Goals
To discuss with your family the specifi cs of your ICD, the ■
treatment program you have just completed, and how they can assist in your recovery
Purpose of Family Session
There are three distinct goals of the family session:
1. Explaining the therapy to the family members/signifi cant others so they are aware of progress and changes made, and what ongoing support you will need.
2. Allowing you the opportunity to inform family members/ signifi cant others about your impulsive behavior in a safe, neutral setting.
3. Assessing what your family members/signifi cant others may need to help them better cope with this problem.
Education about ICD and the CBT-ICD Program
Your therapist will take the opportunity to inform family members and signifi cant others about the disease model of impulsive behav- iors, and the goals of CBT in changing the brain. Your therapist may draw parallels to diabetes or alcoholism to illustrate the biological underpinnings of ICDs.
Family members may report differing concerns based on the type of ICD. Family members of individuals who suffer from PG and CB may often have great anger toward the person due to the fi nancial problems, lying, and manipulation that is often symptomatic of an
ICD. Family members may misperceive the discussion about the biology of the ICD as an “excuse” for you. It is important to stress that although there are strong biological factors underlying the ICD, you are in control of whether you seek treatment and keep working on the therapy. This allows both you and your family and signifi cant others to understand that although the illness may be beyond your control, the choice to do the therapy, and do it thoroughly, is within your control.
Family members may also want to know about the genetics or heri- tability of ICD. They may be worried about their children or other family members. Your therapist will inform family and signifi cant others of important facts about the ICD problem. He or she will also stress that although there are genetic links within families, genet- ics plays only a part of the development of an ICD. Environmental issues, developmental processes, and unknown factors also account for the disorders. Your family will be made aware that other family members may develop this problem, but that it is not your “fault” if children or other biological family members struggle with impulsive behaviors. Family members will be disabused of the notion that your illness is any sort of “infection” within the family. Family members will also be informed that they did not cause your impulsive behav- ior, and do not have to atone for their guilt by taking care of all the problems resulting from your actions (e.g., paying off your gambling or spending debt, returning stolen items to the store, or dealing with the legal problems that may have resulted from your impulsive behaviors).
Debt Related Concerns for PG and CB
If you suffer from PG or CB, your family members may feel that they need to “rescue” you fi nancially, either because they feel guilty or because they worry about you. Your family will be informed that you are working on, or will be working on, payment plans, and that “bailing you out” is not generally a good idea. You need to be honest with your family about your debt, and about any repercussions relat- ing to that debt. Although we do not want your family and friends
your fi nances and adhering to the budget you created in Session 2 (see Chapter 3). Your therapist will inform your family about your payment plan, if one was developed. It is important that family members realize that they are a priority. In other words, household debt will be addressed before anything else. This stresses the idea that the welfare of the family comes fi rst.
Suggestions for Family Member Support
The family session provides a safe setting for you to discuss your impulse control problems with those close to you. Family members can be important allies in managing the symptoms of the ICD. The family session allows you the opportunity to discuss the extent of your impulsive behavior problems, the reality of the resulting prob- lems, and the plans or other solutions that have been put in place to deal with the problems.
Specifi c ways in which family members may help with the therapy include:
1. Family members may be told how they can help remove or reduce your triggers for impulsive behaviors. For example, if feeling lonely on Friday night is a trigger, your family can plan social activities on Friday night and invite you to join them. 2. Family members may want to continue to work with you on
debt. If feeling overwhelmed by debt is a trigger to shop or gamble, then regular meetings with your family to discuss bills may alleviate the catastrophic thinking and avoidance surrounding debt.
3. Family members may be enlisted to help with new healthier behaviors. Ask your family and friends to join you in leisure activities as discussed in Chapter 4.
4. Inform family members about the warning signs of relapse. If they know what to look for, they can help you handle any slips and get you back on track.
Helping Family Members Cope
Family members often fi nd that attending support groups can be helpful. Visiting with other people with similar problems, as well as with other family members, can help you and your family to realize that you are not alone in dealing with impulsive behavior problems. Share with your family the following suggestions for obtaining support:
If you have problems with gambling, suggest that family ■
members attend Gamblers Anonymous and/or Gam-Anon meetings. If your family members have gambling problems of their own, help them fi nd a qualifi ed mental health
professional and reputable treatment program. Your therapist can help you with referrals.
Encourage family members to research support groups online. ■
You may even suggest family and/or couples therapy, ■
particularly if your ICD has negatively affected your relationship with your spouse or partner.
Wrap-Up
Family members and signifi cant others can be important allies in managing impulsive behaviors. The family session allows you to dis- cuss the extent of your impulsive behavior, and the reality of the negative consequences. It is important that you are honest with your family about all the negative consequences of your impulsive behav- ior, especially if they are not fully aware of what is going on. You can take the opportunity during this family session to make requests of your family members that will aid you in your recovery. For exam- ple, your family and signifi cant others may need to control or mon- itor your expenses for an extended period of time. Family and signifi cant others may also need some time to learn to trust you again with regard to your impulsive behavior. This session will pro- vide an opportunity for family and signifi cant others to provide
feedback and ask questions about how to best support you. If inter- personal confl ict has served as a trigger for your impulsive behavior, it may be advisable to work on open, assertive communication. Improved communication will take practice, and you may benefi t from couples or marriage counseling with your signifi cant other to reverse unhealthy (e.g., blaming, accusing) communication patterns.
You may wish to use the form provided below to set personal and family goals to assist in your recovery from your ICD. An example goal is provided to help you develop your own.
Goal Actions Timeline
Improved communication with spouse
Set aside 30 minutes each day, in the evening, after dinner,