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

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.

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Recovery Secrets for Couples: Part 2

My last blog entry (March 8, 2009) gave an overview of the findings from the Family Recovery Project; research aimed at understanding long-term couple and family recovery processes. I was a doctoral student in 2000 and began work on one component of the Family Recovery Project, the “Couples Focus Group”, comprised of reovering couples who had successfully weathered at least five years of recovery, and were happy in their relationship. While this research involved couples with established long-term recovery, I believe that couple recovery should be addressed right at the start of recovery. Implications for couples newly in recovery suggest several important considerations. Arguably, there is a place to integrate couple recovery within the context of individual recovery, even in the early part of recovery. Beginning to integrate new ways of being with each other early in recovery is better than later in recovery and I believe would create better outcomes down the line than if the couple postponed dealing with their relationship only after years of individual recovery. 

The focus group had met for over five years, once a month for two hours, basically talking about their experiences in recovery, but from the couples’s perspectives. There were two follow up meetings after the group ended. The group discussions were audiotaped and my task was to code and analyze the data to understand what happens in the couple relationship after starting recovery. This was a remarkable opportunity to learn from the couples themselves about what works and what doesn’t work in managing recovery from the couple perspective. The couples expressed in the first group that this was really the first opportunity they had to tell their story as a couple in recovery, not just as an individual in recovery.

The task of making sense of the 106 hours of audiotaped recordings began with creating “codes”, themes that captured ideas or concepts relevant in some way to questions of:

  • What do the participants feel is/was important to their couple recovery?
  • What changes took place over time in their relationship? 
  • What problems did they experience in their relationship and what helped to work on these problems?
  • How did these couples differ from couples in early recovery?

I used “Grounded Theory”, a systematic approach  to coding the interactions leading to a process of eliminating themes that don’t hold up, developing themes that do and establishing relationships between themes that unfold into the bigger picture of what is happening. The results from this research provide a theory of long-term couple recovery processes. This research has been ongoing through the Center for Couples In Recovery at the Mental Research Institute and can be summarized this way: The overall picture is that successful long-term couple recovery is a process involving three components of relationship development with changes in these areas taking place over time; less emphasis on individual recovery and more emphasis and focus on the relationship; increasing awareness of the impact that the family of origin has had on his/her own model for how to be in a relationship, now seeking to change the dysfunctional patterns they have learned; and the ability to manage both individual and couple recoveries.

  1. More specifically, “Shifting” is the process that occurs when individual recoveries have stabilized and the couple now wants to focus on the relationship. Individuals continue to attend programs like AA and Al-Anon, but there is an increasing need to reconnect with the partner. The supports from outside the relationship have been important and now there is an interest in developing the relationship that essentially has been put on hold in service of strengthening individual recovery
  2. “Intergenerational Reworking” refers to partners coming to grips with the impact of their own upbringing and what they bring to their current relationship as a result. Dr. John Gottman would refer to this as the “Internal Working Model”, which simply means we learn how to be in relationships from the people who raise us. Sometimes what we learn isn’t so healthy or helpful
  3. “Attending” is the ability for partners to manage closeness, attending to the partner’s needs but not at the cost of one’s own growth or recovery or acting in codependent ways. Boundaries seem clearer and roles and rules of how to be with each other allow for continued couple growth as well as individual growth.

Unhealthy patterns of interaction learned from the family of origin need to be replaced with healthy ones and this is where Dr. John Gottman’s research is so useful; we know what works and doesn’t work in relationships (see www.gottmantherapist.wordpress.com for my blog on relationships).  Finally, learning to care for self doesn’t have to mean putting the relationship on hold for five years. I believe there are ways to address relationship issues without sacrificing individual recovery. This is an ongoing research effort, and how to move through these components is something we need to learn more about. So hold on to the idea: “More will be revealed”.          

    

Recovery Secrets for Couples: Part 1

There have been many studies over the years on the impact of alcoholism on couples and on families, but nobody had ever asked the question: What is normal in family recovery processes? That changed in 1989 when Stephanie Brown, Ph.D. and Virginia Lewis, Ph.D. joined forces as founders and Co-Directors of the Family Recovery Project. Sponsored by the Mental Research Institute in Palo Alto, the Family Recovery Project was the first research project to study recovery processes in the family with varying lengths of recovery time, asking the question: What is normal?

Drs. Brown and Lewis studied families with varying lengths of recovery ranging from two months to 18 years, interviewing and videotaping the 52 volunteer families who also filled out a number of paper and pencil tests. What did they find out? The following is a brief overview:

  1. Moving from active addiction to recovery often comes on the heals of a lot of instability in the family – which preceeds change. The old family system needs to collapse; letting go of old ways of functioning allows for a new life, not regaining the old one
  2. Recovery is a long-term, multileveled process effecting individual development, family development, and the family environment – it is more than simply not drinking
  3. Recovery is a huge transition for families in that so many changes take place, this usually means learning how to adjust and cope with a new set of problems and challenges 
  4. Recovery is a long-term process with different developmental issues associated with transitioning from active alcoholism to early recovery, and to long-term recovery 
  5. Finally, Brown & Lewis emphasize the importance for families to get help, reaching outside of the family to learn new ways of relating, of caring for self and incorporating recovery into individual and family life

What Brown and Lewis emphasize is that a lot of the difficulties couples and families experience in alcoholism recovery is normal! While It is painful when denial starts to crack around the reality of one’s addiciton or around the partner’s addiction, awareness of the realities of alcoholism creates an opening for change. Since individual and family development tends to come to a screetching halt in active addiction, recovery is the process to move forward again: focusing on one’s own needs, redefining relationships, learning to manage feelings, and creating new ways of dealing with the eveyday responsibiliites of life.   This is a lot of change, but as one person recently told me, “Recovery is hard, but it is better than being numb, I want to live life, not hide from it.” 

My doctoral dissertation was based on a separate component of the Family Recovery Project, the “Couples Focus Group”. In that research effort, the question was: What leads to successful couple recovery? I have continued this research as a Research Associate at Mental Research Institute and as Co-Founder with Dr. Lewis of Center for Couples In Recovery. Next time I will review my research findings on what I found out.   As always, questions and comments are welcome. 

Couple Relapse Warning Signs

When an alcoholic/addict commits to sobriety then ends up using again despite that intention, that is a relapse. Thoughts of using, fantasies of “one more time”, or using dreams, aren’t relapses, but one should pay attention to those warning signs.

What about relationships, what are the warning signs that a couple might be on a potential relapse track, meaning the relationship is headed toward increasing distress? Like recovery for addiction, consistency in the relationship is important. The data lets us know that over 80% of the time couples end up divorcing because of feeling emotionally distant. This happens over time, and like the insidious relapse path in addiction, a series of events tend to point to increased likelihood for a bad outcome.

What to look for in relationships? Here is a short list and examples to watch out for: spending less time together, simply too busy; feeling increasingly irritable with your partner, snapping easily; being under a lot of stress; not communicating regularly; recurring negative thought about your partner; not feeling emotionally close; not feeling appreciated.

If you are aware of several of these occurring over more than several days, it is time to do something to get back on track. What you do is going to depend on a number of factors. If nothing else, you might consider sharing with your partner, without blaming, that you are not feeling as close as you would like. Discuss some ways that you both could change that. Left undone, those warning signs might get worse.

You also might talk with your partner about what each of you identify as “warning signs”, and discuss what you might do about it when you notice them. Being proactive and taking care of your needs isn’t easy for many people in recovery, so do your best to try to figure out what is happening and what you need – remember – “Progress not perfection”.

Addiction Recovery: Different Paths

There are many paths to recovery; one size does not fit all. One path is inpatient treatment. As a therapist working with couples before and after inpatient treatment I have found a glaring difficulty for many of the couples: they are on completely different paths from each other. The following are “composites” of the stories I have heard from couples when a partner has been in rehab.

John was admitted to an out of state “name brand” rehab unit. His partner, Mary, initially received a telephone call from the case worker to get some information about the family, and Mary was given information about family week. John was in treatment for over 70 days, during which time Mary’s phone calls to the program were essentially ignored and no further contact from them was made until family week, two days before John’s scheduled discharge. Their response to her anxiety about what happens after inpatient treatment: “Go to Al-Anon and work on your own program”. 

Alan wondered why the family therapist at the program that his wife was admitted to keep talking about his contribution to her drinking, and how he needed to support her in new ways. While he felt this was a very important thing to discuss, he wondered why nobody seemed interested in how his wife’s alcoholism of the last 11 years has affected him and their family. He was told to work his own program, which Alan was willing to do, but Alan also wanted to know how they could deal issues as a couple. There were a lot of responsibilities and issues that still needed to be addressed: their son’s school difficulties, finances, and her parents intrusion into their lives, to name a few. He was told to put these issues on hold for now.

Carol didn’t understand why Jim had to go to so many AA meetings, after all, he stopped drinking and she needed him to help out more at home and with the kids: she felt depleted. Jim was panicked, Carol was pressuring him to not go to the Thursday night meeting, Jimmy needed help with homework. This was his home meeting and the place he felt he got the most support after leaving the hospital. It felt like a no win situation to the both of them

These different paths need to be identified, named, and explored, creating a dialogue around the impact of addiction and recovery on the relationship. It is important that partners work their own program and get support for themselves outside of the relationship. The piece worth adding is: How can couples support each other’s recoveries and at the same time not sacrifice their own?

Couple recovery means at the very least acknowledging that there are three concurrent recoveries: Each person’s individual recovery, and the couple relationship in the context of recovery. My belief is that treatment programs too often heavily emphasize the addiction recovery, they suggest recovery for the other person, and completely ignore the couple relationship. It’s time to look at the bigger picture and all the challenging questions that come with that awareness: How can we best support people in their recoveries and in their relationships?