Strategies in Pastoral Care for those suffering from Alchoholism.



Topic.


Highlight the strategies a pastoral carer would use when responding to a call for help from a family with an alcoholic mother.


Synopsis.

The object of this essay is to highlight the strategies a  pastoral carer would use when responding to a call for help from a family with an alcoholic mother.

It is hoped that by firstly giving a definition of what alcoholism is, and secondly by looking at family systems that an understanding of normal and abnormal family systems may be reached.

As part of any strategy a carer wishes to use there must be an understanding of the problems that face the family both within and without.

Dangers from the mal-use of family therapy and dangers that face the carer will need to part also of an overall strategy for bringing about transformation in any family.

A look will be taken at some of the practical ways in which a carer can assist not only the alcoholic but the other family members as well.

The issue of Co-dependence will be raised as it pertains to both the carer and the family of the alcoholic.

Finally transformation will looked at as it acts as a model for change. Both physical and spiritual arenas will be touched on as the final product of God’s gracious gift to man.


Discussion.


In order to establish what types of strategies would be appropriate for a family who is experiencing the type of crisis or stress that comes hand in hand with alcoholism, it is important to have at hand a model of how the crisis will proceed[1]. Such crisis frameworks can be of invaluable worth in highlighting the resource a Pastoral carer can be to those families invaded by these unwanted, although all to familiar crisis’s[2].

There will be a predictable course of adjustment as the individual and the family unit move through the experience of coming to terms with alcoholism.

It is only by summonsing both the Resistance and the Adaptive resources (see footnote 1) of the family and confronting the problem that a satisfactory outcome can be expected.



Definition of Alcoholism.


What then is Alcoholism?

Depending on one’s view of alcoholism the type of care offered will differ. However this author agrees with the statement made by Warner and Bernard (Pastoral Psychology 1982), “Alcoholism is a spiritual problem, a physical problem, a psychological problem, and an interpersonal problem”. Treatment of one aspect of alcoholism and not all four is a disservice to the alcoholic”[3].

The Twelve StepsA typical symptom of alcoholism is loss of control which has as its complement, a battle for control[4]; this has the potential to destroy both the alcoholic and their family.

As the strategies a carer needs to muster for such a crisis as this is examined it is important to consider research done by Eshbaugh, Tosi and Hoyt[5]. They point out that there are some major differences between male and female alcoholics. It emphasises that most female alcoholics either fall into one of two groups. On one hand those with character disorders and on the other those with neurotic disorders.

Those having character disorders drink possibly because of poor behavioural control, while those who fit into the neurotic group drink to medicate themselves rather than seeking professional assistance to help them cope with the differing crisis’ in their lives[6].

While they admit that their research is not yet fully conclusive it can still act as a means by which the carer can see the need for profession advice and education before making judgements as to which is the most appropriate method of dealing with those in need.

Alcoholism is most often a gradual problem that either causes the family to find homeostasis or equilibrium. Equilibrium being the families endeavours to find stability as the onset of alcoholism grips a family member, while homeostasis is the attempt of the family to rigidly not change[7]. The latter can be the most devastating while the alcoholic is trying to achieve sobriety.

There needs to be clear understanding that, “alcoholism is a compelling plea for help that also carries a covert communication that the would be helper is as helpless as the alcoholic”[8].

Murray Bowen would see as one cause of alcoholism in women especially, the “de-selfing”, of the wife by adapting to the pattern of living as set out by the husband. That is, the gradual surrender of control of choice, and identity as the wife takes on the role of being the supporter of the husband’s career etc, which brings about the loss of her self identity[9].

It is important that as the carer plans their strategies for helping the alcoholic wife and her family, that they establish the state of the family (where everybody is at), and what type of family system they closest represent.


Finding the true type of family system:


The carer would have to seek answers to the following questions. Is the family so enmeshed that it unable to see the changes needed for an individual to survive? Is the family so disengaged that is has little or no interest in the need of an individual for help? Does the family react well to the crisis of an individual member and does it seek to individuate it members while at the same time remaining functional itself?

In other words is the family differentiated enough to face the crisis and cope alone or does the family require some sort of Pastoral intervention to allow it to traverse the crisis?


Models of normalcy:


A loving GodA truly functional family system which has individuated its members would be a poor breeding ground for alcoholism, however to say that alcoholism cannot occur in a functional family is a myth.

An explanation of this last statement would appear to be in order because the family system is a living organism. The family system like the individuals that make up its members is subject to stressors. If the family system fails at any level to act in an appropriate manner to any of these stressors then the likely hood of an individual member turning to some type of dysfunctional behaviour is likely.

Even greater still is the possibility that an individual member may be subject to a stressor outside the family system and then proceed to bring that stress into the family system.

The truly functional family would be one which seeks to individuate each of its members while at the same time be able to cope with the ever changing nature of the individual members[10].


Models of abnormality:


Images of Pastoral CareProblems in living are usually viewed as symptoms of a dysfunctional family system[11]. Likewise such things as pathological communication patterns coupled with enmeshment or disengagement, family violence, substance abuse and scapegoating are indicative of the way in which the major developmental and accidental stresses of life are mishandled by family systems[12].

Complementary relationships, where the “alcoholic loser” is married to the “suffering martyr” are also common.

Extremes of Enmeshment or Disengagement have been seen as significant variables in the etiology and/or maintenance of antisocial behaviours, such as, eating disorders and substance abuse like that of alcoholism[13].

Tension builds within the family when any of these pathological tendencies are present, bringing with it an expression of symptomatic illness. The symptomatic family member e.g. (The alcoholic wife) will be deemed to be expressing system disturbance[14].

It will be the shape that the disturbance takes and the way the family members deal with it, that shapes the way in which a Pastoral Carer will intervene and bring about transformation within the family.


Positives of Family Systems Therapy.


One of the greatest strengths of family systems therapy is that a change in the functioning of one family member can bring about a compensatory change in another family member. Murray Bowen sites the case where through his intervention with the spouse only of an alcoholic, that the alcoholic themselves was cured[15].


Negatives of Family Systems Therapy:


Image of Pastoral Care.Family therapy is most useful when there are family crises such as the abuse of alcohol by one or more members of the family. There are concerns however, that the possibility can arise where the family receives the exclusive resources of the carer. In this situation because not all problems can be construed as a system problem, it is possible for an attitude of, “blame it on the family”, to be used as a means of avoiding ones own problems[16].

Another concern highlighted by Jones and Butman is the close parallel between some radical branches of system therapy and the Marxist ideals of all for the good of the whole. Here an individual could loose identity at the expense of the collective. Pannenberg states that the collective view of person is “sharply opposed to Christian personalism”[17]; the individual has a unique personal relationship with God[18].


Locate possible sources of tension in family.


As the carer proceeds to move into a relationship with the family it will be of utmost importance to find the sources of tension within the family.

One such source of tension can be a difficulty in expressing anger in an appropriate manner, especially in interpersonal relationships[19].

The carer needs to beware of the families attempts to maintain homeostasis, also there needs to be an understanding of boundaries, rules, any complementary relationships and any scapegoating that may be going on inside the family relationship[20].

It will be by careful analysis of these things that a correct understanding of the family system will achieved. This highlights the need for proper education on the part of the carer on how to use the tools at their disposal to correctly diagnose these issues; otherwise other parts of the family will not respond to care[21].


Locate possible sources of tension outside the Family.


If the source of tension to which the alcoholic is reacting, cannot be found inside the family system then it is important that all areas of the alcoholics life be gleaned for possible sources of tension that could be, the, stressor which has driven them over the edge. Such things as work, interests, aspirations and interpersonal relationship can be likely sources of this tension[22].


Dangers for the Carer.


Co-DependencyBefore looking at strategies for the family it would be wise to make mention of the dangers that a carer should beware of when dealing with a family gripped by alcoholism.

Rodney Shapiro outlines two major dangers as; firstly the carer being drawn into the role of “referee”, where the family looks upon and vies for the attention of the carer as a referee. Both the wife and husband seek to find the support of the carer in their favour. Secondly the carer needs to avoid the role of “expert”, that is the couple sees the carer as the expert who has all the answers and all they need to do is follow their advice for their problems to be solved[23].

Shapiro would advise the role of facilitator as being the proper method by which a carer can bring about transformation within the family.

By opening lines of communication between the family members and facilitating and exploring areas of blocked communication the carer is able to remove themselves from the roles of “referee and expert”.

The other area of danger for the carer is the area of Co-dependence. If they are to avoid this trap there needs to be a conscious level of understanding as to the carers own motivation behind their involvement in the helping program[24].


Strategies for the Family.


triangle of codependencyMichael Warner and Janine Bernard posit that the carer should have as their model for bringing about transformation in the lives of the family with an alcoholic parent, child or any family member, Kreb’s therapeutic model of: 1) evaluate, 2) support, 3) refer, and 4) support. Support is included twice because the type of support required for the family before and after treatment is undertaken is different[25].

Clinebell rightly emphasises the importance of the carer to encourage the reconnection of the family with their social relationships both within and outside the church. As a pastoral carer it is important that a good network of support groups exist in the local church with the possible inclusion of a pastoral team who are trained in dealing with the problems of alcoholism[26].

So often just to affirm with the family that alcoholism is an incurable disease but one that is highly treatable will give the family great encouragement[27].


Strategies for the Alcoholic.


Alchoholics Anonymous.The level of differentiation of the alcoholic will be a good indicator of how successful any help or treatment will be. Thus it becomes important as mentioned earlier, to understand their family of origin and how well or how poorly they themselves are differentiated[28].

The carer needs to be mindful that while moving towards the establishment of a relationship with the alcoholic that the alcoholic will be overly sensitive of any criticism and have a propensity towards denial[29].

The manner in which the carer proceeds will depend greatly on whether it is the alcoholic or their spouse that approaches the carer for help. If for instance help is sort by the spouse then there will remain the problem of getting the alcoholic to accept that they are in need of help. However if the carer is approached directly by the alcoholic then the pathway to helping is greatly facilitated.

Referring back to the research down by Eshbaugh et.al. it can be seen that the type of treatment and care offered the alcoholic will differ depending on the cause. Those who are suffering from some loss of character would need an emphasis on internalised behaviour control, while those within the neurotic group would need help in anxiety and depression reduction, these being the main reasons they need to medicate themselves[30].

One of the greatest helps any carer can have at their disposal when working with alcoholics is a connection with an Alcoholics Anonymous group[31].


Strategies for the Spouse.


AlanonA well documented fact that needs to be carefully watched is that in many cases the marital relationship will deteriorate with the alcoholic achieving sobriety[32].

In some cases the spouse may develop psychosomatic or psychological illness after this point is reached[33].

This is why the carer needs to help the spouse achieve a personal transformation both physically and spiritually[34], one which will help them avoid the reaction to loss of identity that comes from having spent time as the leader and carer of the alcoholic.

Likewise, guilt is a problem that is experienced as the spouse is unable to express their own anger. As Shapiro puts it, “it feels unfair to attack someone for behaviour that seems uncontrollable”[35].

Much of this help would come in the form of personal one to one counselling, which would lead to involvement in either an Al-Anon group or some other support group[36].

In many ways the wife achieving sobriety will cause within the family a crisis that is perhaps more threatening to the stability of the family than the alcoholism it 'self had[37]. It will be through this process that the spouse and other family members must navigate as they redefine themselves without a sick or drunk member[38].

In caring for the spouse there needs to be an affirmation of their accepting the alcoholic as having a sickness and a need to release themselves from any responsibility of protecting, curing or being responsible for their behaviour[39]. This releasing means letting go emotionally and giving up all attempts to control or protect them from the consequences of Alcoholism.

Clinebell believes a general principle that should act as a guide for the family of the alcoholic is to “avoid both punishing and pampering”[40]. This will only further alienate the alcoholic from those who are best placed to help them.

Strictly on a practical level the carer needs to have available a list of resources that can be used by the spouse to cope with the everyday problems of life, such as, child care, clothing and feeding children. These types of resources are invaluable to a spouse who must work to meet the day today expenses of living[41]. In other words what community organisations are there and what services do they supply.


Strategies for the Children.


Ala-teenThe children of alcoholics are in many cases deprived of the emotional security that should be forthcoming from their parents and as such are in need of the same help as the spouse. In addition the children of alcoholics are in danger of becoming scapegoats for the family, so as to try and explain away the behaviour of the alcoholic themselves.

So often they can become innocent bystanders as the rest of the family becomes blind to their own contribution to the families dysfunction[42].

The children, irrespective of age need to be networked into support groups within the body of the church, be they AL-Anon or some other group set up for this purpose[43]. A pastoral carer should make all attempts at making a personal relationship with the children a priority so as to be able to be available for ongoing crises in their lives.

Research shows that dependency desires of children of an alcoholic parent are both inadequate and erratic[44]. This frustration for basic needs can lead at some point in a person’s life to the acceptance of alcohol as a compromise solution to a developmental or accidental crisis[45].

The carer needs to be attentive for any form of Co-dependence on the part either of the spouse or any of the children.


Problems of Co-Dependence.


A danger that the carer needs to aware of and make allowances for is co-dependence. That is when one or more members of a family system derive their own personal identity from the caring of others[46]. Jackson defines the co-dependant person as one who “shares a lifestyle in which most personal meaning and value is derived from others”[47].

It appears that families that have a rigid set of autocratic rules are more susceptible to rearing co-dependent children. It should again emphasised the need for the carer to have good lines of communication open with the children of alcoholic parents.

This as mentioned earlier is a problem that carers themselves need to be aware of.


Transformation as a Paradigm of Change.


What then is the outcome to be sort by the carer in any situation, such as that of working with a family with an alcoholic wife and mother? Firstly, there has to be as part of an overall strategy the desire to move both the alcoholic and the family from a point (one of turmoil & conflict) to another point (one of wholeness both physically and spiritually). The recovery for an alcoholic and the family will “include healing in physical, psychological, and social aspects as well as healing and nurturing spiritually”[48].

An important consideration for any pastoral carer is how deep they will go into a ministry like this. Will they only deal with the occasional family that crosses their path or will they take the step of encouraging their own church to become involved in the ministry to the families of alcoholics.

This author would suggest there is a dire need for this type of ministry in as many churches as possible, because it is an area where Christ himself would have been found.

There are however many considerations that need to be made before a pastoral team of this kind could to trained and put into operation. Robert Bremmer has written an excellent article on the some of the considerations that need to be faced before such a program should be established in any environment[49]. The value of this type of article is to highlight the dangers in a “bleeding heart” approach to working with families such as these.

Any strategy the pastoral carer uses must be thoroughly worked out and thought through. To start to work with these families it must always be kept in sight that the goal is transformation and not as already mentioned that of fulfilling some sense of Co-dependence on the part of the carer or carers.


Physical Transformation.


The first form of transformation will be physical and obvious by the changing face of the family as not only the alcoholic but the individual members of the family system come to terms with the problem and learn to deal with it in an appropriate manner. If for instance violence was common in the home it would be expected that this would be dissipated. The physical health and fitness of the family would also be improved as they individually and corporately learn to care for their bodies.


Spiritual Transformation.


A Spiritual Life.However by far the greatest transformation would in many ways be unseen, it lies on the spiritual plane[50]. Herein is the value of programs such as Alcoholics Anonymous, the twelve steps to spiritual wholeness[51], which have been adapted by groups such as Al-Anon to be of benefit for the family as well. This transformation is the taking of life that is experienced at a level less than the creator had intended and giving to it a state of wholeness that is in harmony with every aspect of Gods creation[52]. The central theme of the twelve step program is healing. By working the twelve steps people are able to reclaim their birthright as children of a compassionate God. It focuses on a new relationship with God that transforms people's obsessive needs to cope with the struggles of life[53].

In conclusion, it is here that a pastoral carer has within their reach an enormous wealth of help and assistance as the twelve step program has been tailored to meet the needs of not only alcoholic parents and their children but also the need of those suffering with a varied assortment of emotional and addictive behaviours[54].


Bibliography.


Anonymous, The Twelve Steps: A Spiritual Journey Revised Edition. (RPI Publications: San Diego, 1994).

Balswick, Jack, & Balswick, Judy, The Family. (Baker Book House: Grand Rapids, 1991).

Bowen, Murray, Family Therapy in Clinical Practise. (J. Aronson: New York,1978) 265.

Bremmer, Robert, “Starting an Alcohol Treatment Program: Ethical Considerations”. The Journal of Pastoral Care. Volume 48 No4 (1994) 384-201.

Clinebell, Howard J. Jr, Understanding and Counselling the Alcoholic. (Abingdon Press: New York, 1968).

Davis, Donald I., “Alcoholics Anonymous and Family Therapy”, Journal of Marital and Family Therapy. (1980) 65-73.

Eshbaugh, Dennis M., Tosi, Donald J. & Hoyt, Charles N.,  “Women AlcoholicsJournal of Studies on Alcohol. Vol 41 (1980) 310-317.

Jackson, Walter C., “Co-dependence and the Christian Faith: An Introduction to Compassion AddictionReview and Expositor. Vol 91 (1994) 31-42.

Jones, Stanton L. & Butman, Richard E.,  Modern Psycho-Therapies. (Intervarsity Press; Illinois,1991).

Massey, Denise McLain, “Addiction and Spirituality”. Review and Expositor. Volume 91 (1994) 9-18.

Mullen, Paul M. & Hill, E. Wayne.,     “A Family Systems Model for Pastoral Care and Counselling in Times of Crisis”.  The Journal of Pastoral Care. Volume XLIV No 3 (1990) Fall 250-257.

Pannenberg, W., “Christianity, Marxism and Liberation Theology.” Christian Scholars Review, 18 No 3, (217) 1989. 215-226

Platt, Nancy, Van Dyke, & Moss, Rev David M., “The Influence of the Alcoholic Parent on Episcopal Seminarians’ Ministry to AlcoholThe Journal of Pastoral Care. Vol 31 No1 (1977) 32-37.

Shapiro, Rodney J., “A Family Therapy Approach to Alcoholism.” Journal of Marriage and Family Counselling. October (1977) 71-78.

Reid, John, Class Notes for Pastoral Care A. Transformation as a Paradigm for Pastoral Care.

Warner, Michael D. & Bernard, Janine M., “Pastoral Counselling with Alcoholics and their FamiliesPastoral Psychology. Vol 31 No 1 (1982) 26-39.


Footnotes.


[1] Paul M. Mullen & E. Wayne Hill, “A Family Systems Model for Pastoral Care and Counselling in Times of Crisis”.  The Journal of Pastoral Care. Volume XLIV No 3 (1990) Fall 250-257. The authors put forward the Double ABCX model as a framework for the Pastoral Carer to be able to understand the progression of the crisis and possible outcomes that may be beneficial at each stage to facilitate transformation.

[2] Mullen & Hill, 257.

[3] Michael D. Warner & Janine M. Bernard, “Pastoral Counselling with Alcoholics and their FamiliesPastoral Psychology. Vol 31 No 1 (1982) 31.

[4] Rodney J. Shapiro, “A Family Therapy Approach to Alcoholism.” Journal of Marriage and Family Counselling. October (1977) 73.

[5] Dennis M. Eshbaugh, Donald J. Tosi & Charles N. Hoyt, “Women AlcoholicsJournal of Studies on Alcohol. Vol 41 (1980) 310ff.

[6] Eshbaugh etal, 315.

[7] Warner & Bernard, 28.

[8] Shapiro, 73.

[9] Murray Bowen, Family Therapy in Clinical Practise. (J. Aronson: New York,1978) 265.

[10] Jack Balswick & Judy Balswick, The Family. (Baker Book House: Grand Rapids, 1991) 35-50. See for a full discussion of the systems approach to family.

[11] Stanton L. Jones & Richard E. Butman, Modern Psycho-Therapies. (Intervarsity Press; Illinois,1991) 354.

[12] Jones & Butman, 354.

[13] Jones & Butman, 355.

[14] Jones & Butman, 356.

[15] Bowen, 267f.

[16] Jones & Butman, 368.

[17] W. Pannenberg, Christianity, “Marxism and Liberation Theology.” Christian Scholars Review, 18 No 3, (217) 1989. 215-226

[18] Pannenberg, 217. He goes on to state, “to treat a person as a mere function of society, with disregard for his or her individual human rights, must mean to the Christian that the person is deprived of his or her autonomy and human dignity”.

[19] Shapiro, 73.

[20] Warner & Bernard, 28ff. A concise discussion on the problems of complementary relationships, rules, boundaries and scapegoating is given by the authors.

[21] Warner & Bernard, 28ff.

[22] Shapiro, 72.

[23] Shapiro, 76f.

[24] Walter C. Jackson, “Co-dependence and the Christian Faith: An Introduction to Compassion AddictionReview and Expositor. Vol 91 (1994) 33.

[25] Warner & Bernard, 26.

[26] Howard J. Clinebell Jr, Understanding and Counselling the Alcoholic. (Abingdon Press: New York, 1968) 274f.

[27] Clinebell, 280.

[28] Bowen, 267.

[29] Shapiro, 72.

[30] Eshbaugh etal, 316.

[31] Donald I. Davis, “Alcoholics Anonymous and Family Therapy”, Journal of Marital and Family Therapy. (1980) 65-73. “Alcoholism affects the family of the alcoholic as well as the individual problem drinker. Change in drinking behaviour is often brought about by change in the alcoholic’s family members.. arguments over whether one uses family therapy or AA and Al-Anon persist”. The article by Davis focuses on an integrated approach to the use of these therapies.

[32] Shapiro, 72. Warner & Bernard, 33.

[33] Clinebell, 281.

[34] Clinebell, 282.

[35] Shapiro, 74.

[36] Clinebell, 279.

[37] Warner & Bernard, 37.

[38] Warner & Bernard, 37.

[39] Clinebell, 278.

[40] Clinebell, 279.

[41] Clinebell, 276.

[42] Warner & Bernard, 30.

[43] Clinebell, 289.

[44] Nancy Van Dyke Platt, Rev David M. Moss, “The Influence of the Alcoholic Parent on Episcopal Seminarians’ Ministry to AlcoholThe Journal of Pastoral Care. Vol 31 No1 (1977) 35.

[45] Platt & Moss, 35. Shapiro, 72.

[46] Jackson, 33. Shapiro, 29.

[47] Jackson, 32.

[48] Denise McLain Massey, “Addiction and Spirituality”. Review and Expositor. Volume 91 (1994) 15.

[49] Robert Bremmer, “Starting an Alcohol Treatment Program: Ethical Considerations”. The Journal of Pastoral Care. Volume 48 No4 (1994) 384-201.

[50] Massey, 15f. Massey here deals with the manner in which the twelve steps deal with a spiritual journey for the person as they reconnect their relationship with God.

[51] Anonymous, The Twelve Steps: A Spiritual Journey Revised Edition. (RPI Publications: San Diego, 1994) These steps are 1). We admitted we were powerless over alcohol-that our lives had become unmanageable. 2). Came to believe that a Power greater than ourselves could restore us to sanity. 3). Made a decision to turn our lives over to the care of God as we understood him. 4). Made a searching and fearless moral inventory of ourselves. 5). Admitted to God, to ourselves, and to another human being the exact nature of our wrongs. 6). Were entirely ready to have God remove all these defects of character. 7). Humbly ask him to remove our shortcomings. 8). Made a list of all persons we had harmed, and became willing to make amends to them all. 9).Made direct amends to such people wherever possible, except when to do so would injure them or others. 10). Continued to take a personal inventory and when we were wrong to promptly admit it. 11). Sought through prayer and meditation to improve our conscious contact with God as we understood him, praying only for knowledge of his will for us and power to carry that out. 12). Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs.

[52] John Reid, Class Notes for Pastoral Care A. Transformation as a Paradigm for Pastoral Care.

[53] Anonymous, The Twelve Steps. 1.

[54] Anonymous, The Twelve Steps. 7.


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