The Viewpoint

Learn it - Stabilize

Phase One is the "learn it" phase. This phase focuses on stabilization. Through evaluation and care by medical, psychiatric, and therapeutic staff we help each client complete post acute withdrawal symptoms, restore a proper sleep/wake cycle, establish healthy eating routines, articulate basic goals for recovery, identify triggers, and distinguish between thought, motions and behaviors. In addition, there is an introduction to family systems concepts, accepting ideas around spirituality, and self care. This phase initiates a shift into recovery.

Feel it - Responsibility

In Phase Two our clients begin to find "the meaning" in their active recovery and can identify personal feelings, take responsibility for their actions and use the tools they have learned in daily living. They can anticipate situations and they can separate and identify a reaction from a response. They become active in their recovery, moving through each day with an attitude that supports recovery, health and change. Mood changes, depression and anxiety regulate as the therapeutic process helps each client identify external and internal forces that impact them. Clients are encouraged and supported in open conversation with family members and they also practice recovery methods in daily living situations.

Live it - Solidifying

Phase Three supports all clients in experiencing their new-found recovery. In fact, it is a phase of experiences. There tends to be shift in attitude that includes giving back to the family and community. Mood changes are less extreme and they begin to move through each day with the ability to deepen their commitment to a new lifestyle. There is a higher consciousness emerging with a shift of reliance and the nature of acceptance. Personal power is derived from connection rather than control. Family conversations and interactions are often more spontaneous and on safe ground for all. The focus is now upon deeper issues that intrude on daily serenity, acceptance and stability.

Kenneth Perlmutter In previous columns we have looked at the systemic aspects of families experiencing addiction and its co-occurring illnesses and losses. We know from the research that client outcomes from chemical dependency treatment are most successful based on the length of time the client is in care (ranging from hospital to outpatient) and the degree to which the family system shifts with respect to behaviors and ways of communicating that perpetuate the family system's expression of addictive disease and the co-occurring impaired coping adopted by all members.

Our largest group of clients at Morningside Recovery comprises young adults who come to treatment and extended care with a unique set of needs. Many can be thought of as failing to thrive or experiencing delayed separation and individuation. Today's generation of young adults (18-30) has been adversely impacted by socio-cultural forces which impede individuation. Theirs is the first generation that may not exceed the accomplishments of its parents. Our American society is built on immigrant roots and founded on the notion that parents give their children advantages and opportunities the parents did not enjoy. Imagine a common scenario which describes Morningside young adults and their high-achieving family: your father is head of neurology at a major university hospital and your mother is leads fundraising for a national charity while she is also president of a local political action committee. Your sister graduated from Ivy League school and works full-time in New York City for a top eight accounting firm. Your little brother is heading for a full scholarship to Stanford or Cal to play soccer. Take it one step further and imagine you have a subtle or non-verbal learning disability, find marijuana or alcohol necessary to manage every day life despite its adverse consequences, or have social anxiety, depression, or unreasonably low self-esteem.

In working with family systems which include a stuck young adult, we examine the systemic forces that reinforce the delayed individuation. Common themes include: parental guilt associated with the parents' (frequently denied) awareness that this child cannot achieve at the fullest level; internalization by the young adult of unrealistic expectations that he/she beats self up for being unable attain; unresolved grief and loss from the past the pain of which is being carried through the family's unconscious loading onto the stuck young adult or the delayed individuation process; distraction, disorder, and disconnection which saturate the alcoholic family home atmosphere; inability to face and grieve the loss of the ideal child the stuck young adult once represented; and, distraction from traumatic secrets that are avoided and denied by focusing on and reinforcing the young adult's delayed individuation and its associated difficulties.

To begin this work family members are invited to explore the ways in which their system has been wounded -- a blame-free and shame-free description of a key aspect of their system. We speak about the ways in which the system has become Disordered, Distracted, Disconnected, Deprived and plagued with Denial (the five D's). These characteristics describe the nature of relating and functioning in a way that most family members recognize right away.

We discuss how the disorder, distraction, disconnection, deprivation, and woundedness in the system typically stretch back several generations. As we begin dynamic and experiential work, we make space for each member to look at the ways each has coped with the experience of being the member of such a system. We begin to see how control behavior, substance abuse, disordered eating and body image, workaholism, denial/avoidance, and scapegoating (blame taking) are adaptations - impaired coping mechanisms -- not character flaws. We also see how every member of such as system is likely to create a similar system when they go on to form partnerships and build families of their own. We can interrupt this trans-generational transmission of destructive coping.

All members in such systems experience the family version of addictive disease, namely Stress-Induced Impaired Coping (SIIC). Four common roles are adopted by members in an attempt to manage the intolerable emotional experience of facing family's core which is saturated with lies, secrets, shame, and illness. These roles include escaping (through numbing out, isolating, leaving), taking the blame, trying to fix certain relationships or members, or distracting oneself and others through high achievement (superstars) or high drama.

The treatment for SIIC begins with telling the truth - the emotional truth for each member of what it is like to experience and survive as a member. We look at how authority manifests, love is expressed, communication flows, resources are distributed, crises are managed, distress is shown, privacy has been maintained, and how the family relates to its community and to its past.