Getting Families into Treatment
©1992 by Lewis N. Foster
Getting families to attend family education programs, therapy, an assessment or intake sessions presents a special challenge. As coordinator of two family therapy programs I was faced with training nurses, therapists and other staff in ways to get families into treatment. The most important moment to get a commitment from a family to attend therapy is during the first meeting with the identified patient. Have the family come with the patient to this appointment. They are experiencing pain at this point and are more apt to obligate themselves.
The further you get from the intake or assessment session the more difficult it will be to get the family into treatment. This first meeting calls for specially trained personnel who can begin the family therapy process. At one of the treatment centers where I coordinated the family program, the detox or medical unit Nurses did the admission and intake. They also had regular contact with the family members who telephoned to check on the patient. This provided a special opportunity to remind the family members and to get family members to attend who were not at the admission.
The family information form completed at admission was developed in a way that the questions gently led to the family being faced with making a decision about attending the family program. Questions about presenting problems and related family difficulty preceded the ultimate, "who in your family will be attending the family program to help us help your family member?"
Organizations serve families and themselves well when policy states that intake, admission and multiple family group therapy sessions require the family to attend. Today we can occasionally find admissions and intake personnel who are trained as family therapists. Understanding the basics can make the difference between getting a family into treatment and treating the identified patient without the family. This therapist thinks that family participation is vital. Changes in a family system today mean sound families in generations to come.
Assessment and intake counselors can employ the basics of a family therapy session to connect with the family learn what they want to change, and use the information gained to get the family into treatment. Sometimes getting the family in is easier if the identified patient is not in the room to rescue them. A conversation may go something like the following:
Counselor: Mr. Rouse I would like to talk with you about helping us help your wife while she is a patient here.
Mr. Rouse: I'll do anything I can to help my wife. How can I help you?
Counselor: You know your wife better than us and this will be true even after she is discharged. What I (we) need is for you and your wife to attend our education program so that all of us can be speaking the same language.
Mr. Rouse: Sure, I'm willing to do that. When do you have the education program?
Counselor: We repeat the same program every Tuesday and it begins a 9:00 am and ends at 4:00 pm.
Mr. Rouse: Well, I have to work during the day. There isn't any way I can come all day. My wife can come. Can't I do this in the evening after work?
Counselor: I understand that attending this program will mean you'll have to change your work schedule and make a sacrifice. In fact, that is exactly what I'm asking you to do. Make the sacrifice now to help us help your wife and you'll know down the road that you did the right thing.
Mrs. Rouse: He's the only person in the family working to pay the bills and put food on the table. He really needs to work. He has people depending on him.
Counselor: You have it tough I'm sure. You are also the best person to help us help your wife. You know her better than anyone else and your opinion about what has been going on is very important to us. Without you we have only one opinion and that is from your wife. As you can imagine, if that is all the information we have then the possibility of our being successful is limited.
Mr. Rouse: Well, I'm willing to share my opinion, but I can't come all day on Tuesday. I have to work.
Counselor: Mr. Rouse, I'm willing to provide a note from our physician to your employer if that will help, and if you will give me permission, I'll call the Personnel Manager at your company to help pave the way for you to take a day off. There have been other people from your company here, and your company understands that when things at home are good then your work is safer and more productive. We can't do this by ourselves.
Mr. Rouse: How many days are you talking about me having to take off?
Counselor: I'm asking that you take one whole day and spend it with us in our education program. All the other sessions will meet in the evenings after you get off work. We need everyone living in your home and anyone who cares about your wife to attend the education session too. We say bring the whole family. It doesn't matter how many people come, and the program is free to all who attend.
Mr. Rouse: You want me to bring my whole family? That is the most ridiculous thing I've ever heard. This is between my wife and me, not everyone in the family. We want to keep this as quiet as possible.
Counselor: What I have come to know is that everyone has their own opinion about what has been going on with your wife, and everyone in the family has been influenced by what has been happening. The more opinions we have to work with the better our chances of success. Now that you are taking this step, give us the chance to do the best we can. We are professionals and you are hiring us to help you.
Mr. Rouse: Does that mean I'm the boss?
Counselor: You are the employer and I'm (we are) the employee. You hire me because I have specialized skills and you want me to put them to work for you. To do this, I have to have your support and willingness to let me employ my special ability. That is why you hire me. I don't expect you to trust me now, but, I do ask that you allow me to build that trust by letting me set the pace now.
Mr. Rouse: I don't know, you're asking much more than I expected when we decided to come here.
Counselor: Mr. Rouse, I'm asking you to make an emergency out of this and do what you need to do to bring your family to the education program and multiple family therapy sessions each week. We need you and them to help us set goals, know when the goals have been met, decide when your wife is ready to leave treatment and make plans for when she is discharged. Without your help Mrs. Rouse may not be able to make the changes you know she needs to make.
Mr. Rouse: You sure are pressing me!
Counselor: Thank you! Now you know how important I think it is to get help from you and your family. If you will tell me that you want Mrs. Rouse to stay just the way she is, I'll be quiet.
Mr. Rouse: Oh! No! She has to make some changes. That is why I'm pushing her to get help.
Counselor: So you will come and bring your family?
Mr. Rouse: Let me talk to my boss and see if I can get the day off. I'll call you in a day or two.
Counselor: Mr. Rouse, I want to know when I walk out of this room today that I'm going to have the support I need to do the job that needs to be done. I need to hear you say, "yes, I'll be here and I'll bring my family." Make this an emergency and do what you need to do to be here.
Mr. Rouse: Okay, I'll probably be here.
Counselor: Mr. Rouse, before we stop I want to know that you will be here. If you'll tell me you will be here I'll know that I can depend on your help. My hunch is that if you make a commitment you will follow through with it.
Mr. Rouse: Yes, if I make a promise I'll do it.
Counselor: Will you make me a promise?
Mr. Rouse: Okay, I'll be here and my kids will be here too. I think other family members will come as well.
Mr. Rouse: Okay, so I'll be here by 9:00 am Tuesday morning.
Counselor: Thank you, I'll see you Tuesday, and the first multiple family therapy session will be the following Monday evening at 6:30 pm.
The above conversation incorporates most of the points below that have helped me get families into treatment.
1. I (we) need your help.
2. I (we) can't do it by ourselves.
3. You know your family member better than we (I) do.
4. We need you to help us set goals for your family member in treatment, and to help us know when the goals have been
5. We need your help in deciding when your family member is ready to leave treatment.
6. Your family member in treatment will be (or is) sharing his/her opinion about what has been going on, and we
need your opinion to get a clear picture.
7. Without your help, your family member may not make the changes you know he/she needs to make.
8. We need everyone who lives with the client and any other person who cares to come and help us.
9. We are asking you to make sacrifices to be here for the session(s). With you help, the possibility of success is
10. Do you want your family member to stay just the way they are now? If not, we need your help.
11. We'll provide letter(s) from our Center (Doctor, etc.) to your employer, school, etc., if you need them.
12. If you'll give me permission I will call your employer to provide you with help in getting off work.
13. I'm asking you to make an emergency out of this and do what you need to do to come and help us help your family member.
14. I understand that being a (doctor, lawyer, teacher, nurse, self employed, etc.) is demanding on your time. I'm asking that Mary's (father, husband, brother, etc.) come and help us. It's okay if you leave the (lawyer, doctor, etc.) at home.
15. Read John T. Edwards' book, Treating Chemically Dependent Families: A Practical Systems Approach for Professionals. See the chapter on getting families in for therapy. I trained with him in Charlotte, NC, for two years in the early 1980's.
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