In their book, The Alcoholic Family in Recovery: a developmental model, Stephanie Brown and Virginia Lewis state there are four stages that individuals, couples, and families affected by alcoholism pass through: drinking, transition, early recovery, and ongoing recovery.
The stages are defined by the tasks of change of the stage as well as the length of time of abstinence. Reaching the transition stage involves more than simply not drinking. Brown and Lewis claim that the system of the drinking family is restrictive, rigid and closed and that adaptation to this organization creates pathology within the family. This pathology within the family often makes achieving sobriety more difficult for the alcoholic just as it makes recovery for the codependent more challenging. The defense strategies that the family creates to preserved attachments, unity, and stability eventually cause more trauma, developmental arrest and psychopathology.
A key assertion by Brown and Lewis is that the unhealthy family system must collapse in recovery, and the defensive structures that maintain the pathology of the entire family must change.
The three major goals for treating the alcoholic couple are:
- Interventions aimed at supporting the alcohol user into changing.
- Interventions aimed at improving the quality of the couple or family relationships.
- Relapse prevention for the alcohol user
These interventions are consider “phases of recovery” for the couple. The first phase is treatment for the alcoholic, the second is an adjustment for the couple and/or family, and the third phase is a lifestyle-building phase that promotes recovery for both.
In her book, Treating Alcoholism, Stephanie Brown (1995) says that the therapist should “wonder about the motivation” of couples who initiate couples therapy in the beginning phases of recovery as they may be trying to deflect attention away “difficult individual work” that needs to be done.
For therapy to be effective with the alcoholic couple, it must be directive, psychoeducational and provide concrete steps that can be taken by both partners to change the patterns of alcoholism that impact them.
It’s important that the partner’s recovery programs are relatively in sync. According to Mark Young and Lynn Long in Counseling and therapy for couples, The scenario with the highest probability of success is a couple who presents as a unit deciding that the couple wants to go in the direction of recovery. If either partner is in denial, the couple will present as unfocused in couples therapy because there is no shared problem. The first step towards reaching this sync is getting both partners into recovery. Once both partners are in recovery, they can begin the transition phase by working on a joint treatment plan in couples therapy. In couples counseling, I ask couples what their common goals are in couples therapy and in their marriage, and how they think they could get their individual recovery programs into sync and still maintain healthy boundaries.
Relapse prevention is a significant part of the work in couples therapy with recovering alcoholics. Couples work can be an important tool for preventing relapse. A “relapse contract” between the couple that spells out what will happen if the alcoholic drinks has been shown to be useful in helping the alcoholic to maintain sobriety and creating a sense of safety and trust in the relationship.
Another useful intervention is the use of a genogram to show the couple the pattern of alcoholism and other illness in the family and how it affects their relationship. I would use the genogram and other various tools in conjunction with the recovery process as an “integrative model”. The basic integrative model I would use consists of the following:
- Assessing and Developing an Interactive Definition of the Problem
- Goal Setting
- Adopting New Perceptions and Behaviors
- Maintaining New Perceptions and Behaviors
- Validating New Perceptions and Behaviors
This integrative model gives me as the therapist the flexibility needed for the “start and stop effect” that can occur during the initial stages of recovery from both alcoholism and codependency. Potentially, therapy must start and stop as the couple goes into treatment, relapses or has resistance. I’m aware that working with couples affected by alcoholism presents special problems for the therapist. The work is, by necessity, often confrontative and clients have deep rooted denial.
In addition, there is often a bias against the alcoholic that the therapist has to be careful not to reinforce. Karpel (1994) points out how important it is that the discussion of drinking be presented by the therapist in a casual and nonjudgmental way “in order to avoid triggering unnecessary defensiveness. Although this is true, it is not always possible and it is sometimes advantageous to confront the drinker.
Hedblom, J. H. (2007). Last call: Alcoholism and recovery. Baltimore, MD: Johns Hopkins University Press.
McCully, C. (2004). Goodbye, Mr. Wonderful. Alcoholism, addiction, and early recovery. London: Jessica Kingsley Publishers.
O’Farrell, T. J., & Fals-Stewart, W. (2006). Behavioral couples therapy for alcoholism and drug abuse. New York: Guilford Press.