Interventions and Confrontations – REPOST

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

First Steps for a Worried Parent – A father learns to observe his interactions with his defiant 13yr old

It’s natural to want to fix and change a child/adolescent who is struggling to manage life. Hence it may be a surprise to hear that a first positive stage for a parent who is worried about their child/adolescent is to figure out the predicable steps in parent – child and family interactions. This requires close consideration of a recent interaction with the child/adolescent. The content of the interchange is less important to think about than the reactions of each person. The goal is to identify what the parent may be contributing to unhelpful repeated patterns in the back and forth interaction.

While it might initially seem somewhat tedious, examples of what are constructive questions to ask are:

Where did it take place? What started the interaction? What were the beginning behaviours (what was said and actioned)? What was the emotional tone? How stirred up were your emotions? How did other family members respond? What was the next response? (Behaviours and emotional tone)What happened next? How was that responded to? What happened next? How was that responded to? How did things finish up? What was the left over tone for each person?

Here is an example of a father working to observe the patterns he is a part of:

Joe reported a recent challenging interaction with 13 year old Chloe, his youngest daughter. The family were out for a pizza dinner to celebrate the birthday of eldest son Jake (16). Joe recalled that Chloe started complaining in a whining manner that she didn’t like any of the food choices and wanted to go home. He responded by reminding her that this was an important family dinner for Jake and she should make an effort to support him. He thought that his tone of voice was cheerful, appealing to Chloe to co-operate. Chloe responded irritably saying that they should have known that she hates Pizza. Her Mother Sue responded firmly saying she needs to stop being so selfish and not spoil her brother’s birthday. Jake joined his mother, saying “Chloe you always make everything about you! I get why your friends have had enough of you!” Chloe slams the table and respond to her brother with a cutting counterattack. Joe intervenes and says to Chloe that she doesn’t need to eat Pizza and can order whatever she wants. He uses his best peacemaking voice to suggest that if Chloe can calm down and help them all to have a pleasant family dinner he will upgrade her phone for her (this was something Chloe had been negotiating with him for a while). Chloe backs off and says that she just wants gelato for dinner. Joe orders it along with the family pizza and drink requests. Jake gives his dad a serious stare. Joe interprets it as a challenge to his generosity towards Chloe. Joe recalls that Sue is then mostly silent and sullen. She ignores Joe and focusses on talking to Jake about having his friends over for a birthday gathering. Joe feels very tense about the tenuous state of peace. About half an hour into the dinner, Chloe has finished her gelato and says she’s bored and had enough. Joe encourages her to stick it out for the birthday cake reminding her that the new phone is only going to happen if she does this. He rushes the birthday cake candle blowing and the family leave to go home early. Joe was left feeling highly stressed. He sensed his wife was frustrated and quietly disapproving of how he managed Chloe. Jake seemed withdrawn. Chloe seemed agitated and consumed with getting her new phone. He feels despondent that his efforts are not appreciated. He is deeply worried about his daughter distancing from the family at this vulnerable time in her life and is intent on trying to reverse this possibility.

Can you see the patterns that each family member is part of? Joe was able to begin his reflections by asking himself: WHAT WAS INEFFECTIVE IN HIS RESPONSES?  WHAT DIDN’T WORK WELL? WHAT WAS CONSTRUCTIVE?  WHAT WORKED BETTER? Here are some of his thoughts:

Joe recognised that this was a common interaction, with him trying to be the peacemaker, leading to him trying to bribe or cajole Chloe into co-operating. He could see that Sue was becoming increasingly annoyed with Chloe; and that Jake was getting fed up with his sister and distancing from her. He recalls the earlier years when the 2 siblings got on so well and Sue and Chloe seemed so close. Chloe had seemed to be an anxious child who struggled to separate. Jake had been such a protective brother in her early school years. Since the start of secondary school this all seemed to change and Joe was stepping up to try to recreate a happy family dynamic.

Rather than talk about Chloe’s problems and symptoms (she was having increasing problems with defiance at school) Joe began to focus on himself in the interactions.  He could observe that his efforts were able to achieve some temporary peace in the family as Chloe would back down her loud complaints when he stepped into to offer an incentive.  Mostly he could see that his peacemaking was not effective, in the bigger picture of family relationships and his daughter’s wellbeing… He identified that he was rewarding Chloe’s demanding behaviour which was frustrating his wife and son. He did say that he sensed that Chloe felt that Jake was Mum’s favourite and he tried to reassure her that this wasn’t so. Deep down he sensed that Sue was negatively withdrawing from Chloe. He wondered how much his reinforcement of Chloe’s complaints played a part in fuelling this.  He didn’t know how to change his part in things but he could see that continuing to observe his patterns of interaction was useful. It certainly felt more constructive than working out how to change his daughter.

All family responses are like intuitive dance steps and often, over time, develop predictable patterns back and forth between people. The more that this can be conscious, the more a parent can make choices about continuing what is helpful and changing what isn’t. When a parent can learn to observe their part in responding to the child they are concerned about, they can create a pathway to working out how they can adjust themselves in order to improve the family environment. Small steps are required in working towards changed interactions that promote improved functioning for all – in particular for the most reactive and vulnerable child.

  • Stay tuned for a follow up blog next month on Joe’s next steps to observe and understand his part in his daughter’s increased reactive behaviours. Joe considers the effects of his responses on his daughter’s growth (or regression) of responsibility.

The surprising link between dental hygiene and relationship maturity

As I reflect on what’s changed over the past year I see that this step of progress has less to do with a specific goal about dental hygiene and more to do with being a bit more of a self in all of my relationships.

I’ve been dismal with dental flossing for most of my life– I’ve made many efforts to be consistent with this key aspect of dental hygiene only to lapse as life gets busy. I have never quite understood why the establishment of this good habit has eluded me. Flossing was never a part of my childhood routine in the way that teeth brushing was. Hence I appreciate that it’s always more challenging to establish good habits as an adult if they haven’t been supported by parents in childhood. But this excuse doesn’t really let me off the hook. I recall hearing a conference lecture on geriatric preventative health and my ears pricked up when the doctor declared: “Flossing is not necessary…” this sounded hopeful until he went on to say “…unless you don’t want to lose your teeth!”

I floss regularly a week before a dental check-up but the redness of my gums gives my dentist evidence that I have not been consistent. After getting a lecture on preventing gum disease I improve for a little while but the habit starts to lapse before it is consolidated. A bit of external expert pressure can temporarily get me on track but I haven’t mobilised enough internal ‘self’ to persist. Growing a more responsible self is measured by how much a person can function in life without being dependent on external relationship directives.

2016 however has been a breakthrough for me in this area of my laziness. Surprisingly I have managed to make daily flossing a habit and the results were affirmed at my end of year dental visit. What is it that has enabled this meagre maturity break-through? It has not been a conscious new year (or post dentist) resolution as the evidence over the years doesn’t back this up. As I reflect on what’s changed over the past year I see that this step of progress has less to do with a specific goal about dental hygiene and more to do with being a bit more of a self in all of my relationships. Over the pressures of the past year I have learned a great deal about managing myself in both family and work situations. I have consciously improved my respect for other’s autonomy – asking what is helpful before jumping in, keeping in contact, being more responsible for myself and less focussed on the other, noticing and addressing the sneaky signs of too much tension in me. I have continued my decades of small efforts to have better balance between managing my own health and sharing myself mutually in relationship. There have always been steps of progress mixed with setbacks, but gradually, over time I see the signs that I have grown a bit more inner agency (self) and have seen others in my family do the same.

The capacity to direct one’s self in a responsible manner while also being reliably connected to others – this is the groundwork for improving follow through on many a good resolution. It is less about achieving the individual goal and more about improving life maturity and a steadier emotional state in general. And, as important people in our lives lift their own responsible life management, others in the system are better able to lift theirs.

I can reflect on other previous habit forming failures and see that there have been steps of progress over the past year. Additionally I plan to work to be more responsible in a number of other life management domains —it’s a good size list. I do realise, however, that the broader endeavour to be a more mature self in the important relationship domains of my life is more fruitful that just targeting a specific resolution. My efforts need to be balanced between my relationship and my individual functioning.

I’ve always known that regular flossing is important but having the capacity to turn this awareness into a daily habit has been predicated by growing up a bit more in all areas of my life and relationships – to be more inner directed and less externally motivated. Who would have thought that broadly improving how I manage myself across all of life could translate into a better-quality set of teeth?

The surprising link between dental hygiene and relationship maturity – Jenny Brown