sort that plagues addiction treatment.

Let me commend you for making the attempt. That preoccupation with secrecy (even the fake variety) is a clue that the family is enmeshed, and not in a good way.

As far as getting them involved in spite of themselves: Seems to me you have three possible approaches, depending on the circumstances.

  1. Encouragement from the Court. If the client is court-referred — and I’m guessing he is or he wouldn’t be in treatment at all — you can ask the Court to urge family participation. That might give the less resistant family members the excuse they need to come to meetings. It may be that the wife comes but the mother doesn’t — in families, there’s often one member who’s far more resistant to change than the others. But that would be a start, wouldn’t it?
  2. Meet them off-campus. Some clinicians will arrange a private meeting with family members away from regular program hours, in order to begin the process of engagement. At the local church, for instance. You don’t want to make it a regular practice, but it is a way to assess the situation and prepare something resembling a treatment plan.
  3. Engagement activities. Some programs in rural communities offer regular community meetings or informational sessions (coffee and cookies) that can be attended under the pretense of general community concern, without the stigma of actually being a client. It’s easy to stay after for a ‘casual chat’.

Yep, it’s all extra work for you, but the alternative is yet another unsuccessful treatment episode.


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