Incorporating Family in Substance Use Recovery

Helping college students manage their treatment or recovery from substance abuse requires all types of resources and help. Often, that help comes from the student’s family. What are the keys to properly engaging and incorporating family into the process?

We spoke with The Haven’s Sherrie Kleinholtz, a Licensed Professional Clinical Counselor and Clinical Director at The Haven at Miami University. She has deep experience working with Miami University students in a past role as Director of a Crisis Hotline based in Oxford, OH.

Sherrie Kleinholtz Discusses Incorporating Family in Substance Abuse Recovery

Question: Why is incorporating family or loved ones of the client into treatment important?

Sherrie Kleinholtz: One of the biggest factors in treatment is having support systems and when a client comes in for treatment, we become part of their support system. However, they don't live with us forever. Eventually, they're going to go back out on their own. And when they go back on their own, they lose the support system that they would normally have weekly, or three times a week. And then they could start feeling alone again and put themselves at risk for relapse.

Family and loved ones for clients, it's very difficult because the client is harboring a lot of guilt and they don't want to ask their family for support. The family is angry. They don't really want to give a lot of support. They do, but they don't. And so there becomes this broken bridge between them. And that only intensifies the addiction. So that's a true struggle. But having family there that is supporting you and being nonjudgmental is absolutely priceless because they're your family and they're going to be there for you ongoing if you can keep that bridge strong and steady.

And family members, I think, just feel afraid and they don't know what to do. And so educating the family is as important as educating the client, and I am a huge proponent of treating both. I don't just treat the client, I am always about, hey, when can we schedule your first family session? And a lot of times, the client will be like, they want nothing to do with me. And I say, well, OK. Let's talk about what that looks like. Tell me what's going on with your family? What happened? And that is a pivotal point for clients who didn't realize that a lot of the pain that they may have helped create an environment for, but also on the other end of that, a lot of the pain that their family created for them.

And so we work on that for a little while and then a client gets to a point where they're like, OK. Maybe I'll call them but with you in the room, and let's just see what that looks like. Sometimes the family members will hang up on them immediately. But most often, the family member will pick up and then they will just listen and then that starts the conversation. And then we will schedule one on one session with the family, and then it kind of goes from there. It takes a while, but wounds do heal.

When I work with clients, they mostly talk about wanting to be closer to their family.

-- Sherrie Kleinholtz

Question: And does “family” mean “parents?"

Sherrie Kleinholtz: “Family” is in terms of anyone that the client feels is their strongest support network. That could be their best friend, that could sometimes be their sober support sponsor. It could be a parent, a distant cousin. I have had clients that will bring other therapists into the room that they had when they were younger, and say this person I consider to be my family. Anybody that the client themselves feels that they would call family.

Question: You've described how integrating the family into the care, you've described the importance of that. How does that work when family is not local? I mean you're talking frequently about college students.

Sherrie Kleinholtz: Right.

Question: They might be going to college in some place where they don't live, how do you integrate family into the care when they're not local?

Sherrie Kleinholtz: We do a lot of phone sessions, and so we will put somebody, call them and they will be right on speaker phone, and we have that conversation. Obviously, ideally, it would be great if the families could just come in. But you're right, we're dealing with college students. Most of the time their family is far away. However, I have experienced more often than not, family is willing to take that flight or that drive to come here to be for the those sessions. And what we usually do is we'll schedule them on a Friday or a Monday. They have the weekend to spend with their loved one. And that way they can come, they can do the sessions, and they can have the weekend. Or they have the weekend and then they come, and we do the session on Monday and they go back. And we will make provisions. If I need to come in on a Saturday, I'll come in on a Saturday. We do whatever we have to do to basically help the client get to where they need to be and reach their goals.

Question: Of course, your clients are college students or in that age zone.

Sherrie Kleinholtz: Yes.

Question: To stereotype slightly, occasionally these clients may be at an age where they're trying to separate from family.

Sherrie Kleinholtz: Yes.

Question: How do you handle that?

Sherrie Kleinholtz: I know this is going to sound probably odd, but most of the time, when I work with clients, they mostly talk about wanting to be closer to their family. And I think that's because of all of the possible guilt and just the fear that their family doesn't love them anymore or is so angry at them that they just can't fathom to be around them anymore. And most of the time the clients that I work with don't say, I don't want my family involved. Most of the time, they say my mom is just really mad at me right now and I don't know how to fix that. Or I feel like I'm a bad role model for my younger brother and I don't know how to fix that.

So I very rarely actually hear somebody say, I don't want my family involved. It does happen, but if that does happen what I say is OK, is there a reason in particular you don't want your family involved or is it just that you don't want them to know you're struggling? Or is it because there's a relationship issue that we need to work on? And again, it's meeting them where they are. If they don't want them to know about their issue that they might struggling with, then let's work on that because why do you feel like you cannot open up to your family about that, and we explore that.

And then I also encourage them, OK, who can you bring in for a support session? Is it your best friend? Is it an advisor? Who could that person be for you? And they find someone to come in and sit with them for a support session because it's that important.

Question: What types of issues or hiccups can occur with family involvement?

Sherrie Kleinholtz: Some of the things is that there are old skeletons that basically come out of the closet. There will be things that happened that the parent didn't know about. It could be that there was an assault that the parent didn't know about. Or child abuse that one of them didn't know about. Or that the parent didn't realize how difficult their divorce was on the child. And all of those things are kind of shocking factors that come about, and as a therapist, for many therapists, it's a very scary situation because things get heated many times.

One of my practices is crisis counseling, and so I feel I'm pretty well prepared for that if it does happen. And I've had it happen a couple of times, and you really just have to bring everybody back down a little bit. Take some breaths, regroup, but that is one of the most major things that can occur during family sessions.

Question: What else should people know about the importance of incorporating family or loved ones of the client into treatment?

Sherrie Kleinholtz: Often in the therapy field, it goes missed how important it is about the family being a part of it. I always say that the client should really have at least one member of their family that kind of holds them accountable, and they even have like a code word that they might say. So, in other words, if as a family member if I am Jo Jo's sister and I see things that Jo Jo is doing that makes me concerned, I might just simply use the code word and say banana, and that means hey, what's going on? And what that does is it gives the person who is struggling a moment to respond and think about it before that accusation comes about.

Sherrie Kleinholtz: Then they kind of make a time and a date to meet up and go, let's talk. And then they meet and they say what do you see that is concerning for you? Or yeah, I am struggling and I haven't been reaching out. So to me, I think that's really important.

Question: We've talked about parents as the family members, what about siblings? What's the importance of having siblings be part of a client's treatment?

Sherrie Kleinholtz: Siblings are extremely important and one of the many reasons is because you'll have a younger sibling and an older sibling. And if it's the older sibling that is struggling with the addiction, the younger sibling sometimes gets lost in the chaos, and they're feelings and what they're going through gets missed. And often people think that they don't even notice. The families are under this false impression that oh, they're doing fine. They're busy with their school. But in reality, they're home writing letters saying how sad they are, they're worried about their brother. They're worried about their sister. For them to be able to be honest with them, obviously with age appropriateness. But being able to incorporate them into the treatment on some level I think is always important.

Even if they're too young. Say they're six or seven years old. They notice things. People don't think that they do, but they notice things. And so it's important to be able to say to them, hey, yeah, Marie is really struggling being ill right now, but they're working on getting better. Just something to let them know that they are part of this, and to relieve some of their anxieties about it all. And they become huge support system because that is a true inspiration for the client to heal, both if they're younger or they're older and they're the one struggling. It's very important to incorporate siblings into the treatment.

Question: Thank you.

Sherrie Kleinholtz: You're welcome.