Problem Gambling Treatment: Family & Finances

1. Problem Gambling Treatment: Family & Finances Joanna Franklin MS NCGC II Maryland Center of Excellence on Problem Gambling University of Maryland School of Medicine Jfranklin.ipg@gmail.com www.MdProblemGambling.com

2. Children of Pathological Gamblers • High School Youth with a problem gambling parent were more likely to report: • Abusing stimulant drugs • Overeating • Describe childhood as unhappy • Be depressed or Suicidal • Have legal action pending (Jacobs 1989) • More likely to have a gambling problem themselves (Lesieur and Klein 1987)

3. Children of Problem Gamblers • 8-10 other people are affected by every pathological gambler. (Lobsinger & Beckett, 1996) • Consequences include but are not limited to: • Financial losses • Communication problems • Trust Issues • Chronic lying • Legal problems • Domestic violence (23-40% - Gerstein et al 1999 and Bland, Newman, Orn & Stebelsky 1993)

4. Family Treatment Issues • Monitor levels of conflict • Assertiveness and Communication Skills Training • *Coaching on financial issues and decision making • May need money manager outside of family • Treat within the context of the Culture.

5. Family Treatment Issues • Assess need for individual counseling for family members • Time for expressing anger, fear, distrust • Specific counseling around abuse/violence • Facilitate discussion around issues of separation/divorce • Counseling on limit setting, detaching with love

6. Family Treatment Issues • Education • On comorbid psychopathology and risk factors as well as pathological gambling • Coping with suicidality • Interaction of gambling progression and psychopathology • Maintaining personal as well as financial safety for family • PG as potentially recurring, chronic disorder

7. Family Treatment Issues • Dealing with Toxic Anger • Control v. Involvement (limit setting with family members) • Family pathology often severe • Family offers little or no support • No local self-help resources • Family pathology and money management- need for financial safety

8. Family Treatment Issues • Help family understand shared dynamics/pathology • Listening/Communication skills • Here and Now orientation • Maintaining adult ego state • Conflict Resolution and Problem Solving skills

9. Treatment Issues • Final Assessment • Discussion of relapse warning signs • How can family provide feedback • How can gambler listen to feedback • Gambler’s and family members’ triggers

10. Integrative Behavioral Couples Therapy IBCT • (Jacobson & Christensen 1996, 2001) suggests: • Regularly discuss differences between the couple- this is to reinforce seeing the problem as an “it.” • 2. Discuss upcoming events in light of their differences anticipating potential conflicts. • 3. Therapist and couple would process recent negative events with empathic joining to diminish negative feelings around unpleasant exchanges. • 4. Process positive events reinforcing how each contributes through tolerance and acceptance of each other’s difference.

11. IBCT & Family Gambling Treatment Couples seem to abandon quickly precise, clearly operationalized strategies so carefully taught. (Jacobson & Christensen 1996) Data analysis indicates behavioral change can only go so far. People have a limited capacity to change. Successful intimate relationships exhibit a high degree of tolerance. Developed the paradox of acceptance and change-we change best when we feel accepted. Rather than teaching an array of artificial communication techniques, wouldn’t make more sense to teach strategies that felt natural.

12. IBCT Family Treatment • Present the couple with a formulation of how things got the way they are. • A tentative hypothesis for which the couple provides feedback • Provides a tool for empathic joining- problem is the “it”, not him or her, or him and him, or her and her. • Polarization vs. acceptance: each tries to change the other, digs in heels, acts out, control battles…

13. Financial Management Issues: • The Budget vs. Asset Protection Plan • G.A. Pressure Relief Group • List of all debts and creditors • List monthly expenses • List of all income and assets • Prepare the Plan • Restitution • Money Management

14. Assessing Debt

15. Defining Asset Protection Plan

16. Defining Monthly Expenses

17. Other Personal/Emotional Debts

18. Money Protection Plan • Case examples – Sally • 58 year old, school teacher • Depleted savings, owes $10,000 on credit cards, cashed in insurance policies, bad checks • She has always managed finances • Husband very angry, very controlling, relationship marked by power struggles • Children live out of state, but very supportive • Has close friend who is recovering alcoholic and wants to be supportive • Husband’s brother is financial planner

19. IBCT Family Treatment • Caution: • Over-predicting of negative consequences • Catastrophizing crisis circumstances-believing “I can’t cope.” • Anger as a defense against re-victimization • Self-blame for gambling behavior • Response: • Cost-benefit analysis • Concrete examination of resources • Anger reduction techniques- alternative defenses, focus on self and personal growth. • Challenge “character” conclusions about self

20. Treatment Resources: Counseling the Problem Gambler: A Self Regulation Manual Joseph Ciarrocchi PhD. Pathological Gambling: Eitology, Comorbidity and Treatment. Nancy Petry PhD Don’t Leave it to Chance . E.J. Federman, C.E.Drebing & C. Krebs. Losing Your Shirt. M. Heineman Behind the 8 Ball. L. Berman & M.E. Siegel. Personal Financial Strategies for the Loved Ones of Problem Gamblers.National Endowment for Financial Education and National Council on Problem Gambling. Gamblers Anonymous Pressure Relief Workbook www.Gamblersanonymous.org