Saturday, May 23, 2015

Planning an Intervention for Situations Other Than Addiction

Interventions are not just for those with addiction issues. There are any number of reasons why this may be a good option when a persons’ behavior is a threat to themselves or others and they are in denial about it. Some examples: not taking medications; living in an abusive relationship; inability to manage one’s life due to illness and/or age; driving when they shouldn’t be.  

Consider this approach when talking to the person hasn’t worked and if the behavior, left unchecked, will have negative consequences.

It is important to recognize that a well-planned intervention can work quite well in helping someone make better choices about their life. A poorly planned one can end up with the person feeling attacked, isolated and may actually accelerate the undesirable behavior.

What is an Intervention: After careful planning, an individual is approached by a group of people that:
• Agree that a specific behavior needs to change
• Provide specific examples of destructive behavior and its negative impacts on self, family, friends, work environment etc.
• Outlines a pre arranged plan with steps, goals and guidelines as well as consequences if they refuse to change.

Planning the Intervention: An individual or several individuals who recognize the need for the intervention, meet with qualified professionals who can help with the planning and give guidance. This can include: medical team; condition specific organization (e.g. Parkinson’s Disease Foundation), counselor, social worker, therapist, religious leader, or an interventionist.  As part of this process:
-       Gather information about the extent of the person’s problem(s)
-       Work with a condition specific group to help identify resources and what approaches have been tried with people in similar situations. For example-The local aging service can help with aspects of planning an intervention with an elderly parent who should no longer be living alone.

The Intervention Team: It’s a good idea to have a mix of family, close friends and nonfamily.  Often the person has already heard from their immediate family about their behavior and they’ve tuned it out. However, hearing from friends, community members, co-workers etc. all at once can be the surprise that helps them accept the need to change. Non family can help to diffuse the anger, resentment or sense of betrayal someone can be experiencing as well as making sure the intervention stays focused on the facts and shared solutions. If the individual has a history of serious mental illness, violence, suicidal behavior and/or is taking drugs, it’s important that a professional be part of the intervention team.

Team members need to agree to the behavior change required, the plan itself, be willing to implement consequences and are willing to attend rehearsals.

Write a Script, Rehearse and Stick to It: Knowing what people are going to say and in what order is important. Sometimes a young child might be asked to speak first to set the tone. Keep in mind if a child is going to be involved, they may only need to do their part and then be excused. In addition to identifying concerns, not arguments, and a plan for dealing with the problem, scripts should let the person know they are loved and cared about; appreciated for what they’ve done and are doing; that you are there for them; the proposed plan will work; and things can improve. An example of a proposed script/letter is from a friend to a Mom who refuses to stay on her medications:
-       Statement of love and concern: I am here today because I love you and want you to be healthy.
-       Specific examples that illustrate the destructive behavior:  You couldn’t get out of bed for the last three days to take care of your children because you have been off your medication.
-       A plea for the person to get help: You can have a much healthier life, and be the exceptional Mom I know you are and want to by taking your medication as the doctor prescribed it.
-       Consequences if the behavior doesn’t stop: If you wont take your medication, I will have to report you to social services for neglect of your children.

Note that these letters can be left with the person after the intervention and can serve as important reminders.

Part of the team’s script will include who will do what if the person is ready to make the change. The more concrete the better. For example: Mom agrees that she can no longer live alone. The plan outlines:
• Date when Mom moves into the apartment attached to her son’s house.
• A schedule of dates and times when family/friends will help with packing.
• Date by which her daughter will have the house listed with a realtor and any items left disposed of.

While the number of times you need to rehearse depends on the situation and the nervousness of team members, it usually requires a minimum of two rehearsals. If someone is unable to attend these sessions, it’s best to find a replacement. Role-play to prepare for anger, argumentative behavior. Stick to the script during the intervention because changing it can throw other members of the team for a loop and derail the process.

Setting the date, time and place for the Intervention: Use a private but “formal” spot to hold the meeting.  The person’s home is not the best option as they can easily retreat to a bedroom or bathroom, and it’s also likely that this has been the scene for many heated discussions. Using a neutral space such as a therapist’s office, conference room, church or community center, it’s a lot harder for people to simply walk out and hide. Depending on the person, pick the time of day they function best.

The Intervention: Keep it brief, no longer than 60-90 minutes. During the intervention:
-       Avoid yelling, screaming, physical violence, shame, blame and guilt trips.
-       Stick to the facts and don’t argue with them.
-       Use the script and don’t deviate if at all possible.
-       Be prepared to carry out outlined steps or consequences at the close of the meeting.

Follow up: The plan developed prior to the intervention should outline steps for follow up. If they are not willing to make the change, you need to stay committed to consequences.


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