Family's Role in Treatment

As a family member, you may decide to entrust the treatment of your loved one to Hanbleceya. Please know we will commit to doing everything possible to help him/her achieve the highest level of health and independence possible. However, we cannot optimize treatment results without your support - which also means the support of every family member who chooses to be a part of your loved one's life during and after their treatment in Hanbleceya.

Numerous studies and over three decades of our own clinical experience point directly to a significant increase in the recovery of patients whose families remained involved and appropriately supported the treatment plan as compared to those whose families did not. Family members often report experiencing difficulties effectively communicating and setting healthy boundaries and limits with their loved one, especially when it involves psychiatric and psychological treatment. These difficulties often arise from symptoms common to severe emotional disorders such as the influence of hallucinations or delusions, strong emotional affect, impaired insight and judgment into the effect of the illness on day-to-day living, patterns of extreme avoidance of negative affect, behavioral acting out, and a lack of experience in effectively balancing a healthy life while living with a mental disorder.

When initially placing their loved one in Hanbleceya, many family members are unaware of the significant role they play in the treatment process. One main focus of family participation in treatment involves learning how to communicate with your loved one and helping your loved one communicate with you in ways that are effective and healthy. This will involve, in part, learning how to set boundaries and limits, close communication "splits," and empower your loved one to develop self-reliance skills and begin taking on the task of self-care and personal responsibility for their health and recovery. What follows is a list of expectations and responsibilities that will be asked of you while your loved one is in the Hanbleceya treatment program:

Full support of your loved one’s treatment plan, therapeutic structures, and clinical interventions determined by the Clinical Team.

The Treatment Team employs a wide variety of solid and proven clinical interventions and structures in an effort to support clients in reaching their goals and attaining the greatest level of functionality and independence possible. It is imperative that all members of the client’s system (the Treatment Team, family members, other providers) are “on the same page” and supporting the treatment plan. Because some interventions may not make sense at first or may seem counterintuitive, it is important to seek out clarification from the Team while continuing to support the intervention. Our long-standing experience indicates that when one or more members of a family do not support the treatment plan, the “container” of support becomes “cracked” and the client experiences confusion, fear, or uncertainty over the inconsistency, ultimately resulting in detrimental and potentially dangerous effects on the client.

Examples of therapeutic structures may include limited contact with family members, tying monies earned to specific behavioral goals, requiring attendance at prescribed events, performing community service, or having consequences for non-compliance. If you are ever uncertain as to why a specific therapeutic intervention has been prescribed, please make contact with your family therapist for clarification.

Full support in addressing and changing dysfunctional or unhealthy family dynamics.

When your loved one participates in treatment at Hanbleceya, you can expect a period of adjustment as he or she begins to pursue a new way of life. There will be exposure to a new culture, a new system, and a new community. There are new expectations and new structures, all designed to maximize their recovery.  While all well-intended, this change can be stressful and sometimes frightening. As our clients undergo this new experience, it is common for them to revert to old ideas and rely on old, familiar coping strategies. Your loved one may have learned these strategies early on in life and since mastered their use. Indeed, despite being extremely dysfunctional, faulty coping strategies such as splitting, manipulation, and dishonesty oftentimes manifest throughout the family system. Tragically, such strategies fail to appropriately serve the true needs of your loved one or your family.

It is important to understand that family systems develop the capacity to aid in the proliferation of maladaptive behaviors by becoming desensitized to them, growing accustomed to them, or becoming comfortable operating within them.  This process takes place largely without recognition as the behaviors become a central part of how the family operates. They also serve as a catalyst for keeping your loved one immersed in his/her illness.

Decades of our own experience prove that no family is immune to these dynamics. Although it is out of love that families may become over-involved, anxious, or enmeshed, this provides no consolation as treatment becomes jeopardized and your loved one’s welfare is compromised. As your treatment provider, part of our responsibility is to recognize this and provide sufficient support to help the family recognize these dynamics, the effect they have on your loved one and the family system, and to help the entire system develop more healthy and effective ways of supporting your loved one and existing together.  Family therapy sessions will frequently involve the exploration of these dynamics and require your willingness to develop and implement healthier, more functional strategies for interacting with or responding to your loved one.

Additionally, there are times in the course of treatment that contact with family members can interrupt the client’s progress, cause unnecessary stress and anxiety and create opportunity for de-compensation. This leads to a setback in treatment while time, money and progress are unnecessarily lost. In an effort to proactively circumvent treatment setbacks due to family system dynamics inadvertently disrupting the treatment process, Hanbleceya has designed a policy to be used in rare situations in order to provide needed containment for our clients. This policy is called a Temporary Intervention Order (TIO) and is typically structured to prohibit family contact for a designated period of time. Of course, the clinical rationale for instituting this order will be fully explained ahead of time and will only be issued if agreed upon by the entire Treatment Team.

Full support of the initial 45-day “No Contact Structure.”

When a client begins treatment at Hanbleceya, expect a minimum structure of 45 days no contact to be imposed. The “No Contact Structure” is a very important part of the process of orienting your loved one to the beginning treatment at Hanbleceya. This time period allows for the client to begin the process of “settling in” and getting familiar with the highly structured routine of our program, begin developing relationships with his/her peers, and begin establishing bonds with therapists. Throughout the course of treatment at Hanbleceya, families work closely and frequently with the Treatment Team, which requires a foundation of solid rapport. This time period also allows for family members to connect with and begin establishing a close relationship with the client’s primary and family therapists, a relationship vital to the treatment process. Starting this intensive treatment process is a major undertaking. It can be challenging and emotional, bring up feelings of fear and understandably generate doubts about commitment. Thus, we have found it extremely important and at times essential that the clients and their families do not have contact during this initial orientation process so that each can focus on their respective goals of beginning the treatment process while allowing the other to do the same.

During these initial 45 days, the family can expect one face-to-face family therapy session per week. If the family is not local, the session will then be conducted via phone/video conference call. Whenever the family can travel to attend in person, it is strongly preferred over phone therapy. The family can also expect a weekly “update” via email on how you’re loved one is orienting. Any programming, administrative, or financial questions should be directed to the administrative department.

Support for needed hospitalizations, whether behavioral or medical.

Many of our clients have a history of multiple and/or traumatic hospitalizations. It is one of our goals to reduce this trend and support clients in staying OUT of the hospital. Yet, it is sometimes necessary to effect a hospitalization to keep a client and/or others safe and free from harm. Hospitalizations are also sometimes indicated when a client is to undergo a significant medication adjustment, or when a client needs a form of increased containment and support due to non-compliance with parts of the treatment plan designed to keep the client safe and stable.

As is the case with other interventions we employ, we will make every effort to fully brief you on the clinical rationale in the event the Team determines that a hospitalization is in the client’s best interest. Oftentimes, you will be made aware of the possibility of when this type of intervention could be used, long before the time of its implementation. However, in cases of imminent harm or danger, a hospitalization may be arranged before you are notified, and if this is the case, every effort will be taken to ensure you are informed as soon as is practicable.

It is critical to the integrity of your loved one’s treatment plan that any hospitalization determined and implemented by the Team has your full support. You are free to ask as many questions as needed in order to get clarity and reassurance as to the rationale for the decision. Yet, it is essential that in the moment and at any time you are in contact with your loved one, that the Team has your full support and cooperation.

Not having the ability to employ the full range of clinically-sound interventions necessary to affect cohesive care severely compromises our ability to effectively treat your loved one. If we are unable to rely on having the family’s full support and cooperation of Team decisions, then it is unlikely we will be able to treat your loved one at the high level of quality he or she deserves, and we will likely support you in locating an alternative treatment placement for your loved one.

Attendance at weekly family therapy sessions.

Family therapy can play a significant role in the treatment process. The Treatment Team will make the determination as to the frequency and duration of family therapy meetings. A therapist designated to serve as the “family contact” for each client will work with the family in setting up all appointments prescribed. For those living out of the area, phone sessions or video conferencing may likely suffice in lieu of face-to-face sessions.

Attendance at bi-monthly Family Support Nights.

Every two months, Hanbleceya hosts a Family Support Night for the families of clients being treated in our program. This group’s primary purpose is to provide a supportive environment to connect and interact with other family members in a way that promotes understanding and healing, and it serves as an ongoing repository of experience, ideas, and support. Research consistently shows that social support is a significant factor in determining which families’ loved ones improve. This group also provides education and guidance in how to develop healthy ways of coping with a family member who is ill, how to best support your loved one’s recovery, and support for taking care of yourself throughout the process. Participation in this important part of your loved one’s therapy is a vital component to optimizing the impact of the treatment plan.

Participation in outside therapeutic support, as determined by the Treatment Team.

Supporting a loved one with a mental illness brings its own set of unique and demanding challenges. Taking an active role in the treatment process of your loved one adds even more to the mix. Therefore, it is extremely essential that family members have their own sources of support - learning to cope effectively and successfully with your own feelings about your loved one and his/her illness will help your loved one as he/she works toward recovery.

Personal therapy and support can often aid family members in acquiring strategies for handling crises and relapse, as well as develop healthy ways of coping with worry, stress, and other emotions. Hanbleceya actively incorporates the family system into the treatment plan of the individual residing in the program. Family members are often asked to try out new ways of supporting their loved one, such as through setting new limits, conveying new expectations, and holding firm boundaries. Trying out these new ways of supporting your loved one can sometimes be scary or uncomfortable, as is often the case when we try something new. Hanbleceya may recommend, or at times require, that a family member seek outside support to help facilitate this new process - to get additional support in dealing with the strong feelings that often accompany doing new and sometimes difficult things.  Examples of this include participation in adjunctive individual therapy or regularly attending and seeking sponsorship in Al-Anon.  If we make this recommendation, or requirement, we will be happy to provide you with referral information.

Preparing for the inevitable end of the “Honeymoon” period

For even the most well-intentioned, prepared, and motivated clients, there will likely be a period when the “honeymoon” ends. This can happen as early as within the first couple of weeks or possibly after several months, but it will happen. Thisshift typically occurs when the client begins working more depthfully on difficult or painful issues, is held more firmly accountable to expectations and commitments, is confronted on problematic behavior, and/orbegins hearing things theydo not want to hear or do not like. This shift is usually exemplified by a change in attitude, behavior, and/or general demeanor. You might begin to hear statements like: “this is the wrong program for me”;“They are mistreating me”; “There is too much structure”; “I can't relate to anyone”; “I don't like it here”; “They are taking away my rights”; and/or “They are controlling me.” Your loved one will likely attempt to solicit support fortheirpositionthrough tearful, angry phone calls that may include demands to be taken out of the program.

This is a pivotal time in your loved one’s recovery. When the "going gets tough" is when your loved one really needsyourfull support of the treatment plan. The best response (and what your loved one NEEDS you to say) is "takethis to your therapist to discuss the matter with them.” Disengage from the conversation, even if that means hanging up, then call your family contact or family therapist. They are here to support you and are willing to hear your fears and concerns. It is potentially undermining and severely detrimental to your loved one's treatment to engage in this conversation or indulge the complaints, as it has the capacity toinvalidate the treatment planand support your loved one in escaping and delving further into their illness or unhealthy patterns. This is a topic often discussed at length in our regular Family Support Meetings and may be a focus in your family therapy sessions. Please let us know if you'd like to talk to a therapist more about this issue.

Avoiding and/or discouraging “splitting” behaviors.

Entering treatment is a difficult decision to make and may often be met with much uncertainty, ambivalence, fear and anger as clients (and families) begin the process of coming to terms with what is required to learn how to effectively live with an illness. It is quite common for a client entering treatment to complain about being in treatment, about the program, their treatment plan, the staff, or even attempt to effect change in their treatment plan by asking a family member to intercede. This is called “splitting” and can be extremely disruptive to the treatment/recovery process. Should this ever occur, direct your loved one back to his/her primary therapist to discuss it then call your family contact or family therapist to discuss any concerns you may have. It is important to the integrity of the treatment plan that any attempts to “split” the container are referred back to your family contact so it can be addressed by the Treatment Team.

Refraining from involving your loved one in the financial details of the program.

There is rarely an instance when the client needs to be aware of the financial commitment that you or the family is making toward his/her treatment. In fact, the knowledge of this information can greatly hinder treatment as the client may experience guilt and feel compelled to inappropriately speed up/leave treatment in order to save money. In our experience, when clients are brought into the financial realm of treatment, they often become distracted and worried about resources, which take away from the very important element of focusing on the therapeutic issues of recovery and building health and independence. If it is determined by the Treatment Team that the client would benefit from being involved in the financial aspect of treatment, that will be discussed with you and the issue folded into the client’s treatment plan.

In closing, our primary goal is to help each community member reach their respective goals of health, independence and optimal living. We also strive to help families heal and become more effective and comfortable in learning how to live with and support a family member with a mental illness. If you have any questions regarding Hanbleceya’s family support requirements, please feel free to ask.