Mine, Yours, and Ours, Addiction and Compulsivity in Couples and Couple Therapy

By Ronald Mah

"Mine, Yours, and Ours, Addiction and Compulsivity in Couples and Couple Therapy" demonstrates how the therapist who tries to choose to not work with clients or couples with addiction and compulsivity issues cannot conduct therapy with integrity. As individuals, couples, and family enter therapy, so inevitably does addiction and compulsivity, whether substances or behaviors. The book demonstrates how addiction or compulsivity may be overtly presented, alluded to, or hidden initially in therapy. Arguments about who has what addiction: "mine" or "yours," can obscure addiction or compulsivity that is shared or is "ours." Assessment for addiction and compulsivity is critical in working with couples, since addictive or compulsive elements in a couple effectively sabotage much of the "logical" work of therapy (insight work, communications training, etc.). The therapist must address addiction or compulsivity (perhaps, "first") for other processes to move forward because relationship problems and substance abuse, behavioral compulsion, or addiction are intricately intertwined. The book shows how ambiguous or confusing individual or relationship behaviors become conceptually clear when addiction is uncovered. Problems about relationship, finances, children and family, and work presented in couple therapy often have the shadow of addiction and compulsivity.

The therapist will also learn strategies and interventions to avoid therapy being stalemated by removing the necessity of the individual accepting being labeled an "addict." Co-addiction and the co-addict are examined in terms of mutual and reciprocal processes including attachment needs and family and cultural models in the system of the addictive couple. The therapist is guided to follow vague indications or probable concerns involving addiction and compulsivity, since just about anything can lead to self-medicating behaviors. The therapy can be diverted to premature and ineffective problem-solving rather than also addressing underlying causes for repeated choices and behaviors despite inevitable adverse consequences. The therapist is guided to address how a bad choice clearly identified and previously experienced has become an addictive behavior and/or a compelled choice... that is, a destructive compulsion. The role of the therapist is presented in psycho-education, as a witness, in prediction, and in relapse prevention in the process of therapy and change, along with a multi-layered intervention plan that incorporates inevitable relapse.

• Language: English
• Publisher: Ronald Mah
• Release date: Aug 24, 2013
• ISBN: 9781301521272

Ronald Mah

Therapist, educator, author and consultant combine concepts, principles, and philosophy with practical techniques and guidelines for effective and productive results. A Licensed Marriage & Family Therapist (licensed 1994), his experiences include:Psychotherapist: individual, child and teen, couples, and family therapy in private practice in San Leandro, California- specialties include challenging couples, difficult teenagers, Aspergers Syndrome, Attention Deficit Hyperactive Disorder, learning disabilities, cross and multi-cultural issues, foster children, child development, parenting, and personality disorders;Author: twenty-one project/books on couples therapy for a doctoral program, including substantial work on major complications in couples and couples therapy (including depression, anxiety, domestic violence, personality disorders, addiction, and affairs); articles for the Journal of the California Association of Marriage & Family Therapist (CAMFT) on working with teenagers, elder care issues affecting family dynamics, and assessing dangerous clients, online courses for the National Association of Social Workers- California chapter (NASW-CA) on child abuse prevention, legal and ethical vulnerabilities for professionals, and difficult children, “Difficult Behavior in Early Childhood, Positive Discipline for PreK-3 Classrooms and Beyond” (Corwin Press, 2006), “The One-Minute Temper Tantrum Solution” (Corwin Press, 2008), and “Getting Beyond Bullying and Exclusion, PreK-5, Empowering Children in Inclusive Classrooms,” (Corwin Press, 2009); Asian Pacific Islander Parent Education Support (APIPES) curriculum for the City of San Francisco Department of Human Services (1996), 4th-6th Grade Social Science Reader, Asian-American History, Berkeley Unified School District, Berkeley, CA, (1977), and trainer/speaker of 20 dvds on child development and behavior for Fixed Earth Films, and in another time and career three arts and crafts books for children: two with Symbiosis Press (1985 &1987) and one with Price, Sloan, and Stern (1986);Consultant and trainer: for social services programs working with youth and young adults, Asian-American community mental health, Severe Emotional Disturbance (SED) school programs, therapeutic, social support, and vocational programs for at risk youth, welfare to work programs, Head Start organizations, early childhood education programs and conferences, public, private, and parochial schools and organizations,Clinical supervisor: for therapists in Severe Emotional Disturbance (SED) school programs, child and family therapists in a community counseling agency, Veteran Affairs in-patient clinician working with PTSD and dual diagnoses, foster care services manager for a school district, manager/supervisor for the Trevor Project-San Francisco, and therapists in a high school mental health clinic;Educator: credentialed elementary and secondary teacher, Masters of Psychology instructor for Licensed Marriage & Family Therapy (LMFT) and Licensed Professional Clinical Counselor (LPCC) track students, 16 years in early childhood education, including owning and running a child development center for 11 years, elementary & secondary teaching credentials, community college instructor, and trainer/speaker for staff development and conferences for social services organizations including early childhood development, education, social work, and psychotherapy.Other professional roles: member Ethics Committee for six years and at-large member Board of Directors for four years for the California Association of Marriage & Family Therapist (CAMFT), and member Board of Directors of the California Kindergarten Association (CKA) for two three-year terms.Personal: married since 1981 after dating since 1972 to girlfriend/wife/life partner with two wonderful strong adult daughters, and fourth of five American-born children from immigrant parents- the older of the "second set" of children.

Book preview

Mine, Yours, and Ours, Addiction and Compulsivity in Couples and Couple Therapy

Published by Ronald Mah at Smashwords

Copyright 2013 Ronald Mah

Ronald Mah's website- www.ronaldmah.com

Smashwords Edition, License Notes

This ebook is licensed for your personal enjoyment only. This ebook may not be re-sold or given away to other people. If you would like to share this book with another person, please purchase an additional copy for each recipient. If you're reading this book and did not purchase it, or it was not purchased for your use only, then please return to Smashwords.com and purchase your own copy. Thank you for respecting the hard work of this author.

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Linked Table of Contents

Abstract

Introduction

CLEAR

VAGUE BUT PROBABLE

HIDDEN

Chapter 1: ADDICTIONS or COMPULSIVITY in COUPLES

Chapter 2: BEHAVIOR CHANGE PLUS

Chapter 3: CRITERIA FOR SUBSTANCE DEPENDENCE & APPLICATION TO OTHER ADDICTIONS

Chapter 4: THREATENING TO ABANDON THERAPY

Chapter 5: CULTURAL NORMS AND STEREOTYPES AND DIAGNOSIS

WORKAHOLISM

STEREOTYPES AND ADDICTION

Chapter 6: ALCOHOLIC AND DYSFUNCTIONAL FAMILY SYSTEMS

Chapter 7: CONCORDANT COUPLES

CO-DEPENDENCY, ENABLER, OR CO-ADDICT

Chapter 8: AVOIDING THE ADDICT LABEL BATTLE

A MESS

Chapter 9: COMPLICATIONS AND FRUSTRATION

ATTACHMENT

COUNTER-TRANSFERENCE

SECRECY

Chapter 10: TWO PERSONAS- WHO IS IN CONTROL?

Chapter 11: EARLY RECOVERY

Chapter 12:THERAPIST AS WITNESS

ROOM OF PAIN

Chapter 13: SUPPORT SYSTEMS

Chapter 14: WANTING CHANGE WITHOUT CHANGING

Chapter 15: SELF-SOOTHING AND SELF-CARE INSTEAD OF SELF-MEDICATION

ACKNOWLEDGING AND USING STRENGTHS

Chapter 16: RESENTMENTS AND COMMUNICATION

GENUINE COMMUNICATION

Chapter 17: RELAPSE & RELAPSE PREVENTION

ANTICIPATING AND PLANNING FOR RELAPSE

Chapter 18: PATTERN, PROCESS, AND PLAN

A PROCESS FOR SUCCESS & GROWTH

IDENTIFY PATTERN & PROCESS

PREDICTION

PLAN I — WHAT YOU NEED TO DO

PLAN II – PLANNING TO AVOID SELF-SABOTAGE

PLAN III – RECYCLE PLANS I & II

Chapter 19: THERAPEUTIC RELAPSE

POSITIVE OR NEGATIVE OUTCOME—DECONSTRUCTION

Chapter 20: MIDDLE TO LATER STAGES OF THERAPY

Chapter 21: LIFESTYLE CHANGE

Appendix

Bibliography

Other Books by Ronald Mah

Biographic Information

Abstract

Mine, Yours, and Ours, Addiction and Compulsivity in Couples and Couple Therapy demonstrates how the therapist who tries to choose to not work with clients or couples with addiction and compulsivity issues cannot conduct therapy with integrity. As individuals, couples, and family enter therapy, so inevitably does addiction and compulsivity, whether substances or behaviors. The book demonstrates how addiction or compulsivity may be overtly presented, alluded to, or hidden initially in therapy. Arguments about who has what addiction: mine or yours, can obscure addiction or compulsivity that is shared or is ours. Assessment for addiction and compulsivity is critical in working with couples, since addictive or compulsive elements in a couple effectively sabotage much of the logical work of therapy (insight work, communications training, etc.). The therapist must address addiction or compulsivity (perhaps, first) for other processes to move forward because relationship problems and substance abuse, behavioral compulsion, or addiction are intricately intertwined. The book shows how ambiguous or confusing individual or relationship behaviors become conceptually clear when addiction is uncovered. Problems about relationship, finances, children and family, and work presented in couple therapy often have the shadow of addiction and compulsivity.

The therapist will also learn strategies and interventions to avoid therapy being stalemated by removing the necessity of the individual accepting being labeled an addict. Co-addiction and the co-addict are examined in terms of mutual and reciprocal processes including attachment needs and family and cultural models in the system of the addictive couple. The therapist is guided to follow vague indications or probable concerns involving addiction and compulsivity, since just about anything can lead to self-medicating behaviors. The therapy can be diverted to premature and ineffective problem-solving rather than also addressing underlying causes for repeated choices and behaviors despite inevitable adverse consequences. The therapist is guided to address how a bad choice clearly identified and previously experienced has become an addictive behavior and/or a compelled choice… that is, a destructive compulsion. The role of the therapist is presented in psycho-education, as a witness, in prediction, and in relapse prevention in the process of therapy and change, along with a multi-layered intervention plan that incorporates inevitable relapse.

Link to Table of Contents

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**Author's Note: Other than public figures or people identified in the media, all other persons in this book are either composites of individuals the author has worked with and/or have been given different names and had their personal identifying information altered to protect and respect their confidentiality.

INTRODUCTION

CLEAR

Tamlyn and Phillip came for couple therapy because she felt that she was drinking too much. She had gone to an alcohol and drug treatment program, but they had referred her to therapy instead. She did not meet their criteria for substance abuse. She was a sipper. She had a tall glass of peppermint vodka that she sipped all day long while managing the household and the demands of several children. Rarely did she have more than that. At the treatment center intake, they also found that she was not all that happy about her relationship with her husband of twenty-five years. They suggested that couple therapy might be useful. In the first session, she revealed that she also was bulimic. She threw up just about every day- sometimes, a couple of times a day. Phillip said he came to therapy support her in her recovery.

Mitchell and Kat came for couple therapy because they had been having a lot of conflict over Mitchell's use of pain medication. Mitchell had been an outstanding athlete through high school and college, playing two or three sports. He had gotten an invitation to a professional football team training camp. He had been doing pretty well through the preseason games and stood a chance to make the team as a reserve on the suicide squad as the kick coverage and return teams were called. Then in the last preseason game, he threw himself at the blockers and by the worse of luck cracked vertebrae in his lower back. That was the end of professional sports. It was a tough recovery and he was not the best patient- having little or no patience. He pushed himself too hard too soon and suffered further injuries rather than healing. His post-athletic career vocation in construction made ongoing demands on his physicality. Now at thirty-years-old, he had the gait and motion of an eighty-year arthritic old man. He was in chronic pain and was using up his monthly ration of pain-killers in less than two weeks every month. He turned to alcohol, marijuana, and other street drugs (methamphetamine, in particular) for the remainder of each month until he could get a new prescription. Kat was skeptical that Mitchell was in that much pain, but was really a drug addict who used the physical issues as an excuse. She was on his case all the time to cut back on all the medication whether prescribed or self-prescribed- legal or illegal. She also complained that instead of being involved with her and the kids, he would lose himself surfing the Internet for hours and playing massively multiplayer online games (also called MMO and MMOG) which are multiplayer video games often involving thousands of participants, and available and active around the clock.

These two couples: Tamlyn and Phillip and Mitchell and Kat came for couple therapy that involved issues of addiction and compulsivity in their relationships. The therapist concurred with the substance abuse and dependency treatment program that Tamlyn was not a hard case. However, while alcohol arguably may not been her core issue, it along with her bulimia were almost certainly responses to deeper issues. Nevertheless, alcohol and bulimia contributed stress to her life and relationship with Phillip. A more complete exploration of their relationship found that it was not just Tamlyn with addiction issues. Alcohol and drugs were always a key component between them from since they first started dating almost thirty years ago. They and Tamlyn, in particular adjusted their use when they had children. When the children were younger and more demanding, Tamlyn was the dedicated proud mommy. She was at every PTA meeting, baked the cookies, and drove the fieldtrips. And, graciously accepting the accolades for her children's performances and awards. Phillip had continued to be a daily drinker who overindulged occasionally. At this point, Phillip also had a significant Internet pornography habit that effectively eliminated their sex life together, as well as exhausting him as he stayed up late nightly perusing one titillating site after another. It was likely that addictive or compulsive behaviors were important emotional and psychological self-soothing mechanisms for both of them. Beyond each with addiction issues, they shared addiction issues as a couple. Conversely, Mitchell claimed he used his prescribed medication, his alcohol, and his street drugs strictly for his physical pain. Whether or not he used or abused them as an addict, Kat thought he did. She knew of his demanding and critical father and how damaging it had been for Mitchell. Mitchell had not done well in school and been diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) and been prescribed Ritalin. His father accused him of not trying hard enough and being lazy. Kat knew about these blows to his self-worth and his injuries, but she still felt he indulged himself with self-pity rather than choosing the correct path for himself, her, their marriage, and their children. Her suspicion and anger about his use- his weakness to use whether justified or unjustified contaminated their relationship. They had a cycle of use, abuse, frustration, anger, criticism, resentment, shame and depression, and further use in their addictive process. Addiction and compulsivity clearly were clearly important if not fundamental issues for couple therapy for these two couples.

VAGUE BUT PROBABLE

In contrast, there was no mention of alcohol or addiction initially when Dyson and Samantha came for couple therapy. They had been dating since college and now were in their mid to late twenties. They felt it was time to start thinking about getting married. But Samantha was not sure if she or they were ready for such a big step. Dyson was ready and committed, but knew that Samantha needed to get there too. Samantha brought up various reasons that she felt Dyson was not ready, or how she needed reassurances. The goals and direction of couple therapy seemed clear to the therapist based on this presentation. Then in the third session, Samantha brought up that Dyson had a couple of one-night stands with other women early in their relationship when they were in college seven years ago. Dyson was deeply remorseful about his infidelity. In both situations, he had been drinking and gotten inebriated. He knew what he was doing but the dis-inhibitory effects of the alcohol influenced the mistakes. He was clear they were mistakes. It was alcohol, lust, and opportunity. Without the alcohol, Dyson was confident that he would have never lapsed. He had initiated and gone to therapy for himself. His relationship with Samantha was too important for him to screw up, so he decided that drinking was too much of a risk... just not worth it. Dyson stopped drinking alcohol altogether. It had been seven years since the sexual lapses and over six and a half years since his last alcohol. He was frustrated that his commitment and his behavior was not enough for Samantha to trust that he would not stray again. He had accepted that Samantha was not perfect either and had some issues, but he was willing to work through them. He wondered why couldn't she do the same for him. There continued a cycle of accusations, resentments, and acting out on Samantha's part that Dyson did not appear to contribute to in their current relationship. He seemed to have managed any compulsive issues of his own, but remained a reluctant participant in Samantha's addictive or compulsive cycling.

Alcohol was an issue for Cybil and Gwyn, but not because of abusive or dependent use. They came to couple therapy to help stabilize Gwyn's abstinence from alcoholism. Drinking was not a current problem they needed to work on. Gwyn had stopped drinking for close to three years, but she admitted that she was abstinent but not really sober. She had not worked since several years ago when she was a manager at a big department store chain. Gwyn had been on permanent disability for a while now. Her disability occurred in a work accident as a forklift dropped some boxes of heavy appliances that hit her, leading to a chronic back injury. In the workplace investigation, it was suspected that she had contributed to the accident by not following safety procedures. She had walked right into the path of the forklift despite all the safety precautions. The company lawyers could not prove anything, and they settled to avoid further expensive litigation. Although, the company never found out, Gwyn and Cybil knew that the accident had been due partly to her being impaired. Whether or not she had been technically under the influence at the time, her drinking and/or hangover had left her disoriented and distracted when she should have been following safety protocols. Other medical issues now made it dangerous for her to drink alcohol. Her pancreas and liver had been damaged by years of drinking and resumption of drinking could literally be fatal. Cybil had a lot of resentment for Gwyn's substance abuse and how it had jeopardized the family stability. They had two girls- 10 and 16 years old that had very good academic prospects for going to college- not that Cybil knew how to pay for college as things were financially. Cybil felt the pressure of making the only income in the family as a supervisor at a large mail and package delivery company. She had been able to work long evening shifts three-four days a week so she could be more available for the girls. Cybil had done this when Gwyn was working- never quite sure if she would get fired, take a break, or quit a job. Now that she was on disability, Cybil remained anxious that Gwyn might lapse and throw their tenuous family and financial stability into arrears.

There was no active drinking or substance use either when Shuman and Myanna came for couple therapy, referred by a therapist who had been working with their elementary age son. The therapist had felt that there were significant family issues that were affecting the son's emotional stability and had done a few family sessions. In the family sessions, the therapist saw that there were major communication issues between the parents as they were out of sync in many ways. They came to couple therapy to get more in tune with each other and be consistent in dealing with their son's needs. As the couple therapist conducted the initial intake, each partner was asked about any current or past history with alcohol or drug use. Shuman revealed that he had an alcohol problem for almost twenty years, but now had been clean and sober for twelve years. He said he worked really hard at his sobriety regularly working his twelve-step program. Myanna acknowledged that he was much worse when they were younger and in the early years of their marriage. He had alcohol and drug problems and they had separated a couple of times. But they got back together as he could get sober and because of their son. Myanna complained that Shuman did not spend enough time with her and their son. She felt that if he spent as much time with them as he spent working the program, attending meetings, and sponsoring drunks that they would do a lot better as a couple and as parents. In addition, she said he was so negative towards her and their son. Myanna admitted that she had an issue with credit cards. They had more than twenty thousand dollars in credit card debt, which made their hopes of ever getting their own house difficult. Myanna said he was so nasty about it and never gave her any credit for the money she saved within the household budget. What was worse for her was how Shuman made critical comments about their son's weight. Myanna said he called her fat too, but calling their son fat… making snide remarks at meals really hurt. It made Myanna want to protect their son, which led to arguments at the kitchen table regularly.

None of these three couples: Dyson and Samantha, Cybil and Gwyn, and Shuman and Myanna presented current alcohol, drugs, addiction, or compulsivity problems in their relationship. While there had been problematic use if not abuse or addiction to alcohol or drugs, getting clean was not an issue. The chaos of ongoing abusive or dependent use on the relationship, finances, children and family, and work was not the problems that they had sought the assistance of couple therapy. However, the shadow of addiction and compulsivity sat heavily upon each of their relationships. There were vague indications or