« THE DODGY DOSSIER OF NON-TREATMENT: 2 | Main | COMMENT ON ‘NICE’ ALCOHOL GUIDES BEFORE DEADLINES »

Deirdre Boyd

October 28, 2009

STRUCTURED INTERVENTIONS

...ALL YOU EVER WANTED TO KNOW

Good structured interventions have a 92% success in getting addicts into treatment – and of helping family members even when this does not ensue. Jeff Van Vonderen explains in detail.

Fotolia_6546544_S-Lorelyn Medina “Intervention” has caught the eye of the broadcast media. Thanks to them, what people envision when they hear the word intervention usually falls into one of five categories.

The first is the Sopranos-style intervention, where the “good fellas” beat up on their fellow fella and threaten to ice him if he doesn’t go to rehab.

Second is the talk show-style intervention on a drug addict as presented recently on some TV shows.

Next is the South Park-style intervention where, after being intervened on, the character Cartman goes to “fat camp” and, while there, makes money on the side by selling candy bars to the other clientele.

Finally, there’s the view of threats and ultimata designed to get the person to go somewhere.

And then there’s the more accurate view, which we hear about in TV interviews with well-known people such as Betty Ford, who describe their own intervention experiences.

The concept of intervention conjures up the scene of a room, an office, a living room, where a group of people are sitting nervously. They are waiting in secret for the arrival of the “intervenee” whose relationships – and perhaps whose life – are threatened because of a condition for which that the person needs help.
Soon the intervenee is led into the room under the illusion of being there for some other purpose. The counsellor or interventionist then guides the group through confrontation after confrontation about the identified person’s unhealthy lifestyle and the harmful effects it is having on their health, their job performance, their co-workers, or the psychological and emotional wellbeing of family members, often through  multiple generations.

Finally, the intervenee breaks down, says “Yes, I will get help” and is smothered with tearful, grateful hugs. Or the intervenee jumps up and storms out the door while the friends and family members sit in shock, wondering if they should have gone through with the intervention.

Interventions originally developed mainly in the field of alcoholism treatment. Alcohol is involved in a high percentage of all accidental deaths, traffic fatalities, violent crimes, domestic violence and child abuse. A high percentage of suicides involve alcohol mixed with other substances. More deaths are related to the long-term medical complications from alcoholism. Sadly, only 15% of those with alcohol dependence seek treatment – so interventions are needed.

THE NEED FOR INTERVENTIONS

Fotolia_14019647_fotobazilio As well as alcoholism and drug abuse, there are many other situations in which interventions are appropriate. Consider the following...

...a 50-year-old woman is losing her family as a result of her workaholism... a 25-year-old anorexic or bulimic can barely carry her 100-pound weight on her 5’10” frame and is at risk of sterility or the shutdown of internal organs... a 35-year-old father physically abuses his wife and children... a rigid, controlling man who no longer gets drunk and abuses his family with his fists now uses religion and words to achieve the same results... a bipolar man and his family are living on a dangerous roller coaster because he refuses to take his medications...

For all these situations and more, an intervention can help. When a person is stuck in patterns that disrupt, endanger or demean the quality of life for themselves or others, an intervention is more than appropriate and can make an enormous improvement both in the present and for generations to come.

This article explores some of the mistakes that families commonly make when they experience a crisis that would make an intervention appropriate. These mistakes are wasting the crisis, playing solo, skipping rehearsal, accepting half measures and caving in afterward.

MISTAKE 1: Wasting the Crisis

Fotolia_11441299_taekwondude When a series of events culminates in a situation which is no longer under control, we call it a crisis. Until the crisis, a loved one has been walking on a stressful, dangerous, perhaps life-threatening tightrope. Friends and family often feel helpless. They are an unwilling audience at this dangerous balancing act. And that can sometimes make them feel like they are on a tightrope as well.

When the crisis occurs, it is like the loved one has fallen off the tightrope. They have been fired, abused someone, been arrested, earned a drunk driving charge or any of a myriad of other experiences. Now they are dangling by a fingernail. It’s an emergency. Action is imperative. Time is of the essence.

Yet, all too often, family members and friends reach down and prop the loved one back up – onto the tightrope to resume their dangerous act. Then they wait anxiously for the next incident and hope that it never comes, or if it does come, that it isn’t too serious.

They do this because they don’t know exactly how to give help that will really be helpful. Or they do it because they have been trained through other tightrope mishaps in the past. Or they do it because they find meaning for their own lives by rescuing people who fall off tightropes.

Whatever the reasons, the important thing to remember is that the problem is not that the person has fallen off the tightrope – but that they are living on it in the first place.

So helping someone onto the tightrope is, as they say, merely rearranging the deck chairs on the Titanic. At best, it is a Band-Aid. The goal of an interventionist is to use, not waste, the crisis.

When it is improbable that the loved one will climb off the tightrope on their own initiative, it becomes the job of the interventionist to provide a loving, supportive environment in which people who care can “push” the loved one off the rope, resist efforts to pop them back up, and provide a net of appropriate, qualified expert help to catch them and guide them to a life with their feet on the ground.

MISTAKE 2: Playing Solo

People in need of an intervention cannot, or are unwilling, to see the impact that their lifestyle has on those around them. People concerned about their loved one have found that the efforts they have made alone to suggest, hint, lecture, or otherwise help have failed. Sometimes their efforts have been met with hostility.

Different people have tried to be helpful; each has experienced part of the problem. But the whole picture is difficult for them to visualise. To put it another way, trying individually to help someone is like playing one instrument as part of an orchestral piece without regard to the other instruments or a conductor. It will not sway the audience; worse, the audience might react badly.

The task of the interventionist is to help friends and family members play their parts in harmony so that, during the concert, the loved one can hear the music, or begin to understand what their life looks like and how it affects others. An interventionist is a conductor who trains the musicians to play a piece of music clearly and crisply, music in which the audience can hear the strains of their own lives. Only when the musicians play their parts in concert with one another, under the guidance of the conductor, will the music have a chance to be heard.

MISTAKE 3: Skipping Rehearsal

The most important day of the (usually) two-day intervention process is the first day, the pre-intervention training day.

Typically, this involves a lengthy and intense training session during which family members and other participants – but not the prospective client – become equipped to communicate their concerns and proposed course of action to their loved one in ways that are the most helpful.

Fotolia_578857_S-Darko Draskovic During this time the interventionist gathers and organises information about the person whose life is out of control because of their addiction or other life-interrupting behaviour patterns. Every single detail is considered. Who will speak first? In what order will people speak? What will be said? Who will sit where? Will the person be brought to the intervention, or will the intervention be brought to the person? And how? What if they say no? What would likely be their main objections to accepting treatment? Every base is covered, every crack filled.

The second day involves the actual intervention with the identified patient, followed by referral and escort, if needed, to a pre-identified and booked helping agency.

Herein lies another common mistake made by family members. Time and time again, I have seen people skip that most important first day, the day of preparation. As a result, they can wind up repeating the second day, the intervention, over and over again. If they are not well prepared, the intervention usually fails. They don’t get the answer they want, the persons denies the problem and refuses to get help, and the painful wait for the next crisis begins again.

Also, they have given their loved one a greater opportunity to reinforce the defences keeping them in their destructive patterns.

Or the family members might get the answer they want: “I need help and I’ll get it” – but then nothing changes. Perhaps the “right” answer satisfies the immediate concerns of the family and they back off. Perhaps the family was not prepared with a plan of action, let alone prepared to act immediately to put their plan in place.

MISTAKE 4: Half Measures

Sometimes when a person agrees to seek help, family members are so excited that they accept an inadequate solution to the problem. It is as if they are all passengers on a stalled bus, and suddenly the most out-of-control person volunteers to drive. They are so relieved to have the bus moving at all that they go on an unsafe ride to an unknown, undesirable destination.

For instance, a person who is addicted and whose body is physically compromised from years of alcohol abuse needs to go to treatment. But first they need a safe, medically supervised detoxification program to avoid the dangerous and sometimes life-threatening effects of withdrawal. But they refuse to go to detox, for whatever reasons. Instead, they offer to quit on their own and promise to go to outpatient treatment and AA meetings. Their loved ones are so thrilled by their admission of the problem and willingness to get help that they accept the plan.

While continuing to drink can kill some people, quitting on their own can also kill them.

Is there another life-threatening condition for which we would settle for inadequate or less than the best treatment? When it comes to addiction, families do exactly that, too often.

That is why, before the two-day intervention event, the interventionist is busy behind the scenes planning for the effectiveness and safety of the intervention: orchestrating the time and place for a pre-intervention training session and deciding who should be present; choosing which participants will be most effective in the intervention; weeding out those who could sabotage during the event or prior to it by tipping off the loved one; and, of course, prearranging admission to appropriate recovery services – doctors, lawyers, psychologists, inpatient or outpatient treatment centers, and so on – if the loved one becomes willing to accept help.

Will she need detox? Does he need to be escorted? How can the time between the client’s “yes” and their entry to a facility be minimised and the arrangements be as seamless as possible?

MISTAKE 5: Caving In

I know a person who works for a crisis telephone line. When she suggests to a family that they consider using an interventionist, the most frequently asked question is, “What are the chances that it won’t work?”. Her standard reply is “The most common reason for an intervention not to work is that the family doesn’t do what the interventionist says to do.” I agree.

Often someone gets ahead of the plan. Someone thinks they can do it on their own because they have a “special” relationship with the client. This abandonment of the well-planned group intervention almost always leads to failure.

I have even had a couple of occasions where a family member caved in and began defending the loved one in the middle of an intervention. I understand that it is hard to stop rescuing someone when that has been your main job for years and years. But my experience is that people who choose to get help as a result of a group intervention are more likely to get more comprehensive help, are more likely to do better while they are in treatment, and are less likely to leave before an approved discharge.

There is another time when caving in undermines the whole process: after the client enters treatment. Often a person in a treatment programme threatens to leave or complains about their situation: they don’t like their counsellor; they are “not as bad” as the other people there; the food is not good; another client is getting on their nerves; they do not like their roommate; the centre is not religious enough or too religious.

Suddenly, instead of understanding that their loved one’s new “crisis” gives them a chance to change and grow, family members give the client an “out” – a ride, money for a ticket, even a sympathetic ear. Then they are sad and surprised when the client leaves against medical advice.

Even in these confusing circumstances, an interventionist can help people stay on the clear course that resulted in getting the person into treatment in the first place.

CONCLUSION: Redefining Crisis

Fotolia_11441302_taekwondude Usually, we think of a crisis as something like a drunk-driving arrest, an injury resulting from a violent outburst, the sudden revelation that previous “unexplainable” behaviours are the result of drug or alcohol use. And we would like to avoid these crises at all costs. But I want to offer a different and more helpful definition for crisis. Rather than waiting for the DUI, or the injury, or the loss of a job, there is one crisis which families can and should embrace. It comes into being when they simply say “This situation cannot and will not continue, because I can’t live like this any longer”.

An intervention done correctly is much more than a bunch of people getting together for a confrontation during a time of crisis.

The chinese symbol for crisis contains two characters. The first is the character for danger and the second is for opportunity. Danger is usually obvious to a family in crisis. Finding the opportunity in the crisis and helping the family do whatever it takes to make the opportunity a reality is the role of an intervention specialist.

The negative outcome that otherwise seems so likely and terrifying is not the only possible result of a crisis. Good can come – especially if we find the courage to tell the truth.


JEFF VAN VONDERON is a board-registered interventionist best known for his appearances on A&E reality show Intervention. He has written five books on topics such as family troubles, drug addiction and spirituality. He is also a motivational speaker and former pastor.

Comments

Irvine

hey great post , thanks for the tip's about intervention , i like how you refer to the mistakes of the family

Travis Gardner

great information on facilitating an alcohol intervention

The comments to this entry are closed.