Recovering Couples

It has been a long delay since my last blog entry, a very busy year professionally and personally. I do hope to keep momentum going with raising the issue of relationships and addiction recovery.

The blog title is taken from a piece of Christmas folk lore. In 1897 little eight-year-old Virginia O’Hanlon wrote a letter to the New York Sun asking for the truth about whether there really is a Santa Claus, because  her friends told her there wasn’t. The editor, Francis P. Church, wrote the following:

“Virginia, your little friends are wrong. They have been affected by the skepticism of a skeptical age. They do not believe except they see. They think that nothing can be which is not comprehensible by their little minds… Yes, Virginia, there is a Santa Claus. He exists as certainly as love and generosity and devotion exist, and you know that they abound and give to your life its highest beauty and joy.”

Church’s response was an instant sensation and has become one of the most famous editorials ever written. It was reprinted in the Sun annually until 1949, when the paper went out of business.

So what does this have to do with couples and recovery? The long held belief in the addiction recovery field has been to keep recoveries separate, each individual is encouraged to work their own program and “stay on your own side of the street”. As a recovery therapist, I can’t argue with the emphasis that should be placed on individual recovery. However, by adding a relationship focus in the recovery process you address a way of helping couples and families in the transition through the stages of recovery, in my opinion, is core to a more holistic approach to recovery. My research on successful long-term recovery processes points to the very important role of couple and family relationships can have have in successful outcomes.      

My colleague and friend, Dr. Virginia Lewis is Co-Founder and Co-Director of the Family Recovery Project, at Mental Research Institute (MRI) in Palo Alto. Additionally, she is Senior Research Fellow at MRI and an excellent clinician in private practice. Virginia invited me to continue my research on couples in recovery and together we co-founded Center for Coupes in Recovery at MRI. Virginia’s emphasis on family recovery as an essential component of successful long-term recovery, focuses on the importance of relationships in recovery, describing the complexities and difficulties families encounter, and normalizing those challenges.

There are many in the field that don’t believe in a relational approach to addiction treatment. To them I would say, “Yes, Virginia is right, there is family recovery: It’s exists. Let’s work together to help couples and families manage better, and educate those who don’t believe.”

Some years ago I remember leading a family group at a drug and alcohol treatment center. I opened the group with the question: What does it mean to be a family or couple in recovery? Some people struggled with the idea that the non-addicted members of the family had some part in going forward in recovery. Until that moment many partners had viewed their (addicted) loved one as having the problem; the idea that the non-addicted partner too had recovery issues didn’t fit their expectations of treatment. Either the idea of couple/family recovery never occurred to them, or they simply admitted to feeling angry about having to take some responsibility for fixing things given that they weren’t the ones with the addiction. This feeling is very understandable. The damage to relationships from addiction usually has a history built on broken promises, and countless unintended disastrous outcomes. It is like something destructive has invaded the family unwelcome but unshakable, that is until recovery. Family members often cling to the hope that once the alcoholic/addict gets into recovery their lives can finally be normal. What we know from the research is that while recovery is the end of something - active addiction, it is also the start of something - a healing process and the beginning of building new relationships in family and couple life.

Addiction in the family can be thought of like a mobile or wind chime, one of those hanging art objects that have parts connected by lines, so that when the wind blows all the parts all move. Think of the family as the parts of a mobile and think of addiction like the wind. The wind blows and all the pieces are affected. Recovery is like that too, like addiction recovery affects everybody in the family. All the pieces of the mobile are still connected, but what moves the pieces is different. Families need to know that adjusting to these changes takes time. Everything may seem different and even though the alcoholic isn’t drinking, there still are problems, issues and concerns that need to be addressed: This is normal!

So what is recovery? That is a question that a hundred people might answer a hundred different ways. I would begin the answer with the idea that individual recovery is taking stock of how the addiction has impacted oneself and starting to address the question of what the individual needs to do to keep what is healthy in their lives and change what isn’t healthy. I also would emphasize that the same thing needs to happen with relationships. How has addiction affected relationships and what changes will make those relationships healthier?   

OK, you are in recovery for an addiction or for codependency. Everyone is telling you to work your own program, focus on yourself and on your recovery. The message is  very clear: For now, put your relationship on the back burner. That sounds right to you, but the problem is that everyday you are struggling in your relationship. Increasingly you are feeling distant from your partner and you don’t know if you should even address your relationship concerns, after all, you are supposed to focus only on yourself. Feeling puzzled about where to place your relationship?

As a therapist and researcher I am interested in the “big picture” of addiction recovery. I have learned from my research couples that by addressing individual recoveries and relationship issues, you are creating the best opportunity for successful long-term recovery. A study by Humphrey, Coos, and Cohen (1995) supports this idea. The study followed 385 previously untreated alcoholics at three years and eight years after treatment to find out what factors led to successful long-term recovery. The results from the study indicate that the quality of family relationships is the most predictive variable of whether the alcoholic will maintain successful recovery eight years after treatment.  Additionally, outpatient or therapy sessions and attendance in AA sought in the first three years of recovery increased the likihood of continued recovery at the eight-year mark.  

We know that couples with alcohol problems have higher rates of divorce than the general population and we know that recovery does not necessarily reverse that trend. I believe that the recovery jigsaw puzzle challenges us to try to figure out where to place the relationship piece. Where that piece is placed is going to vary from couple to couple and will depend on a number of factors. I have met with tremendous resistance in the recovery field to this idea, but based on my research and other research that supports this position, I think they are wrong. 

I am interested in hearing from couples and from recovery professionals about your experiences addressing relationship issues in the context of addiction recovery. What has worked, what has not worked, what ideas do you have on how to figure out where to place that puzzle piece? My ongoing research on recovering couples is based on learning from the folks who are in the middle of it. I will post comments and hopefully we can create dialogue.    

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”.          

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. 

Ron had been in recovery from alcoholism for several months. He had been going to AA, had a sponsor, and spoke about his commitment to recovery and how important it was to him. It was Friday night and Ron was going to his 7:00 PM meeting again, stating that a small group was going out for coffee after the meeting. Cindy supported Ron’s involvement with AA, she didn’t really like giving up Friday nights - it used to be their night - but she realized that his recovery program was important.

At 10:00 PM Ron still wasn’t home. She tried to reassure herself that everything was probably fine, but a familiar, creeping feeling of fear and dread began a relentless path in Cindy’s mind. She tried watching television, working with her favored Sudoku puzzle, and self-reassurances, but by 10:40 she was feeling angry, upset, and physically sick. She tried calling Ron on his cell, but it rolled to voice mail. She tried several more times with the same outcome.

At 10:50 Ron calmly walked in announcing his arrival. Cindy carefully scanned him for everything she knew and had experienced when he had been drinking. She went through the check list, looking for tell-tale signs of drinking that she knew so well: they weren’t there. What should Cindy do? Everything in her felt danger, how should she manage that feeling?

Ron immediately picked up on her upset and apologized for not calling. His cell battery was dead, but he admitted he should have called her. He stated it was a great meeting, and that the group continued their discussion in the restaurant over their coffees and dessert.

When a partner fears that their partner has relapsed - either with a substance or with co-dependency - use the “soft start” technique to express your feelings and state what you need. Dr. Gottman’s research on what works in how to raise a problem or concern led him to discover that couples who mange difficult conversations tend to start the conversations with a description of what happened, how they felt about what happened, and what they want. Cindy could say this, “Ron when you stayed out later than I thought and I didn’t hear from you or couldn’t reach you on your cell phone, I was worried and scared that you might be drinking again. I need to know, did you?” Cindy could go on to say that what she needed in the future is for him to call if he is going to be late.

Some would argue that this is co-dependent, checking to see if the partner is drinking. What I have learned is that if couples can own their fears, talk about them and ask for what they need, then these fears don’t build up. Ron and Cindy are learning to simply be honest with those feelings and needs, not control the other.

Ron acknowledged and honored Cindy’s feelings and her request for reassurance and enough details about the evening to understand what happened. He could have gotten angry or defensive, but he didn’t, so the event was dealt with, repair happened, and they drew a bit closer as a result. This helps to build trust, the ability to express and be heard.            

Paul and Alice were struggling in their relationship. I started working with them after Paul got into recovery from alcoholism and a gambling addiction. Alice was in individual therapy and attending Al-Anon, Paul attended AA and Gamblers Anonymous (GA). We had been meeting for two months when the therapy session focused on how they both felt distant from each other, and recalled how things used to be. We talked about what things were like for them during better times. 

They had a lot of history together, many positive times, some painful times. As Paul’s addictions progressed, the negative overtook the positive in the relationship. Recovery is a process and healing takes time. We talked about how important is to share with your partner what you appreciate about the partner, what you like about their qualities. Dr. John Gottman’s research on couples uncovered a very important finding: managing conflict and dealing with the painful parts of the relationship goes much better when there is a foundation of positivity in the relationship. All this means is not just focusing on the negative, and the hurt, but remembering and acknowledging the positive. Even in the most distressed relationships I found that when couples are able to tap into something positive to say to their partner, things go better and actually make dealing with the difficult issues go a bit more easily.

In the session I asked each person to share several things they appreciated about the partner. They had not heard anything positive from the other person in such a long time that they both felt moved by the sincere appreciations that were shared. Paul then said that he felt it was hard to hear anything positive from Alice, he felt shame about how his addictions had damaged their relationship. We discussed those feelings, but also focused on how important it is to put toxic shame in the box of “Not Helpful” because shame is about feeling that there is something wrong with who we are, not that what we did. Paul grew up in a very toxic family, he heard messages his entire life that he was defective and bad. Guilt helps keep is from getting off track from the things we value or the beliefs we have - that is healthy.

Paul heard the difference between toxic shame and guilt,  and is working on it. He is trying to let the positive appreciations sink in, and this is good for Paul and for the relationship. It will help Paul and Alice deal with other things and keep a perspective of accountability, not despicability - a huge difference.

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”.

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?