Couples, Intimacy Issues, and Addiction

Barbara Jo Brothers

• Publisher: Routledge
• Year: 2014
• eBook ISBN: 9781317719298
• Topic: Psychology
• Subtopic: Addiction in Psychology
• Index: Psychology

Explore effective, innovative ways to foster healthy relationships!This thoughtful book discusses fresh and innovative ways to treat partners in distress. It suggests creative therapeutic ways to approach a range of problems and inner needs. Encompassing case studies, theoretical concepts, and original research, Couples, Intimacy Issues, and Addiction offers an intimate glimpse into the painful journey to marital healing.Couples, Intimacy Issues, and Addiction reveals the secret dynamics of marriages in trouble. It offers models for nontraditional relating, insight for handling such devastating crises as adultery, and a fascinating analysis of the marital crisis in the film Eyes Wide Shut. It shows how to use powerfully effective techniques including facilitated imagery, self-psychology, and a phasic model of handling adultery.Couples, Intimacy Issues, and Addiction addresses the tough issues that can shatter a marriage, including:

• balancing privacy and relatedness
• handling the intrusive memory of a late spouse
• facing one partner's addiction
• healing from adultery and other disloyaltiesThough the problems presented in these pages are potentially devastating to any marriage, this book offers an attentive, respectful approach that will be beneficial to both partners. Couples, Intimacy Issues, and Addiction offers solid, tested advice on ways to encourage clients to confront their genuine needs and deal with the ghosts of the past. With these techniques, psychologists, social workers, and couples counselors can help partners on the brink of divorce can build a healthy marriage on a solid foundation of love and trust.

HOW NOT TO PAIR: ADDICTIONS AND OTHER TRIANGLES

Restoration of Intimacy and Connection in the Treatment of Couples with Substance Abuse Issues

Wray Pascoe

SUMMARY. Addictions destroy both individuals and in particular their intimate relationships. Couples remain together for many reasons and when one partner has an addiction, the spouse has the fantasy that when the addiction is addressed the couple relationship will return to ‘normal.’ This article focuses on couple issues that have not been addressed in addiction treatment facilities and examines the role of the couple therapist versus the addiction counselor. Techniques and clinical interventions with this population are discussed and illustrated by case examples. [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-342-9678. E-mail address: <[email protected]> Website: <http://www.HaworthPress.com> © 2001 by The Haworth Press, Inc. All rights reserved.]

KEYWORDS. Addictions, couples, treatment, reconciliation, AA philosophy, techniques

Substance abuse, regardless of whether it is alcohol, cocaine, marijuana or prescription medications, affects numerous couples and families throughout the world. “The National Council of Alcoholism estimates that there are ten million alcoholics … (and) each one of these profoundly affects the lives of at least six other people” (Woititz, 1979, p. 201). Although alcohol consumption in the U.S. and Canada has decreased, other forms of substance abuse has increased. “On any day more than 700,000 people in the United States receive alcohol treatment in either inpatient or outpatient settings … and (according to) the 1992 National Longitudinal Alcohol Epidemologic Survey, a national household survey, approximately 7.5 percent of the U.S. population (about 14 million Americans) abuse and/or are dependent on alcohol…” (Fuller, 1999, p. 69). The literature addresses the issues of treating the substance abuser, the co-dependent partner, and the trauma experienced by the children, but there is a paucity of material in the professional literature relating to couple counseling after a partner has stopped using his or her substance of choice.

The couple may have met and married while one or both were using or abusing some chemical. Consumption of a mood altering substance may have been seen as a part of a ‘normal’ social life and at times appeared to minimize the conflicts that arose in the relationship. However, when one partner, for whatever reason, decides that the effects of the consumption or abuse are detrimental to his or her life or the relationship and/or the couple’s functioning, they may begin to acknowledge the problems and attempt to deal with them. The problems and concerns that were ‘anesthetized’ often become overwhelming with the substance abusing partner appearing to be the root cause of all problems. This is too simple. The focus of this paper will be on the treatment of couples where the substance abuse has terminated and there is a mutual wish for couple therapy. The goal of couple treatment is to establish and maintain “healthy intimacy expression based on individuation of the clients rather than on compulsive codependency patterns” (Smalley, 1988, p. 229). Although there is growing research and writing in the area of substance abuse with some attention given to the negative effects of this abuse on the family, little attention has been devoted to clinical intervention with the couple. Drawing on over a quarter century of clinical practice with couples in settings as diverse as a federal penitentiary to private practice with upper middle class professionals, the author will review the literature, discuss the relevant clinical issues and problems, present an abridged version of the AA philosophy followed by three clinical examples.

The majority of those couples that present for treatment are very vulnerable in that they usually have some awareness that they are dealing with a life threatening medical problem with the accompanying psycho-social dynamics and may have severe doubts about the continuing viability of the relationship.

INTRODUCTION

When the writer was a neophyte practitioner, he approached the clinical director of the program where he was employed stating that a most unlucky woman with whom he was working had just married her third alcoholic husband who like the others showed no signs of alcoholism before the marriage. The question posed to this very senior clinician was, ‘How could such an unfortunate situation occur?’ The director was quick to answer that the woman was of course an excellent selector of husbands. This made no sense to the writer until he had more experience and further training. We all marry or select those individuals who we think we need at a point in time and denial is a common mechanism of defense. When the partner who appears to be the substance abuser denies that he or she has a problem, the other partner may minimize or deny that a problem exists, i.e., mutual collusion. This is frequently the case with well-educated professional couples.

The marriage or relationship may have been maintained with false promises and the ‘hope’ that when s/he stopped using/abusing, the relationship would return to what it was before the substance abuse took over. However, problems that were not resolved earlier in the relationship resurface and need to be revisited. The other difficulty with this view is that it does not account for the passing of time, the long-term resentments and the emotional or physical abuse that may have occurred. The couple needs to realize and accept that the person that they originally partnered with is but a projection or historical fantasy. In recovery, each person needs to come to know him or herself and the other ‘new’ person who has had a psychological and historical journey that may well be very separate from their partner. If your behavior is out of control, your main focus is on your drug or addiction of choice and not the needs of the partner or the relationship. Forgiveness and adaptation will play a major role in the healing process if the couple is going to experience some sense of success.

BEGINNING TREATMENT

Most counselors in the addiction field consider that treatment has begun when the substance abuser admits that they have a problem and that their life has become unmanageable, which is the first step of Alcoholics’ Anonymous (AA), Narcotics Anonymous (NA) or Gamblers Anonymous (GA) recovery program. Some addictions counselors state that it is practically impossible for the addict to remain clean/sober without becoming involved in one of these aforementioned programs. They are very simple but rigid programs which are gratefully embraced by some while others have difficulty with aspects of the program, i.e., the need to believe in a ‘higher power’ (God) or that they are ‘powerless over drugs/alcohol.’ The couple therapist needs to be constantly aware that it is not their job to monitor the sobriety program of the individual nor support or defend any part of it. The therapist’s focus is on the couple and on how the relationship can improve or terminate (Pascoe, 1999).

The partner of the abuser may have attended a program such as Al-Anon, which supports the non-addicted individual. One woman stated to the writer that she had attended one such meeting and found that there were people there (mostly women) who were involved with partners who had been sober for periods of ten to twenty years but were still dwelling on behavior that occurred many years ago. The woman came to the conclusion that this was not a group that would be of help to her.

The therapist needs to know of previous treatment that the couple or individual has experienced and what was useful or not useful. The in-patient model is usually twenty-eight days with one weekend for the partners. However, with managed care and some of the long term follow-up studies which focus on long term sobriety/abstinence, in-patient treatment does not seem to fare any better than out-patient treatment. With the exception of patients with dual diagnosis or grave social instability, … research suggests that less intensive outpatient and day treatment can be as equally effective as residential treatment” (Martin, 1997, p. 6). One possible advantage or disadvantage, depending upon one’s treatment philosophy, is that with outpatient treatment, the family remains intact and the individual does not need to be away from their employment and family for a month. Some critics would argue that this is the main disadvantage.

In addition, the therapist needs to know how each person viewed this aspect of the treatment and what was seen as positive or negative. Many individuals who had in-patient treatment report that this was one of the most positive periods of their lives and felt ‘understood’ for the first time. Michael Douglas, the actor, says of his addiction treatment that the main benefit was that he had “some to talk to … (and that his substance abuse)…comes out of isolation and loneliness. What you are always hoping for is the opportunity to share your problems with someone” (Brown, 2000). Many individuals express gratitude for being able to address their chronic loneliness or emptiness (depression), which in the past they attempted to fill with their drug of choice. The issue of depression must be addressed as “…the essence of recovery lies in the art of bringing a learned and practiced maturity (into the couple relationship) and … the frozen state of depression breaks up and simple healing grief heals the heart” (Real, 1997 p. 286). The partner who in the past may have felt shut out of their spouse’s life may eagerly press for details of what occurred in treatment which are either too new or painful to share immediately. Again, the issue of timing and mutual trust reoccurs.

Frequently, intense relationships are formed during the in-patient period with great effort placed on keeping in contact with fellow ‘graduates’ of the program either through extensive telephone contact or weekend visits. Again, the spouse may feel excluded as they were not part of the in-patient history and are unable to accompany their partner to recovery meetings which are closed. The therapeutic issue here is to help the recovering person to ‘work their program’ while helping the partner and couple deal with the need for separateness and closeness (Fogarty, 1980). Some programs deal with each gender separately while others integrate the sexes in treatment. The pros and cons of this approach need not be addressed here. However, when both sexes are in the same treatment cluster, the opportunity arises to interact with members of the opposite sex who share the same problem and may also be reevaluating their marriage or relationship. Sometimes, although prohibited by treatment facility rules, these relationships become sexual or a preoccupation. This phenomenon was also seen during the period of encounter or growth groups for psychotherapists in the seventies. Lasting intimacy is not an instant process facilitated by openness and risk taking but rather hard work over a sustained period of time. The couple therapist must understand that “… chemical dependency is related to intimacy dysfunction in primary relationships … (and) intimacy dysfunctions do not disappear when chemical use stops” (Coleman, 1988, p. 55, Woititz, 1993).

UNDERSTANDING THE PHILOSOPHY OF ADDICTIONS TREATMENT

The couple therapist with graduate and post graduate training may have some difficulty with the seemingly simplistic approach or ‘catch phrases’ (i.e., fake till you make it, just read the Big Book, keep coming back, one day at a time, and nothing is more important than your sobriety) used by these addictions treatment facilities. This would seem to ignore some of the major psychological issues, which are readily apparent to the experienced therapist. “Care must be given not to hold on too much to AA slogans without exploring their meaning with the individual patient … Lingo not explored leaves the treatment stale when the patient is ready to engage in active psychotherapy” (Rousso, 1995, p. 72). However, the couple therapist must know that the disease of addiction is highly treatable but must be treated for life. Without sobriety, there is no treatment of any kind. Resolving past trauma which may give the individual insight and more psychic freedom, is no ‘cure’ for the addiction. The true addict cannot be like other people due to their genetic and psychological make-up. They cannot learn to ‘handle their liquor.’

The couple therapist who is not familiar with the addictions literature might well consider reading The Big Book which is considered the bible of the AA movement. It was written by the founders of AA, Dr. Bob (a physician), and Bill W. (a businessman) who came together in Akron, Ohio (where the author practiced and taught for sixteen years) to form the now worldwide organization. Although this was first published in the late 1930’s and some of the stories appear to be out of date, your clients have most likely read it from cover to cover. Two other books which might be useful are I’ll Quit Tomorrow (Johnson, 1990) and It Will Never Happen to Me (Black, 1987).

It is important that couple therapists know and accept that they may not be experts in the addictions field but do have expertise in the field of couple counseling. However, it is necessary to be aware of some of the issues of addictions medicine and the potential lethality should the addiction not be treated. Research shows that men are better off both medically and psychologically if they are in a relationship, and this has implications for the treatment of couples with addiction issues. The same may not be as true for women, but they too need a support network and are usually better able to find one for themselves.

Most substance treatment facilities use a psycho-educational model combined with some small treatment groups. Due to the large number of individuals in a facility as well as the level of expertise of the staff, the use of an intrapsychic approach or individual psychotherapy is an exception. The vast majority of staff in these facilities appear to be ‘recovering’ substance abusers who have varying levels of training.

UNDERSTANDING THE DISEASE PROCESS

The therapist needs to determine how the couple views the disease process of addiction. Are there vestiges of the ‘moral’ model, i.e., that addiction is caused by a moral weakness and can be controlled by will power and/or prayer? It is useful to ask the individual who holds this view if they are able to control diarrhea through will power. Do they accept the fact that the addicted person will always be at risk for a relapse, and how will they each choose to modify their life style to minimize the risk of a relapse? Social functions where alcohol is available need not necessarily be avoided, but the couple needs to have a prearranged plan to cope with unwanted offers of alcohol and agree to leave the function if the recovering individual begins to have difficulty coping. Relapse can be a truly life threatening situation. It must be agreed by the couple and the therapist that regardless of what the non-addicted partner does or says, s/he is neither responsible for nor sufficiently powerful to cause the alcoholic/addict to have a relapse and return to their substance of choice.

Recovering individuals who are working a ‘step program,’ i.e., AA or NA, are strongly encouraged to attend 90 meetings in 90 days. This may appear to be an inordinate amount but the wasted and destructive energy that was put into maintaining the addiction is minimal in comparison to the time commitment to the step program. In addition, as negotiation is a skill which is taught by many couple therapists, it may be helpful to see and coach the couple to negotiate how much time will be devoted to recovery issues and how much time for the couple and family.

TREATMENT ISSUES

The focus of the couple therapist needs to be on the couple’s relationship and the barriers that prevent them from becoming a viable couple once again. Recovering individuals who are not in a relationship are advised to refrain from entering a relationship or attempting to resurrect an old relationship for a period of one year. This is not possible for someone who is in a relationship and it is unlikely that the partner will agree to put relationship issues on hold for twelve months. In reality, the question becomes: Is the recovering individual able to face the pressure of couple work?

What is the agenda of the non addicted partner-retribution and the wish for the now sober partner to be appropriately contrite or to attempt to rebuild the relationship? Much of this m...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• ABOUT THE EDITOR
• CENTERED SELVES
• HOW TO PAIR?
• HOW NOT TO PAIR: ADDICTIONS AND OTHER TRIANGLES
• TOOLS: DREAMS, IMAGERY, FANTASY
• Index