2. Problem & Pathological Gambling Treatment Strategies Joanna Franklin MS NCGC-II Maryland Council on Problem Gambling Jfranklin.ipg@gmail.com

3. 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?

4. 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

5. 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?

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

7. Family Assessment Impact of Gambling on Family-Emotional Anger Depression Anxiety/Fearfulness Guilt/Blaming Physical Symptoms History of Abuse/Domestic Violence Suicidality Intensity of Anger and Impulsivity

8. 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.

9. 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.

10. 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.

11. 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

12. 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.

13. 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.

14. 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…

15. 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

16. Problem & Pathological Gambling: Working with Couples and Family

18. 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. Seigel Personal Financial Strategies for the Loved Ones of Problem Gamblers. National Endowment for Financial Education and National Council on Problem Gambling. www.samhsa.govwww.samhsa.gov NCADI Problem Gambling Toolkit