Breaking the Ties That Bind: Intervening on a Loved One in the Grips of ED – Part 3

Transtheoretical Intervention Protocol – Preparing the Team & Rehearsing the Intervention

Now, I want to talk to you about an approach that I refer to as the “Transtheoretical Intervention Protocol,” or TIP.

This model is Johnson Institute based in that it is not invitational. However, it does incorporate the Transtheoretical Model of Intentional Behavior Change as developed by Prochaska, DiClemente, and Norcross.

Stages of Change, Modified

Sometimes, this is called the”Stages of Change.”

This model recognizes not only the needs of the afflicted individual but also the family, and it is designed to accelerate the changes necessary to move the whole family forward into recovery.

Again, the transtheoretical model was developed by James Prochaska, Carlo DiClemente, and John Norcross and one of the classic books that they’ve written is “Change for Good” as well as “Addiction and Change: How Addictions Develop and Addicted People Recover.” These would be a great resource for anyone who’s interested in learning more about the stages of change.

The Stages of Change is based on four processes, stages, which are markers of change and context of change.

In this particular model of intervention, all four of these dimensions are taken into account and incorporated but at a very rapid pace.

Stages of change in counseling is a lengthy process, but in the intervention model, it happens pretty quickly.

Many of you are likely familiar with the stages of change, but, if you’re not, let’s summarize:

Pre-contemplation: The stage I’m in when I’m stuck. I’m not even thinking about change.

Contemplation: this stage is when I’m thinking about it but not doing anything.

Preparation: This is the planning stage. I’m developing the plan for change and how that might look.

Action: In this stage, I’m working on the plan. This stage is usually the most rewarding in that people pat us on the back and say “attaboy, you’re doing good!”

Maintenance: I believe this is the most difficult stage. I’ve made the change, but now I’ve got to maintain that change. I’ve got to take the steps to stay in recovery.

Termination: I don’t believe we reach this stage in all cases.

Some changes can become so permanent and long-lasting we don’t really have to take very many steps to maintain it. In others, recovery is an ongoing maintenance process where people attend recovery support group meetings.

They work with other individuals. They might have a sponsor. They’re actively involved in an ongoing recovery program. They may live the rest of their life in maintenance, and there’s nothing wrong with that.

Initial Consultation

In this model, here are some of the goals/steps:

To begin, I have an initial assessment or consultation. The family might call me, or someone might reach out to me.

The first thing I need to do is determine whether the intervention is clinically appropriate.

I have had some people contact me that, quite frankly, would like me to come to their house put handcuffs on their loved one and drag them off.

That’s called kidnapping.

That is not an intervention.

As such, we do need to determine if the intervention is clinically appropriate.

Is this individual really able to understand what we’re saying or are they so cognitively impaired or caught up in psychosis to where they really can’t understand what we’re talking about?

If it is the latter, the intervention would not be appropriate.

In this initial consultation, I answer a lot of questions about eating disorders, the compulsive behaviors that go along with those eating disorders, and the intervention process.

What does it look like if this family is not already talking with a treatment program?

If this is the case, it is my responsibility then to make them aware and provide information on some programs that might be appropriate for their loved one.

Once we’re ready to go, we have an initial team meeting where I pull together the intervention team.

The criteria that I ask for in putting together the intervention team is that it is people that your loved one either loves or admires or wouldn’t want to disappoint.

These are people that the loved one cares about and that have influence in their lives.

It is often immediate family, but it can also be friends, co-workers, or a coach from school. Any people who have influenced that individual’s life.

I also need to understand the stage of change that each of the team members is in.

As you might imagine, I pulled together a room of eight people, and I’ve got two people in the action stage – they’re ready to move.

I’ve got two people in the pre-contemplation stage, and they don’t even understand about what we’re talking.

I’ve got four people in various stages in between.

They need to identify in what stage of change the team members are. I need to recognize the markers for change and the context to change for the team members.

I’m not going to go into significant detail on those, as you can read more about those in the books that I mentioned. But, I do need to spend a lengthy period of time training the team members on what I want them to write down that they will read to their loved one when we meet with that person.

I need to understand a full picture of what’s going on.

Where is the afflicted loved one in the stages of change?

It is not unusual to intervene with someone who’s been in long-term recovery from alcohol abuse, and now they have an eating disorder.

As such, coming at them as though the alcohol needs to be addressed isn’t the issue, it’s the eating disorder, and that is information I need to know. The team members are the ones that can provide me with that data.

Then, I need to do an evaluation of each team member so I will jot down their name, their relationship to the individual or the identified patient, get to know who’s who, and I’m going to ask them for their awareness of what’s going on.

In some cases, people have an intimate awareness of the details. In other cases, it’s more secondhand, “well, here’s what I heard.” This doesn’t rule them out as being a team member if they’ve got influence and impact in that individual’s life, but I really need to understand the role and knowledge of the team.

Writing “The Letter”

Once everyone has gathered, I’m going to train them on a letter that I want them to write to his or her loved one. I train them to write a three-part letter.

They begin with an affirmation of love. I encourage them to use specific instances such as, “hey, remember that time we were together, we had all this fun, and how much we cared about each other?”

I ask them to note very specific instances to affirm them.

Secondly, they need to present their, for example, they may say, “I’m concerned. Here’s what I’m seeing and about that I feel ____, here’s what I heard and here’s what I feel about that.”

Finally, section three is the tough one as it is the consequences (not punishment!) for choosing against engagement in treatment. The natural consequences of the identified patients’ choices.

Intervention is about choices and consequences. It is not about coercion, judgment, or condemnation

If you’ve been around someone caught up in an eating disorder, you’ve probably noticed that frequently they want to make choices and let everyone else live with the consequences.

That is part of what has to change.

We have to be able to say to our loved one, “I love you enough to give you the consequences of your choices.”

This letter is very critical.

Rehearsal

Once it is complete, we’re ready to do a rehearsal. We rehearse the intervention just as though the loved one was there.

We will rehearse that person’s interest, we will rehearse seating arrangements, and we really drill down to the nitty-gritty.

I want to hear the letters that everyone has written and may make requests for some modifications such as deleting or adding certain words.

We want to avoid judgment with the words we’re using, and we want to put in the team members’ feelings.

We also want to rehearse potential objections that this person may bring up.

When I put the offer on the table to go to treatment, they may say,”Yes, great, it’s time to go!”

However, they may also say “absolutely not.”

If they say no, I’m going to ask the most important two-word question of the day and that question is: Why not?

I want to hear that. I want to know why they refuse to go to treatment so that we can deal with those objections.

This is not an argument; this is not about a fight; this is about choices and consequences.

Our goal is to negate those objections and say, “okay, that’s taken care of” or “that’s not a problem, let’s go. Let’s accept some help.”

In this rehearsal, we also talk a lot about logistics such as seating arrangements in the room, in which order the letters will be read, or handling a “runner.”

One of the biggest fears that family members have is that, when their loved one walks in and sees everyone, they’ll run.

This does happen but very seldom. Even so, we need to be prepared for that and discuss how we will respond.

I want to emphasize: not react, but respond.

We also discuss transportation to the treatment facility.

We have to make sure all of those logistics are covered before we even get to the time that we’re meeting with the individual.

As I mentioned, the letters are read at the rehearsal, and one of the important things about that is it fosters team building.

Quite often, as these letters are read, team members who may have been a little bit leery about this process get on board and begin fully to understand what’s going on.

It also gives me, the interventionist, the opportunity to make some judgments.

It doesn’t happen often, but, there have been some times when, after hearing a person’s letter, I had to exclude them from the process. Often this is because they’re just too angry and that’s not what this intervention is about.

I have a form that I complete as I listen to them read their letters. On this, I jot down some thoughts or ideas from each section and then come back to them and say, “well, let’s use this word in section one, let’s expand that story a little bit in section two, etc.”

Ultimately, this is about the family members sharing with their loved one the impact the eating disorder has had on them and so I often have to coach people on how to use feeling words.

For example, “when you say you’re sad, what does that mean? When you say you’re ashamed, what does that mean?”

I provide them a handout that helps them use the words that they need to use to be able to express what’s going on inside of them to their loved one.

When we identify potential objections to treatment, I literally write these down. I want to hear from the family member, “how might your loved one react? What might their objections be?”

If they say no, we want to rehearse and be ready for how we will overcome this.

In some cases, I’m going to speak to the objection but, in other cases, it may require a family member to step in.

If the reason they’re not willing to go to treatment is that they’re concerned who will care for their dog, I obviously can’t but a family member can.

Depending on what those objections might be, we rehearse and prepare for how to respond to them.

Please See

Breaking the Ties That Bind: Intervening on a Loved One in the Grips of ED – Part 1
Breaking the Ties That Bind: Intervening on a Loved One in the Grips of ED – Part 2

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Source:

Virtual Presentation by Jerry L. Law, D. Min., MDAAC, CIP in the Dec. 7, 2017 Eating Disorder Hope Inaugural Online Conference & link to the press release at https://www.prnewswire.com/news-releases/eating-disorder-hope-offers-inaugural-online-conference-300550890.html

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About the Presenter:

Jerry L. Law, D. Min., MDAAC, CIP is a veteran of 25 years in the corporate world, and his strong leadership and organizational skills lend themselves naturally to the intervention process. Dr. Law is a Board Certified Professional Christian Counselor, a Board Certified Intervention Professional and a Master Certified Drug Alcohol and Addictions Counselor. Jerry brings compassion and a first-hand understanding of how critical it is to break the cycle of addiction in the professional world as well as within the family.

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About the Transcript Editor: Margot Rittenhouse is a therapist who is passionate about providing mental health support to all in need and has worked with clients with substance abuse issues, eating disorders, domestic violence victims, and offenders, and severely mentally ill youth.

As a freelance writer for Eating Disorder and Addiction Hope and a mentor with MentorConnect, Margot is a passionate eating disorder advocate, committed to de-stigmatizing these illnesses while showing support for those struggling through mentoring, writing, and volunteering. Margot has a Master’s of Science in Clinical Mental Health Counseling from Johns Hopkins University.

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The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Published on June 21, 2018.
Reviewed on June 26, 2018 by Jacquelyn Ekern, MS, LPC.

Published on EatingDisorderHope.com