Intervention (counseling)

This article is about orchestrated group interventions. For the approach used in cognitive therapy, see cognitive interventions.

An intervention is an orchestrated attempt by one or many people – usually family and friends – to get someone to seek professional help with a substance use disorder or some kind of traumatic event or crisis, or other serious problem. Intervention can also refer to the act of using a similar technique within a therapy session.

Interventions have been used to address serious personal problems, including alcohol use disorder, compulsive gambling, substance use disorder, compulsive eating and other eating disorders, self harm and being the victim of abuse.

Direct and indirect interventions

Interventions are either direct, typically involving a confrontational meeting with individual in question, or indirect, involving work with a co-dependent family to encourage them to be more effective in helping the individual.

There are three major models of intervention in use today: the Johnson Model, the Arise Model, and the Systemic Family Model.

The use of interventions originated in the 1960s with Dr. Vernon Johnson. The Johnson Model was subsequently taught years later at the Johnson Institute. It focuses on creating a confrontation between a group of supporters and the addict in order to expose the addict to the consequences of their addiction. The confrontation serves to precipitate a crisis in the addict's life that is not threatening, damaging, or fatal, and is used to compel them into treatment before they are able to suffer irreparable social or physical damage as a result of their disease.

The Arise Intervention Model involves exposing the addict and their family members to a collaborative intervention process. Rather than being confrontational, the Arise Model is invitational, non-secretive, and a gradually-escalating process.

The Systemic Family Model may use either an invitational or confrontational approach. It differs from the Johnson Model in that the focus is on fostering a patient, firm coaching instead of creating a negative confrontation. Rather than focusing on the addict, the interventionist fosters discussion with the entire family on how their behavior contributes to the addicted person's continued use of substances, and how to approach the problem as a family unit.

While some interventionists will prescribe to one of the above models over the others, many are able to blend the three models based on what will be most effective for the addict and their family.

Plans for direct intervention

Plans for an intervention are made by a concerned group of family, friends, and counselor(s), rather than by the person using drugs or alcohol. Whether it is invitation model or direct model, the person using substances is not included in the decision making process for planning the intervention. A properly conducted direct intervention is planned through cooperation between the identified family or friends of the person using substances and an intervention counselor, coordinator, or educator. It is important to perform the intervention in an open, large space so as to reassure the person using substances that they are not trapped or cornered. Ample time must be given to the specific situation; however, basic guidelines can be followed in the intervention planning process. (An intervention can also be conducted in the workplace with colleagues and with no family present.)

Prior preparation

Prior to the intervention, the family meets with a counselor or interventionist. Families prepare letters in which they describe their experiences associated with the addict person's behavior, to convey to the person the impact his or her addiction has had on others. Also during the intervention rehearsal meeting, a group member is strongly urged to create a list of activities by the addicted person that they will no longer tolerate, finance, or participate in if the addicted person does not agree to check into a rehabilitation center for treatment. These consequences may be as simple as no longer loaning money to the addicted person, but can be far more serious, such as losing custody of a child.

Family and friends read their letters to the addicted person, who then must decide whether to check into the prescribed rehabilitation center or deal with the promised losses.

Effectiveness

There are questions about the long-term effectiveness of interventions for those addicted to drugs or alcohol. A study examining people who were addicted to substances who had undergone a standard intervention (called the Johnson Intervention) found that they had a higher relapse rate than any other method of referral to outpatient Alcohol and Other Drug treatment. "The Johnson Institute intervention entails five therapy sessions that prepare the client and his or her family members for a family confrontation meeting."

One study compared Community Reinforcement Approach and Family Training (CRAFT), Al-Anon facilitation therapy designed to encourage involvement in the 12-step program, and a Johnson intervention and found that all of these approaches were associated with similar improvements in concerned significant other functioning and improvements in their relationship quality with the addicted person. However, the CRAFT approach was more effective in engaging initially unmotivated problem drinkers in treatment (64%) as compared with the Al-Anon (13%) and Johnson interventions (30%).

Civil liberty and forcible intervention

Sometimes direct interventions involve physical force (for example, by family members or friends) to capture or confine the targeted person. In such cases the intervention may be illegal because it deprives the person of liberty without due process of law.

In popular culture

Real-life interventions

Film and television

• The A&E television series, Intervention, follows participants who have addictions or other mentally and/or physically damaging problems, in anticipation of an intervention by family and/or friends. Each participant is given a choice: go into rehabilitation immediately, or risk losing contact, income, or other privileges from the loved ones who instigated the intervention.
• The Bravo TV reality show, Thintervention, follows American fitness trainer Jackie Warner as she helps a group of eight clients lose weight. Warner's clients receive psychological, nutritional, and lifestyle counseling in addition to physical fitness training.

Literature

• Faye Resnick reveals in the book Nicole Brown Simpson: The Private Diary of a Life Interrupted (1994), which she co-wrote with Mike Walker, gossip columnist for The National Enquirer, that she learned about Brown's murder three days after Brown and her friends forced Resnick to enter a rehab clinic for substance use disorders.

Fictional interventions

Film and television

• In the "Private Practice" episode "Who We Are" (Season 5, Episode 8), the Seaside Wellness group stages an intervention for a defensive and volatile Amelia, who has resurfaced after disappearing on a 12-day drug binge with her boyfriend, Ryan. During the intervention, Amelia mercilessly attacks her friends one-by-one, and Addison, in particular, has trouble seeing her sister-in-law in her present condition.
• In the Party of Five episode "The Intervention" (Season 3, Episode 20), the Salingers hold an intervention for Bailey to confront him about his drinking problem, but he refuses to admit his problem and refuses to seek treatment, so Claudia threatens to disown him unless he gets help.
• In the 7th Heaven episode Bye (Season 5, Episode 7), the Camdens hold an intervention for Mary to confront her for hanging out with her pot smoking friends, underage drinking, losing jobs, and stealing money from Sam and David to pay her bills. Eric and Annie decide to send her to Buffalo to live with her grandparents.
• In The Sopranos episode, "The Strong, Silent Type" (Season 4, Episode 49), Tony Soprano organizes a drug intervention for heroin addict, Christopher Moltisanti.
• In the How I Met Your Mother episode, "Intervention" (Season 4, Episode 4), different interventions happen for various reasons, like magic for Barney Stinson, the English accent for Lily Aldrin, spray tan for Robin Scherbatsky, Marshall Eriksen's Seussian hat and Ted Mosby's fiancé. These are all accompanied by the character in question entering the apartment and finding the rest of the group standing underneath a banner which reads Intervention. As the interventions themselves become increasingly overdone and ridiculous, the group decide to stage an 'intervention intervention' to stop the practice. However, a number of subsequent episodes have reused the intervention banner and motif as a running gag, often when a character behaves ridiculously or obsessively.
• In The Office (US) episode “Moroccan Christmas” (Season 5, Episode 83), Meredith's coworkers arrange an intervention about her drinking after her hair catches fire due to her drunkenness. Afterward, Michael attempts to force her to enter rehab, only to find that he cannot legally do so.
• In the Arrested Development Pilot, the Bluth family arranges an intervention for Michael, which he found to be more of an imposition. A later episode features a flashback for an attempted intervention for Bluth matriarch Lucille, which is ineffective when the rest of the family gets drunk to prepare for it.
• The comedy film But I'm a Cheerleader is about a high-school girl that is sent to a residential inpatient reparative therapy camp to cure her "lesbianism".
• In the Are you there, Chelsea? episode, "The Foodie" (Season 1, Episode 10), Chelsea's friends arranges an intervention for her.
• In the Seinfeld episode, "The Pez Dispenser" (Season 3, Episode 14), Jerry hosts an intervention for an old friend with a drug problem.
• In the Family Guy episode, "Screams of Silence: The Story of Brenda Q" (Season 10, Episode 3), Glenn Quagmire hosts an intervention for his sister Brenda who refuses to acknowledge her boyfriend Jeffrey Fecalman's domestic violence.
• In the South Park episode, "Fat Camp" (Season 4, Episode 15), Eric Cartman is confronted by his mother Liane, his teacher Mr. Garrison, school counselor Mr. Mackey, the Marshes, the Broflovskis, and Dr. Doctor about his weight issues and have him sent to a weight loss retreat.
• A Season 5 episode of It's Always Sunny in Philadelphia centres on the gang's attempt to stage an intervention on Frank because they feel it's no longer fun to drink with him.
• In ER, after John Carter and Lucy Knight were stabbed, Lucy died. Carter eventually became addicted to drugs to control his pain and his workplace colleagues staged an intervention. They told him to go to rehab or he would lose his job. At first, Carter was resistant because he believed everyone thought he was using pain killers but he eventually relented and entered drug rehab.
• In an episode of The Big Bang Theory, Leonard, Penny, Wolowitz and Koothrapali stage an intervention in order to force Sheldon (who doesn't drive) to get his learner's permit because they are all tired of having to drive Sheldon everywhere he wants to go.

Literature

• There is a good-humoured account of a well-meant but perhaps misplaced intervention in Jayne Ann Krentz's All Night Long. The family of the protagonist (Luke) want him to abandon his "destructive" writer-lifestyle and return to the family business. Irene, his new partner, only learns of the intervention at breakfast, after it has already begun.
• In James Joyce's short story "Grace", from his collection Dubliners, the alcoholic Tom Kernan is confronted by three of his friends and persuaded to take part in a religious retreat.
• In the Malcolm in the Middle episode Vacation/Casino, Francis' friend Richie is unable to attend a party Francis is throwing because he is undergoing an intervention by his family.

See also

• Community Reinforcement Approach and Family Training (CRAFT)
• Drug Interventions Programme
• Duluth Domestic Abuse Intervention Project
• Exit counseling
• List of counseling topics

References

Notes

External links

• Intervention Guide Includes letter writing worksheet and how to handle objections.
• Addiction Intervention Guide for Families (from a conservative Protestant perspective)