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CASE STUDY
"Father Brian"
Transitioning from Residential Treatment

Steven Alexander, Ph.D. is a case manager/therapist at Saint Luke Institute.

"Fr. Brian" is fifty-three years old, and has been pastor for five years of a church with 800 households. He is generally well-liked and respected by both parishioners and fellow clergy. Nearly a year ago, however, those around him began to notice uncharacteristic behaviors, including moodiness, agitation, and rarely seen displays of temper. At first, his Spiritual Director and those close to him attributed his changed demeanor to the unexpected death of his brother four months earlier.

Fr. Brian also framed the problem in these terms and asked for the patience and understanding of others. Only weeks later, following several angry outbursts directed towards his "incompetent" staff, did Fr. Brian acknowledge to his Spiritual Director that he was drinking excessively and felt on the "verge of a nervous breakdown." He was referred to Saint Luke Institute (SLI) for assessment, and was diagnosed with a Major Depressive Disorder and Alcohol Dependence. During the assessment Fr. Brian admitted that his drinking "may have been out of control" many times over the past twenty-five years, especially during periods of high stress. Yet, he also took great pride in the belief that he had continued to function outwardly at a high level, never seeking nor being referred for additional help. In fact, Fr. Brian was now experiencing a great deal of shame that his pain had been "so publicly expressed" and that he had failed to keep up with the demands of his work. He also felt that he had "let the parish down."

Disposition:
Fr. Brian was recommended for residential treatment where, during a six month stay at SLI, he ultimately worked on many of his issues, including the layers of grief triggered by the death of his brother. While special attention to any transition from intensive treatment back into community life is always critical, Fr. Brian's situation made him a good candidate for an even more gradual transition program, so he was referred from residential treatment to Halfway House (HWH) care. This was especially true in light of his many years of undiagnosed alcoholism, attendant potential for relapse related to past reticence to seek help, and his greater than usual fear about managing the transition back to ministry - even after completing the residential component of treatment. Fr. Brian's stated goals upon entering HWH were to consolidate therapy gains and to receive more assistance in returning to parish work. Nearing his scheduled discharge from HWH, however, fear and self-doubt about the transition once again surfaced, albeit to a somewhat lesser degree than previously. He expressed concern regarding how he would cope with the reduced structure in his life, and had remaining questions about whether he could manage the workload. Major concerns also focused on a renewed fear that he might relapse into drinking again if the stress became "too much to tolerate" as it had prior to referral for treatment.

Generalizing Treatment Gains:
Fr. Brian's worry that his recovery could be jeopardized by return to the same environment where he had difficulties is a common source of concern for someone coping with an addiction and imminent discharge from treatment. This issue, generalizability of treatment, was a real and valid concern of the treatment team as well. Several programmatic components of treatment at SLI are specifically aimed at addressing this issue.

During the residential aspect of his treatment, for instance, there was an ongoing effort to help Fr. Brian build upon individual and group psychotherapy gains through improved insight into the cause and triggers of problem behaviors, the development of better coping strategies, and generally gaining comfort with the experience of receiving emotional help. Additionally, support relating to Fr. Brian's spiritual life and physical well-being were of great importance in his recovery process. Once he became more comfortable discussing and working through personal issues in therapy and in spiritual direction, he also came to rely on this type of structured support. Ironically, this new dynamic may have played a role in the level of fear he experienced at each stage of transition in treatment. Towards the end of residential treatment a document called the Continuing Care Contract, which details a cooperative plan for ongoing monitoring and psychological follow-up over the course of several years, was also designed to address specifically treatment generalization. For Fr. Brian, HWH served as an additional, transition vehicle which more closely approximated his return to less structure at the parish. While some individuals may not require this type of step-down support, evaluating unique needs is an important aspect of making sure treatment generalizes as well as possible.

In addition to easing back into a work regime via volunteer work experiences, Fr. Brian's continued therapeutic work in HWH included learning to ask that his needs be met (e.g., practicing assertiveness in asking to meet with his Bishop for an extra discharge planning session); building in more healthy parameters regarding work structure (reduced hours/duties initially); implementing the solid support structure initially laid out in the Continuing Care Contract (planning to attend home-based AA groups, making initial telephone contact with core support people in home community, and adding other positive connections while terminating emotionally destructive ones); and, dealing with feelings of shame/embarrassment associated with his absence from ministry (making a plan for speaking with parishioners upon return).

Within this context, it is important to note that ongoing communication between Fr. Brian, his Bishop, Director of Personnel, and his treatment team at SLI ultimately helped to assuage much of his anticipatory anxiety around leaving the HWH, and paved the way for maximum recovery back in the community where he continues his life and ministry in a parish.

LUKENOTES is a bimonthly publication of Saint Luke Institute.
Permission to use these materials must be requested in writing by contacting
lukenotes@sli.org

SLI EDUCATION DEPARTMENT
Saint Luke Institute
8901 New Hampshire Ave.
Silver Spring, MD 20903
(301) 422-5499 • (301) 422-5519 (fax)

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