Stage One: A Circle is Formed
A Concerned Family Member Steps Forward
The consent of one family member, who admits their inability to deal with the situation at hand, to seek and receive professional help is the opening to this first stage of consensus. A licensed behaviorist, whose training and credentialing provide the proper scope and level of clinical expertise to diagnose the family member, enters the member into a signed, consenting treatment agreement. Common diagnoses that legitimately apply include Acute Stress Disorder, Anxiety Disorders, and Adjustment Disorders. Clinical intervention is formally initiated with this act of consent. The ball is now rolling. The battle against the diseased process is begun – war is declared. The focus initially shifts away from the identified patient/addict. Others who can become members of an informed, unified circle of support join as equals and allies to the family member who takes the lead by their consent to engage in the therapeutic initiative. This is done n order to fully educate and empower ALL of the members, including John or Jane who will not join the initiative until after awareness and unanimity are achieved by the circle.
In the consensus model, I’m describing, the member who finds the courage and fortitude to consent to treatment is, de facto, the liaison between the clinical provider(s), circle members that will be selected and invited, as well as peripheral family members. A fully accountable, licensed clinician has the proper training to recognize the medical necessity for the amplified treatment that will ensue.
Stage Two: Formal Group Consent
The consent of the circle to receive clinical guidance is the second stage of consensus to be established. Each member agrees to accept counseling regarding their potential role in the process. It is expedient to choose one member who acts as a liaison and gives formal consent to treatment. A parent, spouse or sibling is often the ideal member to serve in that role. Their formal consent to clinical treatment is made by signing a treatment agreement. All other members sign a collateral agreement to the formation of an action plan, mutual adherence, and confidentiality.
Consent to treatment has already been established with the liaison. The same elements for informed consent are reviewed with all members present: disclosure of (1) credentials, (2) regulatory authorities, explanations of (3) client’s rights, and (4) exceptions to privacy alongside health information protections. Signing a Collateral Consent assures all members AND the absent IP strict confidentiality that the IP and all other members need and deserve. Collateral Consent also inaugurates the process that follows, which
Setting the Stage for Unanimity
In some fewer cases, unanimity among family members is nearly complete when a member (who is naturally appropriate for the liaison role I have denoted) gives consent and identifies prospective members of the support circle. This may lighten the most more often difficult third stage, and help avoid the potential distraction that we’re not focused on the “true” dysfunctional one, the “John or Jane,” and hence obscured focus and even triangulations.
Signing a Collateral Consent assures all members AND the absent IP strict confidentiality that the IP and all other members need and deserve.
Stage Three: Formation of the Plan
Members of the circle participate in a scheduled, multi-hour dialogue. A review of the identified patient’s history is made first. Education about the dynamics of addiction (and/or dysregulation) and recovery follows. Finally, a plan of action is formed about how to challenge and invite the identified patient into stabilization and treatment. The action plan’s strength is grounded in the mutual consensus formed by the circle. Ideally, support circle members sign an accord (Magna Carta) in the form of a letter to the identified patient. Family statement letters may be assigned for individual members as additional preparation for the invitation that will follow.
The treatment options for a prospective patient are always restricted in some measure by existing obligations such as work or parenting, health insurance coverages, medical leave, and countless other variables. The most crucial variable is the willing consent of the prospective patient to receive treatment. The most important factor is to optimize the prospective patient’s success without bankrupting (or over-burdening) the family’s emotional, mental, and material resources.
Again, participants may prefer to join by signature in a document that declares their hopes, expectations. A document that may be likened to a Magna Carta that conjoins lords and ladies under a misdirected monarch (see King Baby literature), or a Declaration of Independence from the prospective patient’s toxicity and injury to their family. (See “Magna Carta” notes)