APPENDICES
APPENDIX A DESCRIPTION OF CHARACTERS
The following characters will be used for role-playing of Network Therapy situations in weeks two, three, four, six and eight of the course.
Adelle
a 35 year old single moderately successful New York stage actress. She has had a problem with Cocaine, Alcohol and Valium on and off since her college years. For the past four months, since she lost an important job, she has been drinking in an uncontrolled manner. She has been drinking vodka throughout the day. This has caused her to miss several important auditions and has aroused the concern of her friends. This prompts her friend Jan to call you regarding Adelle.
Jan
Adelle's best friend. She is a 34 year old aspiring actress who usually takes comic roles. An occasional social drinker, she has been very concerned about Adelle. Adelle's behavior reminds her in part of her own mother's alcoholic behavior.
Potential network members:
Arthur
Adelle's fiancé. He is a supportive and warm person who, in the past four months, has eliminated his social drinking because of his feelings concerning Adelle's out of control behavior. He, however, does enjoy snorting cocaine while having sex.
Robert
Adelle's uncle who is a bar owner. He maintains that he is a moderate social drinker claiming that he always limits himself to three martinis. He neglects to tell you that these are served in seven eleven super-slurp glasses. His favorite bedtime reading, when he makes it to the bedroom is Mr. Boston's cocktail book.
Joseph
A moderately successful director. He has directed Adelle in numerous shows and has been increasingly upset by her erratic and mercurial behavior.
Fred
Adelle's next door neighbor and close friend for the past ten years. He is a 65 year old retiree who is concerned about his friend. He is a teetotaler since beginning a hypertensive regimen two years ago.
Loretta
Adelle's chief rival in the theater. While a fixture in Adelle's life she is far from supportive and has been the chief beneficiary of Adelle's problems in her work. A cross between Faye Dunaway and a rattle snake.
Jonathan
Adelle's younger brother. He is a very supportive person but his job as a international corporate council takes him far from home often.
Pauline
Adelle's mother. She is a 60 year old pediatrician, the recent recipient of the Virginia Apgar award, and 20 years ago received the PTA Mother of the Year Award. She speaks to Adelle on a weekly basis. While career focussed in Adelle's early years, she has been recently been quite concerned about Adelle. Her first husband Alex, Adelle's father, died 10 years ago in a drowning accident under mysterious conditions with small amounts of heroine and cocaine found in his blood. Pauline re-married 5 years ago to Sheldon, a retired engineer for NASA. He has 4 grown children from his first wife.
APPENDIX B ROLE PLAY SCENARIOS
The following scenarios will be used for role-playing of Network Therapy situations in weeks two, three, four, six and eight of the course.
Building the Network:
You are a therapist known for your talents in Network Therapy. You receive a phone call from Jan (described above) who is concerned about her friend Adelle who has been drinking heavily. In this scene you should set up an appointment and ensure that Adelle will get there sober.
Building the Network II:
Adelle and Jan arrive. In this scene you should take a history and begin evaluating the potential network members (described above). In addition the topic of Antabuse ought to be discussed.
Securing and Maintaining Sobriety:
This is the first meeting of the entire Network. It is the job of the therapist to get the patient to take Antabuse and to instruct her about this. In addition her compliance needs to be secured. With the entire group discuss what situations might be particularly difficult. In addition plans for her treatment including the role of outside programs such as AA should be discussed.
Maintaining Abstinence:
Adelle has now been sober for the past three months. Discuss certain issues that may be difficult for her. Improvise but here are several examples.
Robert, her uncle invited her to a dinner party. At the dinner party the cocktail hour lasted for three hours and Seagrams stock jumped five points.
Robert Goulet invited her to breakfast and was insistent that she drink mimosas with him.
On an out of town production of "The life of Robert Goulet--a multimedia extravaganza," Adelle did not have anyone to observe her taking her Antabuse.
Maintaining Abstinence (cont.):
On an out of town audition Adelle "forgot" to take her Antabuse along with her.
Adelle had several auditions none of which went well. In one she was asked to dress in a cod piece and antlers and sing the Barney song over and over. While she feels ambivalently about not getting the part, in years past she would have commiserated with her friends over a bottle of Vodka.
After three months of regular attendance at AA Adelle has begun to resent the authoritarian nature of the program and she has missed several of her regular meetings.
Securing Future Behavior:
It has now been one year of sobriety for Adelle. She is currently the lead in a smash Broadway revival of the musical Carrie. She would now like to resume social drinking and maintains that for many years she was able to handle moderate drinking and that her out of control episode only lasted four months.
APPENDIX C NETWORK THERAPY RATINGS SCALE
This scale can be used to rate the degree to which a learner can perform Network Therapy by engaging in role-play scenarios. An adequate score is equal to an average of three(3) or above on the first ten items, and an average of two (2) or below on the second ten items.
TRAINEES NAME ______________________________________ DATE ______________
Please use the scale below to rate the extent to which the therapist engages in the following behaviors with those present:
1=Not at all 2 = A little 3 = Somewhat 4 = Considerably 5 = Extensively
1. ELICITS RELEVANT SUBSTANCE ABUSE HISTORY [ ] of patient's use and efforts at abstinence, from those present 2. PROMOTES COHESIVENESS [ ] by encouraging team work and diffusing interpersonal conflict among members 3. SUPPORTS GROUP STABILITY [ ] e.g., fosters regular attendance, permits telephone participation 4. FOSTERS A SUPPORTIVE MILIEU [ ] through tactful support of valuable ideas and avoidance of extraneous or divisive material 5. FOCUSES ON ABSTINENCE [ ] e.g., alerts those present to role of conditioned cues, risky situations, etc. 6. EXPLORES CRAVING AND CUES [ ] of relapses, slips, or near slips with patient and others in session 7. PROBLEM SOLVING TO PREVENT RELAPSE [ ] e.g., gets those present to brainstorm ideas for patient to avoid or safely encounter cues and risky situations 8. PROMOTES SUPPORTIVE MONITORING [ ] e.g., Antabuse observation, money control, facilitation of outpatient detox 9. DEVELOPS A PLAN TO AVOID RELAPSE [ ] helps patient and others establish strategies based on cue identification, problem solving, etc. 10. PROMOTES SUPPORTIVE PRESSURE [ ] engages those present to pressure patient to cut off ties to drugs, drug-using friends, etc. 11. FOCUSES ON PATIENT'S UNCONSCIOUS [ ] motivations, resistances, conflicts 12. FOCUSES ON OTHER MEMBERS' UNCONSCIOUS [ ] motivations, resistances, conflicts 13. INTERPRETS TRANSFERENCE REACTIONS [ ] of patient or other members to the therapist 14. FOCUSES ON OR INTERPRETS INTERPERSONAL DYNAMICS [ ] among those present in the session 15. FOCUSES ON OR INTERPRETS FAMILY DYNAMICS [ ] rather than patient's drug use per se 16. FOCUSES ON OR INTERPRETS CO-DEPENDENCY [ ] in attitudes and behaviors of those present 17. ACTIVELY RESTRUCTURES FAMILY RELATIONSHIPS [ ] 18. FOCUSES ON OR INTERPRETS ENABLING [ ] 19. FOCUSES ON OR INTERPRETS FAMILY COMMUNICATIONAL STYLE [ ] instead of patient's drug use 20. FOCUSES ON ISSUES OTHER THAN ABSTINENCE [ ]
