the imperfect family

Dear Therapist,

My family has watched my sister struggle with severe alcoholism for the past 20 years. Recently her situation has become quite dire. Last week she was in the ER.

My concern comes from where to start with trying to help her. She is a very intelligent person, very passionate, very caring. I think this causes a lot of the denial she has about her situation. She used to be a model and make hundreds of thousands of dollars a year...

The issues didn't just start recently. A lot of it stems from childhood issues, a missing father, a displaced family (she is my half sister) and a very disfunctional and disciplinary upbringing. All of this has caused her to really shut down about her issues. Whenever I ask her what she needs to be happy, she denies anything in life making her unhappy and says all her problems arise just from not having enough money - well we know better!

She's been to rehab. We've tried the hard approach. I think we've tried the soft approach, but nothing seems to be working. I think the issue is getting her to admit there is an issue, and getting her to care about it! She has two kids, and that doesn't seem to stop her. What can a loving family do?

Hi Mystery,

It is heartbreaking for you to stand by and watch your sister make destructive decisions. The temptation is to rush in and rescue. This is probably what has been happening for some years now. Various family members try different approaches to 'fix' the situation. This results in what is referred to as 'enabling' and contributes to the shaping of an addictive personality.

Try to stand outside of the situation for a moment and deliberate on what you have identified as some of the stressors and trauma your sister has endured throughout her life. Your sister was abandoned by her father, raised by overly authoritarian parents; the harsh discipline very likely left your sister feeling shamed and unworthy. Her overdeveloped conscience (superego) and her impulse to self medicate (ID) became the overriding factors driving her personality with little space for a healthy ego to mediate sound decisions and embrace life's positive opportunities. Self doubt and an overwhelming desire to fade into the background has her choosing alcohol over responsibilities. In her mind the children are better off without her. Blaming the shortage of money is a useful displacement tactic, this way she does not have to address her substance abuse and ALL that lies behind it. Your sister is likely to avoid the hard work of resolving her original conflicts (abandonment, rejection, betrayal and shame). She knows well the pain that is associated with her past and her reliance on substances is preferable to facing the pain.

Rehab programs vary in their focus. Many twelve step programs, whilst very helpful to some patients, are not geared to provide the long term therapy required to resolve childhood conflict and associated trauma. Some of the more holistic interventions offer 30 to 90 day programs that offer intensive individual, group and family therapy. Unfortunately these programs are often costly. If this is an option I will make some recommendations. Health Insurance plans may contribute depending on the nature of your plan.

At the very least you can surround your sister with validation, realistic suggestions for intervention and unwavering support if she chooses to enter treatment. Family members should take responsibility for their part in her traumatic past and commit to family therapy. Do not judge or shame her, she is doing this already. And very importantly resist all efforts to enable her self destruction. Channel financial and emotional resources into efforts to affect healing via treatment rather than funding her co dependent lifestyle, and communicate clearly to her why you are making certain choices. This is a time for the family to come together and work one agenda only, to take responsibility for the past and seek an appropriate treatment plan that caters to the needs of your sister and the family as a whole.

anxious girlfriend

My girlfriend suffers from anxiety and panic attacks and I'm trying to get her help. The panic attacks can be severe enough that she'll have to pull over on the road and call me to come pick her up because she can't even drive. It seems they're becoming more frequent lately but she refuses to get help. She's pretty adamant about not wanting to go on medication due to side effects she's read about online but I'm worried if she doesn't the situation is only going to get worse. How can I convince her to go get help and that medication might not be that bad of an option?

Dear Concerned,

Panic Disorder can be a debilitating condition. The first step is to encourage your girlfriend to see her family physician or mental health professional to receive an accurate diagnosis. Generalized anxiety disorder often precedes the panic disorder. In other words untreated anxiety may escalate to panic disorder when left untreated. The point is that the experience of continually heightened anxiety serves a purpose. The purpose being to alert the patient to a situation where he or she is feeling overwhelmed by environmental stressors and lacks appropriate coping mechanisms and/or adequate support. It is essential not to ignore the situation since the continual experience of overwhelming anxiety and panic attacks erodes the patient's sense of self esteem and slowly shrinks their world. Avoidant behaviors creep in and a self fulfilling prophecy is created.

Treatment of choice will very likely encompass both psychotropic medication and cognitive behavioral psychotherapy. There are several second generation medications available that are less addictive and generally have fewer side effects. Your family physician or psychiatrist will be able to outline the different possibilities and answer your questions and address your concerns.

Psychotherapy is essential to firstly ascertain the origin of your girlfriend's anxiety. The therapist will gather a history to look at her experience of loss and trauma, unresolved grief, phobias, childhood experience of separation anxiety, illness and the like. Secondly the therapist will seek to gain an understanding of your girlfriend's coping mechanisms, both adaptive and mal adaptive. Cognitive distortions will be addressed and healthier ways of interpreting the world will be facilitated.

Psychotherapy is hard work but a good therapist/client fit will have your girlfriend feel that someone understands her reality and will walk the path with her to recovery. Your physician should be able to help you with a referral to several therapists. There are also several online directories to assist you with your search. You may want to meet with several before making a decision. I hope your girlfriend seeks the help that she deserves.