How to Coach Yourself and Others Coaching Families | Page 76

counselor, "I can't really ask him for my sake because I know he's too busy to come to the family meetings."
This statement suggests that the wife is not completely committed to getting the husband to come to
treatment. On the one hand, she claims to want him to come to treatment, but on the other, she gives excuses
for why he cannot. The purpose of exploring the resistance, beginning with the first phone call, is to identify
as early as possible the obstacles that may prevent the family from coming to therapy, with the aim of
intervening in a way that gets around these obstacles.
Complementarity: Understanding How the Family "Pieces" Fit Together to Create Resistance
What makes this type of early diagnostic work possible is an understanding of the Principle of
Complementarity, which was described in Chapter 2. As noted earlier, for a family to work as a unit (even
maladaptively), the behaviors of each family member must "fit with" the behaviors of every other family
member. Thus, for each action within the family, there is a complementary action or reaction. For example,
in the case of resistance, the husband doesn't want to come to treatment (the action), and the wife excuses
him for not coming to treatment (the complementary action). Similarly, a caller tells the counselor that
whenever she says anything to her husband about counseling (the action), he becomes angry (the
complementary reaction). The counselor needs to know exactly what the wife's contribution is to this
circular transaction, that is, what her part is in maintaining this pattern of resistance.
Restructuring the Resistance
In the process of engaging resistant families, the counselor initially sees only one or a few of the family
members. It is still possible, through these individuals, to bring about short-term changes in interactional
patterns that will allow the family to come for therapy. A variety of change-producing interventions have
already been described in Chapter 4: reframing, reversals, detriangulation, opening up closed systems,
shifting alliances, and task setting. The counselor can use all of these techniques to overcome the family's
resistance to counseling. In the process of engaging resistant families, task setting is particularly useful in
res tructuring.
The next section discusses the types of resistant families that have been identified, the process of getting the
family into counseling, and the central role that tasks may play in achieving this goal. Much of counseling
work with resistant families has been done with families in which the parents knew or believed the
adolescent was using drugs and engaging in associated problem behaviors such as truancy, delinquency,
fighting, and breaking curfew. These types of families are typically difficult to engage in therapy. However,
the examples are not intended to represent all possible types of configurations of family patterns of
interaction that work to resist counseling. Counselors working with other types of problems and families are
encouraged to review their caseload of difficult-to-engage families and to carefully diagnose the systemic
resistances to therapy. Some counselors may find that the resistant families they work with are similar to
those described here, and some may find different patterns of resistance. In any case, counselors will be
better equipped to work with these families if they have some understanding of the more common types of
resistances in families of adolescent drug abusers.
Types of Resistant Families
There are four general types of family patterns of interaction that emerge repeatedly in work with families
of drug-abusing adolescents who resist engagement to therapy. These four patterns are discussed below in
terms of how the resistant patterns of interaction are manifested, how they come to the attention of the
counselor, and how the resistance can be restructured to get the family into therapy.
Powerful Identified Patient
The most frequently observed type of family resistance to entering treatment is characterized by an
identified patient who has a powerful position in the family and whose parents are unable to influence him
or her. This is a problem, particularly in cases that are not courtreferred and in which the adolescent
identified patient is not required to engage in counseling. Very often, the parent of a powerful identified
patient will admit that he or she is weak or ineffective and will say that his or her son or daughter flatly
refuses to come to counseling. Counselors can assume that the identified patient resists counseling for two
reasons: It threatens his or her position of power, and counseling is on the parent's agenda and compliance
would strengthen the parent's power.

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