Table 3.

Themes from Any Family Meeting

Themes	Examples
1. Assessment and Structuring     a. Decisions regarding who belongs      in the meeting and how to engage      those family members. Decision      to include the patient in the      meeting.	“…this foundation (is) missing for some people and there needs to be a family meeting, and where that family should be, and who is the family that should be coming to meetings”
b. Stress the importance of the      family meeting and schedule      early in the admission	“I think the importance is to relate to the family how important that family meeting is. I think it should be discussed almost immediately at the time of admission” “If that family meeting is occurring the day before discharge it’s kind of almost too late at that point”
c. Defining goals of the meeting;      List of possible topics to address-      what are the family and patient      priorities	“I just remember going into a family meeting and not having any idea of what it was going to accomplish, or what its intent, outcome was expected to be” “Send an email to me saying like, in the next forty-eight hours she was going to schedule a family meeting and that it was going to address A,B,C,D, and E” “…I’ve gone to a lot of meetings, and usually the meeting that I go to where I get some material beforehand, not a lot of material but a little bit that kind of prepares me for the meeting- those meetings go better usually, because people are much better prepared to participate in them”
d. Family members’ current      understanding of addiction, first      time or prior experiences and      knowledge base	“In terms of family meetings and things, it seems that very different things have to happen at first, second, or third, whatever and where they’re coming from and where they’re going to… But it does have to focus on education of the family member at that point where they are in the understanding of addiction of their loved one”
e. Define realistic expectations of      the current admission/treatment      episode     f. Begin aftercare planning	“And (define) what our expectation should be from detox, versus a thirty-day program, and start that aftercare treatment discussion immediately
2. Counseling Style     a. Honest and direct     b. Candor and Sophistication     c. Empathic and appreciative	“…you need to be brutally honest” “Because it’s (addiction) definitely a long-term, possibly chronic situation. It seems like candor and knowledge, it’s really important in a very sophisticated way, in an encouraging way, present it in an encouraging way as opposed to maybe being harsh about it.”
d. Avoid discussion of the     following:       i. Money       ii. The past	“I don’t want to talk about who carries the freight, I don’t want to talk about what this is costing… I don’t want to talk about insurance…” “I wouldn’t want to talk about the past; I would want to talk about what to do this afternoon, tonight, tomorrow, the next week, and forget what happened… with the health care professional, you don’t want to waste time with that”
iii. Blame or disappointment	“Don’t get into the blame game because that is counterproductive”
e. Avoid stigmatizing language- like      ‘addict’	“Avoid the use of terms like addict, treatment, recovery, whatever, which are stigmatizing in their nature”
f. Avoid family therapy issues- stick    to the agenda	“….Know your boundaries when you’re in that family meeting. Sometimes our patients can be going through a lot of whatever and want to turn it on (the family) …. (it’s important) to have that clinician keep directing it back to the patient and that’s why we’re here”