Treating Couples in Recovery from Alcoholism: Part 2 Robert Navarra, Psy.D., M.F.T. Published in AAMFT-CA Newsletter, Summer 2003

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1 1 Treating Couples in Recovery from Alcoholism: Part 2 Robert Navarra, Psy.D., M.F.T. Published in AAMFT-CA Newsletter, Summer 2003 In the last edition of the Division News I highlighted some of the findings of the Family Recovery Project (FRP), a three part research design (Family Recovery Project, MAPS, and Couples Focus Group) to study normal developmental recovery processes in family and couple relationships over time (Brown & Lewis, 1995; Brown & Lewis, 1999; Brown, Lewis and Liotta, 2000; Lewis & Allen-Byrd, 2001; Navarra, 2002). Research findings from the FRP indicate families and couples undergo numerous difficulties after recovery begins, and furthermore, these difficulties reflect normal, developmental process. This article reviews research results from the Couples Focus Group. Couple Recovery as a Model for Treatment Consider the implications to relationship development when tracing the path of a recovering couple. First, the couple system is traumatized by the devastating effects of years of active alcoholism. Entrance into recovery is precipitated by the breakdown of denial and destabilization of the addicted system (Brown & Lewis, 1999). Mobilization around individual recoveries further distances the couple as relationship issues are avoided and/or the resources to deal with relationship problems are simply not available. Finally, in long-term recovery the centrality of the couple relationship emerges, highlighting yet another dramatic transition in individual as well as couple development (Navarra, 2002). Couple recovery is a new or underutilized construct in couples therapy. Unlike individual recovery, couples often lack a language for the relationship recovery. Both AA

2 2 and Al-Anon emphasize working individual programs, little is offered or available to bridge recoveries or validate the notion of couple recovery as a legitimate recovery concern. Acknowledgement and exploration of addiction history and addiction recovery is essential in treating recovering couples. Developing a language and understanding of what couple recovery means, normalizing recovery processes and difficulties, and providing a safe structure to discuss these issues and potential solutions, form the basic therapeutic tasks of treatment. Therapists sensitive to the challenges in individual and relational functioning faced by couples in long-term recovery from alcoholism are in a position to provide help articulating and addressing recovery-related problems and issues that otherwise may remain hidden and unidentified. The Couples Focus Group The Couples Focus Group, comprised of three couples with long-term recovery, met over a 7 year period of time with the explicit purpose of talking about couple recovery. Lengths of recovery at the end of the study were 12 years, 16 years, and 17 years. All members were involved, at least for a period of time, in AA and/or Al-Anon. The groups were self-directed; researchers Stephanie Brown, Ph.D. and Virginia Lewis, Ph.D. assumed observer roles. Each two hour session was audiotaped and later analyzed by the author using a qualitative methodology (grounded theory) for content and themes related to developmental processes in long-term couple recovery. Conceptually, the Couples Focus Group provided a rare opportunity for naturalistic observation with participants expressing in their own words their experiences of the

3 3 impact of recovery on their relationship. Of the 61 sessions approximately 106 hours of tapes were available for analysis. Several questions formed the basis for the study: What did the participants identify as relevant issues in their relationship at this point in their recovery? What changes in the relationship concept and self-concept occurred over time? What helped resolve issues? How did these couples differ from couples in early recovery? Grounded theory methodology frees the researcher from preconceived notions and theoretical biases, and provides a systematic approach to coding and data analysis: theory emerges from the data (Glaser & Strauss, 1967; Glaser, 1978, 1998). Grounded theory generates conceptual patterns, not generalizations of the individual participants; there is no claim that the focus group represents all recovering couples. Rather, the group is an ideational sample not a representational sample. The following model of couple recovery is an attempt to see the big picture and is identified as the Couple Reciprocal Development Approach. Couple Reciprocal Development Approach Three main components of couple development are identified in the Couple Reciprocal Development Approach (CRDA): Shifting, Intergenerational Reworking, and Attending. Each component has multiple properties and operates in a nonlinear, interactional dynamic with the other components; (the parts are greater than the whole) the whole is greater than the sum of its parts. These distinct but overlapping phases of development collectively provide the framework for addressing multiple and simultaneous levels of individual and interpersonal processes.

4 4 Developmentally, long-term couple recovery is defined by the couple s movement toward a relational focus as primary, but not at a cost to individual growth and recovery. Developing a stronger couple relationship while maintaining and supporting individual and partner growth marks a developmental milestone not typically found in early recovery. Recovering couples are a heterogeneous group, each couple in the study presented with unique characteristics, but the basic social psychological processes of recovery remained the same. Recovery processes are not static, long-term recovery remains a fluid and evolving process defined by the degree of successful integration and resolution of these components, variability evident within the research group. Movement between components unfolded in the monthly interactions and experiences shared by the participants. Uneven levels of resolution and nonlinear progressions of development confirmed the interdependent nature of the relationships between Shifting, Intergenerational Reworking, and Attending. The integral and reciprocal nature of self and other functioning provides the foundation for healthy resolution of recovery issues. A brief overview of the three components is as follows: Shifting. This component signifies a dramatic shift toward an emerging couple identity, establishment of new role relationships, and reorganization of boundaries. The couple relationship, abandoned in early recovery to allow for individual recovery, now emerges into a place of primacy. Intergenerational Reworking. Couples expressed a deeper awareness and grasp of dysfunctional patterns of interaction internalized from the family of origin and how these dynamics impacted the couple s ability to manage their own family life and couple

5 5 functioning. Increased detachment from family of origin is associated with greater coping ability and tolerance for affective expression, most noticeably grief. Attending. This component is characterized by increased levels of partner attunement and a greater capacity to form an intimate relationship in the context of a growing, individuated self. Couples depicted increased togetherness as an emerging phenomenon but at the same time emphasized the importance of maintaining selfgrowth and self-care. Helping couples assess and understand the degree of resolution and integration of these components of development should prove helpful in facilitating therapeutic progress in couple reintegration and bonding. Normalizing the difficulties of the recovery process through psychoeducational interventions provides reassurance, hope, and direction to couples. CRDA is a model in process, adaptable and modifiable as new data becomes available for analysis. The ultimate test of theory rests with its real life applicability, relevance, and usefulness (Glaser, 1998). Continued research is needed to refine the model and study effective psychotherapeutic approaches. Center for Couples in Recovery The Center for Couples in Recovery (CCR) is a newly developed pilot program sponsored by the Mental Research Institute in Palo Alto, California, and is dedicated to research, education, training, and treatment related to couples and families recovering from addiction. As a research/treatment program, CCR seeks to integrate data from individual and group treatment of recovering couples to further understanding of couple

6 6 recovery processes, continue development of the Couple Reciprocal Development Approach, and to better serve the needs of recovering couples. References: Brown, S., & Lewis, V. (1995). The alcoholic family: A developmental model of recovery. In S. Brown (Ed.), Treating Alcoholism (pp ). San Francisco: Jossey- Bass Publishers. Brown, S., & Lewis, V. (1999). The alcoholic family in recovery; A developmental model. New York: Guilford. Brown, S., Lewis, V. M., & Liotta, A. (2000). The family recovery guide: A map for healthy growth. Oakland: New Harbinger Publications. Glaser, B. G. (1978). Theoretical sensitivity. Mill Valley, CA: Sociology Press. Glaser, B. G. (1998). Doing grounded theory: Issues and discussions. Mill Valley, CA: Sociology Press. Glaser, B. G., & Strauss, A. L. (1967). The discovery of grounded theory: Strategies for qualitative research. New York: Aldine De Gruyer. Lewis, V. & Allen-Byrd, L. (2001). The alcoholic family recovery typology: A new theoretical model. Alcoholism Treatment Quarterly, Vol. 19(3). Navarra, R. J. (2002). Couples in recovery from alcoholism: Long-term and developmental processes. Dissertation Abstracts International (UMI Number ).