By Cindy McGlynn
Spring 2005, Vol 8 No 3
“Educate yourself” and “seek support” are common words of wisdom for people living with a family member who has a mental health or substance use issue. CrossCurrents takes this good advice one step further with practical tips from the experts to help health care professionals guide family members through day-to-day situations.
A family member (usually a daughter) with an eating disorder should not take over meal preparations for other family members and may need to eat her own meal at a separate time. “An eating disorder can completely disrupt mealtimes and interactions around food,” says Anne Kerr, program director at Sheena’s Place, a support centre in Toronto for people with eating disorders. “It’s hard because the daughter may take a tremendous amount of pleasure in reading cookbooks and watching other people eat. But she’s very anxious around normal eating patterns and will start to control the snack food and menus, so other children are incredibly resentful of this. It’s hell for everyone.”
If a daughter is confiding in her mother, the mother may feel like the counsellor and think she is the best person to help, says Kerr. “The parent usually tries to control the child’s life and illness, and it becomes a huge power struggle. Eating disorders are not about food – they’re about control and self-esteem. It takes a medical professional to handle these disorders.”
Kerr says weight loss is so highly valued in our culture that eating disorders may look to family members like a solution to a weight-control problem. Daughters may be rewarded for their efforts and the whole family may end up denying a very serious problem. “People trivialize eating disorders and say ‘I’d like a little bit of anorexia,’” says Kerr. “It’s like saying ‘I’d like a little bit of cancer.’”
Do exhibit positive regard toward the individual but negative attitudes toward the drinking. This means being supportive and loving but also setting personal boundaries around unacceptable behaviour. Dr. Graeme Cunning-ham, director of the Addiction Division of Guelph Ontario’s Homewood Health Centre, suggests saying, “Honey I love you, but you stink when you’ve been drinking, so we won’t make love if you’ve had any alcohol!”
Do attend Al-Anon meetings, get an Al-Anon sponsor and work through the 12 steps even if the family member is still drinking.
According to Cunningham, as many as 80 per cent of problem drinkers modify or quit drinking within a year after their spouse has started to work an Al-Anon 12-step program.
Cunningham says that alcohol dependence alters family rules, roles and rituals and that it is important to validate children’s emotions by encouraging them to express themselves. Parents should listen attentively and share their own feelings about the issue with their children.
Families need to find out who is responsible for debts and how to protect their assets, says Nina Littman-Sharp, manager of the Problem Gambling Service at Toronto’s Centre for Addiction and Mental Health. “Meeting with a bank manager can sometimes be helpful. Family members need to know what their liability is if they have a shared credit card or joint accounts. The family might also need credit counselling and possibly a lawyer.”
Paying off a family member’s debt from gambling will not stop the gambling problem, says Littman-Sharp. If possible, it’s better for the person who incurred the debt to take responsibility for paying it. But if the family does wish to offer financial support, it is best to pay bills directly rather than giving the money to the person with the problem who may be tempted to gamble with it. “We often see situations where there is still trust, so a family member may pay the debt if the person swears they’ll never do it again,’ says Littman-Sharp. “When the gambler relapses, the damage to trust can be huge. It’s a watershed moment for family. And what follows are feelings of anger, rage and loss.”
If the problems are urgent, families may need to take action without the co-operation of the person with the problem. Otherwise, families should try to work with the person. “You can encourage the family member to get treatment, but you can’t force them – it’s their life,” says Littman-Sharp. “Saying ‘I will take all your money away and I’m following you wherever you go’ won’t solve a thing.”
Parents should avoid being coerced into playing a role in the reassuring rituals sometimes practised by people with ocd, says Dr. Richard Swinson, Morgan Firestone Chair in Psychiatry at McMaster University in Hamilton, Ontario. “I saw a boy whose biggest fear was that his parents would die,” says Swinson. “It could be connected to any number. If it was the number six, then his family would die in six weeks or six of his family members would die. He had a complicated ritual where he would have to run upstairs 100 times and then his family would have to stand around him while he went through an elaborate, prayer-like ritual.” It feels cruel to resist offering the reassurance, says Swinson, but such co-operation is an inappropriate anxiety reliever.
Cognitive-behavioural therapy is commonly part of ocd treatment, says Swinson. For example, someone obsessed with the idea of “catching” cancer may take a trip to a cancer care centre as part of therapy. It's important that this exposure therapy not be followed with a lot of reassurance from family members saying, “Oh, of course you didn’t come into contact with cancer. Oh, it’s perfectly safe.” It’s subtle, but it's difficult to do.
Swinson says that, ideally, one family member will agree to become coach so they thoroughly understand the therapy. The coach might initially come to one or two therapy sessions, then follow up each week to stay current with what the family member in treatment should work on for the other six days.
If it is adhd, they won’t outgrow it, says Susan Hayut, a psychotherapist and family educator in private practice in Montreal, Quebec. An early diagnosis is much better than a wait-and-see approach. “Left undiagnosed, kids’ and parent’s self-esteem suffers, kids feel guilty, like they’re bad children and adults feel like failures,” says Hayut. Accurate diagnosis should include things like a detailed individual and family history, iq testing and possibly academic testing using standardized tests and check-lists for parents, teachers or someone who has known the child for many years.
Parents searching the Internet for answers will find herbal products, videotapes and even hats that promise to cure adhd within minutes. “adhd is so disruptive to the family fabric that people become desperate to find a cure and they’re willing to try anything,” says Hayut. “Research shows that the most appropriate interventions in most cases are a combination of medication, counselling for the parents or caregiver and cognitive-behavioural therapy.”
Before being diagnosed, children are often bombarded with negativity: “Why can’t you do this?” and “Why do you do that?” Hayut says that parents can create a more positive environment by encouraging consistent routines, setting rules and explaining expectations. “For these kids, mornings are especially harried,” says Hayut. “Let’s say the parent puts clothes in front of the child and says ‘time to get dressed.’ The kid then plays Game Boy for 20 minutes and doesn’t get dressed. So the rule might be ‘No Game Boy until you’re dressed.’ The expectation is ‘You get dressed in time for carpool.’ They need that kind of help to get through the day.”