30 Sep Louise Stanger Interview – Part Two
Dr. Louise Stanger’s Interview Part Two explores Portraiture, Solution Focused Coaching, Motivational Interviewing, portraying addiction accurately in the media and why cell phones + substance abusers = more harm than good.
Do you ever have a situation where the person who is experiencing a substance abuse or mental health disorder is more cooperative than the parents?
Yes, I have performed interventions where the identified loved one is grateful that their loved ones are offering them a gift of health. They are tired of the life they are living and know inside they need help. As you do this work over time, one learns that many people experience problems in living and very often one will discover a family history of substance abuse, mental health and other disorders. When performing an intervention – if truth be told – 97% of our time is spent with the family in preparation. When I am putting together an intervention, I interview everyone individually. I use a research methodology called “Portraiture,” which was developed by the Harvard qualitative researcher, Sarah Lawrence Lightfoot. Before we ever put anybody together in a group, my partner and I interview all parties in what researchers call a “snowball sample” and become the holders of a portrait of the “identified loved one.” The questions asked each concerned party are basically the same: “Tell me about yourself? Tell me about Sally, or tell me about Joe. What’s really special about them? Tell me what you experienced in the last six months to a year maybe even longer that makes your heart hurt? What are your fears? What are your hopes? What is going to be your invitation?”
This is a heart-centering matter and in using “portraiture,” I learn about all the players, every connection. Sometimes it’s possible to have an intervention where there are multiple people who have mental health problems. Or multiple people may have had substance abuse problems, so if I am unaware of all of the complexities – this helps in preparation and planning. I do think being a clinician is an advantage in this area as I am able to assess and intervene appropriately, mindful of all the participants’ complex needs.
I always team with someone who is in recovery and I think the two skills combined make magic. I view my teammate and I as equals in inspiring change. By having a robust portrait of the identified loved one before we begin, if someone is unable to say something, we can in turn share the story in different way. I only want people to talk from the heart, no letters, unless they are not able to attend the meeting. I don’t use letters because I need people to speak from the heart. When I first began I used too many letters and it felt like that episode in the TV show the Brady Bunch, where Cindy goes on TV and suddenly freezes and can’t talk. A lot of the time we get families who can’t speak. The result is they have no affect when they read a letter. This is heart-centered work. There are times when it’s not beneficial for the identified loved one to be with the family, it can be too uncomfortable. I might have my partner stay with the family, while I take the identified loved one outside. Or my partner may talk to the identified loved one while I speak with the siblings. It’s all very fluid. Getting to “yes,” is not something that takes place in just 53 minutes. As my esteemed colleague, Ed Storti says, an intervention is often a “living eulogy.” You need to say what you need to say, as you may not have the opportunity again.
How do you use “Solution Focused Coaching” with parents?
Peter Berg and Insoo Young, two social workers, developed “Solution Focused Coaching.” Solution Focused Coaching is a pragmatic, here-and-now approach to solving problems, and the goal is to try and find solutions to current circumstances. One solution might be: “I do not need to feel any more pain as a parent, or a loved one, a husband, wife, etc.” Another could be: “We want to get our loved one into treatment.” I lead families to consider solution in a perfect world scenario: “When you wake up tomorrow, what would that world look like to you? What would you want to do to take care of yourself?” This work is getting family members to take care of themselves. Another route is to be totally pragmatic: you’re getting homework assignments, they’re giving suggestions, and helping people moved towards whatever their perfect world is.
I use the concept of the “perfect world” as true solution focused and I talk about a miracle. Solution focused is a very specific modality and I do give staff trainings on it, but the idea is that we are pragmatic and we are present and we work with our client’s motivation to change and confidence about that change.
The biggest difference between motivational interviewing and solution focused is asking the parent/family member the question: “How important is it to you to get your child/family member to treatment?” On a scale of 1 to 10, it might be a 10 for them. We always inquire about confidence by asking, “How confident are you that you could really do that?” That might be a 7 or an 8. A confidence level is usually lower than motivation level and speaks to the tools we need to give to someone so they can make it happen.
When we talk about the family member who is scared that their loved one is never going to talk to them again, they’re going to runaway, they’ll hate them forever if they send them to treatment; and says things like, “They really don’t have a substance abuse problem, it’s all mental health, etc.” whatever it is…..What we’re doing is finding out on a scale of 1 to 10, how important is it to that parent to actually get their loved one help? They may think they are an 8 or a 9 but their confidence level is a 3. The reason it is a 3 is because: “My loved one will hate me.” Why?” “I can’t take away their phone, because I’ll never know how or where they are.” We give them skills so they can move from a 3 to a 5, and from a 5 to 7, etc.
This is really where the art of working with that accountability team comes into play. These families are really scared; after all they have to ask their loved one to change. They’ve yelled at them, they’ve screamed at them, they’ve nagged at them, they’ve pleaded, they’ve given, they’ve taken away, they’ve argued, they’ve jumped up and down, but they haven’t followed through. (I call this building a fence, where theirs have been a rubber fence bending in all different directions.) They haven’t been consistent because they’re scared, not because they don’t know how to, but they’re so scared. Also, there’s the unconscious payoff that, “If I keep you sick, I’m terrific. I can be martyr/victim. I can be a winner. I can look good. I can be perfect. You will always need me and you will never leave.” There are so many unconscious dynamics at play. I don’t believe people set out to do this and I’ve never met anybody who actually set out to have a substance abuse or mental health issue.
Do you see any gender differences when you intervene on a young substance dependent man, versus a young substance dependent woman?
I think some of the more complicated situations are the young meth addicts…..meth/heroin addicts. Honestly, there’s no difference in terms of families, they are very enmeshed, attempting to bail out their loved one, don’t want their loved one not to have their cell phone, etc.
Do they want the individual with a substance abuse/mental health disorder to have their cell phone?
Yes, they want them to have it. It’s probably one of the hardest things we do is teach families that that cell phone is really used to call the drug dealer, not them. It’s false hope that the GPS will tell you where your child is. Don’t worry, when they run out of money they will call you!
The families that I have worked with, regardless if it’s a female or male, have similar characteristics in which they have over identified with their loved one. There’s been some amount of failure to launch because they have not held their loved one responsible. I recently had a thirty-seven year old whose mother was still making him lunch and he had never worked though he graduated college. That is failure to launch. I’ve had fathers – who are in disbelief supporting their loved ones. Jeffrey (Merrick, Louise’s partner) and I were in a hotel room one day showing the dad a room that was torn apart by his daughter. The couch was torn apart, there were spoons out, empty (heroin) bulbs and there was clothing that was more “lady of the night.” The dad looked at me and said, “You know you’ve seen worse.” In the sink there were old ice cream containers, there was blood on items strewn about everywhere, it was filthy. And I said, “No, not really.” That was a dad who was in great pain and did not want to see what was clearly around him.
Regarding a mom, her son was running around the apartment screaming obscenities. (When someone’s high on meth it’s really impossible to get them to “yes.” The only thing we can do is to let them go and then continue circling back to get them to yes.) The mom’s comment to me was, “He just doesn’t like you.” It wasn’t about me; it was not about the police coming or the inability to let go. I think there are similar characteristics between mothers and sons, and between dads and daughters.
It’s so hard as a parent to understand that you did the best you could with the resources you had and now you can learn to do better. You don’t know until you know. That’s a chapter of the new book I’m writing, You Don’t Know That You Don’t Know, Until You Know!
There are not so many gender differences or differences per se, but everyone is different in the way we need to approach them, keeping in mind what they’re willing to do. We have to start where the family is at this moment, and not where we want them to be. I believe in being willing to always tell the truth. And if that annoys somebody, a family member, then they can terminate the relationship. You know you’re doing a good job when the kid takes you off the consent form. With the family we have to say, keep us on the consent form because we’re the ones who are helping.
I heard you speak about how Substance Abuse and Recovery is portrayed in film, what is this and why is it important that the public have an accurate view of alcoholism? What is an accurate view?
You are talking to someone who many, many years ago wrote a grant proposal to Norman Lear, from All in the Family, because I believe that media can teach and that it’s such a valuable tool. I do a presentation called, Going Hollywood, It’s Not so Easy. In this I take a look at film or TV and the way in which it portrays substance abuse and mental health disorders accurately, and the ways it is misleading. For example, that father that I told you about, he didn’t get it (about his daughter) the day that he was in the hotel room. However, he did call me later, sobbing. He had been watching an episode of Breaking Bad. I didn’t tell him to watch it, so I give him credit for this: there’s an episode in where the father (who is supposedly in NA) comes to the daughter’s house and finds her sleeping with her druggie boyfriend. It’s obvious that they had done heroin and he threatened to call the police right then. The boyfriend gets angry and tries to hit him with a baseball bat; it was one of those very intense scenes. Even though it looked a little bit prettier, it was very realistic. At the end the dad was about ready to call the police, but she begged him, “No, I’ll go tomorrow, I promise.” And the father puts the phone down. The next day his daughter tragically overdoses and dies. The father saw that and he called me and he said, “You’re so right.”
Then there’s a movie like Flight where Denzel Washington did a really good job portraying alcoholism. But there are those shows that totally miss the mark. In Nashville, they had a sober companion who was male for a female alcoholic, and he was going to bed with her. That was totally wrong and an example where the show went for the ratings, and not for the truth. And yet they have scenes in Nashville that are so good: when one of the main characters relapses and tears apart the house, and his sponsor shows up.
I think it’s very important to let the public know what’s going on, because I am still an educator. Educate the right way, a picture’s worth a thousand words.
Do you consult about substance abuse or mental health with the media ?
Yes, I have done that and if I am asked I will, providing there are clear consulting guidelines. I speak and perform trainings all across the country, and continue to teach a graduate school course for San Diego State Interwork Institute. I love speaking and training. I just returned from a treatment center in Northern California, where they asked me to perform a special training for alumni called, “How’s it Going?” and I was able to do Family Mapping with their clients. I always create customized curriculum. I’ll be speaking for example at New Found Life in Long Beach the end of September at “Moments of Change” in Florida for A Sober Way from Prescott, AZ. In Florida I am presenting on Courage, Love and Compassion – an integrated approach to training.
Moments of Change 2014 conference for innovations in integrated treatment is taking place September 29 – October 2, 2013 at The Breakers hotel in Palm Beach, FL.
To find out more about Dr. Stanger and her work, please visit her website: