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.    

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”.          

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. 

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.            

Joe wondered if he could ever be a good husband, he didn’t have much of a model in his own family. His father drank every night and fell asleep on the couch, his mother withdrew in angry desperation from her husband, and ultimately from the kids. Anna was angry with her partner, but she didn’t have a clue how to handle that anger. Her mother always told her to “Let things go, don’t make things worse”. Anna’s father was alcoholic who would go into rages; her mother did her best to protect her kids from his anger. Leo’s mother and father both were alcoholic. Family events like dinners, celebrations, birthdays, and vacations would always start off well with laughter and hugs, but would inevitably end up in disaster after both parents would over drink and begin picking on each other and the kids. Leo found himself always feeling anxious at dinner time; he avoided conflict and found himself withdrawing from his wife when she seemed upset.

Joe, Anna, and Leo struggle not knowing what “normal is” in their couple and family relationships. Since beginning recovery with their spouses, each of the couples have been working on establishing new ways of being with other and have begun to make progress. Dr. John Gottman’s research on relationships is a helpful blue print, not for the question of what is normal, but rather, what works in relationships. We know that couples that stay together and are happy are more positive with each other, manage conflict in a gentle way, and basically treat their partner like a good friend. What does it take to do that when you have a difficult family history as your only model of relationship?

My research with recovering couples who have learned to make changes in their relationships have incorporated two important steps in their relationships: 1. Identify unhealthy patterns of relating in their own family of origin that have seeped into their current relationships 2. Disidentify with that pattern, realizing that they actually have choices in how they interact. This last process is “shedding” the past unhealthy patterns, but it happens only after recognizing it. 

All of this takes time, a willingness to look at and talk about family history, and a willingness to try new behaviors with your partner. Healthy couple recovery is an ongoing process, there is no final stage or destination per say, it’s more like continuing to work on the things that bring you closer and help you manage differences. That is what we learned from Gottman’s research - good relationships are a work in progress. We will continue to explore how couples have made significant changes in their relationships, shedding the past and creating new ways of being together.

Addiction is described as a cunning, baffling, and powerful disease; the impact on relationships is devastating. When a partner is addicted, everything in the relationship changes. When the addict/alcoholic is in the middle of the disease denial buffers the addicted person from acknowledging the reality of their addiction and how it is affecting those around them. It is hard for partners to understand why their loved one doesn’t see the damage or do something about it. It seems so clear, yet, there often is tremendous resistance and anger directed at the non addicted partner. 

In Wikianswer.com, being behind the 8-ball is described as this: “In the game of pool, the 8-ball is the last ball a player must sink in order to win the game. However, until he or she has sunk all the rest of the balls (i.e. 1 through 7 or 9 through 15), touching the 8-ball with the cue ball is considered a foul stroke. Therefore, one is said to be ‘behind the 8-ball’, it means to be stuck in a position where any move will have a negative result — to be trapped with no way forward.” If you are in this situation, I imagine this sounds and feels familiar. I call this the “8-Ball Dynamic” because in active addiction, addicts often are very skilled at putting their partners behind the 8-ball: Efforts to get help, or address problems in the relationship, or simply trying to enlist support to manage the responsibilities of  life are met with anger, blocks, challenges, and obstacles of all sorts.

It is important for partners to understand that the drug of choice (or addictive behavior) is the primary relationship for the addict. When someone is in the middle of their addiction, reason and judgment are impaired. The biological impact of chemicals on brain functioning and the psychological mechanisms of denial, projection of blame, and minimization all serve to keep the addict from accepting the reality of addiction. 

I worked in a drug and alcohol treatment program years ago and learned that the staff could never really tell initially who was going to be successful or drop out of the program. Those patients that at first looked motivated could still relapse. Those most resistant to treatment sometimes proved to be the poster child for addiction recovery. We never know what will happen; people can come to that place of “surrender” and suddenly “get it”. In the meantime, all that one can do is to focus on taking care of themselves. Get help and support, go to Al-Anon and/or other support groups. Remember you can’t control your partner, no matter how loving or how angry you get. Recognize the “8-ball dynamic” for what it is, a symptom of active addiction. Don’t buy into the blame or accusations of why the addict is using, instead try to focus on help for yourself. It is a hard thing to do, but you don’t have to stay behind that 8-ball.       

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.

The blog title comes from Dr. John Gottman’s lecture on the importance of listening when our partner is sharing something important. Many people in recovery report how difficult it is to sit with their own emotions, much less their partners emotions. So when our partner expresses worry, grief, or anger we tend to respond with our wonderful words of wisdom; solutions, answers, defensiveness and so on . We then get surprised when our partner becomes angry with us for sharing our thoughtful and sometimes even brilliant insights, “Hey, what is wrong with you, I’m just trying to help here!”

Men tend to problem solve when “listening”, women tend to take on their partner’s problems. Of course these are generalities, but the point here is that what is usually needed is neither of the above responses. So you may ask, “OK, what works better?

I learned through my research that couples with long-term recovery and who were happy in their relationships simply listened, or as one research participant said, “I want to be a witness to my partner’s emotions”. By this she meant a silent witness who remained present and attentive, and who provided emotional support for her partner through the silence. She didn’t need to fix things or to take them on as her problems, this approach fostered intimacy and closeness in a powerful and in a predictable way.

It’s not a coincidence that the very first skill therapists in training take in counselor school is listening, however, you certainly don’t need to be a therapist to be an effective listener; It only takes 3 steps:

1. Don’t talk (this is harder than you think)
2. Communicate nonverbally that you are listening (head nodding, eye contact, “um hmm’s”, etc.)
3. Actually remember what your partner says

That’s it, so unless our partner is asking for more, try defaulting to this approach and see what happens.