Family and the Recovery Process

By Lauren Impraim, MA, LPC
Cottonwood Family Program Manager

When an individual enters treatment for addiction or behavioral health, there is often at least one other person who has been deeply impacted. Some family members would like to point the finger at the identified ‘issue’ being the person who is in treatment; however, the sooner family members accept their own place in the system, true healing can begin to happen for everyone. One thing that needs to be acknowledged is the entire family is walking the path of recovery. Family members and patients often spend too much time “fixing” one another. The best way to support a loved one in recovery is for family members to work on their own self and their own change.

“It is vital to help family members understand how issues such as codependency, shame and trauma all complicate the family system. These things negatively impact effective communication.”

A Family Matter
At Cottonwood Tucson, we believe that recovery is a family matter. Every person in the family system is in recovery. This means everyone in the system plays a role, and they have their own personal work to do. When a person comes into treatment, they are able to gain knowledge and skills to have a foundation for successful recovery. That same client may be willing, open and committed to recover, but, then return to a family system that hasn’t changed. They will, then, be at even greater of a risk to relapse than prior to treatment. The dysfunction in the family system is much stronger than any desire for a life of recovery.
Family members often enter the recovery process protesting and demanding they are not the issue. They will find justifications for their behavior (i.e., addiction, lying, debt, legal consequences, etc), that will keep the focus off of their own emotional wounds. Many family members aren’t able to see the impact the presenting problem has had on the family. Generally, family members may not see their loved one’s behaviors as a mental illness; therefore, they may not understand they have a role in the issues. It is vital to help family members understand how issues such as codependency, shame and trauma all complicate the family system. These things negatively impact effective communication. Knowledge, awareness and insight into these issues can make a difference between a life of illness and life of health in recovery.
Codependency is a concept tossed around a lot in the field of addiction and behavioral health. It is a subject that has grown and developed throughout the years, and may be deeply ingrained in families. When family members are acting on auto-pilot without insight into their behaviors, they may become so consumed in the behaviors of others that they lose their sense of self. When you scratch the surface of a codependent, you will find anger, hurt and resentment.

The Effects of Shame
Shame is a huge contributing factor to relapse. It could be defined as an intensely painful feeling of experience of believing we are flawed and therefore unworthy of love and belonging. More so, something we’ve experienced, done or failed to do makes us unworthy of connection. Shame is experienced deeply within the individual and within the system as a whole. Families often shame one another without realizing it, in an effort to self-protect. It is internal, so it is not always apparent to others, or even ourselves. Many people have learned to hide from shame by using different types of shields. Some people have learned to people-please, others have learned to numb it, and some have learned to displace it. The key is to bring this to awareness, understand the role and to be mindful of not inflicting shame upon shame.

What about Trauma?
Trauma is often the seed to mental health or addiction struggles. Many people do not know what trauma is or how it impacts behaviors. Many people enter treatment with life-long trauma and some developed trauma from their substance use. Society teaches people to ‘buck up’ and ‘push through’ experiences that may be very painful. This leads to normalization of trauma or a disconnection of self in order to survive. People may be unsure how to experience their feelings and may find themselves numbing or pushing away anything that is uncomfortable.
All of these dynamics greatly impact family systems and must be explored for true healing to occur. All of these issues are underlying, hidden. There are times we may not be aware of what’s happening beneath the surface and we respond with impulse. Typically, we respond in a way to try to protect ourselves, but in doing so we could really hurt someone else. This highlights the importance of communication and connection.

Family members need to share their internal experiences and perspectives to come together
In regards to communication, the condition of the environment needs to be considered. Participants receive conversations better when unnecessary stressors and tensions are minimized. It is important to think before we speak and practice using “I” statements. Appropriately using “I” statements, helps to remove the tendency toward shaming the other person due to our own pain or defensiveness. In recovery, feelings are new and can be painful. For many people, they’ve learned to numb their feelings. Therefore, communicating them can be very challenging; however, feelings are not facts. They are meant to be shared to bring upon more authenticity and closeness within the relationship. Lastly, boundaries need to be set. Boundaries are for self-care. They are meant to empower or protect oneself. They are not meant to control or punish another.
In our current world environment, many families are struggling with the implications of extended periods of isolation, financial struggles, and high levels of stress in our day to day lives.

The Struggles of 2020
For those who have been directly impacted by COVID-19 and are struggling with personal illness, these implications are much more difficult to face. We are also experiencing heartbreaking levels of racism and violence, political divides, and riots. It is not surprising, then, to learn that many individuals with sustained sobriety have relapsed or that those with current substance use disorders have experienced an increase in the amount and frequency of their use.
In addition, people are reporting increases in anxiety and depression as well as symptoms of PTSD. It is truly a painful time in our world, tinged with uncertainty and fear.
Families who are confronted with profound implications stemming from these current events may be uncertain how to help a family member who is suffering. Often, it may feel easier to look the other way and hope that the behavior changes over time. Unfortunately, problematic patterns of substance use or significant mental health struggles may continue to escalate long after the thundering noise of our current climate recedes. Family members may be called upon to be the catalyst that opens the door for change and healing in the family system impacted by mental health or addiction. A family member who is struggling will most likely require professional help to begin the recovery process.
Initiating services for a loved one can seem daunting. It often requires an investment of time, emotion, energy, and finances. In addition to these considerations, it is often anxiety provoking to invite conversations that might result in arguments or explosive behavior. It may feel easier to avoid the problem all together. It may help to remember that most people who struggle with addiction or mental health problems want to change their behavior. They may be overwhelmed with shame and self-hatred and may have an initial response that belies their need for help and support. It is important to approach the struggling family member with love and respect rather than accusation or blame. It is often necessary to invite the support of a certified Intervention Professional or Consultant who can help to navigate the difficult conversations necessary in situations such as these. Families can also consider involving the expertise of a trained and licensed Family Therapist or Substance Abuse Counselor who can assess the individual for needs and risks and make recommendations for services.

The Role of the Family
Family members play an important role in recovery. Whether an individual is participating in residential treatment or an outpatient level of care, family members should be included in the process of recovery. In therapy, family members have a unique opportunity to explore their own experiences and to seek ways to improve communication, clarify boundaries, and find healing. Recovery is an opportunity and a responsibility for the entire family.
As you can see, recovery is not a quick-fix. There are many contributing factors and influences, and family plays such a critical role in the process. Gaining awareness, education and direction are great places to start. When we can put our own shame and fear aside and look within, we can change ourselves…which can ultimately help in changing the life of our loved one. It takes great courage to work on ourselves, but it is all worth it.

At Cottonwood Tucson, we are dedicated to providing innovative and evidence-based holistic behavioral health treatment in an environment characterized by safety and respect for patients, family members and staff. Our commitment is to exceed community standards in the professional practice of medicine, nursing and psychotherapy and to operate our facility in a way that demonstrates respect and responsibility to our patients and employees. For more information visit cottonwooddetucson.com, for immediate assistance call (888) 433-1069

Lauren Impraim, MA, LPC
Lauren graduated with her Master of Arts degree in Clinical Professional Psychology from Roosevelt University. Since 2006, she has been working in diverse settings including inpatient, outpatient, juvenile probation and adolescent residential. She believes that building therapeutic rapport is the essential foundation of healing. Given her role as a Primary Therapist for over 6 years, she hopes to help the family members understand more of the therapeutic process. She works directly with families around the importance of boundary setting as well as the importance of self-care.

Kathleen Parrish, MA, LPC
Senior Director of Clinical Operations and Community Outreach
Kathleen is a Licensed Professional Counselor. She earned a Bachelor of Arts degree in Psychology in 1991 and a Master of Arts degree in Marriage and Family Therapy and a Master of Arts Degree in Religious Education from Southwestern Baptist Theological Seminary in 1999. Kathleen has worked in private practice, outpatient treatment, and residential treatment settings. Her work with trauma survivors spans over 25 years, focusing on story, mindfulness, and self-compassion.