CHAPTER 15:
Working with Substance-Related
Disorders, Domestic Violence,
and Child Abuse
Family Therapy: History, Theory, and
Practice
6th Edition
Samuel T. Gladding
Developed by Nathaniel N. Ivers, Wake Forest
University
© (2015, 2011, 2007) by Pearson Education, Inc. All Rights Reserved
Overview
•
The nature, manifestation, and treatment of
substance-related disorders
•
Domestic violence and families
•
Child abuse and neglect in families
Gladding, Family Therapy: History, Theory, and Practice, 6th Ed.
© (2015, 2011, 2007) by Pearson Education, Inc. All Rights Reserved
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Substance-Related Disorders and
Families
•
A significant challenge to families and society
•
Substance-related disorders are even more
destructive
•
Alcohol use disorders
•
•
Alcohol abuse
•
Alcohol dependency
Pseudo individuation / Pseudo self
Gladding, Family Therapy: History, Theory, and Practice, 6th Ed.
© (2015, 2011, 2007) by Pearson Education, Inc. All Rights Reserved
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Manifestations of Substance-Related
Disorders in Couples and Families
•
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
Gladding, Family Therapy: History, Theory, and Practice, 6th Ed.
© (2015, 2011, 2007) by Pearson Education, Inc. All Rights Reserved
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Manifestations in Couples and Families
Continued
Assuming survival roles:
•
•
Enabler
•
Family hero
•
Scapegoat
•
Lost child
•
Family clown
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© (2015, 2011, 2007) by Pearson Education, Inc. All Rights Reserved
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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
Gladding, Family Therapy: History, Theory, and Practice, 6th Ed.
© (2015, 2011, 2007) by Pearson Education, Inc. All Rights Reserved
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Substance-Related Disorder and Treatment
•
Family treatments are among the most effective
approaches for helping those with substance
abuse problems.
•
Engage concerned significant others (CSOs) in the
treatment process.
•
Engage the most disengaged member of the
family, possibly through a direct conversation
Gladding, Family Therapy: History, Theory, and Practice, 6th Ed.
© (2015, 2011, 2007) by Pearson Education, Inc. All Rights Reserved
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Approaches to Treating Substance-Related
Disorder Families After Engagement
•
Community Reinforcement Approach (CRA)
•
Environmental influences
•
Multisystemic therapy
•
Help with emotional, social, and vocational
issues
•
Address feelings and defense mechanisms
•
Prominent theoretical approaches: structuralstrategic, Bowen, behavioral, Adlerian, and
multifamily therapies
Gladding, Family Therapy: History, Theory, and Practice, 6th Ed.
© (2015, 2011, 2007) by Pearson Education, Inc. All Rights Reserved
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Prominent Theoretical Approaches
•
Structural-strategic
•
Bowen
•
Behavioral
•
Adlerian
•
Multifamily Therapies
•
Use of Community Resources and Prevention
Gladding, Family Therapy: History, Theory, and Practice, 6th Ed.
© (2015, 2011, 2007) by Pearson Education, Inc. All Rights Reserved
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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)
Gladding, Family Therapy: History, Theory, and Practice, 6th Ed.
© (2015, 2011, 2007) by Pearson Education, Inc. All Rights Reserved
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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).
Gladding, Family Therapy: History, Theory, and Practice, 6th Ed.
© (2015, 2011, 2007) by Pearson Education, Inc. All Rights Reserved
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Those Who Batter
•
Come in “all shapes, sizes, classes, races, and
sexual orientation” (Almeida, 2000, p. 23)
•
Pit bulls
•
Cobras
•
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
Gladding, Family Therapy: History, Theory, and Practice, 6th Ed.
© (2015, 2011, 2007) by Pearson Education, Inc. All Rights Reserved
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Assessment of Domestic Violence
Barriers
•
•
Legal
•
Psychological
•
Difficult to determine level and prevalence of
violence
Levels of violence
•
•
Common couple violence (CCV)
•
Severe abusive violence (SAV) or intimate
partner violence
Gladding, Family Therapy: History, Theory, and Practice, 6th Ed.
© (2015, 2011, 2007) by Pearson Education, Inc. All Rights Reserved
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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).
Gladding, Family Therapy: History, Theory, and Practice, 6th Ed.
© (2015, 2011, 2007) by Pearson Education, Inc. All Rights Reserved
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Treating Domestic Violence
•
Conjoint or Couples Therapy
•
Intimate Justice
•
Educational Treatment
Gladding, Family Therapy: History, Theory, and Practice, 6th Ed.
© (2015, 2011, 2007) by Pearson Education, Inc. All Rights Reserved
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Child Abuse and Neglect in Families
•
Child Abuse (acts of commission)
•
Child Neglect (acts of omission)
Gladding, Family Therapy: History, Theory, and Practice, 6th Ed.
© (2015, 2011, 2007) by Pearson Education, Inc. All Rights Reserved
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Child Abuse and Neglect Statistics
•
“In 2010, child protective services (CPS) 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.
Gladding, Family Therapy: History, Theory, and Practice, 6th Ed.
© (2015, 2011, 2007) by Pearson Education, Inc. All Rights Reserved
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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
Gladding, Family Therapy: History, Theory, and Practice, 6th Ed.
© (2015, 2011, 2007) by Pearson Education, Inc. All Rights Reserved
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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
Gladding, Family Therapy: History, Theory, and Practice, 6th Ed.
© (2015, 2011, 2007) by Pearson Education, Inc. All Rights Reserved
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Childhood Sexual Abuse
Includes the following:
•
•
Unwanted touching
•
Making sexual remarks
•
Voyeurism
•
Intercourse
•
Oral sex
•
Pornography
Gladding, Family Therapy: History, Theory, and Practice, 6th Ed.
© (2015, 2011, 2007) by Pearson Education, Inc. All Rights Reserved
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Childhood Sexual Abuse
Boys
• Least reported
Girls
• Most reported
•
Most commonly done
• Most commonly done
by perpetrators outside
by a person within the
of the family
family
•
12% to 18% are
sexually abused during
childhood or
adolescence
Gladding, Family Therapy: History, Theory, and Practice, 6th Ed.
© (2015, 2011, 2007) by Pearson Education, Inc. All Rights Reserved
•
1 in 3 is sexually
abused by age 18.
15-21
Treating Child Abuse and Neglect
•
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).
Gladding, Family Therapy: History, Theory, and Practice, 6th Ed.
© (2015, 2011, 2007) by Pearson Education, Inc. All Rights Reserved
15-22
Treating Child Abuse and Neglect
•
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
Gladding, Family Therapy: History, Theory, and Practice, 6th Ed.
© (2015, 2011, 2007) by Pearson Education, Inc. All Rights Reserved
15-23
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 Bowenbased family-of-origin work to behavioral
interventions
Gladding, Family Therapy: History, Theory, and Practice, 6th Ed.
© (2015, 2011, 2007) by Pearson Education, Inc. All Rights Reserved
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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
Gladding, Family Therapy: History, Theory, and Practice, 6th Ed.
© (2015, 2011, 2007) by Pearson Education, Inc. All Rights Reserved
15-25