Interventions and Confrontations – Are they the most helpful ways to respond to severe problems in a person we care for?
Because I view a person’s symptoms as part of their system of relationships I now focus on expressing my own position in the relationship rather than focus on the problems in the other.
Last week a relative called me to talk through their ideas for an “intervention”. They wanted to challenge a friend to admit to their symptoms and agree to get some professional help. I appreciated the deep care behind this request. I heard about how a long term friend had been exhibiting increasingly severe symptoms that were threatening many aspects of their wellbeing. I was happy to be a sounding board for my relative and to share some of my principles for communicating such important concerns to someone we care about. The term ‘intervention’ usually refers to the effort to gather a group of people together and confront a person about their need for help. It is often used in the case of serious drug and alcohol dependence. Web sites on how to do interventions describe the context:
People with serious addictive behaviours are often in denial that they have a problem. When heart to heart talks and other attempts to help prove ineffective, you can join forces with friends, families and a professional interventionist to confront the person with the truth and a detailed plan of action.
Many years ago I was a participant in such a strategy and experienced a long term fall out in the relationship as the years progressed. In more recent years I have come to a different view of such strategies. Because I view a person’s symptoms as part of their system of relationships I now focus on expressing my own position in the relationship rather than focus on the problems in the other. Here are the key principles – some of which I shared with my relative:
- The goal is to express to the other that they are important in my life as opposed to challenging how they are living their life.
- Rather than confront the other with the problems in their life – which evokes intense defensiveness – I want to express my wish to have them as part of my life well into the future.
- In conveying my care for having them as a living and important part of my life I will share some of the observations I have had that have triggered my concern.
- I use the language of “I” rather than “You” in describing what I have observed and what fears for their wellbeing have been activated.
- I describe the effects on me and our relationship and how this is different to the strong loving bond I am committed to as we continue as part of each other’s lives. This is different to describing my view of the effects on their life – positioning self as the expert overseer of another’s life can be heard as patronising and drive a wedge into the relationship.
- I aim to talk one on one with the person rather than pull a group together to confront them. A group confrontation easily leaves a person feeling ganged up on.
- I commit to ongoing contact with the person to show that my care for them is more than words. I don’t expect that just a conversation will change anything. I am committed to addressing my part in any unhelpful aspects of the relationship pattern over the long haul. This means I will not resort to distancing.
- I will be truthful and not accommodating but my effort at honesty will be from my perspective and principles rather than a dogmatic declaration that I am an expert about the other. My effort towards speaking honestly will be grounded in real examples not in my subjective judgements and opinion.
- I will watch my tendencies to be an expert about others rather than staying mindful of my own immaturities. I will stay clear of treating another person as a ‘diagnosis’ but rather will view them as a fellow human being who can be an important resource in my life.
- If I were to focus on just a diagnosis in another it is all too easy to hand them over to an expert program as a way of reducing my own sense of distress- and my responsibility to work on myself in relationship with the other.
I appreciate that it isn’t easy to know how to address serious concerns about another’s life course or symptoms. Are there exceptions? I certainly conveyed to my relative that they know their relationship with their friend and will find their own way to deal with it best. Every situation is different and there may be occasions when a more direct intervention is the most caring thing another can do. At certain times it may be most loving to call in an emergency assessment service. Even in such cases I would aim to be transparent about my willingness to do this if I ever thought that my loved one’s safety or those of another were under threat.
My view is that a group or individual confrontation of another is almost never constructive. It sets up a one- up/one- down relationship where the person feeling challenged is evoked into high reactivity rather than being able to listen. They hear judgement rather than heart-felt concern. They can be fixed into the postion of a ‘patient’ in their relationship system. My system’s lens reminds me that people get into vulnerable symptomatic places in life via their position in their relationship/family systems. This means that if I change how I relate in that system I can contribute to a less regressive and anxious field for the most vulnerable person.
Bowen on confrontation in a family system:
ON CONFRONTING FAMILY MEMBERS
‘As an oldest son and physician I had long been the wise expert preaching to the unenlightened, even when it was done in the guise of expressing an opinion or giving advice….During my psychoanalysis there was enough emotional pressure to engage my parents[others] in an angry confrontation…At the time I considered these confrontations to be emotional emancipation. There may have been some short term gain…but the long term result was an intensification of previous patterns.”
Family Therapy in Clinical practice P 484
ON RELATING TO A PERSON IN THE SICK ROLE
‘In those families in which both parents could eventually tone down the sickness theme and relate to the ‘patient’ on a reality level, the ‘patient’ changed. After one family had emerged from their unreality, the ‘patient’ said, “As long as they called me sick and treated me sick, I somehow had to act sick. When they stopped treating me sick, I had a choice of acting sick or acting well.”’
P 86 ‘Interventions and Confrontations’ – Jenny Brown