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Transcript of Liar, Liar, Money’s on Fire Treating Families of Problem Gamblers Gary Lange PhD MFT, NCGC, CAS,...
Liar, Liar, Money’s on FireTreating Families of Problem Gamblers
Gary Lange PhD
MFT, NCGC, CAS, BACC
760-773-1014
www.GaryLangePhD.com
CodependencyCo-dependent: “A person who has let someone
else’s behavior affect him or her and is obsessed with controlling other people’s behavior” M. Beattie
Co-dependency is “when you depend on another person for your happiness, security, life satisfaction, even self worth.” Sugg and Siegel 2009
Enabler: person who intervenes in such a way as to prevent the problem gambler from facing the consequences of their actions.
3
Focus on the family means....
The family needs time and resources
Their recovery is different and they need their own program beyond getting the gambler to stop
They need knowledge for protection
They deserve hope for a better life
Treatment overview:Emotional IssuesBetrayal, deceit and resentment
May have enjoyed the winning times and are reluctant to give up the spoils
May have truly not known about the problem
May have believed they were crazy
Little known about impact on children
Significant Other* Involvement
Ingle et.al. 2008
Gamblers who have a Significant Other, are older, employed and have had some undergraduate education, stay in treatment longer and are more successful
Oregon State OPG N=2575
Gamblers without SO (86%)
Gamblers with Involved SO (14%)
Length of TX 146 days (+80) = 226 days
Successful TX 34% (+21) = 55%
Characteristics of FamiliesLoyal; Defer gratification; overly responsible
Personal/Family History of Addictions
High resilience and tolerance for pain
Low self-esteem
Over emphasis on $$$$$$
Putting out the FireInvolve FamilyAssess who is supportive$$$ ProtectionDiffuse emotionsPush Gam-Anon, support
Gary Lange Ph.D. Dissertation
23 Symptoms/Patterns of Codependents studied before and after Betty Ford Center’s Family Week of Treatment
17 statistically significant reduction over 4 months
10 statistically significant reduction over 12 months
10/23 Symptoms/Patterns statistically significant reduction over 12 months (Lange, ’86)
Frequency of drinking/using
Frequency of over drinking/using*
Functional sexual problems
Nervous/apprehensive
Difficulty concentrating
Stiff neck and shoulders
Depressed
Withdrawing from supportive relationships
Sleeping problems
Weight loss* (not stats sig at 4 mos.)
Family Phases of Progression: 1. Denial: makes excuses for gambling;
becomes great financial manager/manipulator
2. Stress Phase: arguments; attempts to control gambler; enjoys gifts from gambler; provides bailouts; secrets, isolation
3. Exhaustion Phase: confusion; physical symptoms; rage; anxiety and panic; separation/divorce
4. Hopeless Phase: reactive, suicidal (Wexler)
Stages of Recovery
1. Critical Phase: desires and accepts help; recognizes true problem; self-focus and self-care; guilt diminishes; deals with resentments; stops bailouts
2. Rebuilding Phase: increased self-confidence; communication; problem solving; making decisions; realistic planning
3. Growing Phase: sharing; relaxed; closer with family; more affectionate and trusting (Wexler)
The 8 Techniques for Treating Families (Lange, 2012)
1. Crisis Intervention
2. Educatation
3. Forgiveness
4. Making Decisions
5. Assertiveness
6. Managing Stress
7. Negotiating
8. Trust and Hope
1. Crisis Intervention (Lange, 2012)
Monitor for Safety, physical, emotional or sexual abuse, neglect
Assess Co-occurring Disorders: Depression, anxiety, Axis II…
Monitor needs of all family members/kids/others
Assess severity of $$$ and legal problems
“Yes we love you, No to gambling”
2. Educate about the Recovery Process (Lange, 2012)
Path is seldom smooth, quick or easy
The Gamblers’ impaired midbrain and affects of Neurotransmitters
Each chose their path and speed
Decrease stress Decrease Craving
Treatment will improve the families’ physical and emotional health
3. Forgiveness vs. Forgetting
(Lange, 2012)
Survival based on learning and remembering Write a list of things that are difficult to
forgive him/her for doing Apologize Forgetting is a spiritual release
4. Making Decisions (Lange,
2012)
Stop Procrastinating NOW
What do you have power over?
Establishing priorities
Communicating; “When you gamble/_____I feel…”
3 things important to me…
5. Assertiveness (Lange, 2012)
– Tender (Passive) Tough (Bulldozer)
– Refusing others' requests if they are too demanding
– Being firm so that your rights are respected– Expressing positive AND negative emotions
6. Managing Stress (Lange, 2012)
• Is the crisis over with?
• Continue to set priorities, structure
• Breathe, walk, sit, play, sleep, eat, relax…
• Explore options for assistance.– Therapy– Gam-Anon• Sponsor• Family/group support
The Gam-Anon Myths of TrustTrust is something you can give to another.
Trust should be given unconditionally to a loved one.
Trust is the foundation of a relationship.
A person is completely trustworthy or completely untrustworthy.
Love and trust always co-exist.
Adapted from "The Gam-Anon Way of Life"
7. Negotiation around $$$ (Lange, 12)
– Pull a credit report; what is in your name or held jointly?
– Take in the mail or use a P. O. Box– Work together to pay bills, although a
responsible family member should probably handle the money.
– Change passwords on all accounts.– Meet with someone about
pressure and budget relief
8. Trust and Hope (Lange, 12)
Stop name calling and negative projections
Practice small behavioral trust exercises
Utilize your support system
Acceptance
Spiritual release
Change Today and have Hope in a Better Tomorrow
Stages of Family Recovery Jo Ann Towle, MA www.familyinterv.com
Respect that family members are at different phases of grief and understanding of their pain
Accept the reality of the loss (shock, denial, bargaining)
Working through the pain (anger and depression)
Adjusting to the environment (starting to accept)
Emotional relocation of the loss (acceptance and recovery)
24
Families Recovering
Against All Odds
Helping Family Members
of Problem Gamblers Rebuild
A 15-Session Workbook
Judith Sugg, Ph.D., and Renee Siegel, M.A.
Family Cases
What are the crisis/clinical issues?
What legal/ethical issues are present?
What is your diagnosis on all axes?
What would your treatment plan be?
Case I: Sarah
Sarah is a passive, codependent female client who complains that her husband is gambling and spending all of the family’s money. She claims that her extended family is tired of bailing them out. If she fears the “embarrassment” of going to Gam-Anon and doesn’t believe in a God, how can you help her? What resources, books, etc would help her?
Case II: Fan and her husband
Fan is a 34 yo Asian immigrant who comes with her husband who has a black jack addiction. They have two children and he began gambling when she was first pregnant. He works 12 hours per day earning $9/hr. and is worried that if he doesn’t stop gambling, he’ll lose his job, the only income for his family.
Fan’s English is understandable, but her husband has a strong accent and refuses help in his native language. Fan often translates for him during the session. It is difficult to strategize about treatment options, support systems or developing behavioral strategies because of the language barriers. A psychic told her husband that he would have a curse for 2 more years. Fan is busy with the children and the household but knows you can tell him what to do to stop gambling.
Case IV: Rodriguez FamilyThe Rodriguez Family of 4 come because
the divorced mother is scared and wants to leave town. She reports answering the door one night to two large guys who say if she does not give them $2000 by Friday, they are going to harm, her 17-year-old son, Manuel. Even though Manuel reports 5 symptoms of DSM IV 312.31, he minimizes his gambling and seems aloof. The daughter, Maria who knew about her brother’s gambling is willing to give her mother the money out of her savings. Their live-in grandfather says, “to hell with the threat”.
28
Resources Berman, Linda and Siegel, Mary-Ellen, 2008, Behind the Eight-
Ball, "A Guide for Families of Gamblers", University.
Ingle, Prajkta et.al., 2008 Significant Others and Gambling Treatment Outcomes, J Gambling Studies 24:381-394
Gam-Anon: www.gam-anon.org
Lange, Gary, 2010, You Bet Your Life: Pathological Gambling, DVD, GaryLangePhD.com
Petry, Nancy, 2005, Pathological Gambling: Etiology, Comorbidity, and Treatment, Wash, DC., www.apa.org
Personal Financial Strategies for the Loved Ones of Problem Gamblers. National Endowment for Financial Education and the National Council on Problem Gambling
Sugg, Judith and Siegel, Renee 2009, Families Recovering Against All Odds: “Helping Family Members of Problem Gamblers Rebuild”, ABC Wellness Centre, Scottsdale, AZ
GaryLangePhD.com
DVDs:DVDs: “Pathological “Pathological Gambling”, Gambling”,
““T-ender L-oving C-T-ender L-oving C-ommunication”, “It’s About Time ommunication”, “It’s About Time Management”, “Feelings ‘R’ Us” Management”, “Feelings ‘R’ Us” and “Getting Past Tense” and “Getting Past Tense” $25.00 $25.00 each (760-773-1014)each (760-773-1014)
[email protected]@GaryLangePhD.com