14. Wanting Change w/o Changing - RonaldMah

Ronald Mah, M.A., Ph.D.
Licensed Marriage & Family Therapist,
Consultant/Trainer/Author
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Mine, Yours, and Ours, Addiction and Compulsivity in Couples and Couple Therapy
Chapter 14: WANTING CHANGE WITHOUT CHANGING


The addict and couple's resistance to following treatment ironically demonstrates both their willingness and the uneven capacity to change.  The individual and the couple often profess wanting to change but with sometimes unspoken reservations and qualifications.  One or both partners may want to stop having conflict without stopping substance abuse or behavioral excesses.  They may want to curtail addictive use or behavior without stopping altogether.  The individual may want to stop using or acting out, but not address underlying issues.  Or, want to address underlying issues without confronting the trauma.  The partner may want the addict to stop abusing substances or stop compulsive behaviors but not consider examining his or her enabling behaviors.  They want change without changing.  Early treatment often involves the therapist confronting the various deals and compromises that the addict and co-addict have colluded on in order to avoid more scary and painful issues.   The partners will bargain for intrinsically incomplete and/or misleading strategies for dealing with the addictive use and behaviors.   Working with the addict and co-addict becomes like a therapeutic "Let's Make a Deal" negotiation.  The therapist needs to tolerate and indulge their need to fulfill delusional hope of avoiding their secrets, while eventually moving them forward towards goals with greater integrity.

The partner's interactions with the addict can be very complicated.  "‚Ķseveral paradoxical injunctions exist in relationships that include afflicted partners (e.g., drug abusers, aggressive individuals, depressed individuals, and eating disordered individuals) and that these paradoxes ultimately impact expressions of control by the functional family member (i.e., the partner with no problem interfering with day-to-day functioning) in the relationship.  In the context of a relationship where one person is functional and the other afflicted, the functional person is very likely to intermittently reinforce behaviors they actually want to extinguish.  This reinforcement occurs when functional family members first nurture the substance-dependent individual when they are in 'crisis,' thus ultimately reinforcing the behavioral compulsion.  Then, as caregivers become resentful, as is likely to happen (Asher, 1992; Wiseman, 1991), they may fail to nurture the afflicted individuals, thus failing to reinforce the behavior.  The lack of care giving by the functional partner not only communicates resentment, but also is likely an attempt to punish, or extinguish the undesirable behavior of the dependent partner.  However, INC (inconsistent nurturing for control) theory argues that the intermittent nature of this punishing behavior will actually increase the behavioral compulsion.  Thus, functional family members unintentionally strengthen the likelihood of the substance-abuse behavior through intermittent reinforcement and intermittent punishment" (Cropley, 2006, page 494-95).

The therapist needs to carefully examine the couple's dynamics for so-called "helping" behavior, specifically with respect to inconsistent nurturing for control (INC) theory.  The non-addicted partner or enabler, co-dependent, or co-addict is thought early in relationships to initially reinforce the problematic addictive behavior before deciding it was negative and undesirable.  Once the partner figures out the behavior is problematic, he or she punished the addict even more.  Eventually, the partner ends up with "a mix of reinforcing and punishing strategies, resulting in an overall pattern of inconsistent reinforcement and punishment.  This cycling is central to the inconsistent nature of reinforcing or punishing communication strategies postulated by INC theory" (Cropley, 2006, page 495).  The therapist therefore cannot simply reinforce the partner of the addict assuming that his or her actions are inherently supportive of change and work against further use or relapse.  Partners will verbally criticize or verbally abuse, set up various rules intended to prevent or curtail use or behavior, make demands to stop, and confront the addict.  It is possible according to INC theory that such tactics rather than decrease negative use or behavior, actually may increase it.  On the other hand, "partners who were more consistent in punishing substance abuse and reinforcing alternative behaviors (e.g., encouraging attendance at AA meetings) had substance-abusive partners who relapsed less.  Moreover, more successful partners also reported less depression than those with partners who relapsed more (Le Poire et al., 2000).  This is important for two reasons.  First, partners of substance-abusing individuals can help reduce their partners' recidivism.  Second, this assistance can also translate into better mental health outcomes for the partners" (page 495).  Therapy should duplicate this strategy and work on the partner being consistent in punishing addictive behaviors and in reinforcing alternative behaviors.  As much as hoping that just telling the addict to simply stop, promoting partner consistency may also prove to be very complex.  The partner's inconsistency of responses may have deep emotional and psychological roots that therapy may need to address along with the addict's issues.

ADDRESS:
433 Estudillo Ave., #305
San Leandro, CA 94577-4915
Ronald Mah, M.A., Ph.D.
Licensed Marriage & Family Therapist, MFT32136
CONTACT INFORMATION:
(510) 614-5641 or (510) 582-5788
fax: (510) 889-6553
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