Could this be the same Minnesota Model? Is Gunderuplund still open or closed?
Confrontation in the Minnesota ModelSource:
http://www.counselormagazine.com/content/view/608/63Found, 6th heading down.
In the late 1940s and early 1950s, a synergy between three alcoholism treatment programs — Pioneer House, Hazelden and Willmar State Hospital —birthed an approach to the treatment of chemical dependency that was widely replicated in the following decades. Confrontation was not a technique used within the original Minnesota Model, but was gradually introduced in stages. The first stage was the emergence of “tough love” — a concept from Al-Anon that when interpreted within the treatment context, argued that the alcoholic needed to be confronted directly about his or her behavior and held accountable for the consequences of that behavior. An important corollary was the concept of “enabling.” This concept depicted well-intentioned attitudes and behaviors exhibited by those around the alcoholic that, by protecting the alcoholic from the consequences of his or her behavior, inadvertently sustained the alcoholic’s drinking and related problems.
While the concepts of tough love and enabling eased the way for the introduction of confrontation techniques, it is surprising that group confrontation would emerge within a model of treatment so heavily influenced by AA. AA and the peer-based lay psychotherapy models that preceded it were distinctly non-confrontational, with AA even discouraging crosstalk at its meetings. In the AA meeting culture of the 1930s and 1940s, members did not provide direct feedback or advice to one another, but responded to any disclosure by sharing their own related experience. Confrontational therapies are clearly not rooted in the origins and core literature of AA .
Confrontational techniques emerged within Hazelden as staff sought new ways to engage and manage a subset of clients they perceived as having severe characterological problems. In the late 1960s Hazelden began treating younger opiate and polydrug addicts whose behaviors were harder to manage within the treatment milieu. Seeking solutions to this dilemma led Hazelden staff to visit Eagleville Hospital in Pennsylvania which was pioneering “combined treatment” (integrated treatment of alcoholics and addicts). Eagleville had emulated the confrontation techniques of Synanon, Daytop and other early TCs and became the conduit for introducing these techniques at Hazelden. Openness to such confrontation techniques at Hazelden came in part from working with addicts who were perceived as “sicker” and harder to reach.
In 1967, Hazelden started a “Repeaters’ Program” and began using a peer evaluation (“hot seat”) technique within the group therapy session on this unit. In this technique, a member of the group occupied a center chair within the group, and his/her attitudes and behaviors were critiqued by other group members using an inventory sheet of 23 items, 22 of which were character defects; e.g., resentful, prideful. By the mid-1970s, the use of the “hot seat” technique had spread to all units at Hazelden and commonly included the use of derogatory language and labels. This technique was spread into the larger field by former Hazelden staff and the large numbers of people who received training at Hazelden.
In the late 1970s, the use of confrontation was re-evaluated at Hazelden. The use of the “hot seat” in the women’s units was stopped when it came to be viewed as too harsh and disrespectful. The use of confrontation on the men’s units also changed. A new inventory was integrated into the peer evaluation process that included character assets, and the person being evaluated was moved from a center chair to a chair within the group to reduce his or her vulnerability. To emphasize this change, the “hot seat” was re-
christened the “love seat” and an emphasis was placed on the use of “compassionate confrontation.” By 1985, Hazelden was already describing confrontational counseling as a thing of the past:
There was a time when the dominant mode of chemical dependency treatment was based on a “tear ‘em down to build ‘em up” philosophy. . . Counseling sessions sounded disrespectful and dehumanizing. And they were . . . Patients . . don’t need to be “put down” to deal with symptoms . . they need to be treated as individuals, with the same rights and respect we expect for ourselves. We’re concerned because many treatment programs still use these confrontational techniques. Some even call themselves Hazelden or Minnesota models. It’s true that we once used confrontation. But we found a better way (Hazelden Foundation, 1985).
Through the 1980s and 1990s, the emotional tone of treatment within the Minnesota Model further changed from a harsh challenging of the person to a respectful process of inquiry about incongruity of a person’s words or behaviors (e.g., using clarifying questions in response to discrepancies between what a person said yesterday versus what he or she is saying today; what a person reports versus what his or her family members report; and discrepancies between a person’s words and his or her behavior). Profane confrontations came to be viewed as disrespectful, ineffective and professionally inappropriate. The earlier emphasis on personal confrontation by professional staff or one’s treatment peers shifted in these decades to a preference for self-education (bibliotherapy); self-evaluation (via structured self-assessment exercises); experience sharing (staff and peer self-disclosure); open-ended and cross-checking questions; and structured opportunities to see oneself in the stories of others.
The story of confrontation within the Minnesota Model and the larger alcoholism field would be incomplete without reference to constructive confrontation in the workplace and family intervention. Constructive confrontation was a strategy utilized by workplace supervisors to address alcohol-related deterioration in employee work performance. The strategy was heavily promoted in the peak period (1960s to 1970s) of occupational alcoholism programming (Trice & Beyer, 1984). Many alcoholism treatment organizations trained local workplace supervisors in the use of this approach which focused on confronting alcohol-related work problems and linking the problem employee to professional assessment and treatment services via a company-sponsored occupational alcoholism consultant.
During this same period, three propositions emerged about family adaptation to alcoholism: 1) alcoholism is a family disease; 2) the homeostasis of the alcoholic family is maintained through elaborate defense mechanisms of all family members, e.g., denial (portrayed metaphorically as the elephant in the living room that no one acknowledges); 3) family members inadvertently support the continued course of alcoholism through their enabling (e.g., excuse-making, over-compensating, rescuing) . In other words, the early model of alcohol/addiction as a disorder of individual character was broadened to conceptualize the family as pathological and heavily defending the status quo. Education of family members encouraged a strategy of “tough love” that was thought to speed up the day when the alcoholic would “hit bottom” and initiate recovery.
In 1973, Reverend Vern Johnson proposed use of a technique of family “intervention” through which the bottom could be raised to meet the alcoholic. In this technique, family and significant others staged a professionally-facilitated confrontation with the addicted individual to share detailed feedback on the person’s drinking and its effects on others and to request that the individual take specific actions to resolve his or her drinking problem. The technique gained considerable prominence when First Lady Betty Ford entered alcoholism treatment in 1978 following a family intervention organized by her daughter, Susan Ford Bales.
Family intervention became quite popular and developed as a sub-industry within the field of addiction treatment.
Also:
Vivian Sorenson:
http://www.linkedin.com/pub/5/71b/947http://fagbog.netdoktor.dk/resultat.asp ... tamodellenhttp://www.sundhedsfagbogen.dk/q/234/li ... Id=&page=8