Interventions

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A strong area for FamilyLight is intervention with people who are resistant to therapeutic help that they need.   This involves a small but growing number of our clients.

Background information: (Click here to skip this section and go to current information on intervention)  

Our consultant, Tom Croke, has extensive experience as an interventionist, originally trained in the 1980s,  following methods of Joseph Pursch, M.D., who famously was the professional who guided the Betty Ford intervention.   These methods are quite similar (but not quite identical)  to the methods of the Johnson Institute which originated the general concept of intervention as we know it today.   He also studied a number of alternative approaches to intervention that were popular at the time. 

One badly misunderstood fact of intervention is that when an intervention is done properly the professional "interventionist" does not do the intervening.   The role of a truly skilled interventionist is to train and guide family, close friends, and (in the case of the Pursch methods where Dr. Pursch's method differed from the Johnson Institute's method) a recovering person demographically similar to the person targeted in the intervention.   In the case of a Pursch/ Johnson style intervention, the process of preparing this "intervention team" is time consuming.   This means it is quite expensive, if the interventionist is being paid by the hour.  

We do know of "interventionists" short circuiting this problem by doing  little preparation and depending  heavily on the power of their own persuasion, sometimes interspersed with threats.  This is what we generally saw on the television show "Intervention," although we acknowledge that we did not see many episodes.  What we did see was sloppy intervention work.   Our experience with this kind of intervention is that sometimes the targeted person does get to treatment, but ill prepared for treatment and tends to leave very soon after arriving. 

In any properly executed preparation, the people closest to the person targeted, learn to be firm and loving at the same time.  Social networks surrounding people with addiction issues and many kinds of mental health problems, not to mention adolescents who are merely spoiled and unruly, almost invariably, some would say absolutely invariably, interact in a manner characterized by the term "Drama Triangle."  In some cases, the Drama Triangle was present prior to the problem targeted, in other cases it developed as people tried to adjust to the problem targeted.  Any effective intervention method with long term success involves change in the people closest to the targeted person ending the drama triangle, ending enabling, and nurturing the ability to be firm and loving at the same time. 

In the case of a Pursch or Johnson style intervention, this is part of the preparation procedure. The people closest to the person targeted, get together under the direction of the interventionist and learn to set very firm limits while showing love and completely avoiding the Drama Triangle.  In addition, the team learns a specific structure in which they confront the targeted person lovingly but very firmly with the nature of the problem, the need for help, and the fact that the enabling which has characterized this group of people will not continue. 

At the time of the confrontation (Pursch or Johnson style), the "interventionist" is present, but says very little to the targeted person.  His or her job is to coach the team, not be the captain of the team.  The team approaches their task affirming their lasting support but expecting immediate results.  The usual message is that if the person does not accept treatment -- now -- the person is sacrificing the support of the members of the team until treatment occurs.   When this is well done, it makes a deep impression that leaves the targeted person with a gut level understanding that the manner in which they have survived in the past without treatment will not continue but the support of loving friends in the process of positive change is deeply affirmed.

Other intervention methods with which we have had success, are characterized by family and friends gaining a healthy style of interaction either in a crash program or over time, but apply the resulting loving firmness over time.  Surrounded by only healthy interaction with the people the targeted person depends upon for survival, the person will eventually change their behavior, turning to treatment as may be necessary.  We can usually coach people through this type of intervention by long distance cmmunication that is included under our one time standard fee.   Beyond those elements, what actually happens in each intervention as described in this paragraph is very different from one case to another.

A Pursch/ Johnson intervention creates intensive stress for a short period of time.  Alternative forms of intervention that are effective involve less intensive stress but the stress of maintaining the "intervention stance" must be maintained over a longer period of time.

The key constants  in successful interventions are (1)  that caring friends and family approach the situation in a truly loving yet firm manner and (2) that the person on whom you are intervening discovers that getting help and/or making change will be better than not doing so.  We also need to be sure that we do not unintentionally add emotional pressure that would trigger self harm.

All too frequently, and on the television show "Intervention" most of the time, what is presented as a quality intervention is actually professionals muscling a person into treatment by a combination of threats and slick salesmanship. This is sometimes effective to produce a short term  behavior change or to physically locate a person in a treatment setting initially.   It will not usually result in lasting change nor lead to a person actually becoming committed to treatment and using the resources of the treatment center.   Too often the confrontation of a Pursch or Johnson intervention is confused with being "the intervention."  This is a misunderstanding, sometimes supported by less competent "interventionists."  The confrontation is one part of some interventions.  

Regarding the caution on self harm, we are also aware that some people use a threat of intentional self harm as means of blocking intervention attempts and fostering enabling.  In many cases this goes to the extent of faking suicide attempts.   Unfortunately families are between a rock and a hard place in these situations.   In our experience, without intervention, the behavior escalates to the point that very dangerous, even if faked, suicide attempt eventually occurs.  For that reason putting pressure on the person at any given time raises the risk for that moment but not doing so makes a bigger crisis in the future virtually inevitable. 

Recently we have mostly discontinued Johnson/ Pursch style with young people under 18.  The expense of properly preparing an intervention of the kind simply is not necessary when we can send people to schools and programs on parental authority, where the issues of an intervention will be taken care of while therapeutic progress is happening.  We would not refuse it but it has been a long time since one was indicated in a family that has come to us.  We do sometimes work with an alternate form of intervention with adults and teens while they are at home.  We will use a behavior contract where a teenager will  be asked to demonstrate ability to avoid certain troubling behaviors.   We will work with with parents to interact with their son or daughter to use affirming language at all times, imposing consequences for behavior that are fully predictable by the young person.   The problem with these alternate forms of intervention  is that the people intervening need to lay aside their dysfunctional interaction over a period of timem not just for a quick intervention meeting.  

These standard methods are not always workable. We have learned that with mentally ill people and with people with issues such as Autism and Pervasive Development Disorder,  we must work out an alternative plan modifications consistent with the above principles.    

Current information:

When we are approached about a person who is resisting treatment, our approach varies very widely with the circumstances.  If this person is legally a minor, we usually can get the job done within our standard procedure, although parents might need to be prepared to use a transport service. 

When we contract with a new family, we have a set fee for records review, home visit and six months of unlimited follow up.  For most families that represents a comprehensive service, covered by a single comprehensive fee (plus travel expense) for the initial contracting period (as of August, 2012, that is six months in most cases).  Except when we are doing an intervention, no additional client expense for the initial period of the service agreement should be anticipated.   In the case of an intervention, additional in-person meetings might be necessary and we will charge additional fees and travel for those.  This extra time and therefore extra cost is most likely to occur when the traditional Pursch/ Johnson style of intervention will occur.  (For explanation of "Pursch/ Johnson style intervention" see above section entitled "Background Information")   Extra in-person time leading to extra fees is much less likely to occur with other forms of intervention but still possible.

We stress that in any effective intervention the most important part of the work addresses family and friends on the intervention team so that they have the skill and motivation to maintain loving support without enabling.  This is even important when a minor is sent into treatment on parent custodial authority.  No matter how good the individual treatment, the young person is likely to return to old ways unless the family and close friends provide loving support without enabling.  Any successful exceptions to that usually involve the young person cutting off old relationships and creating a new network of support.

This differs from may professional "Interventionists" who will respond to a description of addict behavior and then sell their services for an intervention and maybe even suggest a proposed treatment location before having any sense of the level of commitment of immediate family and close friends as to their commitment to the processes that make intervention effective for the long term.   In many cases the Interventionist is being paid a finders fee by the treatment facility involved; we are paid only by the family that engages us and our treatment recommendations are never driven by offers of payment. 

When we receive an inquiry from a new family where task before us will involve and intervention, we attempt to clarify to that family that the cost of our services may be higher than in other situations and might not be fully predictable.  We map out with the family our initial approach to the case, where we try to stick as close as we can to the model of records review followed by home visit that we do with our non-intervention clients. But circumstances do not always allow that in intervention cases.  If we are headed toward a Pursch/ Johnson style intervention, we might not plan to meet the person for whom treatment is desired in the beginning of the process at all.  Initial meetings might be only with the proposed intervention team. 

Unlike far too many interventionists, we will not pursue a Pursch/ Johnson style intervention without a commitment from the would-be interveners to the time and cost of a very thorough preparation of the intervention team.  We do not take on interventions where the expectation is that professionals who do not know the person targeted for intervention have primary responsibility for persuading the targeted person to go to treatment. 

An intervention with staying power depends upon the effectiveness of the people from the natural social environment of the targeted person in communicating that the enabling is over and continued support of the group depends upon obtaining the best in treatment and making maximum personal effort to turn things around; It has been said that the famous evangelist Billy Graham could convert anyone for five minutes.   (Actually what Dr. Graham did often had more staying power than that, but the saying makes a valid point)  Aa single confrontation from a professional they had never previously met if initially effective at all, usually leads to the problem implicit in the saying about Dr. Graham. 

When  people  hear about how we approach interventions they sometimes react suggesting we do not do classic intervention.  Actually we stick much more closely to the script of classic forms of intervention than most people who simply bill themselves as interventionists.  We do not accept a job for a Pursch/ Johnson style intervention unless we are certain that the people engaging us are prepared to follow through on all they need to do to set up a proper intervention team in the classic sense.  It is our understanding that Dr. Pursch and the Johnson Institute had the same policy. 

A sign of someone not doing a true classic intervention is the interventionist hearing a description of what the targeted person has been doing and then based on that declaring his or her ability to go forward with an intervention.  We also When a Pursch/ Johnson style intervention is not a practical possibility we will consider a more gradual approach.  Ultimately any approach to intervention that is effective over time involves immediate family and closest friends first and foremost addressing their own triangulating and enabling behavior -- and maintaining the change over time. Methods that do not incude that might cause a person initially to enter a treatment program but the change will not last. 

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