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Thomas and his colleagues (Thomas & Ager, 1993; Thomas & Santa, 1982; Thomas, Santa, Bronson, & Oyserman, 1987; Yoshioka, Thomas, & Ager, 1992) from the University of Michigan developed a unilateral family therapy approach for the partners of alcohol abusers. The procedure requires between four and six months of intensive work with spouses, in which various treatment components are applied depending on the client’s circumstances. All clients are first provided with a treatment orientation in which they are fully informed about what is in store during treatment.
Next, a clinical assessment is conducted in which the drinker’s behavior and consumption habits are identified and the partner’s responses to drinking are explored. Most partners then proceed to four modules of “role induction” with the aim of helping them “adopt a positive rehabilitative role” (Thomas et al., 1987, p. 154). This part of the training addresses the effects and seriousness of alcohol abuse, ways of enhancing the relationship, countering the ways in which the partner may be enabling drinking, and extinguishing nagging and other dysfunctional aversive behaviors. After the role induction modules, the partner is instructed in the use of “programmed confrontation” and “programmed request” to induce the drinker to enter treatment, reduce drinking, or both. Regardless of whether the foregoing interventions are used, partners are trained in the basics of controlled drinking therapy (for example, see Barber & Eltringham, 1988) so that they are in a position to facilitate change in the event that the drinker decides to cut down.
The unilateral therapy program also includes interventions to improve the well-being of the nondrinking spouse. For example, an effort is made to increase the partner’s independence from the drinker, and the partner is also encouraged to discuss emotional problems such as stress, depression, and anger. Two final interventions aim to foster maintenance and generalization of any gains made by the drinker as a result of the partner’s intervention. The first is “spouse support” and consists of providing ongoing encouragement to the nondrinker, and the second involves training in the basic tenets of Marlatt’s (Marlatt & Gordon, 1985) relapse prevention procedure. Although the primary objective of unilateral family therapy is to reach the resistant drinker through the spouse, the program does incorporate interventions for optimizing the partner’s well-being, and in the event that the drinker’s alcohol intake does not decrease, the spouse’s well-being becomes the sole focus of the intervention (see Yoshioka, Thomas, & Ager, 1992).
In a controlled trial of the procedure, Thomas et al. (1987) used newspaper advertisements to call for volunteers from among spouses of heavy drinkers. A total of 25 spouses (24 women and one man) were randomly allocated to treatment or to a waiting-list control group. Spouse reports of drinkers’ levels of consumption and dependence were consistent with serious drinking problems. At baseline, all clients were administered a battery of 20 instruments before clients in the treatment condition were provided with six sessions of unilateral therapy. The battery included measures of spousal coping, family functioning, and the drinker’s consumption. At the end of the six months and again 12 months after treatment, all clients were reassessed using the same battery of instruments. Results revealed that 61 percent of the partners of spouses in treatment either entered treatment or reduced their drinking by more than 50 percent, compared with none of the spouses who did not receive treatment. Unfortunately, the authors did not report scores on their measures of partner well-being but merely noted that “the number of subjects in the categories was too small for conducting systematic statistical analysis”.
Nevertheless, the authors confidently concluded that their unilateral family therapy procedure “was clearly associated with a reduction in drinking and a diminution of general life distress. Some positive gains were also evident for affectional expression and sexual satisfaction for the marital partners”. In the absence of any supporting data, however, none of the conclusions about partners is justified. Yoshioka et al. (1992) also reported that the wives’ anxiety and anger abated as a result of unilateral family therapy, but they too provided no empirical support for the assertion.
Unilateral family therapy has now been implemented in controlled trials with a total of 64 female and four male spouses of problem drinkers, although only 36 clients have ever completed at least one intervention of the procedure in its final form. The procedure clearly holds great promise, especially in relation to the resistant drinker, but to date there is no evidence that the technique improves the subjective well-being of the women who participate in treatment. Indeed, further replication trials are clearly needed before we are entitled to invest firm confidence even in the procedure’s putative effect on drinkers. The final problem confronting unilateral family therapy is that it is a protracted (and therefore expensive) intervention that would be virtually impossible to replicate accurately.
- Barber, James G. and Robyn Gilbertson; “Unilateral Interventions for Women Living with Heavy Drinkers”; Social Work; Jan97, Vol. 42 Issue 1; p69-78
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