Archive for Psychotherapy

Sex Addiction is a Relational Disorder

I’m struck by the fact that people with addiction issues, when confronted with the destructive effects of their behaviors, often find it harder to stop. This is especially true, in my clinical experience, when it comes to compulsive sexual behavior, aka sex addiction. Why is that?

Therapy clients who struggle with drinking or substance abuse tend on the whole to accept – eventually, and with my ongoing support – that they do have a problem with drinking or using, and that these behaviors are an obstacle to happier living. Once “the cat is out of the bag”, they usually attempt to reduce or quit using, over time, or else quit therapy altogether.

Those struggling with compulsive sexual behaviors, however, may remain ambivalent for years, while remaining in therapy – aware of their dependence on these behaviors and the destructive effects of same, while wrestling with whether or not they want to stop. It’s a matter of two steps forward, two steps back, over and over again, with no change in sight.

Additionally, it is often reported to me that there appear to be more people in Alcoholics Anonymous with long-term sobriety compared to those in Sex Addicts Anonymous or Sex and Love Addicts Anonymous or other 12-step programs for healthier sexuality. Those with long-term sexual sobriety – or “abstinence” – tend to be fewer in number. Again – how come?

I know there is a lot of controversy in the mental health field about whether sexual compulsivity is truly an “addiction.” It is not my intent here to address that complex question. Suffice it to say that the suffering of those who can’t stop, in the face of heartbreaking damage and loss, is staggering to behold. If one of the key criteria for an addiction is an inability to stop in spite of negative consequences, then compulsive sexual behavior more than qualifies as an addiction.

So, if one assumes we are in fact dealing with two actual addictions, we are still left with the aforementioned disparity between drug/alcohol vs. sexual sobriety. Is it because one can live without drugs or alcohol, but cannot “remove” sexuality from one’s being? We are, organically speaking, sexual creatures, and the goal of treating sexual addiction is not to remove one’s sexuality but to create healthier, more intimate and less self-destructive behaviors.

I suspect that, because we are dealing with sex after all, the issue goes even deeper. Sexual desires and fantasies often emanate from the very core and are difficult to interpret. Heterosexual men with compulsive sexual issues, for instance, may desire sex with other men while staying married to a woman; some pursue sex with transvestite prostitutes, in ways that put themselves at legal and medical risk. I know of high-functioning women who are compelled to conduct serial affairs, virtual or real, with men whose only apparent goal is to sexually “use” them in sadistic or degrading ways. These are people who have little to gain, it would seem, and everything to lose.

Another complication is that sexuality is a relational activity. It always implies another person, either real or fantasized. One can use heroin or drink alone, as many do. But it always “takes two to tango”, even if one of those people is a fantasy or “virtual” person. Even when one uses online pornography, for instance, another person is “present”, at least onscreen.

Close readings of sexual fantasies and compulsive behaviors can be revealing of one’s buried self-concepts and unexpressed needs; an S&M fantasy may represent a way of coping with an overbearing or shame-inducing caregiver, by sexualizing the pain and staying in control of the fantasy/scenario (even if one is the “M”). Those struggling with scenarios of dominance over others may be trying to compensate for intolerably low self-worth, an attempt to control chaotic emotions leftover from a traumatic upbringing.

My experience with straight men who compulsively watch porn often reveals a desire for a woman who can offer everything but demand nothing, and disappear when the encounter is over, before she decides he’s “too much” for her, or “gross,” or perverted, etc. It’s a sort of mini-relationship, easily controlled by someone who usually has a desire for and deep fear of intimacy, who gets his needs met quickly and then signs off.

It’s almost as if these fantasies provide a window into the psyche, revealing unmet needs. Like the need to feel in control, to express repressed desires, to sexualize (i.e. numb or self-medicate) hurtful or shameful feelings or other emotions that are unconscious or too difficult to articulate.

These are feelings and needs that cannot be expressed in their actual relationships – usually because they are perceived as “disgusting” or “too much” for their partner. Of course, their partner very often has her own “stuff” and tends to be closed off, angry, controlling, etc. It’s an extremely painful dynamic that I see with many of my male clients – straight and gay – who struggle with sexual compulsivity.

Why would a man, or anyone really, seek an “emotionally unavailable” partner? Because we tend to gravitate toward the familiar, even if what is familiar is dissatisfying or even abusive.

Very often the person chooses an emotionally closed off, or overly aggressive (or withdrawn) partner because, in reality, the alternative is too scary. It may sound strange, but what’s even scarier than not finding love – especially in cases of a traumatized upbringing, which includes just about everyone I work with – is actually finding it! Why is that? Because love can be lost or taken away, leaving the person abandoned and traumatized (again) – even more painful than being mistreated or ignored. In the latter case, at least you know someone is there.

Thus the person suffering from core interpersonal trauma – the result of a faulty caregiver, another human being – who ends up sexualizing their needs via the behaviors described above, hovers between a desperate yearning for and deep aversion to intimate connection. The sort of “mini-relationship” described above is often a substitute. It satisfies…for a while. One connects, finds relief via sex and affection (what’s actually virtual feels real at the moment) – then detaches before becoming too invested or emotionally “at risk” for abandonment.

That emotional risk, believe it or not, is usually more frightening than the prospect of the legal or health risks that accompany these behaviors. Abuse and emotional distance is familiar, even if painful, while the possibility of genuine love is new and terrifying.

Thus the compulsive behaviors are a temporary solution to the very real and shameful problem of a confusing inability to connect with others. I say “shameful” because very often the feeling is something like, “I’m an idiot because I don’t know how to stop. Why do I do such disgusting things. What a piece of garbage I truly am.” (Even if the person is outwardly successful, wealthy, etc. As they say in recovery, it’s always an inside job.)

One of my clients once said in my office, with a smile on his face, “I have no love in my life. I’d only ruin it if I did”. This was a successful, married attorney with a compulsion to see prostitutes.

It took me a few moments to realize the smile was an awkward attempt to conceal shame, not any sort of bemusement. That smile was one of the saddest things I’ve ever seen.

What I want to stress here is the pain that needs soothing is, in part, not the result of an unrequited hunger for love, nor a fear of finding it, but rather an impossible non-reconciliation between the two.

Here are two opposing, powerful forces at work, with radically different agendas – one to connect, the other to protect. Without help, this internal conflict results in unmanageable emotional turmoil and frustration. The cycle never ends, until the person says “enough,” and seeks help.

I’ll talk next time about how therapy can, when effective, provide a slow but steady path towards healthier intimacy and a chance to escape the suffocating shame and loneliness that so many of my clients describe as a slow-moving poison — leading them to behaviors they so desperately want to stop, but can’t.

(Originally published on goodtherapy.org. All rights reserved.)

What if my Addicted Partner won’t stop?

A very poignant comment to my article last month, from H. Hall, really struck a nerve. Again, I am very grateful for feedback of any stripe.

In regard to my suggestion that the spouse of a person with alcoholism/addiction begin to change her (or his) way of living, i.e. by seeking counseling and other forms of support, I might have overlooked a crucial point which these readers thankfully pointed out. I implied that when one family member changes, the entire family “system” must change. Reader H. Hall wrote to say that things did change in her situation; she ended up leaving a husband who refused to stop drinking.

This may seem like a bitter victory. Sure, things changed: first an alcoholic husband, then no husband at all! Thanks for the advice, oh wise one.

The sad fact is that sometimes a partner doesn’t change. I know of no hard and fast statistics; my own therapeutic experience is that most of the partners or family members of the clients I work with do attempt to stop or curtail their drinking or using when confronted with the possible loss of a relationship.

But this, unfortunately, is not always the case. Sometimes a person would really rather choose the bottle over their family. This is the absurdity and heartbreak of addiction. This is also why I consider it a form of mental illness, because I don’t believe a sane, balanced person would make such a choice. Sometimes a person gets so lost in the fog of their using that they become unwilling or unable to accept help from absolutely anyone. They are literally out of their minds.

It reminds me of the story from “The Little Prince”, where the Prince encounters a man with a drinking problem. The man says he drinks because he has a problem – the problem is that he keeps drinking.

Here, in this type of situation, is where the partner has to answer a very difficult question. And that is, What kind of life do I want to live?

Some might say that the marriage vow “till death do us part” needs to be taken seriously, in sickness and in health; since addiction is a form of sickness, to leave one’s partner even in these circumstances would be unconscionable. Others might say, I’m not going down with the ship…if he wants to drink himself to death, fine, but I’m not sticking around to rearrange deck chairs on the Titanic. Such a person may decide that he or she wants to separate, in the hope that this might help wake up the spouse with alcoholism, or that he or she wants to start over again, in the hope of a saner, happier life. Neither seems “wrong” to me (assuming, of course, that neither the partner nor children are being abused).

However I would argue that, if someone decided that they were going to stay – perhaps due to one’s own existential viewpoint, or even financial considerations that make leaving impossible – then finding help and support is equally if not more important than a case where the partner leaves. Living with a person active in their addiction is unimaginably stressful. It’s an esteem-killer. It causes anxiety, depression, it is infuriating and generally crazy-making. Feelings of grief and loss are often involved, since very often the “good” part of the afflicted person may disappear in a haze of alcohol, pills or smoke.

If you do decide to stay, why not find an outlet for your stress, and a way of supporting yourself in dealing with the day to day heartbreak? Otherwise, you might find yourself taking out your anger and grief on your co-workers, friends, or even your children. Or, just as tragically, you may start taking it out on yourself, in a way that provides some temporary but ultimately harmful anesthetization of your own. This includes anger, by the way. Sometimes rage is easier to deal with than heartbreak, or grief. But it can lead to harmful behaviors that push loved ones away.

I would like to say that making changes yourself will automatically “jolt” the addicted person into action. But that’s not always the case. Still, in a miserable situation, something or someone needs to make the first move if there’s to be any hope at all of change.

Even if you find yourself in a difficult situation where your partner won’t or isn’t ready to stop, I still believe you owe it to yourself to find some support. Even in the worst of situations, we all deserve at least a little bit of kindness, empathy and warmth.

(Originally published on goodtherapy.org. All rights reserved.)

Please do Disturb: Seeking Change in an Alcoholic “System”

The great Buddhist teacher and author Pema Chodron once suggested in a recorded talk that we hang a sign in our kitchen that says, “Abandon hope”. At the time, I agreed with the listener who exclaimed, “That’s outrageous!”

Hope is of course essential to peaceful, purposeful lives. The lack of it can lead to despair or nihilism. Hope offers solace in stressful times, a balm for chafed nerves; it often marks the road forward.

But there’s a catch. Hope, like fear, is usually about the future. Fear says, “Something bad is likely to happen”. Hope says, “It won’t be so bad, in fact it might not happen at all.”

Notice that both statements are about the future, rather than the now. Too much focus on the future can create a detachment or dissociation from the present, on one’s current feelings, perceptions, or overall experience. But experience is our greatest teacher. If someone is mistreating us, it is our bad feelings which tell us so; if we’re feeling loved, it is our emotional and psychic experience which tells us we’re safe, cared for, and so on.

We also learn from our present needs and desires which path to take, which roads on our personal “map” look promising. Passionate suffering, or positive relationships with others tell us whether we’d like to stay where we are, or seek safer ground.

I’m not suggesting we wallow in emotionalism, but rather become attuned (or seek help in doing so) to our own emotional experience, to interpret the language of the heart and spirit. For it is our current experience which, with some discernment (since these things are often subtle), tells us what to do and where to go.

This is one reason why we therapists and psychologists are always repeating that cliché, “Get out of your head”. We can fantasize so much about better scenarios in the future that we fail to take action in the now. Living only for the future, or fearing that the future will only be a repetition of the past, creates paralysis, which in turn creates cynicism, self-loathing and bitterness. These things push away opportunities for growth and prosperity of all kinds, be it emotional, financial or otherwise.

I see this all the time with clients who love, and live with, people with addiction. Life in a house or relationship where addiction is present can be so painful that, sometimes, thinking of a better future is the only way to tolerate or survive. It’s horrific now, but it will be better when…(fill in the blank). The only problem is that “when” may – like Godot – never show up.

Thus, too much future-focus leads to present despair, which only creates obstacles for change. Cynicism, for example, gets us thinking, “well, why bother doing anything at all…things will never change, life will always stink, guess I’m screwed.”

Interestingly, this line of thinking parallels the rationalization of someone abusing substances – i.e., “it’s a stupid, unfair world, so who cares, might as well get loaded.”

Why bother changing, if change is meaningless? May as well keep doing what you’re doing, and getting what you’re getting (i.e., misery).

In spite of any bitterness, spite or rage you might be feeling, if you’re living with an addicted person, the desire and need for a more unified, loving connection pulses somewhere beneath the surface. I’ve never failed to find it, however faint, in anyone I’ve been honored to work with in my practice, even folks who come in saying, “I give up, it’s hopeless.” (I always congratulate them on their strength and courage in seeking help.)

The bottom line is that something, or rather someone, needs to change, in a situation rife with stress and heartbreak. As the old adage goes, “if you want something different, do something different.” Usually the members of an alcoholic family freeze with anger or fear at this point, as if to say, “Sure, we need change. You first!”

Why not you?

Clinical observation in the mental profession has shown repeatedly that if one person changes, the entire family “system” changes. And addiction always adversely affects the system as a whole. The system becomes chaotic and volatile, yes, but patterns and routines – or homeostasis – emerge. The idea here is that something, no matter how small, must be done to shake up the system. But why should the non-using person take that step? Isn’t that the responsibility of the one drinking or using?

Partners or families of people with addiction are always shocked at how hard it is for them to adjust, when the partner gets sober. They report to me high levels of fear, sadness, anger, or other intensities – because holy heck, their partner is actually listening! They, like the addicted one, are “de-thawing” from a traumatizing eco-sphere where feelings get ignored, rejected or stuffed. It’s understandable, albeit naïve, to think that, if “they” get their act together, “I” will be much happier. Changing one atom affects the whole molecule, even when that change is positive.

Sometimes families of addicted people say to me, “I don’t want to rock the boat” by seeking help for themselves. I say, “Yes, you do!” Because if addiction is present, the boat is likely to hit the iceberg anyway, with or without you. Why not increase the odds of positive change by doing some rocking, to see if you can wake the captain and crew from their slumber, and change course?

It may sound a bit counterintuitive. In many areas, when we’re unhappy with a situation, we change it from the outside. Don’t like your grocery store or gym? Find a new one. Have a headache? Get aspirin. Don’t like that show? Change the channel.

But this is different. Not only because you can’t trade your partner or family in for a new one (though there are moments you wish you could), but also because there are circumstances wherein the only thing you can change is yourself, your own thoughts, feelings, perceptions, to jar the overall “system” towards healthier functioning.

To expose denial. To set healthier boundaries. To start telling your authentic emotional truth, without rage or fear. To say to yourself, “No, I’m not crazy, things are really messed up around here and I can trust my observations and feelings.” To get some support for standing up for yourself, against the abusive patterns of addiction.

It really is possible. Of that I’m hopeful…

(Originally published on goodtherapy.org. All rights reserved. Copyright 2011 by Darren Haber)

(Don’t) Keep Coming Back, Part II

Thanks again to those who responded to my last article on why some partners or loved ones (POLOs) of those struggling with addiction/alcoholism may be reluctant to attend Al-anon. I’ll sum up the answers into 4 categories, based on public and private (i.e., emails to me) responses to the article:

1. Denial. For a POLO to attend an Al-anon meeting is to admit that the problem really is that bad. To give up the illusion that maybe things ‘aren’t so bad’ is to open a pandora’s box of emotions, such as anxiety, terror, guilt, shame and so on. A few of my patients have told me that attending a meeting was extremely depressing – i.e., “I can’t believe it’s come to this”. (Which, by the way, is a reason many of my patients who struggle with addiction give me for not wanting to return to AA meetings, that said meetings are “depressing”.  Interesting how addiction and co-addiction sometimes parallel each other.)

2. Embarrassment/Shame. Some readers told me they lived in small towns where everyone seems to know just about everything about everyone else. Thus attending a meeting is like letting the cat out of the bag, or “ratting” on the struggling loved one.

For others, attending a meeting is an implicit (or explicit) admission that they themselves are not enough to help the loved one. It’s a public admission of “weakness” or “not enough-ness”, since one of the underlying tenets of co-addiction is, “If he really loved me, he’d stop for good”.  This isn’t really true, but it feels true – and so attending a meeting is almost like stating, out loud and in public, “I’m really not enough for him or her to want to change”. And what a painful feeling that is.

3. Fear of Change. Another way of putting this is the old saw, “the devil you know is better than the one you don’t”. It is very hard to change the status quo or homeostasis of our lives. This is why, for instance, those who struggle with weight issues often continue to struggle even after a corrective procedure such as a lap band or gastric bypass, and so forth. The real “battlefield” is in our psyches, not our stomachs. This is also why people in the throes of addiction are encouraged to continue their recovery even after physical sobriety is established: underneath addiction lies a host of issues, including emotional, mental and relational problems that are not going to automatically straighten out just because the bottle has been trashed. That’s a fantastic start, yes, but now life itself must be lived – without the bottle – which is where the deeper, more lasting changes occur, or where “the rubber meets the road”, in recovery parlance.

It’s also very difficult, by the way, to begin focusing on yourself if you’re in the habit of keeping such close attention on the one with the addiction.  In fact it’s something akin to a foreign concept, the thought being, “Why would I focus on meI’m not the one with the problem.”  Of course, change has to start somewhere, and one person within an addictive system (family) can create outward ripples that effect everyone around her, with any baby step towards sanity, healing and healthy change.

4. It’s not my problem. Few said this but there were a couple of folks who said, essentially, that the addiction wasn’t their problem, and so it was up to the addicted person to take action and responsibility. This might be the opposite of a POLO who gets overinvolved, i.e. a distancing that amounts to, “don’t ask don’t tell”. This isn’t to say that any member of an addictive family is responsible for the behavior of the struggling person, or anyone else within the family. I guess my only concern here would be, pretending an elephant isn’t in the room doesn’t mean it’s not there, especially if you have to live in the same house as that elephant.

Thanks again for your valuable feedback.  I’m open to exploring this topic further, or others if you have any ideas. 

Copyright 2011 by Darren Haber.  Originally published on goodtherapy.org

(Don’t) Keep Coming Back

Many of the partners or loved ones (POLOs) of those struggling with addiction often seem reluctant to get help for themselves. I’m not sure why that is, but I’m hoping this article provides some answers.

These beleaguered folks are often fixated on the behavior of the loved one who struggles with drugs or alcohol (or other compulsions). Of course, it’s hard not to fixate on rampantly destructive behaviors. It often seems as though families where addiction is present are always struggling to either avoid or deal with addiction’s collateral damage (financial, emotional, professional, etc). I’m coming to the conclusion that because the behaviors surrounding addiction are so darkly magnetic, a constant pull on the family’s attention, it may be hard to understand why focusing on oneself is important.

I praise and encourage those who come to my therapy office to seek help, since admitting to a stranger (even if that stranger is a mental health provider) that one cannot solve a problem without help is itself demoralizing. Never mind that addiction is one of the most difficult maladies to treat, complex and subtle; for any person in our individualized, “do it yourself” society, saying “I can’t figure this out” often feels like an admission of weakness or incompetence. Especially if the problem involves a family member; most clients come to me with an inner critic shouting, “Why can’t you get a handle on this?” or “Why are you putting up with this?” or “You must be a really crappy parent/partner to warrant such mistreatment.” Very often, the feeling is that the POLO has themselves done something wrong, even if the possibly addicted person appears remorseful or contrite after yet another “incident”. It’s almost as if addiction’s sinister vortex draws out the dark underside of all of those who live in its wake: a vexing and demoralizing experience.

The part that stumps me, however, is why these folks are reluctant to try al-Anon. It was suggested to me that my recommending al-Anon may be akin to saying, “I as your therapist can’t really help you, you need to get help elsewhere.” When I therefore do make the suggestion, I am careful to emphasize that such support is to be in addition to and not instead of my therapeutic assistance. Attending meetings and sharing with others one’s struggles can be a wonderful counterpart to individual therapy – and, incidentally, is good role modeling for the struggling loved one, who may benefit from attending meetings themselves.

Still, reluctance prevails. A person will attend meetings for a brief period and then stop. I will (gently) encourage them to return, but usually they prefer not to. This, of course, is not at all “bad” or “wrong”.  Therapy in itself is amazingly effective, over time, though it often takes longer without the adjunct of group support. There just seems to be something healing about sitting with others who understand your problem and accept and support you unconditionally, in spite of all those feelings of not being good enough or smart enough, etc.

I’d be very interested to hear from you about why you think this is. I’m not at all trying to blame anyone here. Perhaps it’s a reflection of al-Anon itself. I know that some meetings are more attractive than others, depending on the group, the area/city, the strength of the program, and so on. I understand that 12-step is not for everyone. I know that if seeing an individual therapist is awkward, facing a roomful of strangers to discuss a shameful, agonizing problem is even more so. Sometimes meetings are far and few between, depending on where you live. And some seem to focus more on the problem than the solution, leading to a generally grim, even depressing “vibe”.  Still, I’m trying to get a handle on what might help those clients integrate into a process that has proven very helpful and supportive for those who take to it, and what suggestions I might make to those clients brave enough to give it a shot.

Copyright 2011 by Darren Haber.  First published on goodtherapy.org.

“Disease” or not, that is the Question…

This definition of “alcoholism” was published by the Journal of the American Medical Association in 1992: “Alcoholism is a primary, chronic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. The disease is often progressive and fatal. It is characterized by continuous or periodic: impaired control over drinking, preoccupation with the drug alcohol, use of alcohol despite adverse consequences, and distortions in thinking, most notably denial.”

Note that “alcoholism” is synonymous with “alcohol addiction” or, it is now generally accepted in the medical and mental health fields, with “drug addiction”.

The concept was actually introduced by the AMA in 1956, and yet – over 50 years later – it remains difficult to digest, both for those struggling with substance abuse/dependence and their loved ones. I treat many families and partners of people struggling with addiction, and they often retort, after I introduce the concept, “I just don’t buy it” or “I have a real problem with that”. Why?

The first objection is that the “disease” idea often sounds like a cop-out, or rationalization, as if the struggling person is shirking all responsibility or accountability by saying “hey, I have an illness, don’t blame me!” For those who have suffered for years in the face of destructive addictive behavior, this is not the mea culpa they’ve been hoping for. This is not restitution, or restoration of love, trust or other relationship essentials: this, they often tell me, is a dodge.

My first response, usually, is that calling addiction a “disease” does not get anyone off the hook for anything. To dodge treatment for this “disease” – which includes full acceptance that one’s drinking or using is out of control – is like a diabetic refusing insulin: irresponsible and self-destructive. In my view, an alcoholic (or person abusing alcohol) may not be responsible for the cause but they are responsible for the cure. This silences the endless debate about whether the struggling person is “bad” and gets down to brass tacks: i.e., treatment.

That treatment may include a 12-step program such as Narcotics or Alcoholics Anonymous, whose 4th step asks the recovering person (RP) to take a “fearless and thorough moral inventory” of himself. Later steps 8 and 9 ask the RP to make direct amends for past harms done and then to change current behaviors, for instance step 10 which says “when we were wrong, promptly admitted it”. The time for self-centered behavior, in other words, is over. Other programs like SOS or SMART Recovery or the Matrix follow similar principles of honesty, self-sufficiency and recalibration of values. And any recovery counselor worth his/her salt will find a way to “call” an RP on his B.S. in an appropriate way. The same goes for group therapy, where peers are encouraged to “call each other” out on suspect self-justifications for “old behaviors” that now need to change in order for sobriety to stick.

Of course, the partner or loved one (POLO, for short) probably has little to no reason or evidence to trust in the beginning, so some skepticism is expected. But no one gets a free pass in the effective recovery treatments I’ve employed or observed.

However, the “disease” concept brings another advantage in that it takes the moral burden off of the RP, while leaving intact the responsibility for cure. In recovery circles it is common to hear that “we’re not ‘bad’ people trying to be good, we’re sick people trying to get better”. Many if not all RP’s live with a disproportionate sense of shame, guilt and general self-loathing. With very few exceptions, a person does not treat others poorly unless she thinks poorly of herself.

The same actually holds true for the POLO, who usually harbors an imbalanced sense of responsibility for not being able to “stop” or limit the addictive behaviors. If he loved me, the thinking goes, he’d stop for good. Meanwhile, the POLO often attempts to become a “stopgap” against the chaos and destruction threatening the very fabric of that relationship-system. The attempt to contain or reign in the insane behaviors eventually fails, leaving the POLO feeling like a failure – and isolated, despairing. This only stokes more resentment, thus cultivating even deeper divisiveness and negativity within the system.

This cycle only stops when one of the parties steps out of the system and “breaks the loop” by doing something different. This is why I encourage my patients, who are stuck in this system with an active addict who may not (yet) want help, to continue therapy and at least try al-anon, in order to carry the seeds of hope and sanity back to the relationship, planting the seeds of change within the system. Sooner or later, the person who is dependent on or abusing substances is going to have to change in order to continue to participate in the relationship; the POLO will, with support, get to the point where enough is enough, and set loving but firm boundaries and/or consequences, saying “no” to both the harmful behaviors and the disease.

The tragedy of addiction is that affects everyone in the system, rather like a virus that “infects” everyone linked to the person. The closer the relationship, it seems, the more virulent the infection. So many POLOs come to my office full of the same self-loathing the addict feels; each party blames the other while secretly hating him/herself, with feelings of unworthiness and shame, while wrestling with denial and – usually – the desire to control. Denial helps the POLO survive the day to day insanity, where leaving is difficult, since it is often felt as an abandonment, even more so when kids are involved. If it were really “that bad”, staying would be impossible.

Control is an understandable impulse as well, since someone has to be responsible for the day to day functioning of the house: bills, groceries, general upkeep, and so on. And the terror of seeing a person self-destruct is almost indescribable; to stand by and do nothing (or leave) would be equally insane and selfish. Yet the attempts to monitor, control or reduce the addict’s drinking/using eventually fail, leaving the POLO with an even greater sense of unworthiness, weakness and other shame-based self-perceptions.

Here is where the “disease” concept helps too, as it can be seen as an illness which affects everyone in the system, requiring overall treatment rather than mere strength or smarts. The loved one or partner is, therefore, not weak or stupid or unworthy; he/she has been affected (and infected) by an unstoppable monster of a disease that prefers death but settles for misery.

Thus all can be united to do their part against a common cause, individually and together, to fight a multi-tentacled beast that gives no quarter to those who try to fight it alone, without requisite tools, including empathic support and understanding.

Copyright (c) 2011 by Darren Haber.  All rights reserved.

1+1 = 0

Years ago I treated a female client in her 30s (“Mary”), married with two teenage children, who was struggling in her marriage to an alcoholic husband.

Mary and I had a strong rapport, which included a shared sense of humor. She’d tell me laughter was a release of tension for her, and also created a kinship with me, her therapist. Her life was no sitcom, to be sure, but she felt comfortable with a wry observation or two, from either of us, particularly where her children were concerned. Their “teen logic” and rationale for wanting what they wanted, yesterday, often made us chuckle.
One day, however, I inadvertently put my foot in it with an ill-timed laugh, as she described to me an argument she’d had with her 17-year-old daughter over marijuana use. Her daughter was insisting that pot helped her write better papers for school, by “opening up her mind”. I laughed at that briefly (an ex-marijuana user myself), before noticing Mary’s distressed expression. This was a moment where she on a typical day would also laugh, but not today. In fact it seemed as though I may have worsened the tension she was obviously feeling.

I said I was sorry if I had trivialized her feelings; she said that wasn’t the cause of her upset and, in fact, felt “bad” for being too serious about things that day. Upon exploration, though, her feelings were understandable. She was feeling despair after this argument, since her daughter’s defense of pot eerily paralleled her husband’s rationalization for drinking, which “relaxed” him for smoother engagement at home. (A subjective point of view, to say the least.)

Suddenly her daughter, whom she saw as an ally, was seen as a potential “defector” to the cause of addiction – a terrifying concept, which stirred a sense of deep aloneness. It left her, I imagined, with that horrific isolation every member of an alcoholic family – including the alcoholic – feels much of the time. In fact, our relationship (between me and Mary) might have felt compromised in the wake of my misattuned chuckle. Not only did she feel a sudden gaping distance between us, but she also felt “wrong” in the way that many partners or loved ones feel; in this case, she felt she was being “too serious” in not laughing with me, as she usually did, that her feelings were somehow “wrong” for being too serious. Such was the intensity of this negative self-perception that I sensed she may have felt “wrong” just for being. The shame, isolation and self-loathing she felt, in that moment (as a representation of too-frequent other moments in her life, rife with chaos beyond her control), were practically yelling for attention.

It was almost as if she felt invisible: not heard, not seen, because of this fundamental “wrongness” that cancelled her out. In that nightmarish void, the other seems to vanish as well. When we disappear into that temporary annihilating space, it seems the world itself goes blank. We feel hidden, with the terror of never being found.
Fortunately, our rapport was strong enough that I could make reparation for my faux pas. She insisted it was minor, though I was careful to hold a place for the intensity of the loneliness and self-doubt (and, possibly, rage) she may have felt in the office – and even more so at home, given the severity of the turbulence and chaos. (On top of, of course, having to raise two teens in such an environment, without much help from her spouse.)

It brought home to me several things: the primary importance of therapeutic rapport and trust between therapist and client; the repetition of annihilation anxiety that, tragically, appears and re-appears with alarming frequency in the face of active addiction; and most of all, the intolerable isolation that rises up around us when the gap between ourselves and others opens up into a void.

This is why support and allies are so crucial to those in this type of situation; we need connection in the face of such awful stress, which often becomes “normal” in living with addiction, like living with air or noise pollution in big cities. We get used to it, it’s really not so bad. Until it is.

This article was first published on goodtherapy.org. Copyright 2010 by Darren Haber.  All rights reserved.

Latest on families and addiction

Hi there, please check out my latest post on goodtherapy.org concerning families, addiction and treatment:

http://www.goodtherapy.org/blog/recovery-addictions-family/

Tiger, meet Carl

It may be a little tacky to address the overhyped scandal du jour, but I can’t help noticing a psycho-spiritual element in regards to the Tiger Woods saga.  It brings to mind Carl Jung’s comments on the “dark” (or repressed) part of the personality, what he called the Shadow.  The Shadow contains those skeletons we prefer to keep in the closet of our (un)conscious mind, the underbelly of the ego as it were, the parts we’d rather not see.  Often we project these parts onto others and blame them, to sanitize ourselves.

These shadow-parts conflict with the self-image we prefer.  But in truth there is always a yin to our yang: where we are strong, we are sometimes weak; where we are smart, we are sometimes ignorant.  These dark “stumbles” bring up powerful feelings that are difficult, sometimes impossible to handle, feelings that may lead us to feel stupid, rejected, a loser.  Often we self-medicate to handle them.  When a champion like Tiger stumbles, we may feel consoled, as if to say “ah, he’s human just like me”. 

Reconciling these two parts of ourselves, and owning the dark side (rather than shaming or blaming others, i.e. minority groups, family members, etc.) is one of the great tasks of human growth.  It is an essential part of what Jung called “individuation” – or, really, growing up.  Without accepting both parts, warts and all, we are doomed to repeat the same behaviors over and over again to get rid of shadowy feelings.  It might be overeating, or overspending, or too much TV, caffeine, booze, what have you.   Those behaviors are the calling card of our Shadow, trying to get our attention.  We ignore it our peril.

Some have asked if I think Tiger Woods is a sex addict.  Frankly, it’s none of my business.  Besides, addiction is self-diagnosed.  But it is worth noting that, in Jung’s words: “It is often tragic to see how blatantly a man bungles his own life and the lives of others yet remains totally incapable of seeing how much the whole tragedy originates in himself”.  (Jung, 1959)  That last part is crucial to treating addiction, and to psychotherapy itself.

Help Yourself

It’s often as difficult living with someone in active addiction as it is wrestling with the addiction itself.  The “co-addict” often wonders how and when to set appropriate boundaries, what he/she is responsible for, how much control to take, and how much actually exists.  There is often an inexplicable sense of free-floating guilt, as though the addict’s self-destructive behavior is at least 50% the co-addict’s fault – sometimes more.  These dark, confusing feelings create isolation, anger and often hopelessness, all of which are bound in a layer of shame, so that the co-addict minimizes or even omits the truth of what’s going on to others, lest an outside person think that things at home aren’t being managed “correctly”. 

This phenomenon is as traumatic and destructive as the actual addiction, leading to the insanity of repeating ineffective behaviors over and over again.  Just as the addict seeks control (in vain) over the drug or drink, so the “co” seeks control over the addict (in vain).  The serenity prayer, one of the keystone mantras of recovery, can be put into action with the assistance of the right support group and the right therapist.  It’s liberating and empowering to discover what the co-addict can change about themselves, and their own behavior, as the first step on the road to relief.  One of the many paradoxes of all relationships, but especially this type, is that working on oneself is also good for one’s partner.  Very often the work one does in therapy and elsewhere becomes a “program of attraction” that the addict wants to emulate, and that can create hope for all parties since someone, at last, is taking new action.