Clients in a community based residential treatment facility seek help for co-occurring disorders such as alcohol and substance abuse combined with mental health issues as depression, bipolar disorder, anxiety, schizophrenia, obsessive compulsive disorder, a variety of personality disorders, and attention deficit disorder.
During the screening and intake processes, it is extremely difficult to determine whether the substance abuse was caused by the mental health issue or the mental health issue was caused by the substance abuse – or neither. As far as effective treatment goes, it does not matter. Both conditions must be treated in parallel. If depression that accompanies alcohol dependence goes untreated, even though the client may be effectively treated for the abuse, it may reoccur and serve to provide the emotional pain that triggers a relapse into alcoholism. The anxiety that is a common cause of dysfunctional behavior in alcoholic and addicted clients’ lives has been passed on from generation to generation. Until these clients understand the sources of their anxiety, its causes, and the effects it has had on their lives, they will continue to work on the symptoms and not the causes of their illness.
The major schools of Transgenerational Theory and therapy over the past three decades include Natural Systems Theory (Bowenian), Symbolic-Experimental (Whitakerian), Contextual (Relational Ethics), and some aspects of Object Relations Theory.
Natural Systems (Bowenian) Theory was developed in conjunction with research on families with a schizophrenic member and looked at connections between inpatients and family members. Symbolic-Experimental Therapy was developed when Carl Whitaker and two colleagues began working with adults hospitalized with psychotic symptoms in the 1940’s. They experimented with cotherapy and the use of consultation by therapists, as well as families of origin sessions. The Contextual Approach focuses on the work done by Ivan Boszormenyi-Nagy and colleagues since 1965 on the concept that unresolved multigenerational pressures contribute to later emotional symptoms. In the history of marital and family theory, the influence of psychoanalytic theory was the foundation for the work of Paul and Framo, Virginia Satir, Murray Bowen, Carl Whitaker, and Salvador Minuchin. It is based on a European view of self-in-relation. It examines how a young individual adapts to the family environment that Westerners define as mother, father, and child. These studies are important to the therapist in a co-occurring disorder facility in that they provide reliable and valid tools to help guide clients out of the darkness of addiction and depression and allow them to break the chains of the bondage that has held them back from fully participating in society. A primary focus of this therapy, after identifying the Transgenerational Transmission of anxiety, is to help the client gain emotional maturity.
An expression of emotion is what makes us human. Many people do not know how to express their emotions in healthful ways that promote good relationships with friends and family members. Learning how to deal with one’s emotions – how to direct them toward positive outcomes, express them without harming others, and give voice to emotions in order to improve communication – is a vital tool. All emotions are valid. Each has a place in the design of a person’s psyche and spirit. Each person, to a certain extent, is going to have a unique response to life’s situations, problems, circumstances, and challenges. One person may weep at the beauty of a moving piece of music, another person may sit in silent awe, and still another person may stand to give a thunderous applause. We must allow others the privilege of their expression. We also must give one another the privilege of expressing emotions privately. One of the features of emotional maturity is the recognition that while we can advocate the healthful and free expression of emotions, this does not mean that a person be required to express emotions in the presence of others, especially when not with safe people. For most clients, the realm of emotions has uncharted territories. They may be unsure of the language of emotions. They may have neglected or feared to explore areas of their inner lives as they acted out in their addictions and dysfunctions. It is important to note that trends and similarities will be evident from generation to generation as the client takes this journey into emotional maturity.
Research on distressed versus Nondistressed couples by Transgenerational Transmission theorists have been doing “single-subject research” by examining marriages one at a time with researchers from sociology, anthropology, social work, and social psychology surveying couples in the lab. Research concludes that families of origin pass on preferred values, styles of intimate relating, meanings and beliefs about difference, tolerance and acceptance, fairness, mutuality, and other intrinsic aspects of family life. Transgenerational theorists hold that healthy marriages include a love bond that allows couples to form an emotional boundary around the twosome that makes it different from other connections – more focused, intense, and intimate. This growth can only be attributed to emotional maturity. In light of this research, it is important to examine how emotions relate to behavior.
Emotions and Their Relationship to Behavior
Emotions work in a very basic way, common to both men and women. Emotions are attached to every thought. We have a way of “feeling” about every idea we entertain. We allow a thought or idea to take root in our minds. We visualize that thought taking place in reality, and then we make a decision in the will about how to respond. The degree to which our emotions are part of this process – in giving birth to an idea, in enhancing the visualization, and in compelling us to make a decision – determines how quickly and how intensely we will act on the idea. It is our thought life that we are to govern with diligence. For emotional maturity, we must go out of our way to halt the flood of violent, seductive, and tempting messages that come unsolicited and often undesired.
There are four ways to start controlling our emotions:
- by experiencing the new life we have in recovery from substance abuse and mental illness
- by examining our dominant thoughts and identifying dysfunctional core beliefs
- by exchanging thoughts and feelings that are contrary to healthy living
- by expecting the change through exercising the power of metacognition.
A failure to control our emotions – which may include correcting or changing our emotional responses to life – can be devastating, especially if our errant emotions lead us to harm ourselves or others. In a co-occurring disorder substance abuse treatment facility it is critical to be able to work with clients identifying the Transgenerational sources of anxiety that can lead to addiction and mental illness and to begin the process of developing emotional maturity. This process may include developing a healthy self-esteem and dealing with shame, guilt, anger, and rejection.
Charles W. Graham B.S., M.Ed., CADC II
Charlie Graham joined the SLBTS team in June 2005 to start the Celebrate Recovery program for our clients seeking a Christian-based recovery. Prior to that, he served as a leader and Assimilation Coach at Saddleback Church’s Celebrate Recovery from 1998-2006. He has consulted nationwide to churches starting Celebrate Recovery programs and has participated in various speaking engagements on recovery topics. His expertise in communication and group dynamics enables him to serve on all levels, from individual counseling to small groups to large organizations. He is a PsyD. Candidate at the California Graduate Institute of Psychology.