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 an addiction or some kind of traumatic event or crisis, or other serious problem. The term intervention is generally used when the traumatic event involves addiction to drugs or other items. 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 alcoholism, compulsive gambling, drug abuse, 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 four major models of intervention in use today: the Johnson Model, the Arise Model, the RAAD 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 RAAD model focuses on using positive psychology and setting up the scene and removing barriers prior to the actual in person intervention. It uses Active listening and open ended questions in a sales process that puts the client in the drivers seat to make an educated decision. The process is quicker (5 hours) and creates less resistance on the part of the client.

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 addict's continued abuse 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 drug or alcohol abuser. Whether it is invitation model or direct model, the abuser is not included in the decision making process for planning the intervention. A properly conducted direct intervention is planned through cooperation between the identified abuser's family or friends and an intervention counselor, coordinator, or educator. It is important to perform the intervention in an open, large space so as to reassure the abuser 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'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 addict that they will no longer tolerate, finance, or participate in if the addict does not agree to check into a rehabilitation center for treatment. These consequences may be as simple as no longer loaning money to the addict, but can be far more serious, such as losing custody of a child.

Family and friends read their letters to the addict, 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 addicts 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 addict. 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 drug and alcohol abuse.

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 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.
• 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.

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)