Having an Intervention Without Shame or Stigma
Speaker Series featuring Alison Broussard and Tanya Cook. Interviewed by Lana Seiler, MSW, LCSW - Director of Trauma Services at All Points North Lodge:
Alison Broussard: Alright, my name is Alison Broussard, I’m a certified ARISE interventionist. I'm from the Houston area -specifically The Woodlands - but we cover all of Houston. Actually, we work all over Texas, throughout the United States and beyond.
Tanya Cook: My name is Tanya Cook. I am also an ARISE interventionist, and I partner with Alison. We do interventions together in the Houston area and really all over. This is just something that we really love to do. We love helping families and helping individuals. It's our passion and our dream to keep doing this.
Lana Seiler: Welcome, I'm really excited to have you guys with us. It’s such interesting work, intervention. Really, it’s such an important piece of the journey to get someone the help that they need. So I have a ton of questions, and there’s a lot I want to hear from you too. Let's start from the beginning. You guys said where you're from, but I'd love to hear how you got into what you do. Whoever wants to start is fine.
Tanya Cook: Okay. I actually left a Corporate America position of 25 years after going through well over a decade of dealing with addiction in my family. I have four sons, and my two youngest struggled with opioid addiction in particular. So it was quite a journey (it’s always a journey), and we're still on that journey. There are a lot of ups, a lot of downs, a lot of treatments, a lot of not knowing what I didn't know, and really pouring myself into family education and just doing my best to support my sons, knowing that I had to. I’m beginning to get emotional. I knew it. I mean I just knew, probably for the last two or three years of my prior career, that all of that pain that we had gone through needed to be turned into a purpose. It would just be in vain if not. I learned so much, and I knew I had a lot to give others. So that's why I do what I do.
Alison Broussard: I think for me, I am a woman in long-term recovery from alcohol and am about 10 years into my recovery journey. I began working at a treatment center, and I remember that one of the craziest things was that one of the prerequisites for working there (for this particular position) was that I had this history with a struggle. I was going to be teaching The Big Book at this facility and helping their clients with the next part of their journey. So, they'd been in inpatient treatment and then moved to continuing care, because we know this is a lifelong journey.
Working in that continuing care area allowed me to build up the resources I have, learn different programs that are out there, and really just communicate. I mean, I was getting to meet with these clients day in and day out to talk about what it was like to live the recovery journey - meetings, sponsorship, IOP, PHP, the all the next things. There were times also just to speak about intervention.
I remember working for that same facility, and I was introduced in treatment to some people. I remember the lady didn't come to go to treatment. She came to just visit, but she was leaving and asking, “Should I want to stay?” So, they brought me in and said, “You should talk to her.” I remember kind of praying the whole way down, “I don't know what she needs, but I know she needs something. Maybe some words that I might have for her could potentially change the course of what she had decided to do.” And she ended up staying in treatment.
I think that sparked my real interest in an intervention, even though I didn't really know that's what it was. That just kind of led to the next thing, that went to the next thing, and all of a sudden, I remember starting to look into different models of intervention. I really landed on ARISE because of what it encompassed with the entire family component. It wasn't a short-term, quick in, throwing someone off guard, just getting someone into treatment. It was really a longer-term with the whole family. It was like this work that was going to be supported, and there's so much more but anyways...
Lana Seiler: Great, well yeah, let’s continue with that because I do want to know. Also, it is a bit of a niche being in intervention, just through what I know of that work from being a clinician myself, it can be very high intensity. It takes a lot. So, I am interested to hear - and either of you can answer this. What model do you use? What do you love about the model you use? What could be improved upon? How do you do this type of work? It's hard work.
Tanya Cook: So interestingly enough, I was actually exploring types of intervention. I knew I wanted to do intervention, but I didn't know where to even begin to start looking at the different models and which one to train in. That's actually how I got introduced to Alison. I had actually known someone's family that she was working with. When I was networking with this individual, she said, “You know, you really need to meet Alison Broussard.” So, I kept hearing, “Alison Broussard, Alison Broussard.”
Anyhow, I looked into it. ARISE is actually, I believe, the only evidence-based interventionist model out there. So for me, I had kids that were chronic relapses. (Some people call it chronic relapse. Some people call it treatment-resistant.) All I know is that we kept having to go back. So, I looked at the statistics and the statistics for the ARISE model.
ARISE is an invitational model. If you think about some others - and there's a lot of other great intervention models - some of them you had the individuals caught off guard. So, they're very angry and sad. They're going to come to treatment and for the first week minimum if not two weeks, they’re just mad. They're mad at their family. And so they can't really get into their recovery.
I think the first thing that caught my attention was that it was invitational versus confrontational. Because we actually invite them to the table and actually create a scenario with a network of individuals in the family, we solicit their involvement in agreeing with the family to say, “Yes, in fact I do have a problem. I need to get help.” So they come in voluntarily. I mean we're not saying that they come in skipping and jumping. I'm not really sure who comes into treatment that way.
But I will tell you - because I spoke of the statistics - we work long-term, as Alison said, with their family. We contract for six months minimum. The statistics are that in the first week of meeting with a family, 60% of our individuals will be in treatment. By 3 weeks, over 80% will be in treatment. That's the best statistic.
What I love is that once we take an individual through this entire six-month process - and their families because the family component is so important, and this is the evidence-based part of this - nearly 60% or a little over 60% will still be clean and sober when they’re out. So I don't know about you, but the statistics that I usually see are single digits. So, I mean even if you want to cut that in half to 30%, it’s a good model. Do you want to add to that?
Alison Broussard: I'm thinking that there's a lot to say, but I don't know if you have another question you want to ask.
Lana Seiler: I have plenty of questions, but if you want to add on, add on.
Alison Broussard: I think for me - just talking about the family components and also going back to people not really jumping and skipping on their way to treatment - it is about them joining in. This is a non-shaming, non-blaming process, and a lot of that works through what's called a genogram. Tanya and I love to talk about the storytelling which you guys have spoken of a lot since we've been here this weekend. We really build that genogram out so that they can see that this did not start with them.
When people can see that, it takes this layer of shame off the top. Again, then they're able to join in because shame really, there's my favorite quote, I’m just going to use it, “Shame is a bully. Grace is a shield.” That's Anne Voskamp. She does a lot of writing regarding mental illness and addiction, and it's just the truth. If you feel shamed, you almost can't join in a process that is life-giving because you know you're blocked from getting that help.
Even talking about stigma an things like that, I mean there’s a lot of that out there. But when we begin to open that conversation up with families, Tanya and I are not secret keepers. We talk about that and the importance that. You're as sick as your secrets. When we begin to give a safe space for those conversations to occur and to talk about these hard things, like you said, this is hard work. We're talking about the hard things with families, we really are. We're going in, probably at the most vulnerable and most sacred moment. Although they feel like everything is falling apart, Tanya and I know that things are just getting good, so that they can move forward.
Lana Seiler: Thank you. Do you see a place for that sort of “caught off guard” type of intervention? Is there a place for that or do you see it always being appropriate for an invitation?
Alison Broussard: I would say I think that there is. There are times when people are very close to death. Maybe they’re using substances that are just ticking time bombs. I still believe you can start with an invitation, but I do think that there are cases where, for whatever reason, they can't join. Then you know where to move into. So this is done in phases, the ARISE model actually has a kind of space for that. It's really increasing some of the family’s pressure.
I think with everything there’s either internal or external. We all would prefer internal. I'd rather it not be some external thing that comes onto them like legal issues, an illness, or even for them to get injured, death, or anything like that. It's about them starting to feel that internal pressure that comes with the family, just increasing their severity of even holding boundaries to say we cannot join you if you're going to continue doing what you’re doing. So, I think in that light, that's what we kind of see.
Tanya Cook: Yeah, and I’ll say the way that the model works is that it is invitational, but we love it when they show up for the first meeting. I will tell you that we have great success with our clients showing up in the first meeting - our “Person of Concern" that's what it's called in the ARISE model. We meet with or without them, but with most of the families, the Person of Concern can't stand to think about their family members meeting and talking about them. They're just not going to have that, so most of the time they're going to show up or they get mad and they say, “I'm not showing up because I’m going to boycott this, and I’m going to make it not happen.” So, what we do is we say, “No, the meeting's going on with or without you.” Then we tell the family member, “We're just facilitating, you need to understand that.” So, we’re kind of behind the scenes coaching the family, but we will tell the family member, “That's great, but let them know the meeting is going on with or without them.”
The most that we have made it is about three meetings and the person comes in. Again, I mean it is a little concerning sometimes if we know time is of the essence. Sometimes, we have to think about that and get creative with that. Again though, we coach the families. I will tell you, recently we did an intervention where, even though we totally scripted how to invite their loved one to this meeting, we got in the meeting, and there were 18 family members which was awesome. I mean awesome, there is strength in numbers, that's what it’s all about. The first thing that the father had to say was, “Well, this obviously is not a financial planning meeting.”
Alison and I just looked at each other because we never knew that our Person of Concern was told that it was a financial planning meeting because that wasn't what we had planned. It wasn't what we had asked them to do, but again, we're guiding and we're coaching. But at the end of the day, the family are the ones doing the work.
I will tell you that one was a success. Aside from that one little piece of it, it was textbook perfect. We did that genogram. We made that case, “Look this didn't start with you. Look at all of this red indicating addiction and alcoholism throughout the generations.” There was some significant trauma that we were able to highlight. Then each family member went around the room and expressed how that person's drinking was affecting them, how it was making them feel, and what they needed her to do. By the end of the night, she just completely disarmed, and it was a “yes.” She was in treatment within the next 48 hours.
Lana Seiler: So, it sounds like you do a lot of work with the family, and you even work with a family for a while after the loved one hopefully gets help. What does that look like in terms of the work with the family while their loved one is in treatment and then on-going? This will be my last question, but if you could just speak to that.
Alison Broussard: So what we're doing is we're meeting with the family while the loved one is in treatment. They're getting help, they're getting education, and they are getting to be able to work with a therapist and go deeper in and do that deeper work. Tanya and I are not therapists. We're not clinical. What we do is have meetings then direct the family members when it's evident that more work is needed. We help them get connected to therapists. Sometimes we’ve had multiple people go to treatment. Andybe there are groups they can be apart of. That's a big part of what we do is getting the family members connected to Al-Anon or Nar-Anon, any of those 12-step groups, or beyond that. It's kind of whatever resources we can find that we can help the family members get to.
We also work with the treatment center, typically with treatment centers that have a very robust family program. We make sure the family is connected to that. Some treatment centers do it better than others.
I’ve heard really good things about what you guys are doing here in connecting with families. So, that's very important to us. All we're doing is supporting that. If they give us any sort of push back like, “I'm busy that week,” we fight that with you guys. We join along with you, and we love to collaborate. We know that we're a part of a bigger team, especially when we’ve got one of the loved ones going into treatment. We know that then we're joining you in all of that.
So, although we're not clinical, we definitely point to all of those clinical pieces. We still have meetings with the families to discuss things when a loved one goes to treatment sometimes. We know we're always sending them to great places that have great food. But some of the key things we get are, “This food is awful. They are hurting us here. We don't like it. The sheets are like a really low count.” The full gamut, we hear all of it. So we remind the family, “It's okay to hold your boundary. They really are being taken care of well. I promise you that.” So that’s an important part that we play, and we continue those meetings for 6 months. If the loved one stays in treatment for 30 days, we're still meeting. Sometimes it's four months, it just depends.
Tanya Cook: We also do things like we work with them on helping them identify how to not enable. We will have them reading books and listening to podcasts. You know, I’m shameless. I went to a pal's meeting a few weeks ago or so and picked up some tools from there on enabling, in fact. So, we work through different things to get them fully prepared for when their loved one comes home.
One of the things that we do each and every time that we meet is a check-in. We want to make sure everybody's doing okay. There are bout six questions probably that we ask each person in each check-in. One of them is, “Do you have any agenda items?"
They're bringing things to the table. It may be there's a young child, and we help them dialogue around how to message to that young child when he asks, "Where's mommy? Why is mommy gone?" Things like that. Whatever they bring up, it should be. I mean, we've had problems with dogs.
It's a big thing that we do to keep the shaming and the blaming out of the room. We make sure that we're helping that family move forward. It's beautiful because we see divorced parents that have come together for the first time in many, many years for the good of their adult child. So healing just comes about organically, and we just need it so much. There's transformation. It's really a beautiful, beautiful model, and we do a lot of it. So we've seen it work over and over and over.
Lana Seiler: Well, thank you so much. It's been really informative and wonderful to have you guys.