Liar, Liar, Moneyâ€™s on Fire Treating Families of Problem Gamblers
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Liar, Liar, Moneys on FireTreating Families of Problem Gamblers
Gary Lange PhDMFT, NCGC, CAS, BACC760-773-1014www.GaryLangePhD.com
CodependencyCo-dependent: A person who has let someone elses behavior affect him or her and is obsessed with controlling other peoples behavior M. Beattie Co-dependency is when you depend on another person for your happiness, security, life satisfaction, even self worth. Sugg and Siegel 2009Enabler: person who intervenes in such a way as to prevent the problem gambler from facing the consequences of their actions.
*Focus on the family means....The family needs time and resourcesTheir recovery is different and they need their own program beyond getting the gambler to stopThey need knowledge for protectionThey deserve hope for a better life
Treatment overview:Emotional IssuesBetrayal, deceit and resentmentMay have enjoyed the winning times and are reluctant to give up the spoils May have truly not known about the problemMay have believed they were crazyLittle known about impact on children
Significant Other* InvolvementIngle et.al. 2008Gamblers 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=2575Gamblers without SO (86%)Gamblers with Involved SO (14%)Length of TX146 days(+80) = 226 daysSuccessful TX34%(+21) = 55%
Characteristics of FamiliesLoyal; Defer gratification; overly responsiblePersonal/Family History of AddictionsHigh resilience and tolerance for painLow self-esteemOver emphasis on $$$$$$
Putting out the FireInvolve FamilyAssess who is supportive$$$ ProtectionDiffuse emotionsPush Gam-Anon, support
Gary Lange Ph.D. Dissertation23 Symptoms/Patterns of Codependents studied before and after Betty Ford Centers Family Week of Treatment
17 statistically significant reduction over 4 months10 statistically significant reduction over 12 months
10/23 Symptoms/Patterns statistically significant reduction over 12 months (Lange, 86)Frequency of drinking/usingFrequency of over drinking/using*Functional sexual problemsNervous/apprehensiveDifficulty concentrating
Stiff neck and shouldersDepressedWithdrawing from supportive relationshipsSleeping 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) Crisis InterventionEducatationForgivenessMaking DecisionsAssertivenessManaging StressNegotiatingTrust and Hope
1. Crisis Intervention (Lange, 2012) Monitor for Safety, physical, emotional or sexual abuse, neglectAssess Co-occurring Disorders: Depression, anxiety, Axis IIMonitor needs of all family members/kids/othersAssess severity of $$$ and legal problemsYes we love you, No to gambling
2. Educate about the Recovery Process (Lange, 2012) Path is seldom smooth, quick or easyThe Gamblers impaired midbrain and affects of NeurotransmittersEach chose their path and speed Decrease stress Decrease Craving Treatment will improve the families physical and emotional health
3. Forgiveness vs. Forgetting (Lange, 2012)
Survival based on learning and rememberingWrite a list of things that are difficult to forgive him/her for doingApologizeForgetting is a spiritual release
4. Making Decisions (Lange, 2012) Stop Procrastinating NOWWhat do you have power over?Establishing prioritiesCommunicating; When you gamble/_____I feel3 things important to me
5. Assertiveness (Lange, 2012) Tender (Passive) Tough (Bulldozer)Refusing others' requests if they are too demanding
Being firm so that your rights are respectedExpressing positive AND negative emotions
6. Managing Stress (Lange, 2012) Is the crisis over with? Continue to set priorities, structureBreathe, walk, sit, play, sleep, eat, relaxExplore options for assistance.TherapyGam-AnonSponsorFamily/group support
The Gam-Anon Myths of TrustTrust is something you can give to another.Trust should be given unconditionally to a loved one.Trust is the foundation of a relationship.A person is completely trustworthy or completely untrustworthy.Love and trust always co-exist.Adapted from "The Gam-Anon Way of Life"
7. Negotiation around $$$ (Lange, 12)Pull a credit report; what is in your name or held jointly? Take in the mail or use a P. O. BoxWork 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 projectionsPractice small behavioral trust exercisesUtilize your support systemAcceptanceSpiritual releaseChange Today and have Hope in a Better Tomorrow
Stages of Family Recovery Jo Ann Towle, MA www.familyinterv.comRespect that family members are at different phases of grief and understanding of their painAccept 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)
*Families Recovering Against All Odds
Helping Family Members of Problem Gamblers Rebuild
A 15-Session WorkbookJudith Sugg, Ph.D., and Renee Siegel, M.A.
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: SarahSarah is a passive, codependent female client who complains that her husband is gambling and spending all of the familys money. She claims that her extended family is tired of bailing them out. If she fears the embarrassment of going to Gam-Anon and doesnt 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 doesnt stop gambling, hell lose his job, the only income for his family. Fans 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 brothers gambling is willing to give her mother the money out of her savings. Their live-in grandfather says, to hell with the threat.
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 24:381-394Gam-Anon: www.gam-anon.orgLange, Gary, 2010, You Bet Your Life: Pathological Gambling, DVD, GaryLangePhD.comPetry, 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 GamblingSugg, Judith and Siegel, Renee 2009, Families Recovering Against All Odds: Helping Family Members of Problem Gamblers Rebuild, ABC Wellness Centre, Scottsdale, AZ
GaryLangePhD.comDVDs: Pathological Gambling, T-ender L-oving C-ommunication, Its About Time Management, Feelings R Us and Getting Past Tense $25.00 each (760-773-1014)Gary@GaryLangePhD.com
*Classified in Impulse Control Disorders section
*Renee: Talk about some of the frustrations of treating families or spouses as an adjunct -- OR, talk about some of your experiences or frustrations in early recovery, trying to get advice, ect.*******************
RENEE: Talk about what and why we did it, just introduction Works with individuals (clients) use with counselor or group DVD Say: We thought youd like to get a glimpse of what a couple of groups might focus on, some of the exercises theyd do, and what the interviews look like.******