What is an intervention? What is its objective?
An intervention is a deliberate process by which
change is introduced into peoples' thoughts, feelings and behaviors.
A formal intervention, like we are discussing
here, usually involves several people preparing themselves, approaching
a person involved in some self-destructive behavior, and talking to the
person in a clear and respectful way about the behavior in question with
the immediate objectives being for the person to listen and to accept help.
Although the intervention process has been formalized, the idea is not new. Thinking back, most of us can remember a time when
someone or something - a teacher, friend, or set of circumstances impressed
us in a seminal way which altered how we understood ourselves and changed
our perspective. Moments like these constitute turning points where new
vistas open allowing us to see things differently and to recognize opportunities
we did not know existed before.
The overall objective of an intervention is to
begin to relieve the suffering caused by a self-destructive behavior -
the suffering of the person engaged in it and the suffering of family and
friends.
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FAQ Index - Practical Matters
What self-destructive behaviors are appropriate
for intervention?
Any self-destructive behavior can be addressed
in an intervention: alcoholism, alcohol abuse, alcohol addiction, drug abuse, drug addiction, gambling, sex addiction, eating disorders, computer addiction, internet addiction and any other self-destructive behavior.
Generally people think of substance abuse as being
most applicable to intervention. In fact, that will be the example used
throughout this discussion. However, any addiction or compulsive behavior is appropriate. Even an elderly person, no longer able to live alone safely yet resisting assisted-living arrangements,can be helped through the intervention process.
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Why is it necessary or desirable to conduct an
intervention?
Because nothing else has worked.
Most people attempt to change a person or situation
through reason and discussion, usually one-on-one. When this fails, frustration
may lead to anger. This can go on for years.
Appeals to reason and one-on-one discussions rarely
produce change in someone engaged in self-destructive behaviors.
On the other hand, an intervention that includes several people meaningful
to the person, that is executed in a controlled and logical way, that focuses
on changing everyone's behavior at least for the moment, is highly effective.
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What can my family expect to happen during an
intervention?
In order to prepare for an intervention, family
members and friends gather to discuss the details with the interventionist.
They jointly decide what form the intervention will take, identify who
should be included in the intervention, develop education and treatment
plans, develop an intervention plan and schedule, and then execute the
plans.
Family and friends often enter this process with
apprehension and frequently with a high level of frustration and anger.
They often feel betrayed, confused, guilty, and defensive.
They sometimes blame each other as well as themselves and the addicted
person for their difficulties.
All can expect these
feelings tempered or resolved during an intervention.
Sharing and expressing feelings gives purpose to the rehashing of old pains,
and allows the family and friends to receive comfort and to begin to resolve the built up rage and hurt that has influenced many
of their relationships and interactions.
These intervention meetings transform the family in ways necessary for lasting change to occur.
And this cohesive group approaching the addict offers
something much better than a confrontation. The group creates
a different world for everybody to live in.
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How did the idea of intervention develop?
Family intervention, where family and friends
band together and encourage a drinker to accept help for his drinking,
has been used successfully for over thirty years, ever since Vernon Johnson
first began experimenting with the technique in the early 1960's. This
intervention technique was and continues to be the standard against which
all further developments are compared and measured. And rightfully so.
Johnson's classic volume I'll Quit Tomorrow, published in 1973, includes
the basic rationale and approach to interventions still used today. This
approach was published later as a separate book, Intervention, in 1986.
Both books remain excellent primers on the subject for the professional
and layperson alike.
However, there have been many developments over
the last few decades. And even though these developments are but variations
on Johnson's basic themes, some of them are significant. First of all,
people recognized that the intervention technique was applicable to a broader
range of environments and issues than just alcoholism in the family as
most people originally thought. For example, intervention is now used not
only in domestic situations with family and friends, but also in many other
environments, among them businesses and corporate boardrooms (often called
"Executive" interventions), the military, professional sports,
and various professional associations including impaired professional groups
in the mental health field. And in addition to addressing alcohol abuse and addiction, interventions
are also done for people with other compulsive behaviors such as drug abuse, drug addiction, gambling, sex addiction, eating disorders, computer addiction, internet addiction and other self-destructive behaviors. Recently they are
even being performed for violent rages.
Thus intervention activity has increased both
by serving a wider and more varied population and by addressing a broader
range of issues. And concomitant with this increase has been an increase
in several other areas including the numbers of people conducting interventions
and in refinements and variations on the intervention technique itself.
As the applications of interventions has grown,
and as more people with a broader range of backgrounds have become involved
in conducting interventions, many refinements on Johnson's original techniques
emerged. Some of these refinements are due to the population served. For
example, the approach to interventions can vary considerably from one conducted
in a safe corporate board room to one conducted in a potentially violent
poor inner city apartment. Also the mechanics of the intervention often
vary depending on the style, training and history of the interventionist:
some interventionists are assertive, some relaxed and laid back; some interventions
are done by one practitioner, others have more than one: some interventions
are done in the drinker's home, others in the interventionist's office;
some interventions focus on getting help for the drinker, others on promoting
recovery for the whole family.
In short, the acceptance by the general public,
the refinements in intervention approaches and techniques, and the range
of self-destructive behaviors for which interventions are now appropriate,
have all increased substantially since Vernon Johnson first expressed his
ideas on the subject over twenty years ago.
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Why haven't I heard about interventions before?
Because people don't do them very much. "Intervention" is not a common household word.
Interventions are not being used nearly as much
as they could be for two major reasons. First of all, people cannot do
what they don't know about, and even after the remarkable advances of the
last decades, the public still remains generally unaware that the intervention
process exists.
Of equal concern, the little that is "known"
about interventions is too often simplistic, distorted, incorrect, overstated,
understated, or misconceived. For example, the public generally believes
an intervention to be an aggressive, intrusive, attack of some kind, rather
than being, as it truly should be, the kindest and most loving thing family
and friends can do. Unfortunately some are intrusive attacks.
Increasingly, however, interventions emphasize love and concern rather
than blaming or name calling.
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What are the forms or variations an intervention
can take?
There is no absolute right way to intervene in
someone else's life. In fact, there is a school of thought that argues
that any form of intervention is abhorrent, a violation of free speech
and of an individual's right to choose. Nevertheless, as individuals and
as a society we are always influencing others whether or not we want to,
and sometimes we decide to intervene purposefully.
In addition to family interventions there are
workplace interventions involving Employee Assistance Programs, executive
interventions for senior personnel in professions or corporations, court
involved interventions and diversion programs, interventions by Impaired
Professional Programs conducted by professional membership organizations,
and many others.
When thinking about family interventions, however,
there are generally four basic orientations: Simple, Crisis,
Classical, and Systems.
A. Simple Intervention
Sometimes just a simple request from someone who
matters can turn the tide. Simply ask the person to not drink. Believe
it or not, this sometimes works.
It is extraordinary how many times this has not
been done because of a belief that nothing was ever going to change. And
if this has not been done, it should always be the first step before any
more complicated or involved form of intervention is embarked upon. (Occam's
razor)
B. Crisis Intervention
This is the polar opposite of the Simple Intervention.
Crisis Interventions occur in dangerous situations involving reckless driving,
weapons, hospital emergency rooms, or violence or threats of violence.
It is obvious in these situations that a person is in immediate danger
to himself or others. The immediate objective in these cases is to calm
the crisis and to create safety for all.
Remember, a crisis often creates golden opportunities
for family members to help someone accept help.
C. Classical Intervention
The most common form of family intervention remains
the Johnson's approach or some variation thereof. It has been used for over
thirty years for thousands of interventions with great success.
The focus is on the drinker. The
immediate goal is for the drinker to enter treatment, hopefully soon.
Family involvement varies, but at the very least
there is enough involvement to plan the intervention prior to the intervention
day. Family involvement is often extensive after intervention day to
address problems that arise either for themselves or for the drinker.
Family education is primarily aimed at preparing
for the intervention day. There is frequently some additional education
after intervention day to help the family adjust to the changing circumstances.
Many treatment programs have fine family programs designed to educate the
family in addictions and how to take care of themselves when living with
a recovering person.
D. Family System Intervention
A family systems intervention focuses
on the family. The goal is for everyone in the family to change their ways, at least in regards to the self-destructive behavior, knowing that this changed behavior will have a tremendous influence on the drinker.
In this view the whole process is considered
to be the intervention. Intervention day itself is not nearly as significant
as in a more classical approach since the whole family,
including the drinker, is considered the subject of the intervention. The
drinker is sometimes invited to participate in the process from the beginning.
Family involvement begins very high and continues to be high whether or not the drinker goes to treatment.The educational process is viewed as integral and emphasizes the basics
of addiction, the roles of guilt and shame in the family system, the recognition
of enabling and provoking behaviors, and the development of a recovery
plan for each family member. The goal is for each family member to change
behavior and consequently change the situation or system in which the drinker
has thrived.
Note that although these forms of intervention
were discussed separately, they are rarely so distinct in practice. Many
of the characteristics of one can be found in the others depending on the
situation. For example, system considerations are always a factor even
in the more classical approachs, but are usually not so openly addressed. Because of the many differences among families and situations, an actual intervention often becomes a blend of several of these forms.
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How do you determine which intervention approach
to use?
Of the several things that need to be considered,
the first is always the issue of urgency and safety. If you are responding
to a crisis, the intervention approach you choose will reflect that urgency.
Immediately address the crisis and ensure everyone safety. Family education
and future plans can come later.
However, if you are dealing with a chronic problem
the classic, the family systems, or a blend of these approaches are available
to you . Your decision on how to proceed will depend on several factors
including what your family members are prepared to do, on their geographic
dispersion and to a great extent on the orientation of the interventionist
you find to help you.
Discuss with the interventionist the most realistic
and practical approach to take given the thoughts, feelings and location
of the family members.
Remember, an intervention is often a highly charged
emotional experience and the family needs to be working with someone they
trust. In theory all of the intervention orientations work. However, most
interventionists have developed a personalized approach that leans to one
form or the other. Look for someone whose approach makes sense to you.
Choose someone you can trust and then let them help you.
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What can my family expect in the long run from
doing an intervention?
A new dance.
Think of a family's interactions as a well choreographed
dance. Everything they do and say to each other has been perfected by hours
of rehearsal. Each member recognizes their cues and executes their steps
without thinking - day after day after day.
Imagine the dancers circling around one member's
drinking problem. Everyone knows the moves by heart, even the drinker.
And although everyone hates the dance, no one can imagine how to stop doing
what they are doing. In fact wanting to stop has become a part of the dance.
Guilt and suffering are also written in. The family could go on like this
forever.
An intervention is a controlled or choreographed
crisis. The dance, business-as-usual behavior of the drinker and family,
is stopped for a long enough time to get everyone's attention.
One day a group of the dancers stand still when
they would normally being turning somersaults. At that moment everything
changes in the family.
Although the transition is not always smooth and
some dancers may bump into each other at first, the important thing is
that the dance is brought to a stop; the drinker has no one left to do
the old steps with. And at long last the family has the drinker's complete
attention.
It now becomes possible for a different dance
to begin.
An intervention changes the dance.
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PRACTICAL MATTERS:
What should my family think about when considering
an intervention?
Major considerations in all interventions include
the following:
Can my family do an intervention without professional
guidance?
How can I know if the interventionist is any good?
How urgent is my situation?
What should be the objective of my intervention?
Who should participate in the intervention?
How should I handle angry , hopeless or reluctant family members?
How can we intervene when my family lives all around the country?
How much time will be required of the participants?
How much elapsed time does an intervention take?
Where will the planning meetings and the intervention take place?
What kind of treatment works best?
To Remember
The first item is truly the place to start.
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Can my family do an intervention without professional
guidance?
Of course, but be very careful.
Interventions are difficult and delicate matters and it is important that
they be done properly. Nearly all interventions can benefit from the advice
and counsel of a professional experienced in the intervention process.
Many families waste a great deal of time and effort trying to organize
an intervention by themselves and often it is so difficult that the intervention
never takes place at all. Sometimes, unfortunately, it does take place
and at best nothing happens at all and at worst a great deal of harm is
done.
The first thing to do is to seek out the advice and council of an interventionist.
At least make the call and talk a little. You don't have to commit to anything
until you are ready.
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How can I know if the interventionist is any
good?
By the interventionist's experience and your sense
of comfort and trust.
Specialized training is required to guide a family and work colleagues
through the intervention process successfully. Most people, including many
in the addiction field, have a simplistic view of interventions, greatly
underestimating the knowledge, skill, flexibility, and courage necessary
on the part of an interventionist. Although a background in addictions and human behavior is essential, the
normal aims and methods of individual, group and family therapies are insufficient.
The amount of training, experience, skill and supervision among people
doing interventions varies considerably, and it is difficult to evaluate
an interventionist's qualifications or performance. So when meeting an
interventionist for the first time, inquire about how long he or she has
been doing interventions, about how he or she conducts interventions. Develop
a sense of whether or not the interventionist knows what he or she is doing.
Follow your instincts; you will know.
It is important that you trust the interventionist. Should you ever find
you are uneasy or that you are being asked
to do something you do not understand or agree with, you would be wise
to stop the process and find someone else.
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How urgent is my situation?
The driving force in many interventions is urgency
and safety. Do you need to act immediately to save the person's life, or
is this an ongoing problem that does not pose an immediate threat? The
answer often determines what actions can be taken.
For example, an elderly couple slowly drinking themselves into the grave
is not in as urgent need as a man on a binge with the car keys in
his hand. A family dinner where adult children gather to speak reasonably
to their parents about going into treatment could get the attention of
the elderly couple, whereas nothing short of an arrest for drunk driving
may stop the man on a binge.
Thinking about the level of urgency prior to the initial meeting with the
interventionist will make the meeting more productive.
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What should be the objective of the intervention?
The relief of suffering is the underlying agenda
of any intervention. Changing the self-destructive behavior at the root
of suffering is always the focus regardless of the form an intervention
may take.
Nearly all families begin the intervention process in the same basic stance:
"A person in my family is drinking too much.
I worry he will have an accident and die. I want him to stop drinking so
he will be happy and the rest of us can stop worrying. Nothing we have
done so far has done any good. An intervention is our last hope. Will it
work?"
An immediate objective of most interventions is
to have the drinker accept help of some sort - detox, residential treatment,
outpatient treatment, AA, therapy or some combination of these. The classical
model often defines treatment for the drinker as its primary objective.
Sometimes a family can readily understand how changes in their own attitudes
and behaviors can be a powerful influence on the drinker and are willing
and able to invest time in their own education and treatment. When this
happens the objective of the intervention is broadened into having everyone
in the family (including the drinker) accept help of some sort -- education,
self-help groups, therapy and other forms of appropriate treatment.
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Who should participate in the intervention?
In the classical intervention, everyone who is
meaningful to the drinker is a candidate for inclusion in the intervention.
For a family systems intervention, anyone who is affected by the drinker's
behavior is a candidate for inclusion.
Elderly family members are sometimes not included because of their health
or from a desire to minimize stress for them. This is often a mistake and
serious consideration should be made to include them whenever possible.
Children are also powerful members of the family, and although
they should be protected at all costs, they often can be participants in
an intervention to everyone's benefit including theirs.
Furthermore, the process is not dependent upon the number of people. Successful
interventions can occur between a husband and wife or parent and child
with little or no involvement from any one else.
How many people actually participate depends upon many factors; geography
and other practical concerns must be considered. If the family is dispersed
around the country and some members can not afford to attend, the intervention
can still be conducted.
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FAQ Index - Practical Matters
How should I handle angry , hopeless or reluctant
family members?
Always discuss with the interventionist the most
realistic and practical approach to use. Do not make decisions about these
matters prior to this discussion; the interventionist may have some helpful
ideas.
Sometimes people are too angry, too hopeless or too frightened to participate
in an intervention. Other family members may want to be there to show support
but are truly not interested in learning very much about the situation
or in discussing how it has affected them. Still others may be willing
to do whatever it takes, within reason, of course. And still others are
very aware that the problem is much larger than just one person and that
everyone needs long-term sustained help. It is not uncommon to have all
these positions present at the same time in the same family.
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How can we intervene when my family lives all
around the country?
During the initial stages family members often use
the mail, phone and email to communicate with each other and with the interventionist.
Sometimes they can only come together for a day at most and preparation
work by phone or fax is the only option. Other times they can come together
for a long weekend (3-4 days) and can take advantage of all the benefits
of face to face communication.
Sometimes a family member can not participate fully due to schedule commitments,
cost of travel or for other reasons. These situations can be accommodated
also. People who cannot be present sometimes write letters that can be
used quite effectively.
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How much time will be required of the participants?
The minimum time investment usually
involves two or three sessions with the interventionist, the time spent
on intervention day, and a follow up session. Sometimes this can be reduced
even further.
As a practical matter, however, interventions should be viewed as a long
term process requiring a rather large time commitment. Discuss this with your
interventionist.
Families often use the intervention process as an opportunity to educate themselves about
the illness, to develop an understanding of their role in the drinker's
problems, and to formulate and execute treatment plans for themselves.
These families may have several sessions with an interventionist before
and after the actual intervention. They may also decide to participate
in a support program such as Alanon. Occasionally a family will decide
that they want the support of extensive family therapy for the educational
and emotional support they need to make the changes in all their lives.
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How much elapsed time does an intervention take?
A normal time period is in the range of two to
three days to several weeks preparation time prior to intervention day,
and as much time as necessary after that. This can vary considerably.
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Where will the planning meetings and the intervention
take place?
Meetings among the family members, with or without
the drinker, can take place anywhere that makes sense including the drinker's
home, the interventionist's office, a friends home, a friend's office,
a church, a hotel room, anywhere at all.
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What kind of treatment works best?
There is debate about what kind of treatment works
the best. There are choices between inpatient treatment, outpatient treatment,
AA, and of course the "nothing but the person's change of heart"
approach. An argument can be made for almost any of these treatment approaches.
Sometimes it will be obvious which approach is more suitable. For example,
if the person is in an acute crisis, inpatient care is more than likely
advisable. Cost considerations also drive treatment decisions. The interventionist
could favor one approach over another.
Again, your interventionist has a broad range of knowledge of the treatment
resources available. Be open and discuss all these considerations.
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FAQ Index - Practical Matters
Are there any books on intervention?
There are several Books on intervention, some
of which are listed below.
As you obtain and read these books, please remember
that there are many ways to conduct an intervention. Beware of overstatement;
each author has biases. Reading a book does not make someone qualified
to do an intervention. Read a book if you wish, then contact
an interventionist to guide you through the process.
Johnson, Vernon E.
Intervention
: How to Help Someone Who Doesn't Want Help : A Step-By-Step Guide for
Families of Chemically Dependent Persons
- An excellent primer.
Johnson, Vernon E.
I'll
Quit Tomorrow : A Practical Guide to Alcoholism Treatment - Revised
edition (September 1990).
- Where it all started - A classic in the field.
Rogers & McMillin
Freeing
Someone You Love from Alcohol and Other Drugs : A Step-By-Step Plan Starting
Today! - Rev/Expnd edition (February 1992).
- As good as any and better than most.
Schaefer, Dick
Choices
& Consequences - 1987, Johnson Institute.
- Intervening with teenagers.
White, Robert & White, Deborah (Editors)
Addiction
Intervention : Strategies to Motivate Treatment-Seeking Behavior -
1998, Haworth Press.
Intervention considerations in a variety of settings.
These as well as other books on Addiction, CoDependency, Recovery can also be found and ordered immediately
via the internet. See Books.
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To Remember
Hope, ambivalence and fear are common for many
people embarking on an intervention. An intervention can sometimes
be quite stressful. Remember the fundamentals.
First of all, no one can predict with certainty how the someone will react.
Acceptance, anger, relief, hope, confusion are all usually present to some
degree, and sooner or later each will emerge. How each will manifest prior,
during and following intervention day varies considerably.
Second, reduce your investment in the outcome of what occurs on "intervention
day." Remember that intervention day is only
one part of the process. Intervention truly starts with the
first inquiry for help and lasts well beyond intervention
day. Family and friends continue to learn and change for months and years.
It is this knowledge and change that, in the long run, not only help family
and friends maintain perspective and resolve, but may also help the person
to take the matter seriously and to focus on accepting help.
Finally, the intervention is always done with love and respect. And no
matter what happens on intervention day, it will most certainly get the
person's attention. If the person refuses to do what is requested, he/she nearly always changes for the better in some way, usually by
accepting some form of help later: either later that same day, the next
day, the next week, or the next month or two.
In short, it will never be business as usual again for anyone.
