C.A.R.E. to Start a Movement?

Couple Recovery is Coming Out of the Shadows

I have worked as a therapist for a long time, but about fives years into my practice it occurred to me that I didn’t really know how to help couples with substance issues. More on that in a moment, first I have a true confession, public and everything:

Back when I was trying to get licensed as a Marriage & Family Therapist, after completing the three thousand hours of internship, correctly submitting the proper paperwork and documentation, the last step involved being interviewed by a three person board – California no longer does that by the way. This board was a pretty scary thing for me to think about, in fact, kind of terrifying at the time! Their job was to filter the good from the bad, the knowledgeable from the uniformed, the competent from the incompetent, you get the idea. First you had to present a case, then they present a case and ask you all about it, then…whew, they interview you, with intense analytic acumen. I remember feeling at the time that my group of three had mastered the then popular therapist flat, non-emotional face; it was really hard to get a read on any of their reactions to what I was saying. I couldn’t tell whether I was impressing them at all, or whether they were wondering, ‘How did this guy get this far? Thank God we are here to protect the public’.

What I really remember most is one of the final questions they asked, something like this: “Is there a group or type of client you feel you don’t work well with, or that you feel uncomfortable with?” Hmm, I thought a while.  “Well I don’t feel that I’m very effective with alcoholic clients or drug addicts”. There I said it, I was truthful and now they are going to suggest I go back for intensive training and try again in another year or two, or three. Maybe they will, kindly of course, suggest I  get career counseling and look at other options. It turns out I passed.

What is striking to me is that I was still struggling with that discomfort with alcoholics and addicts almost five years after being licensed.  The problem I became  aware of at the time was that literally 80% of my clients had substance issues that were affecting them and their relationships, and I still didn’t know what to do. This started my journey on trying to know what to do. I began reading, began coursework and completed the Advanced Drug & Alcohol Training Certificate at UC Santa Cruz.  I had the opportunity to lead a men’s group at a treatment center, and over time became a clinical director of the program.  My training and affiliation with Dr. Stephanie Brown at and the Addiction Institute led to the wonderful opportunity to take on research through the Family Recovery Project, that Stephanie and Dr. Virginia Lewis co-founded at the Mental research Institute. My dissertation was on couple recovery from that research project. I got my doctorate and continued at MRI as a Research Associate while continuing my private practice. Virginia and I ended up co-founding the Center for Couples in Recovery, where I have continued my research for the last 10 years.

Needless to say, I feel very different about working with individuals and couples struggling with addiction and recovery. I now understand that addiction is a disease, we now know a lot about the neurobiology of addiction. A useful understanding of addiction, in my opinion, is the Bio-Psycho-Social-Spiritual-Cultural model, accounting for the many dimensions of addiction. We also know a lot about what it takes to make relationships work.

The problem I see now is that while we talk about addiction as a “family disease”, we don’t really treat it that way. When an addicted partner gets into treatment or recovery, often the couples are separated and told to not get involved with any kind of couple work. While it is crucial for partners to  establish their own recovery from this disease, I have come to learn that it is quite possible to address couple relationship issues as well, supporting individual recoveries as well as the couple recovery. By providing couples with tools to manage their relationship while they are trying to manage their own recoveries (hopefully), greater success is likely. Longitudinal research informs us that 8 years post primary treatment for alcoholism, couple and family relationship health was identified as a statistically significant variable. Or, stated less like a research geek, if your relationship is healthier, the chances are better for continued recovery.

Couple Recovery: Will it explode or fizzle?

C.A.R.E. – Couples Addiction Recovery Empowerment 

Is there a place for couple recovery? Couple Addiction Recovery Empowerment (CARE), is a concept or approach in recovery that accounts for the relationship, supporting the idea of dealing with three recoveries concurrently: both individual recoveries, and the couple recovery. This approach is a very different model than the current models of recovery and treatment. How did this come together for me? Here’s the story on that.

I trained with Drs. Julie & John Gottman, and have been very involved  with the Gottman Institute for the last eight years. We are currently collaborating on integrating our research models into a relational approach to recovery. This approach, the “Couple Recovery Development Approach” (CRDA), blends the Gottman research on what works in relationships and what predicts relationship meltdown and divorce, with the CRDA model emerging from my research. This collaboration with the Gottmans and the Gottman Institute has led to developing a new Gottman workshop for recovering couples, “A Road Map for the Journey: A Gottman Workshop for Couples in Addiction Recovery”. This model is also clinically applicable for individual therapists and recovery counselors to help couples develop couple recovery. 

Two very newly created internet resources I have created:

1. http://couplerecovery.org/ A website providing information and group forums to share ideas and stories on about couple recovery.
2. https://www.facebook.com/CoupleRecovery A Facebook page “Couple Recovery Development Approach”, offering resources and another opportunity to share and create community.

These new resources are works in progress and any and all feedback is greatly appreciated.

Care to join the movement? It’s going to take a community.

Addiction Recovery for Couples: Path for Healing or A Ticking Time Bomb ?

“I don’t know. Will managing relationship issues while managing my own recovery blow up on me?”

Okay, alcoholism or drug addiction has impacted your relationship and you are sorting through what all this has meant to you. Most importantly, you are trying to stay on track with your own recovery and wellness because you realize you have to. For too long you feel like you have lost yourself in this disease, one way or another. There is so much to sort through and to come to  grips with. A lot of the time you feel overwhelmed, especially when you see your partner and the triggers get tripped. You try not to react, but sometimes you can’t stop it.

The good news is that there are recovery options for the alcoholic and co-alcoholic. The recovering community extends open arms to those struggling with dependency and co-dependency. People whose lives have been touched by addiction know what it is like, and can offer support, hope, and tools to recover from this powerful disease.

While you realize that self-care is the center piece of any good recovery program, you still have a relationship, either with the alcoholic or co-alcoholic, and that too seems to need some attention. In so many ways, things have not gotten better between you, even after recovery.

We know from the research that the transition from active dependency to early recovery is very difficult on relationships – This is normal! Moving into recovery brings its own set of problems: it is new, unknown, and so much is going on that even though things are better in many ways since recovery, not everything seems better or easier. Unfortunately the toll that addiction takes on couples is reflected in divorce rates that are somewhere between 4-7 times higher than normal, with many divorces taking place after beginning recovery. The idea that couples should not address their relationship issues until well into recovery, perhaps a year or more, is an untested belief. On the contrary, we know from longitudinal research that relationship wellness is one of the single biggest predictors of long-term recovery success.  Perhaps the problem is that we have not given this idea of couple recovery much of a chance, nor provided the right tools for couples.

It seems that for some the position of avoiding the couple relationship is bound up in the fear of losing individual recovery if the relationship takes any kind of priority. However, the reciprocal relationship between successful individual recovery with the health of the couple relationship is established in the research literature. What if couple recovery included a strong emphasis on supporting each partner’s individual recovery, while at the same time offered tools for couples to begin to more effectively manage the changes in their relationship as well as start to deal with the baggage of addiction? What if couples were given a path to take that would provide some direction in:

• Figuring out a way of incorporating recovery somehow into the relationship
• Help managing conflict
• Guidelines for setting boundaries
• Understanding what healthy relationships need
• Know what predicts relationship melt-down 
• Support each other’s recovery, without taking responsibility for it
• Learn ways to prioritize one’s own recovery without having to ignore the relationship
• Be able to differentiate between unhealthy codependency and healthy interdependency

There are plenty of good reasons and times to only focus on one’s own recovery and not try to deal with the relationship. Sometimes it’s a matter of timing, sometimes it has to do with simply not having any desire to have much of anything to do with the relationship. However, in those instances of living with recovery while also having to manage some aspect of the relationship – like shared parenting responsibilities, joint decision-making, or wanting healing in the relationship – then a relational approach to recovery should at least be considered with specific goals in mind, which obviously could vary greatly for each couple.

The path will not be easy, recovery is not easy, and there are risks for sure. How to decide whether you are willing to explore the concept of couple recovery? One way to grapple with the idea of going forward with a couple approach  is when there are good reasons for wanting things better in the relationship, regardless of why and to what end. Couple recovery  may actually ultimately be the path of least resistance, all recoveries considered.

I would love to hear any thoughts about the idea of couple recovery and what the pressing issues are for couples in long-term or early recovery. Thanks 

What I Have Learned From the Gottmans: Where to Start?

Okay, Let’s Start with the Research

John Gottman’s research on the longitudinal course of relationships began in 1972 when he and Bob Levenson  asked the question: What predicts divorce? At the time there were only six studies on divorce and none were at all helpful. John and Bob did not exactly have a vote of confidence from the academic and research community. John, a professor at the University of Washington, and Bob a professor at UC Berkeley, received much skepticism  with responses characterized by the question: “Social scientists can not predict individual behavior very well, how can you predict relationship behavior?” John and Bob’s research outcomes surprised even them; relationship behavior is predictable, they indeed found out what is associated with relationship breakdown and with relationship stability.

The three areas of John and Bob’s research involved: interactions, physiology, and perception. It turns out that each of these areas have significance in understanding and determining relationship trajectory: either towards stability or instability. What they discovered was that relationships have a  balance between negativity and positivity, called”set points”. In dysfunctional relationships these set points are habitually toward negativity with a dynamic of blame and/or withdrawal, referred to as the “Four Horsemen of the Apocalypse. With over 90% accuracy John and Bob could predict what would happen to the relationship with the knowledge collected in just a few hours. The  consistent escalation in negativity impacts the couple’s ability to repair hurts and conflicts just as the consistent calm characterized in the healthy relationships was an indicator for relationship stability.

The research was multi-dimensional, involving over 3,000 couples from every major racial and ethic group in the United States, and included a twelve year study of committed gay and lesbian relationships. This is pretty compelling stuff, but what happens next sets this cutting edge research in a unique category of research. It is one thing to  have learned about these relationship patterns and dynamics that provide a way of understanding and predicting relationship trajectory, but it’s quite another thing to make use of it in a very practical and applicable way. It wasn’t until John began collaborating with his psychologist wife, Dr. Julie Schwartz Gottman, that methods were developed to help couples. The outcome of this innovation of blending science and practice was a relationship model developed by the Gottmans, the “Sound Relationship House (SRH) theory. The SRH model provides a map for working with couples involving three different components of relationship – Friendship, Conflict, and Meaning –  broken down into 7 different levels. The SRH model is a non-linear, interactional model, with separate but related levels that effect each other.

Now Let’s Talk About What They Did with the Research

Together, Drs. Julie and John Gottman co-founded the Gottman Institute, a vision aimed at helping couples and training therapists in this research-based approach of couple therapy. The Gottmans created “Art and Science of Love:  A Weekend  Workshop for Couples, an intensive experiential workshop where couples are provided tools and given information on what emerged from the research.

Additionally, through Gottman Institute has trained countless therapists over the years and has developed training program options with opportunity to deepen the understanding and application of the SRH model. In the spirit of “pass it on”, the Gottmans have transitioned from providing all the training to training Certified Gottman Therapists to be trainers and to continue what has been this important work.  What a gift it has been to be a part of this work. Untold hours have been spent by the Gottmans and their team under the able direction of Etana Dykan Kunovsky (who has been there from the start), and Alan Kunovsky, developing and continuing to evolve the workshops for couples and the the training workshops for therapists.

I’m not intending to write this article as an advertisementt, but rather as an acknowledgement and public appreciation of a brilliant model of research and practice that has  developed into a process of bringing  important information about relationships to couples and to therapists.

What I believe drives the success of this model is the underlying philosophy John and Julie hold, that the SRH theory and methods of intervention are continuing to evolve and be developed and deepened. Like all healthy relationships, growth is ongoing, we are never really done in the sense of reaching a certain stage of development – “Whew, we have arrived”. Rather the ups and downs, success and failures all lead to a sense of continuing change and growth.

What This Has Meant To Me

Over 10 years ago I began my own research with couples in recovery from addiction. This work has continued with the support of the Mental Research Institute (MRI), where I am a Research Associate in addition to my private practice. It turns out that we know a lot about how addiction affects couples, but not very much about how to actually help relationships impacted addiction. I too have been met with skepticism over the model I have developed helping couples in recovery, because couple therapy traditionally is discouraged unless they have years of recovery.

Much to my own surprise I have found striking similarities with SRH model and my Couple Recovery Development Approach (CRDA). What I didn’t have, however, were interventions to help couples. This is where Gottman Method therapy enters. I have been fortunate enough to collaborate with John Gottman in developing my own adaptation of Gottman therapy for recovering couples. This research/practice model developed by John and Julie Gottman has motivated and inspired me, and provided a road map of sorts on how to develop this model and get the work out to couples and to recovery professionals and therapists. Both Julie and John express their continued support and mentoring in developing a workshop for recovering couples and tools for clinicians in helping recovering couples.

With Gratitude

Couples in Addiction Recovery Empowerment (CARE), is a concept of  relational approach to recovery, one that supports individual recovery in the context of the couple relationship, essentially creating a “Couple Recovery”. As I have learned from the evolution of John’s research to a model of practice:

• I am grateful for beginning this phase of work with the support from the Gottman Institute and John & Julie  
• I aspire to innovate and continue to collaborate in developing couple recovery approaches.
• I hope to be a part of creating a vision of couple recovery as a widely accepted practice within recovery circles
• Perhaps others will feel motivation and continue to motivate me in carrying this forward

A Road Map for the Journey: A Gottman Worshop for Couples in Addiction Recovery, is a two-day workshop I developed in collaboration with John and Julie Gottman and sponsored by the Gottman Institute and Edgewood Seattle Addiction Services. The workshop debuts April 5 & 6, 2014 at held at Edgewood Seattle. After a decade, this is quite a dream come true. I am very grateful to be a part of the Gottman Community.

Trauma Is Not Codependency: Part 2

When you get wrapped up in feelings, be cautious in how you label those feelings

In my last blog article, “Trauma Is Not Codependency: Part 1”, I addressed the importance of acknowledging and understanding that active dependency on drugs and alcohol creates trauma for both the addict/alcoholic, as well as partners and family members of the addicted person. I’m sure this is not really a news flash for anyone, but I do wonder if many recovering couples recognize and understand that it is normal that the impact of active addiction does not end when the alcoholic (or addict) gets into recovery. In fact, despite initial feelings of relief that the partner is now in recovery, there may be ongoing struggles with feelings, such as: fear of relapse, being on guard, or experiencing an enhanced state of sensitivity to the partner’s behaviors  (hypervigilance); nightmares, startle responses; depression, and generally, feeling triggered and on alert.

My research couples consistently identify emotions and managing emotions as one of the toughest parts of recovery.  It’s not surprising if we think about the person recovering from addiction needing to develop a whole new set of behaviors supportive of abstinence and of recovery, but also needing a way to understand and cope with the roller coaster of emotions without numbing. Similarly, the alcoholic’s (addict’s) partner will need to identify their own unhealthy behaviors created by active addiction and develop ways to disengage by focusing awareness on own needs and on self; it is no less of a challenge for the coalcoholic to manage emotions. Often times intense feelings of fears, worries, and upset feelings for the coalcoholic are understood to be a codependent relapse, the sign of unhealthy emotions and an inability to detach. I believe that this take misses the mark. 

A relapse for an alcoholic isn’t really a relapse unless there is the actual behavior of drinking or using. Having thoughts, cravings or ideas of using may be warning signs for possible relapse: but it isn’t a relapse. Hopefully the alcoholic learns through work with a sponsor, program or recovery therapist or coach how to read these potential relapse triggers and what to do about it.

I believe that the same is true for the coalcoholic (the addict/ alcoholic’s partner) in that feelings and thoughts are different than behaviors in defining relapse. For example, you could argue that the coalcoholic who feels responsible for their partner’s addiction is demonstrating active codependency. Another position is that while these are feelings that warrant exploration, understanding, and probably education, unless that person actually takes action to try to control the alcoholic’s behavior, then this is in the category of learning to manage the feelings and it is not a relapse merely because you have those feelings at all – it’s what you do with those feelings!

Addiction and Post Traumatic Stress Disorder PTSD

A big part of recovery is learning new behaviors to replace the old behaviors, which ultimately can apply to perceptions and beliefs as well, replacing old beliefs with new beliefs and thoughts. This is the essence of “working a program”, integrating new ways of thinking which ultimately helps us to actually change behaviors. These new understandings can change our feelings about ourselves and partners and lead to new ways of acting and living consistent with healthy boundaries and healthy relationship patterns. What happens when intense feelings are felt in reaction to an event or feared event, and no amount of logical thinking, education, program or reassurance helps?

It might help to understand that the consequences of active addiction always involve levels of trauma, for both the alcoholic and the coalcoholic. So how does this relate to feelings? Our brains are wired to be on the lookout for danger, and past experiences become a measure of what is dangerous. It is perfectly normal and understandable for these trauma reactions to emerge in early recovery and well into recovery.

When we get our button pushed: emotions follow

A couple I am working with James and Karen (not their real names)  have been seeing me for about 10 months. James has been in recovery from alcoholism for 4 months and has stayed alcohol and substance free during that time. He has been attending Alcoholics Anonymous 3-5 times a week, just found a sponsor and is attending an aftercare program once a week. Karen has been attending Al-Anon once a week and sees an individual therapist trained in addictions treatment.

James and Karen came into a session reporting having had a major breakdown in their relationship. In the prior week James came home from an AA meeting later than usual. He called to let Karen know he would be late, that he was hanging out with some AA friends getting coffee after the meeting. James reported, “She was a mess when I walked in the house, she totally lost it. I didn’t do anything wrong, I called, what else could I have done, get a note from my sponsor (he said sarcastically)?” Karen reported that when James called to say he would be late, at first she felt a little uncomfortable, but almost immediately after hanging up her feelings escalated into raging anxiety, dread, anger, and fear. She described feeling nauseous, “Sick to my stomach, I couldn’t help it”. So did Karen have a full blown codependent relapse? Is this a sign of her pathology and her need to control James schedule and whereabouts? I think a more useful way to understand Karen’s reaction is that she was experiencing Post Traumatic Stress Disorder (PTSD). These feelings are triggered from previous trauma of the countless times during the active drinking years that James would come home late, often calling with lies and excuses, coming home drunk, then denying drinking and escalating in his aggressive and accusatory defensiveness. Karen’s feelings are normal in the sense that it is understandable why she reacted the way she did given the trauma she has experienced and the triggers embedded in James phone call. The issue isn’t that Karen had these feelings, it’s more about identifying and learning to manage these trauma reactions.

James didn’t do anything wrong but he did need to understand- as did Karen – that her reaction was an involuntary trauma reaction triggered in the parts of the brain designed to protect us from danger. The hippocampus (memory) and amygdala (emotions) are linked through an emotional memory sequence that aims at identifying possible threats.

I don’t believe it’s ever helpful to pathologize these reactions, but rather, I explore where they come from and help couples understand trauma reactions. When James understood Karen’s reaction was PTSD, and not about him “screwing up again”, he was able to move more toward compassion. Similarly, when Karen was able to see her reaction as a full blown PTSD, then she was able to better let go of her guilt and SHAME for her feelings. We discussed what to do in the future when there are strong reactions that likely have been triggered. This isn’t to say that additional individual focus like extra support from Al-Anon or a sponsor and/or a therapist wouldn’t be helpful or appropriate as well, in fact, we in fact explored these options. Identifying and understanding triggers and PTSD will be an essential tool for both James and Karen in their navigating recovery individually and as a couple.

Trauma is not Codependency: Part 1

What Box Do I Put These Feelings In?

When a partner gets into recovery all sorts of emotions tend to come to the surface. These emotions may at times feel in opposition, with hope next to fear, relief side-by-side with anger, and so on. If you have experienced these swings then you know how confusing and overwhelming emotions can be, sometimes rapidly go from one feeling to another: triggers can seemingly come out of nowhere. You may think that something is wrong with you, perhaps feeling like you are crazy. It may very well be that the recovering partner may be experiencing the same emotional roller coaster, at times feeling gratitude for recovery, and other times really struggling with all the newness and uncertainty of early recovery: “How am I am going to get through this?” “What happens next?” “How do I manage all these emotions, sober?” “My relationship? I can’t even go there!”

As the recovering addict and partner experience these swings and ups and downs, twist and turns in their emotional life, an awareness can creep in, with increasing anxiety: “Does this mean I am really messed up?” I have heard people in early recovery ask me, “Do you think I am bipolar?” “What’s wrong with me, I should be grateful and relieved, and sometimes I am…but other times I feel sad, angry and fearful”.

Sometimes these feelings are explained as an “emotional relapse” a regression into an unhealthy emotional state, which for the addict precedes behavioral relapse. For the co-addict an emotional relapse is negative self-talk or emotions that are associated with codependent relapse: controlling behaviors; enabling the partner’s addiction; perfectionism; and low self-esteem, putting one’s own needs last.

Obviously, it is really important to figure out what emotions are being experienced and whether there is a risk of these emotions leading to relapse. For the addict and alcoholic managing emotions sober is a whole new ball game, for the co-alcoholic/addict self-care may be a new mind-set. Recognizing one’s own needs and the importance of caring for self means asking for support and help; this is not always easy, so you may need to start with giving yourself permission to reach out.

However, not all strong negative emotions related to addiction (and recovery) are a sign of unhealthy emotions of emotional relapse or of codependency. Sometimes these feelings are related to re-experiencing traumatic feelings triggered by emotional memories of the addiction. This is as true for the addict/alcoholic as it is for the co-addict. Most people have heard of Post Traumatic Stress Disorder (PTSD), but probably have not heard this associated with recovery very often. We tend to think of soldiers returning from the battlefield when we think of PTSD, but chronic trauma, and addiction is certainly that, can leave a person vulnerable to the symptoms of PTSD. The National Institute of Mental Health defines PTSD (http://1.usa.gov/cc8g:)

1. Re-experiencing symptoms:

Flashbacks—reliving the trauma over and over, including physical symptoms like a racing heart or sweating
Bad dreams
Frightening thoughts.
Re-experiencing symptoms may cause problems in a person’s everyday routine. They can start from the person’s own thoughts and feelings. Words, objects, or situations that are reminders of the event can also trigger re-experiencing.
2. Avoidance symptoms:
Staying away from places, events, or objects that are reminders of the experience
Feeling emotionally numb
Feeling strong guilt, depression, or worry
Losing interest in activities that were enjoyable in the past
Having trouble remembering the dangerous event.
Things that remind a person of the traumatic event can trigger avoidance symptoms. These symptoms may cause a person to change his or her personal routine. For example, after a bad car accident, a person who usually drives may avoid driving or riding in a car.
3. Hyperarousal symptoms:
Being easily startled
Feeling tense or “on edge”
Having difficulty sleeping, and/or having angry outbursts.
Hyperarousal symptoms are usually constant, instead of being triggered by things that remind one of the traumatic event. They can make the person feel stressed and angry. These symptoms may make it hard to do daily tasks, such as sleeping, eating, or concentrating.
It’s natural to have some of these symptoms after a dangerous event. Sometimes people have very serious symptoms that go away after a few weeks. This is called acute stress disorder, or ASD. When the symptoms last more than a few weeks and become an ongoing problem, they might be PTSD. Some people with PTSD don’t show any symptoms for weeks or months.

While PTSD can trigger an emotional relapse, a distinction between codependency and PTSD helps us to put the feelings in the right box in terms of understanding what is happening. The adverse effects of addiction may be likened to the concept of second-hand smoking. “Second-hand alcoholism”, or second-hand addiction, refers to the negative impact on others emotionally, psychologically, spiritually, and relationally because of someone else’s of addiction. Rather than assuming the person is having a codependent relapse, consider that these feelings can be understood as a reaction to trauma.

As science continues to provide tremendous gains in understanding addiction as a brain disease, beliefs and attitudes about dependency are finally shifting away from the moral model of addiction – that is, blaming the alcoholic for having a moral weakness. Similarly, I believe that a better understanding the concept of second-hand addiction removes judgement and assumptions about partners affected by addiction as a symptom of unhealthy codependency.

More on trauma, codependency, and second-hand addiction to follow in the next blog

Recovering Couples: How to Develop a Deeper Friendship with Your Partner

(Originally published in New Times: For Addiction Recovery, July/August, 2007)

Friendship is essential in developing and maintaining an intimate relationship. Based on John Gottman’s ground breaking research involving 3,000 couples over 30 years on what makes relationships successful, we now know what it takes to foster friendship in an intimate relationship.

Gottman found that couples with greatest relationship satisfaction consistently demonstrated strengths in 3 areas of developing their friendships: “Love Maps”, “Fondness and Admiration”, and “Bids and the Emotional Bank Account”. Each of these components require specific relationship skills and tools; and for recovering couples this raises the question of how to address recovery issues in the relationship. Let me introduce you to three couples, problems they are experiencing in their friendship, and what they can do about it.

Couple #1: John drove home from his AA meeting excited about an awareness that opened up new insights into why he had been struggling all week to stay sober. As he walked in through the doorAlicegreeted him with “About time you got home, what a day I had with the kids. Alan needs a bath”. John silently felt deflated and resentful, shrugged his shoulders stating “OK”, and walked pastAliceto tend to his parenting.

Key Skill #1: Love Maps

Good friends know something about their friend’s world; it’s sharing the day to day experiences that bring people closer together. People change over time and to keep up with these changes good friends make a committed effort to sit and listen, without judgment.

John and Alice need to take time to catch up with each other’s day. Agreeing to set a time each night to get a “live update” fosters a sense of knowing your partner and his/her world, and of being known and understood by your partner. Finding a time to talk after Alan’s bath, John could share that he had a particularly meaningful meeting. For example, without sharing details and without breaking anonymity, he could simply let Aliceknow how he feels about what he is learning about himself. Asking Aliceabout her day and the pressure she felt with the kids will go a long way in giving Alicea sense that John cares about her and her struggles. Unless asked for, the key is to avoid giving advise or giving one’s own perspective, rather just listen with the goal to understand a little bit more about your partner’s world.

Couple #2: Samantha was learning in Al-Anon and in therapy how difficult it was for her to ask for what she needed. She felt desperate as she looked at her partner Chris concluding that he was a big part of the problem. Her thoughts went to how he always focused on himself. Despite her momentary awareness that she was “taking his inventory”, she continued to make a long mental list of his shortcomings

Key Skill #2: Fondness and Admiration

Friends are able to express what they like and appreciate in each other. Feeling loved, liked and appreciated creates feelings of emotional safety and trust. Would you stay in a friendship where you felt criticized and judged, probably not? Likewise, couples need to remember and focus on the positive qualities and attributes of their partner.

While Chris isn’t perfect, if asked what Chris’s strengths are, Samantha may remember that Chris did take her out for a wonderful birthday dinner last month. She may recall that he often asked her how her meetings are going and if she would like him to call her mother to say they are not able to attend the family reunion this year because he has a work conflict. Noticing and giving voice to what we appreciate in our partner provides balance, avoids black and white thinking, and brings positivity that will ultimately help deal with the negative problematic areas of the relationship.

Couple #3: Recovery was going well for Lisa; she just celebrated another sobriety birthday, felt connected with her sponsor, and loved her Thursday night meetings. Happiness finally seemed a possibility, but as her recovery progressed positively, her relationship with Bill seemed to deteriorate. In recent months they stopped going out to dinner, an activity they used to love on Friday nights. The tension in the silence felt heavy, and when they did try to talk, they often ended up arguing, so Bill and Lisa tended to just avoid each other.

Key Skill #3: Bids and the emotional Bank Account

Remember the song “You’ve Got a Friend”? The lyrics tell of how the friend expresses his commitment to the friendship, he will be there, just give a call. Every time a partner calls or reaches out for connection or attention, it is called a bid. When the other partner responds to that bid, it’s like money in the emotional bank account and builds friendship and closeness. However, if the response is ignored, or if what comes back is negative or attacking, it’s like taking money out of the emotional bank account and damages the relationship. Gottman found it was the little bids and positive responses that made a huge difference in the big picture of the relationship. For example, “How was your day?” is a bid. A turning toward that bid and building up the emotional bank account would be any response that acknowledged the partner’s interest, for example: “It was boring…It was great…I’m mad about it and would rather not talk about it, but how was your day?”. Frequent bids and positive responses to those bids can turn a relationship back on the path of a good friendship

Lisa and Bill, once they understand the importance of bids and the emotional bank account, could focus on trying to better recognize when the partner is reaching out, then respond and acknowledge with words or a smile. Studies indicate if bids are ignored and rejected, the bidder stops trying. The net effect over years is an emotionally distant relationship. Lisa and Bill, as with the other two couples, will do best if they can try to incorporate and work on all three components of friendship: Love Maps, Fondness and Admiration, and Bids.

Recovering couples are challenged with finding a place for recovery in the relationship. Some partners are both in recovery, but are unsure how to share more as a couple in their individual recovery journey. Some individuals find themselves alone in their recovery or even criticized by their partners for being in recovery. Regardless of each individual situation, developing a better friendship means “progress not perfection” in each of these areas. Having a discussion about these concepts is a step in the direction of improving or strengthening one core aspect of a satisfying relationship, friendship.

 

 

 

The Couple Recovery Development Approach: It’s Time (Special Thanks to Dr.John Gottman)

Couple Recovery: There is a path to follow

Many people and events over the last eight years have contributed to my interest and commitment to researching and exploring the concept of helping relationships where one or both partners are in recovery from chemical dependency.  My firm belief is that individual and couple recovery approaches are not mutually exclusive. We know from research that long-term successful recovery from alcoholism has a strong correlation with a positive and healthy relationship. That really isn’t surprising if one thinks about it, but what is surprising is why we don’t account for that variable in treatment – sooner than later in the recovery process.

Certainly there are circumstances when the relationship will need to take a back seat with efforts focused on individual recovery, but even then, it can be helpful to give couples strategies to manage these times. In active addiction, the elephant is the unspoken reality of that addiction. When couples are managing recovery, I don’t think we need to create a new elephant by discouraging and avoiding the reality of recovery in their lives.

Mike had been in recovery for almost 15 years and recalls how difficult the first year of recovery was, on him and especially on his relationships with his wife and family. He states that he wished he had been able to talk to his wife  about some of what was happening for him and in the relationship. Instead, the advise they received at Mike’s treatment program was to focus on their individual recoveries only. They followed this advise, remaining silent on the recovery issue and on all the changes they were experiencing – recovery was off-limits. He was to work his program, she was to work on hers. Ellen too regrets that they didn’t have the tools to even acknowledge the huge changes taking place in themselves, their relationship and in their family. They now have those tools and for the first time feel they are a couple in recovery, they feel closer together, and support the idea of  “Couple Recovery” sooner not later in the recovery process.

I am a therapist and researcher. A brief bio: I  have specialized in chemical dependency treatment since 1987 in my private practice; I have completed two addiction certifications, Advanced Drug and Alcohol Training (UC Santa Cruz) and Master Addiction Counselor (National Certification); I have trained with leaders in the field; worked as a clinical director of a drug and alcohol clinic; and did my doctoral dissertation on long-term recovery process in couple relationships as a part of the Family Recovery Project, directed by Co-Founders Stephanie Brown, Ph.D. and Virginia Lewis, Ph.D., at the Mental Research Institute in Palo Alto. The overwhelming consensus in the field has been that doing couples work in early recovery was a bad idea. Over time, in my work with individuals and couples in all stages of addiction and recovery, I came to see that not addressing couples issues was in fact a critical oversight. It isn’t couples work that is the problem, it is how to approach the couples work that becomes the central issue. Assessment is core to determine what kind of approaches are appropriate in any given situation. Relationships don’t go away once a person begins recovery, wouldn’t it be better to account for that reality in recovery?

   Getting on the right track

After I completed my dissertation and completed my doctorate I was invited by Dr. Virginia Lewis to stay at Mental Research Institute as a Research Associate. We co-founded Center for couples in Recovery. The research continued and I learned that the skills used by couples in long-term recovery could in fact be adapted to couples early in the recovery process. My clinical experience in individual couple therapy and multi-couple therapy groups was confirming that Couple Recovery indeed had a place, even in early recovery. As I shared my model at professional conferences at the American Association of Marriage and Family Therapists, and the California Association of Marriage and Family Therapists, the feedback from therapists was consistently positive as we raised the issue: “Why aren’t we helping couples in addiction recovery?”

I found out through my friend and colleague Lynda Voorhees, MFT, Certified Gottman Therapist,  that that the research-based Gottman Method Therapy model and interventions were very congruent and compatible with my developing model of treating couples in recovery. I did not have to rediscover the wheel!  Fast forward – I completed the Gottman training, became Certified in the Gottman Model and went on to complete training as a Gottman Method Consultant and Trainer and began presenting my research at Gottman Conferences.  John Gottman expressed his enthusiasm for this model and research and offered to collaborate on this relational approach to addiction treatment I had named “Couple Recovery Development Approach” (CRDA). John graciously invited me to co-author a chapter he was invited to write for Routledge Press, and he asked me to include in this chapter my own research on recovering couples (Case Studies in Couples Therapy: Theory-Based Approaches, 2011) e. Additionally, John asked me to join the Relationship Research Institute as a Research Scientist and suggested we apply for funding to set up set up a randomized clinical trial in treatment programs comparing outcome results from standard treatment with outcomes from the CRDA program.  John’s encouragement, support, and mentoring has been an invaluable experience for me personally and professionally and I am deeply appreciative to him for his contributions to the field of relationship therapy and for his nudging me along on my own journey.

Here’s where things are at:

Phase 1: In collaboration with John Gottman, I further developed CRDA through John’s insights and suggestions for additional interventions and adaptations inspired by Gottman Method Therapy research. John’s suggested a workshop format followed by multi-couples groups as a follow-up. I thought that was brilliant! Additionally, feedback from the monthly meetings of the Recovery Forum at Mental Research Institute has been a steady stream of support, feedback and encouragement. The Recovery Forum consists of therapists interested in addiction treatment, research, education, and writing – much like the old days at MRI  – a think tank.

Phase 2: In May, 2011 I offered a CRDA workshop at Santa Clara University Professional Development Department (thank you Dr. Jerry Shapiro) training therapists, counselors and students through explaining the model and having participants role play the couple exercises. I offered the workshop again in July at Swedish Hospital in Seattle, this time co-presenting with John Gottman who brought his latest work on trust and betrayal – a very relevant addition to the workshop – and an additional technique for relationship repair. These workshops functioned like focus groups of therapists sharing their responses and ideas about the interventions and how to best help couples in early recovery

Phase 3:  In September I am giving the workshop to couples at three drug and alcohol treatment programs: Thank you to Sequoia Center in Redwood City, CA; Alternative Options in Cerritos, CA (Los Angeles area); and Bayside Marin Treatment. Sponsored by a grant for Center for Couples in Recovery at MRI, couples will take this two-day workshop to learn and develop skills in conflict management, problem solving, managing emotions, ways to support individual recovery programs, repairing the damage from the past, and how to develop a “Couple Recovery”. At the end of the workshop, we will once again ask for feedback in this prototype workshop.

Phase 4: We will be seeking funding from NIAAA for a two-year randomized clinical study looking at the effectiveness of standard treatment in outpatient programs verses couples given CRDA interventions on  measures comparing relapse rates, relationship satisfaction, quality of life, and taking a closer look at the relationship between relapse rates and relationship satisfaction or dissatisfaction. The couples in the CRDA group will be given a two-day workshop with six follow-up multi couple group sessions.

Phase 5:  Don’t know what that is yet, but that’s ok – (One phase at a time)

Many people have supported this work, too many names to mention here, and I am grateful for your support, ideas and encouragement. It will take a community to make “Couple Recovery” a standard part of addiction treatment and recovery approaches. CRDA is simply one approach, not the only approach – Recovering Couples Anonymous (RCA) has been a leader in advocating a couple approach to recovery. Now we have research to help us with a road map to find our way through the maze of couple recovery issues and challenges.

I will keep you posted on how things go over the next month. I’m always interested in thoughts and ideas about couple recovery so I welcome your responses.

Trust: A Tricky Balancing Act

Trust is basic to the foundation of any significant relationship, it’s really hard to imagine anybody feeling comfortable in a relationship where  trust has been consistently broken. How do couples affected by addiction deal with the ongoing issue of trust – or more to he point mistrust? Many addicts and alcoholics in recovery will often focus on one day at a time, the position that one can’t guarantee never using again, all one can do is take recovery day by day, or perhaps hour by hour. So what does this mean to the partner who is being told, or simply knows and understands that reality?

Tom had been struggling with his wife’s recovery from alcoholism from the start. At first he felt tremendous relief when she began going to AA meetings and reassured him of her commitment to deal with her drinking problem. Tom found that his relief was  soon replaced by increasing anxiety, plagued by a relentless internal and silent stream of anxiety fueled by questions he couldn’t turn off: “Are  her eyes blood-shot, maybe she’s tired, or has she been drinking?” “Why isn’t she home, the meeting was over 40 minutes ago?”  Will she drink if I tell her how angry I really am at the mess her drinking has caused?” “Will she drink because of the stress she feels at work?” “Is that alcohol I smell on her breath or is it the new toothpaste she bought?…Why did she buy new tooth paste?”

Jana knew her husband struggled with trust, and while she could understand his anxiety, she also resented it. From Jana’s perspective she was doing everything she could to work her program, stay sober, manage a high pressure job as a mid-level manager in a major accounting firm, and tend to the thousand other things on her plate. What bothered Jana the most was that Tom’s mistrust was starting to feel like the new elephant in the living room – they both knew it was there, but nobody was talking about it. Their relationship felt as off  balance as it did before Jana stopped drinking, just in a different way.

Tom didn’t want to upset Jana, but sometimes he couldn’t hold back the questions or the extended looks that communicated the fear and anxiety he was feeling. Jana felt guilty about her alcoholism and felt that she owed Tom a lot of patience, but it was becoming increasingly difficult for her to deal with the tension every time something triggered Tom’s fears.

We discussed their feelings in a therapy session. I told Jana and Tom that their struggles with trust were normal for a couple in recovery, especially early recovery. Things do not get automatically better when a partner gets into recovery, in fact, new problems emerge, and problems in the relationship that have laid dormant start to re-emerge. While old problems may need to be put away a bit longer for now, current feelings and struggles with trust need to be dealt with in the here and now.

What strategies might help Tom and Jana?

1. Tom needed to learn more about co-alcoholism and how to deal with his own control and fear issues regarding Jana’s recovery. Through education, group support, and an awareness of Tom’s own recovery issues, Tom would get better at recognizing and managing his feelings and accept he can not control recovery outcomes for Jana.
2. At the same time, there is a place to discuss feelings here with a model of managing feelings that breaks from traditional “stay on your own side of the street” advise. I encouraged Tom to share his feelings and to ask for what he needed when it concerned his own recovery, not Jana’s. The formula starts with: stating what is happening – expressing feelings – asking for what you need. For example, when Tom thought Jana’s eyes looked bloodshot and that worried him, I told Tom he could say, “I noticed your eyes look blood-shot. This makes me anxious and brings back old feelings”. That may be all he would want to say stating, “I just want you to know what I am feeling and why.” He may need more however and add the question “I would like to know if you did drink last night after the meeting .” I realize this approach breaks with current conventional thinking about codependency, and Jana could lie anyway, but this process at least brings the question out in the open, rather than leaving it unspoken and lingering. The “rule” in most alcoholic families is that members can’t talk about what the see and what they feel – I believe recovery is about doing the opposite.
3. I encouraged Jana to not respond defensively and to try to understand that it is understandable that Tom is going to struggle with trust because drug and alcohol dependency patterns almost always includes patterns of deceit and lying, as the dependent person struggles with their own loss of control and inability to stop. This certainly was the case with Jana’s drinking history and her attempts to hide and deny her drinking from Tom. I don’t ask partners to trust each other or to expect trust, I ask them to share what their struggles are in a non blaming way and to normalize those struggles. I stated, “Of course Tom is not feeling trust, given the toll that alcoholism has taken on trust, but if couples can manage it,  it is helpful to the recovering couple’s relationship when partners can begin to share what concerns them and know that their partner will try to hear and respond to those concerns. So Jana you could state, ‘When you look at me that way and worry about me relapsing, I feel hurt and frustrated that you may not see how hard this is and how hard I really am working, but I would rather you tell me what you are thinking then silently holding it in and withdrawing – that makes me even more tense.’

Is this codependent? I could see an argument for viewing this approach as codependent if the motivation for Jana and Tom to share feelings and ask these questions is to control or manipulate. What we are aiming for here is trying to establish a way for partners to express what they see, what they feel, and what they need – as long as it is not about trying to control their partner’s recovery.

If Tom is concerned that Jana missed a meeting this week, I could imagine standard advise as, “That’s her program, she needs to work on that; You need to work on your own program.” Not bad advise, but another approach could be for Tom to focus on sharing his feelings about this WITHOUT having a goal to change her behavior. For example, “I noticed you missed a meeting this week. I realize this is your program and that you are in charge of, but I have to say I do get a little anxious when you miss a meeting.”  I would encourage Jana just to listen and acknowledge Tom’s feelings. “I can understand why you would feel that.”

Trust (and recovery) really is a balancing act. There will be times and circumstances to not to have the above type of conversation, but I am hoping couples will work at trying to find that balance so that recovery does not become the new elephant in the living room.

Recovering Couples: When You Take the FUN Out of DysFUNction

Are We Having Fun Yet?

Margaret and James used to have a good time together – that is when they were both drinking. They had quite a ritual, with both coming  home from work around the same time they would begin their daily pattern of  happy hour. For many alcoholic couples, happy hour doesn’t stay happy as alcohol begins to change moods, temperaments, and judgement, all leading to unhappy hour. This wasn’t the case for James and Margaret.  They rarely fought during their happy hour and often had lively conversations filled with laughter. They both saw this time  as a time to bond. Drinking time was a fun time for them, often lasting several hours. After dinner, well not so much fun, with both falling asleep usually watching television. Drinking wasn’t so fun always at other times either as health issues for Margaret and escalating work-related difficulties for James led to poor performance reviews. James sales position required some evening and at home work which simply wasn’t happening.

Remarkably, both Margaret and James decided to stop drinking at just about the same time, and both began working a recovery program. They both went to AA and eventually found sponsors.  What surprised them both was that their relationship satisfaction dropped after they stopped drinking. James had about 8 months of sobriety and Margaret with 10 months when they started couples therapy.  James discouraged, commented, “Boy is recovery a buzz kill, literally! Aren’t relationships supposed to get better? Why aren’t we having more fun?” Margaret nodded her head in perplexed agreement. This was a great question, and not an uncommon issue or concern for couples in early and in ongoing recovery.

The couples that do best over time find ways to establish new rituals of connection and find ways to celebrate and have fun that don’t involve drinking or drugging. This is especially difficult when couples have relationships with their families of origin, and one or both of those families have highly ingrained rituals around drinking , with no model of how to be together and have fun without substances. Un-recovered family alcoholism presents a major issue to confront when individuals try to establish recovery in their lives and still be a part of their familiy where drinking is central.

“What do you two do for fun now that you no longer drink?” I asked after hearing about their former happy hour (or two) nightly get together. “Well,” Margaret replied,” We tried continuing our happy hour time with non alcoholic drinks”. “How has that gone?”, I asked, kind of knowing what the answer would likely be. James chimed in, “I don’t know what to talk about. We just sit there like we don’t have anything in common anymore. Sorry honey…” as he looked at Margaret, “…but it’s really kind of boring”. Margaret started to get defensive, but then had to admit that she really wasn’t having a good time either.

      Time to Establish Some New Rituals for Fun

Trying to establish a non alcohol happy hour just didn’t work, too many associations with their drinking. They both needed to learn how to be together having fun in ways that didn’t involve drinking. Both coming from alcoholic families, neither one had family experiences to draw on, both families maintained drinking as a central activity at all family gatherings and celebrations.  As we continued our work in therapy, Margaret and James discussed new activities that they were willing to try together. For years they both expressed an interest in taking yoga, but drinking always would win out with mutual promises of “Next time”.  Now that they could, they decided to take a yoga class together, and found that the socialization following class really opened up their friend network, something long neglected. Margaret and James began attending parties hosted by the yoga class instructor and other members of the class. They found themselves open to new ideas about other things they had long talked about doing but never quite got to. James got his piano keyboard out of the closet and began to practice again, entertaining ideas of trying to get his old group together . “Who knows, maybe we can actually play some gigs again now that I won’t be so loaded that I insult the club owner”.

It turns out that play is an important drive, hard wired into all brain circuitry.  Dr. Jaak Panksepp, noted psychologist and neuroscientist, writes about the emotional command systems in the sub cortical structures in our brains that when activated predictably lead to specific behaviors; play is one of them.

All couples really need to make play a part of their relationship. It doesn’t really matter what activities you choose as long as you both enjoy it. Also, taking time for yourself to develop interests, nurturing a playful self is an important part of every individual recovery program that all too often is overlooked.

Think about the things you might want to do with your partner that could be a fun, shared experience, as well as finding or getting back to your own individual interests.

Taking the FUN out of dysFUNction means putting the FUN back in FUNctional recovery.

Swinging Into Recovery From Addiction

Recovery Has Its Ups and Downs:

Do I Want To Get On?

Several years ago Jerry and Carol (not their real names) came in for couples therapy. They stated that they had a good marriage, but that they needed a “tune up”.  Jerry talked about how he felt that stress was impacting their relationship, Carol agreed, but also expressed concern over Jerry’s drinking and wanted him to better control his drinking, like he used to. Over the next several months we addressed their relationship concerns, but what emerged as a central issue was  the fact that Jerry’s  alcohol (mis)use was seriously affecting the marriage, his relationships with his young children, and recently, his work. In our counseling sessions we had explored Jerry’s drinking and where it might fit on the drinking continuum between heavy, abusive, and dependent. Understandably, the possibility for Jerry and Carol that Jerry had an alcohol dependency was frightening, but the evidence was mounting. When Jerry opened the session to talk about his latest drinking episode, he said “I have to stop drinking, I don’t feel in control anymore”. When we discussed what happened and what led him to decide that he wanted help to stop drinking, Jerry described what he remembered about the night.

Jerry attended an important meeting in San Francisco that ended very successfully with his small company closing a lucrative deal. After the meeting he and two of his colleagues decided to celebrate and go out for drinks, something Jerry had not done before because of his policy not to drink at work-related events. Over the course of the evening Jerry drank too much,  neglected to call Carol, and somehow got home safely after 2:30 am. The next day Jerry felt tremendous shame and anger at himself, there were parts of the evening he could not remember and the parts he did remember were embarrassing. He knew he had hurt Carol and felt like he had hit bottom.

Jerry decided to begin going to AA and agreed to pursue referrals to therapists specializing in addictions for individual therapy. The decision to get into recovery from dependency is not an easy one for most people. Self-identifying as an alcoholic or co-alcoholic is a huge shift in one’s identity. Also, learning what works to stay sober and manage life – all at the same time – takes effort and  adapting to a new way of thinking, behaving, feeling. It comes with its “fits and starts”. Carol and Jerry continued couples therapy, and Carol agreed to begin her own recovery in Al-Anon. She also attended with a close friend a recovery group with a Christian orientation that she felt would be a good match for her.

Couples Need Their Own Recovery

Each Person Finds Their Own Way of Moving Through the Ups & Downs

Carol found the support from her groups extremely helpful. At first she felt embarrassed, self-conscious and a little guilty that she was somehow ‘telling a secret” about her husband’s drinking problem. However, she also felt others understood her and supported her in her recovery and what she needed to do to stay on track in her recovery.

Jerry too  found AA difficult at first. After he committed to go, it still took another 3 weeks before he was able to walk through the door of a meeting. Once he was there he stated it was easier. He found a sponsor 1 month later and stayed in close contact with the sponsor. There was one occasion, several months after Jerry started attending AA, when Jerry “experimented” with having a glass of wine at the restaurant he and Carol went to with another couple they were close to. Jerry felt uncomfortable telling their friends that he wasn’t drinking, so he had just one glass and made an excuse for not having more.

Jerry and Carol shared that even at the time both agreed to this plan ahead of time, that they felt uncomfortable with the decision. While the glass of wine didn’t lead to more drinking, Jerry shared that afterwards he started thinking again about drinking, and wondering if perhaps he could control his drinking this time. Work with his sponsor, some additional meetings, and work in our couples sessions all seemed to help him become clear about the risks and soon he felt clear again about what his recovery was about – his commitment to abstinence.

The couples work focused on a number of issues:

1. Helping Jerry and Carol adjust to the tremendous changes taking place in their relationship on a day-to-day basis
2. Exploring ways to support each other’s recovery without taking responsibility for it – keeping boundaries clear
3. Finding a way to talk about how each felt affected by alcohol and the impact it has had on them personally and in the relationship – without blame or accusation

 

Couple Recovery Allows Room for the Relationship

With All of Its and Downs

Carol and Jerry began to find ways to talk about their concerns about all the changes that were happening in their relationship: what they were going to tell friends and family about Jerry not drinking anymore; the time away from each other as they both were involved in their own recoveries; struggles with fears of what the future would hold, and the ever-present fear of relapse; dealing with some of the baggage from the past and the impact of alcohol on their relationship, and now the impact of recovery on their relationship; the awareness that both Carol and Jerry had alcohol issues in their family of origin, and how this factored into their recoveries and their relationship.

Central to couple recovery is the focus that each person is responsible for their own recovery, but both partners are responsible for the relationship. Supporting each other’s recovery doesn’t qualify as “codependent” when boundaries are clear and the focus is on finding ways to appropriately discuss individual needs and relationship needs without blame and without taking on all the responsibility. While active alcohol or drug dependence often becomes the “elephant in the room”, recovery can become the new elephant. Every relationship has its ups and downs, recovery aside, what helps is to find ways to connect that work for both partners.

Recovery Can Replace Dependency as the New Elephant in the Room

He doesn’t Look So Scary, Does He?

 

Addiction Recovery: Looking Ahead

Looking Ahead at Recovery: What do you see?

I remember as a kid, we would be on vacation at some scenic observation area on the way, and there they were: those coin-operated binoculars. I also remember being absolutely fascinated with those things, thinking how cool they looked, all metal and indestructible, those beauties could swivel to move the viewing area vertically and horizontally. All it took was an available binocular and 25 cents.

Somehow, I couldn’t seem to appreciate the view until I was able to take a turn. If they were all being used I would feel impatient, scanning for the one that seemed to have the shortest line. Except, there weren’t really lines typically, it was more like people milling around either not interested in using the binoculars and simply standing close to one, or people actually waiting for the next opening.

Even as a kid I knew  it was good to have strategies when hoping to get some coveted time with the viewer on a popular vista. I would scout for the people looking for change, men digging deep in their pockets and women opening their purses, find something away from where they are standing. Next, I would check out where the kids were, they always wanted to use the binoculars. I would be on the lookout for people hitting the binoculars and yelling out something like “Hey, what’s the matter with this thing? It just ate my quarter!” Somehow losing 25 cents to a machine becomes very important to our sense of injustice in those moments. Well anyway, avoid that machine. Finally, when I would actually get my cherished time on the binocular, I would really want to make good use of that time, zooming in on every area within that view. You never really knew for sure just how much time you had, so every second counted. A little trivia – the average time ranges from 1.5 minutes to 2.5 minutes. These devices have been manufactured since the early 1930’s by a company called Tower Optical, they are still in operation and only make about 35 devices a year. The basic design has never changed and I think they still charge 25 cents.

It turns out that about the same time Tower Optical began producing their viewers that theories about alcoholism began to emerge. As early as 1930, long before the advent of family therapy as a field, treatment concerns for the alcoholic focused on the importance of family interactions in influencing drinking patterns. In the 1940’s and 50’s psychoanalytic theories focused on the wives of alcoholics, speculating a relationship between the wife’s personality functioning (usually described in negative terms) and her ending up in a relationship with an alcoholic husband. It wasn’t until the late 1960’s when family therapists began applying concepts and theories again to alcoholism treatment specifically.

When I look ahead at recovery I see us rediscovering what the theorists started with in the 1930’s – relationships as a core issue when treating chemical dependency. Looking at addiction as a “family disease” should mean treating the whole family. There is a circular relationship between the addict/alcoholic and the family: each affects the other. There has been a lot of research on that relationship, and only now are we beginning to see the importance of that circular relationship in recovery as well. Recovery means so much more than not using the substance – more on that in a later blog.

Let’s imagine that you are standing with other people at an interesting vista. Let’s make the vista the future of recovery and trying to figuring out what’s helpful to you (if you are in recovery) and to other recovering people. Let’s further imagine that we all have a viewer available. Wouldn’t it be great if we could share what we see? What part of the scene jumps out? What is the vision we can share with others. Looking out, what do we hope to see? I’m betting couple recovery is out there, ready to be seen and rediscovered.

Yours, Mine & Ours (Recovery)

You may remember or heard of the old movie, “”Yours, Mine and Ours”, with Lucille Ball and Henry Fonda (1968). A remake starring Dennis Quid and Rene Ruso came out in 2005. The movie was loosely based on the true story of Helen and Frank Beardsley who had 8 and 10 children respectively at the time their former spouses died. They ended up marrying and became  an instant family of 18 children, an endless interest to an amazed public. Most of the original movie was shot in San Francisco by the way.

In a most unlikely scenario, apparently things worked out fairly well for the Beardsleys.  They learned how to adapt their life styles and make things work, requiring creativity, perseverance, and learning what works. So what does this movie have to do with recovery and couples?

Last Friday I spoke about couple recovery at a speakers luncheon sponsored by Bayside Marin Treatment Center. The setting was a wonderful sample of a beautiful sunny day in San Francisco – sights, sound and food – right on the Embarcadero. The venue was at the Delancey Street Restaurant associated with Delancey Street Foundation, the leading self-help residential program for those who have hit bottom around alcohol, drugs, including the  homeless and those who have been in jail or prison. Volunteer efforts from some of the best chefs, restaurant owners and wait staff launched the resident staff who then in turn trained those after them. This is a core philosophy of Delancey Street, learn and pass it on.  The residents learn success, productivity and ultimately contribute back to the community. Another unlikely scenario that has worked out because of creativity, perseverance, and learning what works. A model community.

I believe that we are at a new era in addiction recovery. Bringing the relationship into the process of recovery adds an important dimension of recovery that has the great potential for each partner to feel support and understanding in their own recovery process. At the same time relationship issues no longer need be ignored or avoided. By developing a couple recovery three recoveries are addressed: each individual recovery and the couple recovery. Several of the therapists I spoke with after the talk expressed excitement and enthusiasm for this concept and the need to include the relationship in recovery.

To some, this idea will seem like another unlikely scenario, but we now know through research that couple stability predicts long-term sobriety. We also know that there are certain tools and relationship skills that all couples can benefit from and will greatly influence relationship stability.  I am suggesting that we put the research together with creativity, perseverance, and learning what works for each couple.

I want to thank Bayside Marin Treatment Center for sponsoring the luncheon and providing the opportunity to share ideas on helping recovering couples.

For more information on the Delancey Street Foundation in San Francisco Click Here

Relapse: What Now?

Joel walked into my office looking tense and uncomfortable. He was there  for his weekly therapy session where we have been addressing his amphetamine use and depression. His eyes avoided mine, clearly he was upset about something. 

Joel is just now dealing with his amphetamine use and coming into the realization that he may have an amphetamine dependency. This is a huge transition for anybody who begins to realize that “Maybe  I CAN’T control this”.

“What’s happened Joel”, I asked, suspecting the answer would relate to his drug use. “Well, I made a phone call to a Mexican pharmacy. They sent me my order (a stimulant used to treat ADD) and I used them over the weekend. This feels like such a dead-end”.  

Joel had relapsed, but had been able to tell me. Relapse and shame tend to go together, as they have for Joel. “I’m glad you told me. Let’s talk about what happened. Does your partner know you used?” Joel and I used the rest of the session to deal with what he shared, and what next steps he might consider.

 It turns out that Joel did tell his partner. While I am not working with the couple, I offer ideas to Joel about considering relationship issues in the context of his recovery.  Relapse translates to the need to reevaluate the current program and strengthen it somehow.

How can couples manage relapse? One of the strategies I talk about with couples is to have a relapse strategy in place. Once somebody has committed to sobriety/recovery, the couple can talk about what they would do and what would need should the partner relapse. For example, one couple I worked with came up with a plan that should there be a relapse, the addict partner would take the next steps in increasing a recovery plan to include an evening treatment program. His partner said she would need to be able to tell her family, so she could get support. She also talked about her need to be in a couples support group or 12 step program like Recovering Couples Anonymous (RCA). Both partners said they were committed to the relationship and would want to work in ways to manage recovery for the both of them individually and as a couple.

Couples who can talk about relapse – the thing they hope will never happen – are better equiped to deal and manage with relapse if they are prepared. Hopefully relapse fears can freely be talked about, and built into an ongoing dialogue.

Having said that, we still take it one day at a time. 

Want A Relationship Boost? Try This

Jeff spoke about the deep roots that alcoholism has had in his family. He is an adult child of two active alcoholic parents and his brother is in recovery from addiction.  It turns out that in his family, despite his parent’s active alcoholism, not all family gatherings are so bad. I asked how Father’s Day went, he replied that it actually went OK. Jeff went on to say that is sister had a great idea that he really liked.

It worked this way. Jeff’s sister asked Jeff and their brother to write out 30 separate positive things about their father – these had to be real appreciations and expressing gratitude for what each person genuinely felt. Jeff’s sister took the lists and cut out each affirmation and put them a nicely decorated jar. The gift they gave their father was a nicely decorated jar that every day, for 90 days, he could pull from the jar one of the affirmations that one of them wrote.

Jeff was quite taken with this idea stating, “I wish somebody would do that for me”. This exercise in positivity stands in great contrast to the negativity often experienced in alcoholic families. The challenge is in the ability to find the positive, and to feel one could honestly express gratitude and appreciation to the family member or partner.

It certainly would have been OK for Jeff to pass on this idea if he didn’t feel comfortable participating.When I asked Jeff about how he felt about writing these positive things about his father, he replied that it helped him to remember some of the positive things his father did, “He did do some things right.  He was there at my sports events in high school, and has tried to support me through some of my recent challenges”.  For Jeff this worked, much like a gratitude list works in AA. Jeff gained something for himself  in the exercise.

Denial is usually thought of in the context of denying addiction. I suppose one could argue denial could also be related to not acknowledging positivity as well. There is compelling research that when we are feeling negative about a relationship, awareness of anything positive about the relationship isn’t noticeable or on the radar at all. Neutral and even positive interactions are viewed as negative.

Think about whether this could work in your relationships that could benefit from a boost and whether you would want to discuss this idea with your partner and/or family members. Good luck.