Family's Role in Treatment
Hanbleceya has been involved in the treatment of severe and complex mental illnesses since 1979. One of our primary goals is to help clients achieve the highest level of independence and self-sufficiency possible by learning how to effectively and responsibly manage the symptoms of their illnesses. Over the past 3+ decades, our Team has had the opportunity to work with thousands of clients and their families to build a system of treatment that involves the family and the client working together toward healing, thereby establishing a path for successful and effective living. As such, we rely on a number of therapeutic strategies designed to help families become more successful in navigating life with a loved one experiencing mental illness. Many of the strategies described in this document only work when the family is fully involved.
So, at this time, please review this document thoroughly and carefully, and ask whatever questions you need for clarity. Full family involvement and participation is essential, therefore before beginning we want to make sure that you are very clear and certain that you are ready and willing to play an active and central role in this life-changing process.
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Family-Related Therapeutic Strategies
We strongly believe that family members play a critical and central role in the process of supporting individuals with a mental illness with learning how to create a life of health, stability, and success. Sadly, we have repeatedly heard family members complain that they have not been included in previous treatment and often have felt “out of the loop” or unimportant in the process. Our approach is the opposite. You are vital to the treatment process and we believe your loved one’s chance to heal and learn how to live a more stable and successful life depends on your involvement.
Below you will find a brief description of some (but certainly not all) of the primary therapeutic strategies that the Hanbleceya program utilizes, all of which require significant involvement and commitment from a client’s family. Please review each item thoroughly.
1) The initial “no contact” period
The majority of families and clients who enter into treatment with Hanbleceya report that the communication patterns within the family have become chaotic, unhealthy, or even harmful while trying to manage the effects of the mental illness. Family members often describe feeling overwhelmed and lonely, having become the sole “manager” of a loved one’s needs. As such, it is very common for family members and clients to become entangled with one another in an attempt to simply survive.
When clients begin treatment at Hanbleceya, there is often a “no contact” period put in place. The purpose of this therapeutic strategy is to give clients and families some time to “untangle” any unhelpful or even harmful communication patterns that have developed in an attempt to deal with the illness. You can think about this “no contact” period as an opportunity to take a break, take a breath, collect yourself, and get ready to start interacting with your loved one in a new and healthier way. Another purpose of this initial “no contact” period is to help the client focus on settling in, orienting to the structure and schedule of the program, beginning to develop relationships with peers, and establishing bonds with therapists. During this period, family members work closely with an assigned family therapist to establish goals for family therapy and to develop strategies for relating with each other more effectively.
There is no set amount of time for the initial “no contact” period; the length of time depends on how quickly a family is able to apply newer, more effective strategies for interaction and communication. At the onset of family therapy, it is essential to identify each family’s relationship strengths, while also making critical shifts in patterns that appear to be hindering growth. This preliminary work sets the stage for producing long-term changes, culminating in more satisfying familial relationships.
2) Hospitalizations
Unfortunately, many of our clients have histories of psychiatric hospitalizations—for some this has occurred multiple times. It is our goal to reduce this trend by supporting clients in staying out of the hospital. However, in the event that a client is unsafe or poses a danger to self or to others, a hospitalization may be necessary. Hospitalizations may also be indicated when a client is to undergo a significant medication adjustment.
As is the case with other interventions we employ, we will make every effort to fully brief you ahead of time if the Clinical Team and the client’s psychiatrist determine that a hospitalization is needed. Typically, the possibility of a hospitalization will be discussed long before the time of its implementation as client symptoms are observed to be slowly increasing, or a significant medication change is warranted. However, in cases of imminent harm or danger, a hospitalization may be initiated before you are notified. In this situation, every effort will be taken to ensure you are informed as soon as it is practical.
3) Family Therapy
Family therapy is an essential part of the treatment process, as families help provide the necessary containment for clients. Without such containment, clients have difficulty learning how to manage their illnesses effectively and develop increased independence. Families provide a wealth of expertise about how clients think and respond; therefore family therapy provides an avenue for the Team to gather information about the methods that have worked well with clients and those that have not. Many clinical interventions are based on information gathered in family therapy.
Family therapy also provides a venue for families to heal themselves. Family members have often invested a lot of time, energy, and resources to a client’s care, and there has not been much energy left over for the rest of the family to live life as they desire. Family therapy also teaches skills for decreasing the emotional burden that exists when a loved one suffers from a mental illness. This helps families grow to function in a more cohesive and whole fashion. Mental illness not only affects parents who are unsure of how to respond to their mentally ill loved one, but also affects siblings who can become marginalized due to the care the mentally ill family member requires. Sometimes it also marginalizes the family from extended family members who do not want to deal with the devastation the mental illness can cause. Family therapy supports the process of re-establishing healthy bonds among various family members in both the immediate and extended family.
Typically, family therapy sessions begin during a client’s second week of programming; and your assigned family therapist will contact you during the first week to set up a family session time. If your family is not local to Hanbleceya, family therapy sessions will be conducted via phone or video conferencing, although in-person family therapy is preferred when possible. Family therapy sessions typically start without the client present in order for the family to establish some initial goals and prepare for the client to join the sessions. In the initial meeting with your assigned family therapist, it will be determined who in the family will be participating in the weekly sessions. Once this determination is made, it is expected that all identified members attend and participate each week. Additional family members and extended family may be added to sessions when it becomes appropriate.
4) Bi-monthly Family Support Group (FSG) and Bi-weekly Family Video-Conference Psycho-Education Group
Every other month, Hanbleceya hosts a Family Support Group (FSG) for the families of clients either in a Hanbleceya program or awaiting admission. The primary purpose of this group is to provide a supportive environment for families to connect, interact with, and learn from other families in a way that promotes understanding and healing. Research consistently shows that social support is a significant factor in determining which families’ loved ones succeed in treatment. By putting family members in contact with one another, this group provides a unique opportunity for education, guidance, and assistance in developing healthy coping skills when supporting a family member who is ill. It is also a place for family members to talk together about self-care throughout the treatment process.
Hanbleceya’s Family Support Group serves to reinforce concepts and strategies addressed in family therapy and through support services such as Al-Anon or NAMI. In this way, the group functions as an ongoing repository of experience, ideas, and support, shared between people who have faced similar challenges and triumphs in supporting their loved one’s journey toward mental health and independence. Participation in this important part of your loved one’s therapy is a vital component to optimizing the impact of the treatment plan.
As an adjunct to the family therapy, we offer a Family Video-Conference Psycho-Education Group for up to seven families at a time. This group is held on an alternating week basis for eight sessions, during which education about various topics/themes/theories from family therapy are highlighted and discussed in more detail. In our experience, this group has been valuable to those families who are looking for a greater understanding of the material, those who are struggling with some of the treatment recommendations and for those who may benefit from the added support of getting to know other families in similar situations as themselves. For these reasons, your family therapist may recommend you join one of the groups. In order to improve the experience for the members in the group, it is requested that all members attend the full 8 sessions to obtain the potential value. Some of the topics addressed in the group include your role in treatment, how to determine the differences between mental illness vs. acting out, enabling, tough love, expectations of your loved one, successfully launching into adulthood, and self-care.
5) Support for You
Supporting a loved one with a mental illness brings its own set of unique and demanding challenges: the emotional toll of handling the feelings about having a loved one with an illness, the physical toll of helping your loved one get his or her needs met, and the financial toll of paying for treatment or costly hospitalization—to name just a few. And, now you are contemplating taking on an active role in the treatment process of your loved one at Hanbleceya. We understand and have compassion for all you are doing and giving, and it is critical that you have support as well. Effectively managing your own feelings and making your well-being a priority not only serves you, but also models for your loved one how important responsible self-care is to success and stability in life. Therefore, we may recommend that you pursue and participate in the following sources of family support:
- Al-Anon:
Al-Anon has been influential in supporting family members in learning how to take care of themselves regardless of the choices their loved ones make. It provides an avenue for family members to share their own experiences living with a loved one with mental illness or addiction. Developing the ability to relate to others in a similar situation is a vital part of getting support and healing.
- Personal Therapy:
align=justify>Family members also may be asked to seek outside support to deal with the strong feelings that often accompany doing new and sometimes difficult things with a loved one. It may be recommended that a family member attend individual therapy to get this additional support. If we make this recommendation, we will be happy to provide you with referral information.
- “Boot Camp” Family Programs:
Family members may also be asked to attend a family program that includes many similar concepts to those found in Al-Anon. These programs often last a week and help family members understand how to create better boundaries as well as have a different, more meaningful relationship with a loved one.
6) Handling complaints
Entering treatment can be a difficult decision to make and sometimes involves a level of uncertainty, ambivalence, fear and anger as clients and families undertake the process of making lifestyle changes to learn how to effectively live with a mental illness. As the process unfolds, and clients (and families) begin to address difficult or painful issues, sometimes the uncertainty, ambivalence, fear and anger increase. This is normal. It is not uncommon for a client to want to give up or leave treatment at these junctures. A client may call his/her family in an effort to be taken out of treatment; he/she may call to complain about the program, the cost, other clients, or a number of other issues in an attempt to be supported in leaving.
This, of course, can be very difficult for the family. As loving family members, you want to be there for your loved one and try to help him/her through the situation. However, when a client’s complaints are indulged or given in to, the client is less likely to take responsibility to solve his/her own problems and will learn that if he/she complains enough, then someone else will step in to solve the problem. Part of the program’s goal is to support clients in learning how to advocate personally and efficiently problem solve, in other words, function as an independent adult.
In order to preserve the integrity of the client’s treatment plan, we strongly recommend that if your loved one calls you to complain, you direct your loved one back to his/her therapist to discuss his/her issues as it is a part of learning how to take care of one’s self. If your loved one attempts to solicit your support in leaving treatment, this initiates a pivotal time in your loved one’s recovery. When the "going gets tough" is when your loved one really needs your full support to stay and work it through. The best response, and what your loved one needs you to say is: "Take this to your therapist to discuss the matter.” Disengage from the conversation, even if that means hanging up. If you personally have concerns or complaints, please contact your loved one’s therapist to discuss the matter. The therapists are here to support you and are willing to hear your fears and concerns. It is potentially undermining and detrimental to your loved one's treatment to engage in complaining conversations, as this can interfere with the goal of teaching independence and responsible self-care.
7) Housing and potential safety interventions
It is critical to the healing and recovery of Hanbleceya’s clients to have a safe, clean, and harmonious space in which to live. Therefore, Hanbleceya has clear rules and guidelines for behavioral conduct and participation in the housing program that all residents are required to follow. Please review the “Housing Rules and Guidelines” document that all clients review and sign before being admitted to Hanbleceya’s housing program.
The reason this topic is included here is because it is an area where families are instrumental when an intervention is needed. In fact, a family’s participation in housing-related interventions determines the client’s continued ability for participation in the Hanbleceya program and has great influence on the larger scope of the client’s healing process.
In the event a client behaves in a way that causes the living space to be unsafe, unhealthy or disruptive to the healing efforts of other clients, some level of intervention will be necessary. Of course, this does not include the routine challenges and struggles we expect from anyone in the process of learning how to live cooperatively and respectfully with others. However, if a client is verbally or physically violent, brings drugs or alcohol in to the house, arrives to the house intoxicated, has sexual relations with another client, or behaves in a way that creates a dangerous situation for him/herself or others, the client will immediately forfeit his/her space in housing until proper safety can be restored. This is the moment where your involvement is paramount.
As mentioned, if a client behaves in a way that creates a danger for others, he/she can not be in housing until safety has been fully restored and there is a plan in place for the problem behavior not to recur. Therefore, if this situation applies to your loved one, you will be contacted immediately and supported in making a decision on what you would like to have happen next. In the event of self-danger, a hospitalization will likely be indicated (see item #2 above). If hospitalization is not warranted, you will need to make a decision about where your loved one goes. Sometimes families choose to send their loved one to a local board-and-care facility. If clinically appropriate, the client may be eligible for admission to the Vision Quest facility. Sometimes families choose to put their loved ones up in a local motel. Sometimes families choose to bring their loved ones home. Sometimes families choose to let their loved ones experience the direct consequences of their behavior and not provide an alternative housing situation. In this event, Hanbleceya will offer to transport the client to a local shelter if desired. Sometimes clients will find their own alternative sleeping arrangements such as at a friend’s house.
In the event your loved one loses his/her housing privilege, your therapists will discuss with you the pros/cons of the various interventions available, and will make recommendations to you on behalf of the Clinical Team. However, it is important to recognize that it is your decision as to what happens next should your loved one lose his/her housing privilege. We will do our best to guide you in making a decision most helpful to your loved one’s growth and progress.
8) Talking to your loved one about finances
We have found that unless a client is personally paying for treatment, it is generally unhelpful to have the client involved in the details of the financial commitment that the family is making for treatment. Sometimes knowledge of the financial details can hinder treatment as clients may experience guilt or feel compelled to “fake it” through treatment in order to give the impression that treatment is not needed. We have found that when clients are brought into the financial realm of treatment, they often become distracted and worried about resources, which can take away from focusing on the therapeutic issues of recovery and building health and independence. If it is determined by the Clinical Team that the client would benefit from being involved in the financial aspects of treatment, this will be discussed with you and the issue folded into the client’s treatment plan. Therefore, our strong recommendation is that you not talk to your loved one about the financial details of treatment costs, but instead bring your concerns or comments to the Clinical Team. Your therapists will help guide you on how to best address your concerns with your loved one.