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 often 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 most often used when the traumatic event involves addiction to drugs or other items. Intervention can also refer to the act of using a technique within a therapy session.

Interventions have been used to address serious personal problems, including, but not limited to, alcoholism, compulsive gambling, drug abuse, compulsive eating and other eating disorders, self-mutilation, tobacco smoking, "workaholism", and various types of poor personal health care. Interventions have also been conducted due to personal habits not as frequently considered seriously harmful, such as video game addiction, excessive computer use, and excessive television viewing.

Direct and indirect interventions

Interventions are either direct, typically involving a confrontational meeting with the alcohol or other drug dependent person (the most typical type of intervention) or indirect, involving work with a co-dependent family to encourage them to be more effective in helping the addicted individual.

The use of interventions originated in 1960s with Dr. Vernon Johnson. The Johnson Model was subsequently taught years later at the Johnson Institute. There are some pockets of thought within the substance abuse treatment and intervention industry that the un-informed alcohol or drug dependent person is negatively affected by so-called "ambush" inherent in the Johnson Model direct intervention. However, beyond anecdotal evidence, there are no scientific studies which confirm that theory.

Two of the major models of intervention that are utilized today are known the Systemic Family Model and the A.R.I.S.E. model of intervention. While the A.R.I.S.E utilizes a predominantly invitational approach, in practice many of the same aspects of the Johnson Model are used. Systemic Family Model interventions may use an invitational approach but often utilize the direct approach. Both models rely heavily on having the family as a whole enter a phase of recovery. This helps take the focus off the addicted individual and notes the need for the entire family unit to change in an effort for everyone who is involved to get healthy.

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. Ample time must be given to the specific situation, however, basic guidelines can be followed in the intervention planning process. (Note that an intervention can also be conducted in the workplace with colleagues and with no family present.)

Prior preparation

Prior to the intervention itself, 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.

Controversy

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.

This study however, is outdated and is inherently flawed. An outpatient treatment center is the incorrect level of care for a vast majority of intervention patients. The very nature of outpatient treatment assumes a high level of willingness from the patient to engage in treatment. While an intervention does raise the willingness of the patient for the short term, that willingness often wanes within a short period of time. If the patient is not referred to a residential center away from the triggers and temptations of his home environment, he is at an extremely high risk for relapse. An intervention patient should be under the care of counselors and therapists who understand his or her specific psycho-social profile, unique to intervention patients, and should receive that care in a residential setting.

More research needs to be done in the area of long term effectiveness of pre-treatment interventions specific to drug and alcohol abusers.

Civil liberty problems with forcible intervention

Sometimes direct interventions involve physical force (e.g. by family members or friends) to capture or confine the targeted person. Typically a government-licensed psychotherapist is involved. Indeed, the government's involvement prevents the intervention from comprising a crime, such as battery or kidnapping. In such cases the person has (usually) neither been served with any legal action alleging the necessity of intervention, nor had the opportunity to appear in court to defend against the proposed intervention. Civil libertarians argue that in such cases the intervention may be illegal because it deprives the person of liberty without due process of law.

Interventions in popular culture

True-life interventions

In 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.
• The comedy movie But I'm a Cheerleader is about a high-school girl that been sent to a residential inpatient reparative therapy camp to cure her lesbianism.
• In the movie The Dilemma the characters hold a intervention for the main character.
• In Hop Fred O'Hara's family holds an intervention for him as he still lives with his parents.

In literature

• Faye Resnick reveals in the book Nicole Brown Simpson: The Private Diary of a Life Interrupted (1994), which she co-wrote with gossip columnist for The National Enquirer, Mike Walker), 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

In film and television

• In The Sopranos episode, "The Strong, Silent Type" (Season 4, Episode 49), Tony Soprano organizes a drug intervention for heroin addict, Christopher Moltisanti.
• In "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 fiance.
• In The Office (U.S.) 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 popular literature

There is a good-humoured account of a well-meant but perhaps misplaced intervention in Jayne Ann Krentz, 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.

See also

• Drug Interventions Programme
• Duluth Domestic Abuse Intervention Project
• Exit counseling
• List of counseling topics

External links

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