Problem & Pathological Gambling Treatment Strategies

Joanna Franklin MS NCGC-II

Maryland Council on Problem Gambling

Jfranklin.ipg@gmail.com

Problem & Pathological Gambling: Working with Couples and Family

The Relationship is the Client.

Identify the Intimacy Based Needs.

Identify the Reality Based Needs.

Can we Ally with the Power Base in the Family?

Who Has the Power in This Relationship?

Which Family Members are Forming the Identified Relationship?

Problem & Pathological Gambling: Working with Couples and Family

Think Family First.A Couples Modality = Greater Inroads in Treatment

(Counseling the Problem Gambler, J.Ciarrocchi 2001).

More Objective Data on the Gambler’s Behavior

Family Often Represents the Ultimate Level of Motivation for the Gambler Helps combat the High Drop Out Rate

Opportunity to Educate the Family Against Bailouts

Relationship Counseling Reduces Communication Delays Among Family and Counselor

Family Screening

Does Family Have Significant Financial Problems

Are Financial Problems Related to Gambling (Either causing them or seen as solution)

Have You Been Concerned About Extent of Gambling of Family Member?

Family AssessmentFamily members knowledge of gambling severity Amount of Time Amount of Money Legal Problems Debt Lying Impact on Relationship Other consequences/problems

Family AssessmentImpact of Gambling on Family-Emotional

Anger Depression Anxiety/Fearfulness Guilt/Blaming Physical Symptoms History of Abuse/Domestic Violence Suicidality Intensity of Anger and Impulsivity

Problem & Pathological Gambling: Working with Couples and Family

Three Common Family Responses (J.Ciarrocchi 2001)

1. Accepts the gambler with little loss of intimacy.

2. Develops a relationship with gambler of a parallel existence, emotionally cold, some level of interaction, may have appearance of unity but tacitly has minimal expectations around intimacy, protects self from gambler and coexists.

3. Family remains together, but with intense conflict. Regardless of gamblers abstinence family remains chronically angry.

Problem & Pathological Gambling: Working with Couples and Family

Expect to find an array of relational problems.

Be aware of partners defending themselves by reminding clients of the harm they have caused, this can escalate into chronic conflict, destroying motivation to improve and creating incentive to withdraw emotionally and physically.

Problem & Pathological Gambling: Working with Couples and Family

Families are often shocked, surprised or devastated

with the scope of the gambling problem.

Families are forced to process “on the run” while

trying to cope with crises.

The developmental time lag has often left the gambler

in a contemplation stage for some time, continually

processing and reprocessing available data before

deciding to change.

Problem & Pathological Gambling: Working with Couples and Family

First goal is supporting the gamblers desire to recover.

Couples work accomplishes this through:

1. Developing environmental controls

2. Working towards financial recovery together

3. Handling legal issues

4. Providing a forum for the partner to ask questions & ventilate,

5. Give feedback on the gambler’s behavior,

6. Obtain emotional support

Problem & Pathological Gambling: Working with Couples and Family

Integrative Behavioral Couples Therapy IBCT (Jacobson &

Christensen 1996, 2001) suggests:

1. Regularly discuss differences between the couple- this is to reinforce seeing the problem as an “it.”

2. Discuss upcoming events in light of their differences anticipating potential conflicts.

3. Therapist and couple would process recent negative events with empathic joining to diminish negative feelings around unpleasant exchanges.

4. Process positive events reinforcing how each contributes through tolerance and acceptance of each other’s difference.

Problem & Pathological Gambling: Working with Couples and Family

Couples seem to abandon quickly precise, clearly operationalized strategies so carefully taught. (Jacobson & Christensen 1996)

Data analysis indicates behavioral change can only go so far. People have a limited capacity to change.

Successful intimate relationships exhibit a high degree of tolerance.

Developed the paradox of acceptance and change-we change best when we feel accepted.

Rather than teaching an array of artificial communication techniques, wouldn’t make more sense to teach strategies that felt natural.

Problem & Pathological Gambling: Working with Couples and Family

Present the couple with a formulation of how things got the way they are.

A tentative hypothesis for which the couple provides feedback

Provides a tool for empathic joining- problem is the “it”, not him or her, or him and him, or her and her.

Polarization vs. acceptance: each tries to change the other, digs in heels, acts out, control battles…

Problem & Pathological Gambling: Working with Couples and Family

Caution: Over-predicting of negative consequences Catastrophizing crisis circumstances-believing “I can’t

cope.” Anger as a defense against re-victimization Self-blame for gambling behavior

Response: Cost-benefit analysis Concrete examination of resources Anger reduction techniques- alternative defenses, focus

on self and personal growth. Challenge “character” conclusions about self

Problem & Pathological Gambling: Working with Couples and Family

Problem & Pathological Gambling: Working with Couples and Family

Family Treatment: Resources

Counseling the Problem Gambler: A Self Regulation Manual Joe Ciarrocchi PhD.

Losing Your Shirt. M. Heineman

Don’t Leave it to Chance . E.J. Federman, C.E.Drebing & C. Krebs. Behind the Eight-ball L. Berman and M.E. SeigelPersonal Financial Strategies for the Loved Ones of Problem

Gamblers. National Endowment for Financial Education and National Council on Problem Gambling. www.samhsa.gov

NCADI Problem Gambling Toolkit