Rosemary Hilbert

 The primary purpose of this section is to explore some of the issues the counsellor will identify when working with the problem gambler. However, because identification and treatment are so closely connected, it seems logical to provide a brief overview of some of the family treatment formats that have been developed. Educational, supportive groups tend to be structured and offered in six to 12 sessions. A program for families of gamblers only would be ideal. Some treatment centres offer a two-day or weekend program designed originally for families of substance abusers, and have found that family members of gamblers have found the information relevant to them.

Topics may include:

• What Is Gambling and How Does Problem Gambling Develop?
• The Risk Continuum
• Self-Care and Coping Behaviours
• Boundaries
• How Change Occurs (The Stages of Change)*
• Coping with Intense Feelings
• Cognitive Distortions Regarding Gambling
• Money, Credit, Debt, Bail-outs
• Legal Responsibilities
• Discussing Financial Issues with the Gambler
• Relapse: Understanding the Concept of Relapse
• Debt as a Trigger for the Gambler to Lapse

*The Stages of Change may seem an unlikely topic for a family group, yet understanding that change is a process of many steps can be useful in helping the spouse to answer the question: “Why don’t they just stop gambling?” Understanding that change is reinforced by support and reward may also influence the spouse’s actions during the difficult phase of early recovery.

Relapse prevention and the family
There are many reasons why gamblers and family members are frequently reluctant to discuss relapse prevention.

• If there has been recent positive change in the gambling behaviour, the spouse may wish to avoid “hexing” the success by talking about the possibility of relapse.
• The spouse may remember arguments that developed when she asked if her spouse had returned to gambling.
• Perhaps there were many promises made to quit gambling. Those promises were repeatedly broken and now she shrugs with a gesture of hopelessness and believes no real change can occur. She focuses on protecting herself from further hurt and withholds any reward or reinforcement for the gambler’s attempts to change.

The spouse may have already given an ultimatum: if there is one more episode of gambling, the relationship is over.

In counselling, the couple learns that the risk of relapsing is reduced if triggers or high-risk situations are identified and alternative strategies and coping behaviours are developed in advance. The role of social support and reinforcement in reducing relapse is also important.

Barbara McCrady (1989) has explored the role of the spouse in relapse prevention. Her research focused on couples where the problem was alcohol, not problem gambling, but the model is transferable to family members of problem gamblers.

Some counsellors have found that encouraging the spouse to remember a personal experience of relapse has increased their understanding of the gambler’s urges and risk to relapse. Have they ever tried to quit smoking? Or dropped out of an exercise program? The Avoiding Relapse exercise can be used by the spouse to develop the awareness of triggers to relapse and coping strategies employed by the gambler. Encourage the couple to work together on the exercise. Improved communication can result. The spouse is not responsible for the gambling, or the changed behaviour, but the spouse does have a role to play in supporting the gambler’s positive responses. She can focus on her own cognitive and behavioural reactions, knowing that her reaction may reduce or prevent the likelihood of relapses. The parent of the young gambler and the son or daughter of the senior gambler can also benefit from this exercise.

Developing a Treatment Program for Couples

Ganzer (1999) has described a structured program designed for the treatment of problem gamblers and their spouses. Problems and attitudes brought to the counselling by the gamblers were:

• denial that the gambling was a serious problem
• financial debt
• lack of honesty
• overconfidence
• gambler’s fear of losing spouse
• gambler’s grandiosity and narcissism.

This program was offered to couples in a group format. Topics presented and discussed in group include:

• anger
• lack of trust
• sexual dysfunction
• lack of intimacy
• lack of spirituality
• criticizing or blaming.

Improving communication skills and giving the couple permission to accept their feelings may be a beginning for some couples. As referenced earlier, Steinberg (1993) also provides the outline of a program for couples.

Capacity Building and Providing Culturally Sensitive Counselling to Your Clients

In many cultures, people turn to their physician or the priest or minister for information and advice. Seeking help at a community agency would be strange and uncomfortable. As your agency develops community networks, recognize key people who may have already identified gambling problems in their communities. Teachers, clergy and physicians may be important referral partners. Or, recognizing that you will never be able to provide the special needs of all problem gamblers and their families, you may be in a position of capacity building; that is, you educate and encourage trusted community people to assist the families while you act as consultant.

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