" /> Pårørende til misbruger - samtaleterapi ved psykolog Kristina Hermann

For adult children of alcoholics, now in its third Danish edition.

 A forthcoming workbook in English for adult children of alcoholics.

ALCOHOLISM AND THE FAMILY

Very little attention is paid to how profoundly a family member’s drinking problem affects the rest of his or her immediate family. Therapeutic approaches, family dynamics, as well as popular conventions have long maintained a sharp focus on the person who does the drinking.

But if you are a relative you are likely faring as badly, from an emotional point of view, as the person who is addicted. You too need help in addressing and repairing the consequences of the abuse.

The consequences of the addiction are not the same for every member of your family—there is a difference between being a child, a parent, or a spouse of an alcoholic. Likewise, if you are an adult child, you could be facing your own specific difficulties in living your own life.

Common amongst relatives of alcoholics, however, is tremendous pain and stress.

THE SPOUSE OR PARTNER OF AN ALCOHOLIC

Alcoholism can generate an environment of uncertainty and repeated disappointments. Your relationship with the drinker may be characterized by turmoil, quarrels, tension, long periods of deadening silence. If you have children together, you may often feel that you are alone in the responsibility for their care, and that you are constantly being let down.

Most spouses of the alcohol-addicted develop codependency. This is a pattern of behavior in which, because you have lost confidence that the person with the problem can manage her own life, you try to assume responsibility for her. You become like a parent and get overinvolved, creating an imbalance that doesn’t benefit either of you. For spouses or lovers, this codependency can often lead to depression. 

Professional advice and guidance can be a lifesaver if you are in a relationship scarred by alcohol abuse. In most cases, depression and loss of hope begin to fade when you stop taking excessive responsibility for your partner.

Even if the alcohol abuse in your relationship has stopped, you may need help shaking unhealthy habits of thinking and behavior that the situation instilled in you. You changed yourself in some ways to accommodate your partner’s drinking, and now is the time to undue that damage, to set healthy boundaries and take better care of yourself.

Now is the time to break up your codependent patterns and get the life spark back. 

THE CHILD OF AN ALCOHOLIC

A child or young person with a mother or father who drinks is in urgent need of help. Of all the family members who suffer the effects of having an alcoholic relative, children are the only ones who cannot walk away. This leaves them at risk of lasting damage from that harmful environment.

Even if the mother or father has stopped drinking, the child needs help to understand how the years of parental alcoholism affected him. Many children and young people, channel a large amount of energy into developing defense mechanisms against the hazards of alcoholism, at the expense of the development of their own unique personalities.

They may have difficulty accepting praise, love, and recognition. They may have suffered disappointment so often that they don’t believe happiness is possible, or they don’t believe they deserve it. This is the sort of damage that a parent’s alcoholism can do.

Above all, the young person must be made aware that she has never been the cause of her parent’s drinking—she is not at fault in any way. Furthermore, her mother or father’s problems and state of mind are not her responsibility. She must have permission to discover and define her own self, and must be encouraged to set limits that will protect her, rather than allowing her to get drawn into the role of family rescuer. 

THE ADULT CHILD OF AN ALCOHOLIC

If you are an adult who was raised in a family with a drinking parent, it is likely that the experience left you with some problems that are common to alcohol abusers’ children. A parent’s drinking tends to overshadow a child’s most basic needs—not only protection and care, but predictability and help with learning to handle emotions.

One of the most common difficulties that people with backgrounds similar to yours grapple with is low self-esteem. But there are many others, including:

  • A sense of emptiness
  • Difficulty in setting personal limits
  • Self-care issues
  • The feeling that the role you play is not authentically you
  • A tendency to take on too much responsibility
  • Overinvolvement in your alcoholic parent’s life
  • Extreme loyalty to your drinking parent, even though she treats you poorly
  • Difficulty believing in and trusting other people
  • A feeling that inexplicable guilt and shame deep inside you make it unsafe to open yourself up to others
  • A sense that you have to “manage” yourself, with a fear of spontaneity
  • Mood swings
  • A tendency to be extremely self-critical.

Exposure to parental alcohol abuse reduces a child’s potential for personal development and destroys his sense of attachment—which, existentially, are a human’s two most basic needs. In addition, abuse often triggers traumatic and unpredictable events. The combined effects can leave a child facing some of the following formidable challenges:

Loneliness, Shame, and Isolation

It is typical of families with addiction problems to be reluctant to address them. Often, the family only isolates itself more and more, and friends and acquaintances fall away. Many children and young people are even forbidden by their parents to talk to people outside the family about the problem. A child can end up hesitant to bring friends home, or may sacrifice her social time to stay home and take care of his drunk parent, or his siblings.

Goals for promoting change:

  • Bring awareness of the problem out into the open, and help him overcome shame about family dependence problems
  • Provide an opportunity to participate in a community with other children/youth with similar problems
  • Provide a safe environment in which to talk about his situation
An unhealthy drive to act as the parents’ caregiver

Children and adolescents in families with addiction problems act as caregivers, both practically and emotionally, for their parents. Becoming overinvolved in the parents’ problems, they become convinced that if they don’t assume that responsibility, the problems will not be solved. Children and adolescents from addicted families are prone to anxiety and are often plagued by catastrophic thoughts and concerns about parents’ health, finances, and so on.

Goals for promoting change:

  • Give the child her childhood/youth back
  • Help the individual recognize and overcome her need for overinvolvement with her parents and responsibility for them
  • Help her change patterns of obsessive thoughts about the future
  • Give her tools for achieving peace of mind and body
  • Help her engage more deeply in her own life
  • Communicate with her parents about their responsibilities, and support healthy development that lets parents be parents and children be children

Weak personality development, overdeveloped survival strategies

Children, adolescents, and adults who are not confidently attached can find themselves in a state of stress, grief, and insecurity on a daily basis. Stressed children do not develop. Instead, their energy gets channeled into one of the three modes of survival behavior: fight, escape, or freeze.

Fight occurs when, for example, a child enters the rescue role and tries to solve or remedy problems that his parents themselves do not handle. Escape might manifest in a range of avoidance behaviors: The child wraps himself up in his own thoughts and feelings, avoiding contact by, for example, staying in his own room, playing computer games, watching television, or reading excessively.

Finally, a child may freeze in situations in which he is overwhelmed by violence against which he cannot protect himself. This is a state in which he is unable to speak, his thought processes grind to a halt, and he feels incapable of acting. Many children from abusive homes describe situations in which they suddenly get so stuck that they cannot attend to the business of their own schoolwork and life.

Goals for promoting change:

  • Help the person understand the general consequences of the abuse, so he can externalize his and the family’s problems
  • Help him learn to escape his stress
  • Help him develop self-esteem and self-confidence by being with adults who are accessible, responsive, and positively committed
  • Emphasize his right to say yes and no.

Weak mentalization ability

Mentalization means developing an understanding of one’s own thoughts, feelings, and reactions, and developing an understanding of others. As such, it is essential to the ability to develop as a person, but it can be a difficult skill to acquire in a family with addiction.

Families with addiction problems often develop dysfunctional forms of communication, involving drama and intense conflict, or shaming and abuse. A general tendency toward denial, often combined with violence and threats, impedes the development of communication skills. This deprives the children of the chance to learn to understand themselves and the situations they find themselves in.

Many children, adolescents, and adults from alcoholic homes struggle to see their own lives in terms of a coherent life story. Denied the chance to react in a natural way to what goes on around them, they often end up identifying themselves as the cause of the family’s problems.

Goals for promoting change:

  • Develop the person’s mentalization ability with regard to herself, so she feels safe in expressing her own feelings, thoughts, and needs when appropriate
  • Develop her mentalization ability with regard to her environment, so she becomes more secure in understanding and reading other people
  • Develop her sense of security to the point that she will be comfortable seeking help in the future, if needed.

Unprocessed trauma, failure, and loss

Many children, adolescents and adults from families with addiction issues are traumatized and burdened by unprocessed emotions, losses, and failures. Parents with addiction problems often inflict terrible damage on their children without taking responsibility for that harm or helping to repair it. The children are left with heartbreaking stories that are all the more burdensome because they are not able to talk with anyone about them. 

Untreated trauma is a potent force that can lead to depression, self-harming behavior, abuse problems, eating disorders, anxiety, and other problems.

Goals for promoting change:

  • Help the individual process the feelings around stressful events and not bottle them up
  • Paint a clear picture of the hazards of the toxic environment he has been exposed to
  • Support him in developing a positive and caring regard for himself
  • Determine whether he is developing inappropriate strategies for coping with his difficulties
  • Equip him with tools that will help him regulate powerful emotions

Insecure attachment style

Children from substance-abusing homes are uncertain that they can find needed protection from their parents. This can cause them to develop an insecure attachment style, which can affect their friendships and their behavior in future relationships.

Adult children of alcohol abusers have, on average, a higher divorce rate than most other adults, and their relationships are generally more fragile. But those patterns can be broken: Secure attachment patterns can be learned, making it possible to experience security in one’s relationships.

Goals for promoting change:

  • Help the person dare to trust and connect with others
  • Give her a positive experience of being part of a community
  • Help her learn to seek help and support when she needs it
  • Help her learn to maintain a sense of being herself when she is with others.

Increased vulnerability to addiction

Adult children are at high risk of developing an addiction and addiction themselves, primarily because they have been raised with parents who have not been sufficiently capable of helping neither themselves nor the child / adolescent to regulate difficult emotions and an appropriate ways of finding balance and wellbeing.

In drinking, taking drugs, or feeling that you can gain control of yourself and your emotions by controlling your weight, for example, it can be reaching for a quick way to get out of helplessness and severe discomfort, which in turn can easily develop into an addiction.

THE PARENT OF AN ALCOHOLIC

Codependency is a particular hazard if you are the parent of someone with a drinking problem. You might often be terrified that your child’s addiction is somehow your fault, and your first impulse might be to try to help your child in every possible way. This often translates into taking on an active parenting role, as if your adult son or daughter were still a child.

The result is codependency, with you as the parent no longer able to set healthy limits on your involvement in your child’s life, no longer able to discern what you can and cannot help with. A fear of letting go of the afflicted child, of admitting failure, can drag you deeper and deeper into the toxic realm of the problems the drinker faces.

If your alcohol-abusing son moves back into your home, and you take over his life (paying his debts, waking him up in the morning, filling out his job applications, trying as best you can to motivate him), it may seem as if you are freeing him of challenges that could trigger even worse abuse. But in fact you are simply managing his difficulties and possibly reducing his motivation to escape the habit.

What you must realize is that your codependency will not help your child escape his addiction. In fact, it will only perpetuate the problem.

With the right guidance, you can gain insight into the actual nature of your child’s alcoholism and into how it might be stopped. You can learn how to help in ways that won’t sustain the problem or make it worse.

MY METHODS

Substance abuse destroys relationships, dissolves family cohesion, and corrodes attachment. My therapeutic approach, therefore, is deeply rooted in attachment theory and mentalization-focused understanding. Its methodological starting point is acknowledging, systems based, holistic, and solution oriented, and it has evolved, been worked out and tested and adapted, over many years. In addition, I always draw on my practical and theoretical knowledge of addiction and the issues related to addiction. This holistic approach enriches the treatment by being open and flexible, meeting a person exactly where she is and adapting to her special needs. Abuse affects the whole family’s life, but individuals have their own unique needs, and the holistic approach makes it possible to focus specifically on the requirements—and resources—of a particular person. 

Why these methodological approaches?

Mentalization

Mentalization means holding mind in mind. In other words, to develop understanding of one’s own thoughts, feelings and reactions, and develop understanding of others. Children of parents with substance abuse problems have often failed to develop those capabilities. But mentalization is a prerequisite for being in satisfying relationships. The ongoing exercises in the program support the child in expressing himself and discovering coherence in thoughts, feelings, and experiences. At the same time, shame and denial are released.

Attachment theory

Attachment theory explains the child’s reactions to neglect and indicates the focus points for repairing the damage that substance abuse problems may have caused. Attachment theory provides an understanding of the child’s dependence on the adults around them, and that the child, starting at birth, wants attachment to and positive contact with his caregivers. Therapists are role models for the child and for the child’s parents. In order for a child to have peace of mind, he must experience a high degree of accessibility, responsiveness, positive engagement, attention, and predictability from the adult.

An acknowledging presence

An acknowledging presence—based upon recognition—is the basis of all development, psychological as well as neurological, from birth to maturity. Recognition serves several important functions for children and their development.

Recognition is stress-regulating. When a child is stressed and disregulated, acknowledgment helps her feel that she is understood and that all of her responses make sense. This allows her to derive meaning from the experiences and relieve her anxiety. In a group therapy situation, recognition from therapists and other children and adolescents can steer a child toward a better understanding of the burden she bears, as well as repairing the damage of failure, loss, and unfair treatment.

Recognizing presence is a primary objective of the approach and behavior of all practitioners throughout the program. In addition, parents are supported and inspired by the children and young people in the program to develop their skills at appreciative presence. A recognizing approach in work with children from alcoholic homes develops the children’s mentalization ability.

System based, solution focused

In all work with families and relatives of substance abusers, both studies and practical experience have proved that a systems-based approach to problems related to abuse makes very good sense. Much research shows a clear correlation between the development of abuse and the typical reaction patterns among family members (codependency, for example). There is extensive evidence that the whole family is affected and changes its behavior. Most catastrophically, as the family’s problem-solving behavior changes, the problem goes unaddressed as the family loses awareness of it or stop acknowledging it. In a systems-based approach to treatment, family members learn to take better care of themselves and leave the consequences of the addiction to be faced by the person with the addiction. This promotes healing, and reduces the risk of relapse by the person with a pattern of substance abuse.

My solution-focused method supports children and adults in breaking free of inappropriate survival strategies and suggests new possibilities in terms of both action and thought. This approach can also be very effective within the treatment of the substance abuse itself.

ABOUT GROUP THERAPY

Over the course of my career, I have developed a specialty in group therapy. My experience shows it to be an especially effective approach to problems related to substance abuse, and it now forms a prominent part of my practice. Group therapy is not restricted to any specific age group: As described below, I work with children, teens, young adults, and adults, sometimes in combination. (For a look at one particular group program, see http://www.desmaaskuldre.dk/De-sm%C3%A5-Skuldre-2418.aspx].) I also provide instruction and workshops for professionals seeking to lead group therapy sessions.

Children's group

The children’s groups I facilitate are ongoing for 42 weeks of the year, with enrollment allowed at any time during that period. An assessment based on the needs of the individual child determines how long he participates.

The purpose of the group is to create a safe space for the child—a place where it is “OK to be me.” In the child’s eyes, his family has broken down, and the world has to a greater or lesser degree become unpredictable. The group provides structure, predictability, confidentiality, and an acknowledging presence, with the children gradually getting to know each other and the adults, to create a healing effect. In the group, the children meet adults who are perceived as credible and who behave consistently from one encounter to the next.

Throughout our group work, it is made clear to the children that everyone is responsible for confidentiality, and that group leaders and children will jointly decide what information, exercises, drawings, etc., can be shown to parents. Part of our task is to create a connection between the child’s free space and her other world. We aim to improve the parents’ ability to sense their child’s needs, while at the same time respecting the child’s need for privacy and confidentiality.

Themes addressed in the children’s group include: 

  • What is alcohol abuse? 
  • Who does the abuse affect, and how does the abuse affect the whole family? How has it affected you? 
  • What do we do with difficult emotions? 
  • Friendships—being a good friend. What are my problems with friendship, and what are my parents’ problems with it? 
  • What is it like to have secrets? What is it like to feel alone and different? 
  • How can I stop worrying and thinking disastrous thoughts? 
  • Who can I seek help from? 
  • What is my story?
  • What am I good at? 
  • What makes me happy?

Parents or other adults from the family network take part in a mid-term interview and a final interview. At the final interview, the therapist will make suggestions as to which follow-up actions might benefit the child.

Children and Parents Course

A weekend course for children and an adult parent or other caregiver, in which children and adults are both together and separate at various times throughout the weekend.

In the children and parents course, children meet other children who face similar problems. This can come as a great relief—the loneliness that many of them feel is broken when they meet other kids in the same situation.

The children and parents course’s chief purpose is to provide children with knowledge about alcoholism as a disease, and about its influence on the whole family. This is supported by teaching, exercises, play, and warm togetherness. The children get the opportunity to experience simply enjoying themselves and being open and honest without feeling misgivings or guilt about it.

Children and parents courses include a conversation between the family therapist, the child, and the accompanying parent. The focus of this conversation is on what the child wants to say, imparting the message that the adult is to support the ongoing healing process and help the child care for herself.

Teen Group (13- to 17- year-olds)

Like my children’s group, an ongoing group running 42 weeks a year, with continuously open enrollment. 

Following an initial interview, the teen is allowed to participate in the group for the number of weeks that he or she needs to. Ten-week courses are typically recommended, but the duration of participation can be either longer or shorter, depending on an individual assessment. Teenagers can participate regardless of whether their parent is receiving treatment for substance abuse, and whether or not the parent is even in contact with the teenager.

At the outset, one or both parents, or another adult from the teenager’s network, can be invited to participate in an introductory conversation. The teenager also has the option of coming to that initial session alone. (In the latter case, Danish law requires that the parents or another adult be informed if a course is started.)

Should an adult participate in the initial interview, it is only for a portion of it. The primary focus is on the teenager, in order to best assess her need for support and determine how best to meet her current needs. 

The teenage group focuses on the young person’s needs and experiences. The teenager gets the opportunity seen and understood in relation to the stresses she has been subjected to, while developing a forward-looking perspective with an emphasis on long-term positive development. The group also fosters coping skills that make the participants better at dealing with life’s challenges.

Themes in the group include: 

  • Basic knowledge and understanding of addiction and the way it affects the whole family
  • Understanding how a person becomes a substance abuser, and how to avoid the hazards of youth-alcohol culture
  • How can I raise my self-esteem?
  • How can I strengthen my self-confidence and understand my own feelings and reactions better? How can I realistically set beneficial limits, and recognize, then manage, the strain caused by the substance abuse?

The program ends with a final interview, to which the parents or other adults from the teenager’s network are invited. Forty-two weeks per year, continuous enrollment. Following an initial interview, the young adult participates for the number of weeks that he needs. As with the teen groups, ten-weeks is typically recommended, but length can vary, depending on an individual assessment. 

The young adult group focuses on the young person’s needs and experiences. The group offers an environment in which the young adult can talk about the stresses she is under and do the repairs. The themes and activities have a forward-looking perspective with emphasis on long-term positive development. Work within the group helps ensure that participants acquire tools that make them better at coping with life’s challenges in a broad sense. There is a focus on personal development and on strengthening the individual’s social skills with respect to relationships, work, and education.

Typical themes in the young adult group are:

  • Trauma treatment and how to regulate your nervous system
  • Mindfulness and how to shift bodily experiences, awareness and reactions through exercises
  • Closeness, intimacy, and relationships 
  • Fear of things going well
  • How can I build self-esteem and self-confidence?
  • How do I stop my inner critic? 
  • Codependency: How can I break out of those patterns? How do I relate to my family while still taking care of myself? 
  • Basic knowledge and understanding of addiction and how it affects the whole family.

Adult Children of Alcoholics Group

“Adult children” groups run 42 weeks of the year, with continuous enrollment. Following an initial interview, the individual participates for the number of weeks that he or she needs. Ten-week courses are typically recommended, but length can vary depending on an individual assessment. 

The adult-child group focuses on the needs and experiences of adults who grew up in homes in the shadow of alcoholism. The group offers an environment in which a person can talk about the stresses she is under and do the repairs. The themes and activities have a forward-looking perspective with emphasis on long-term positive development. Work within the group helps ensure that participants acquire tools that make them better at coping with life’s challenges in a broad sense. There is a focus on personal development and on strengthening the individual’s social skills with respect to relationships, work, and education.

Typical themes addressed in the adult-child group include

  • Trauma treatment and how to regulate your nervous system
  • Mindfulness and how to shift bodily experiences, awareness and reactions through exercises
  • Closeness, intimacy, and relationships 
  • Fear of things going well
  • How can I build self-esteem and self-confidence?
  • How do I stop my inner critic? 
  • Codependency: How can I break out of those patterns? How do I relate to my family while still taking care of myself? 
  • Basic knowledge and understanding of addiction and how it affects the whole family.