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Working with Substance-Related Disorders, Domestic Violence, and Child Abuse

Chapter 18

Chapter 18


Substance-Related Disorders and Families

A significant challenge to families and society

Substance-related disorders are even more destructive

Alcohol use disorders

Alcohol abuse “problem pattern where drinking interferes with work, school, or home life” in addition to other difficulties with the law and society (Stanton, 1999, p. 1)

Alcohol dependency person is unable to control his or her drinking behavior even after trying

Pseudo individuation / Pseudo self

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Manifestations of Substance-Related Disorders in Couples and Families (1 of 2)

Shielding of the substance-related abuser by nonabusing members of the couple or family


Expression of negative feelings


Focusing energy on the substance abuser

Misusing family resources

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Manifestations of Substance-Related Disorders in Couples and Families (2 of 2)

Assuming survival roles:

Enabler: spouse or other family member on whom the substance abuser is most dependent and who allows a substance abuser to continue and become worse

Family hero: an adult or oldest child who functions to provide self-worth for the family

Scapegoat: a child who attempts to distract the family focus away from the substance abuser by acting out in a disruptive manner

Lost child: child who suffers from rejection and loneliness and offers a substance abuser family relief

Family clown: often youngest family member who provides the family with humor and thus reduces tension

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Individual Manifestations


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


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

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Substance-Related Disorder and Treatment

Family treatments are among the most effective approaches for helping those with substance abuse problems.

It is helpful to engage concerned significant others (C S Os) in the treatment process.

Also, it is important to engage the most disengaged member of the family, possibly through a direct conversation

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Approaches to Treating Substance-Related Disorder Families After Engagement

Use the Community Reinforcement Approach (C R A)

Consider environmental influences the theoretical basis for assessing is multisystemic therapy

Help with emotional, social, and vocational issues

Address feelings and defense mechanisms

Consider prominent theoretical approaches: structural-strategic, Bowen, behavioral, Adlerian, and multifamily therapies

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Prominent Theoretical Approaches





Multifamily Therapies

Use of Community Resources and Prevention

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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)

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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).

Although some men are the victims of abuse and violence by their mates, the large majority of those assaulted each yea are women.

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Those Who Batter

Come in “all shapes, sizes, classes, races, and sexual orientation” (Almeida, 2000, p. 23)

Pit bulls heart rate increases as they become verbally aggressive with their partners

Cobras heart rate decreases as they become verbally aggressive

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

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Assessment of Domestic Violence




Difficult to determine level and prevalence of violence

Levels of violence

Common couple violence (C C V)

Severe abusive violence (S A V) or intimate partner violence

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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).

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Treating Domestic Violence: Conjoint Therapy (1 of 2)

Involves seeing the couple together

Assessment of safety required

Three conditions must be met:

Mans participation must be voluntary

Special agreement about confidentiality must be established

An optimal therapeutic stance must be achieved (Bograd & Mederos, 1999, p. 296)

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Treating Domestic Violence: Conjoint Therapy (2 of 2)

Couple therapy may work if the following criteria are met:

Only a history of minor and infrequent psychological violence or abuse has occurred

No risk factors for lethality are present

The man admits and takes responsibility for abusive behavior and also demonstrates an ongoing commitment to contain his explosive feelings without blaming others or acting out

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Treating Domestic Violence: Intimate Justice

The theory encompasses three ethical dimensions and nine ethical concepts (Jory & Anderson, 1999, p. 350).

It is akin to solution-focused approaches and confronts disempowerment and abuses of power in a partnership while challenging internalized beliefs about how one should treat ones partner (Jory et al. 1997).

Through knowledge and insight, both behavioral attitudes and behaviors in couples may be modified.

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Treating Domestic Violence: Educational Treatment

Educationally, programs based on intimate justice theory and C B T have been employed with domestic violence families

The Duluth model is one approach

A C B T model of treatment

Holds the premise that people learn violent behaviors because they are reinforced for them in cultural and social circles

People can unlearn these behaviors and learn new ones through cognitive-behavioral means, such as education

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Child Abuse and Neglect in Families

Child Abuse (acts of commission)

Child Neglect (acts of omission)

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Child Abuse and Neglect Statistics

“In 2010, child protective services (C P S) 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.

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Effects of Child Abuse




Cognitive, academic, and psychological impairment

Less satisfaction with life and increased likelihood of behavioral, cognitive, and affective disorders

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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

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Childhood Sexual Abuse (1 of 2)

Includes the following:

Unwanted touching

Making sexual remarks



Oral sex


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Childhood Sexual Abuse (2 of 2)


Least reported

Most commonly done by perpetrators outside of the family

12% to 18% are sexually abused during childhood or adolescence


Most reported

Most commonly done by a person within the family

1 in 3 is sexually abused by age 18.

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Treating Child Abuse and Neglect (1 of 2)

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).

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Treating Child Abuse and Neglect (2 of 2)

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

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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 Bowen-based family-of-origin work to behavioral interventions

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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

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