The partners and the couple go through therapy basics to stabilize the addict's use or acting out, confront secrets and collusion, stabilize couple's interactions, improve self-esteem, establish support systems, begin tentative attempts to create opportunities for trust, risk trust, and de-stabilize the couple's dysfunctional system, and re-stabilize the system to be tolerate discomfort necessary for growth. Couple therapy in general goes through comparable processes, but addictive use or behavior as opposed to other problematic reactions often causes a much more profound severity of disruption and emotional devastation. This is exceedingly difficult and substantial work, yet it only lays the foundation for the next stage of therapy. The complexity and severity of distracting and overwhelming pitfalls before reaching the higher levels of intimacy and functionality for the addict, co-addict, and couple may be unconsciously purposeful. "Problems" may serve to prevent the partners from getting to more terrifying issues. Wounds and resentments that are pre-historical to the relationship have been shielded from examination by chaos caused by addition, painful dynamics, multiple life, work, and family crises, and other dysfunctional complications.
The couple tends to bring up recent history or grievances in their relationship, while being oblivious to how much older wounds and ancient resentments have been triggered. While recent or current actions and choices are important to their dynamics, partners often think they occur in isolation from other life experiences. At the very minimum, there is a pattern of negative choices, including substance use or compulsive behaviors within the relationship. In most cases, the pattern of negative behaviors and the pattern of dysfunctional interactions have endured for years- often since the beginning of the relationship. In some cases, the pattern may have been relatively benign or the disruptions manageable until substance abuse or compulsive behavior began. The therapist should find out if the couple enters therapy shortly after substance abuse or compulsive behavior began or if it began after a substantial period eventually becoming an enduring pattern. Therapy may be qualitatively different when substance abuse or compulsive behavior started recently and is a relatively new pattern. The individual or the couple that recognizes the dangers of the substance abuse and compulsive behavior and then enters therapy quickly is likely to be more aware, mentally and psychologically sophisticated, less negatively entrenched, and more motivated. And, the underlying issues may be less severe and more amenable to be addressed. And, collateral damage from the abusive use or behavioral compulsion would not be as severe. On the other hand, if the pattern is old and enduring, it will be more entrenched and the underlying issue probably more severely painful. The couple would have avoided dealing with sub-crisis level emotional destruction for years, and only have come to therapy when it had reached a critical mass far beyond their self-delusion abilities to deny.
The first problem in the couple's communication is their instinctive minimizing of issues. They will present for improving communication skills, better intimacy, more sex, parenting skills, less conflicts, or finding more fun or being happier. Implicitly or overtly the partners collude to not tell the therapist about substance abuse or compulsive behaviors. Nor, do they necessarily speak about depression or anxiety, emotional pain, feelings of isolation and abandonment, or childhood neglect, or abuse. They fail to bring up emotionally unavailable fathers, unpleasable mothers, preoccupied parents, alcoholic family systems, crank-addicted parents, incest, molestation, or rape, or witnessing domestic violence or drug and criminal violence, sexual identify issues, or homelessness and poverty. The therapist must listen with a cynical ear and suspect that both partners are withholding important information and/or do not recognize their importance. The therapist as a good listener must be a curious probing investigative listener. Experience and knowledge about addiction, dysfunctional addictive systems, roles in the family, and adult and relationship consequences should guide the therapist's inquiry. The addict tends to come from identifiable spectrums of family dynamics. The partner of the addict tends to come from family systems with shared experiences. The relationship of the addict and co-addict also tends to follow dysfunctional patterns recognizable to the theoretically knowledgeable therapist.
When the addict and co-addict fail to bring up important information, the therapist can pointedly and directly ask them. For example, the therapist not only ask each partner about his or her history and current pattern of substance use and of problematic behaviors, but ask about any history of addiction in each partner's extended family. The therapist should ask Daryl about his parents, how his father interacted with his mother, what was his use of alcohol, whether he had affairs, how his mother dealt with conflict, was he grandiose, entitled, omnipotent, or controlling (characteristics of narcissism seen in Daryl) and so forth. Uncovering controlling behavior, addiction, and sexual infidelities similar to Daryl's behaviors would not be surprising. The therapist should ask Marilyn if Daryl has similarities to her father, if their relationship was similar to her parents' relationship, if her father had alcohol issues or was controlling, if her mother was long suffering and stoic, and so on. The therapist should ask Carl about how alcohol or drugs were used in his family, including his extended family: uncles, aunts, grandparents, and cousins. How did family members deal with stress and conflict? The therapist is checking if Carl's evening drinking to deal with Bethany was modeled for him in his family. Also, if there are models of other dominant critical women and cowering men that may have influenced him. Was anyone in Shuman's family a "dry drunk?" Shuman's long abstinence may have precedent in his family. Had one or both of the partners such as Cybil or Gwyn grown up with an addict or someone in recovery? The sophisticated therapist upon hearing of no addiction or substance abuse in the addict's family should inquire about rigid controlling or dominating family dynamic, which may be from individual personality as well as from religious or cultural backgrounds. Certain cultures as well as religions are more authoritarian and controlling versus others. Whereas Mitchell's father was rigid, demanding, and impossible to satisfy (especially, since his ADHD was not understood), Gwyn and Tamlyn grew up with religious dogma that was comparably unforgiving. The therapist should also investigate for history of abuse-especially sexual abuse, trauma, mental illness, or physical disabilities that may have caused extraordinary stress and possibly rigid controlling family systems, which tend to mimic addictive family systems. The therapist must follow any trail with the barest scent of potential relevance. Following the trail often uncovers issues that client ignorance as opposed to denial kept out of the focus of therapy. Tamlyn remembered her molestation but did not know that it could be related to her alcoholism, relationship challenges, her bulimia, or her initial attraction to Phillip despite him being ten years older than her. Samantha did not realize that her borderline instincts or her cutting behavior could be rooted from childhood sexual abuse. Or, why she continually lashed out at Dyson despite his relative supportive consistency. The clients often just do not know to look or what may be important. Until the therapist informs the partners with relevant psycho-education about various potentially relevant influences on emotions, thinking, and relationships, they often do not know what they need to communicate in therapy and to each other at home.
Even when partners recognize relevant things to discuss, they may still be adverse to bring them up because of habitual communication styles. Or, they may have poor skills communicating. "The four viable couple styles (by frequency) are complementary, conflict-minimizing, best friend, and emotionally expressive (McCarthy, 1999c). The clinician needs to explore what had been the marital style and what couple style the woman now wants. The most typical pattern for sexually compulsive men is the conflict-minimizing style" (McCarthy, 2002, page 282). The therapist should investigate if the addicted partner (non-sexual) uses a conflict-minimizing style interacting with his or her partner. For example, passive-aggressive Carl as the addict to critical Bethany and dependent Marilyn as the co-addict to controlling Daryl were both conflict-minimizing if not conflict avoidant. Other partners discussed could be almost all be arguably considered conflict-minimizing as well. A conflict-minimizing style "allowed the secrecy and avoidance which are core characteristics of compulsive sexual behavior" and may be also fundamental to other addictive behavior. "Typically, the couple style the woman now wants is the complementary style. Many couples fall into, rather than choose, the emotionally expressive style where highly charged emotions swing from accusations and anger to protestations of total trust and undying love. Although this can be reinvigorating and dramatic, in the long run it subverts rather than builds the trust bond. The 'emotional roller coaster' is destabilizing because the couple makes promises that cannot be kept. He commits to never even think of acting out, which is unrealistic. This couple style makes for better movies and songs than it does for a solid satisfying marriage" (page 283). Kat often exploded verbally at Mitchell, especially when she caught him lying again about using up his month's supply of prescription pain medication by the second week of the month. Samantha harangued Dyson for his perceived failings- frequently bringing up his seven-year-old indiscretions despite his catering so much to her needs. Shuman was highly passionate about his dedication to his twelve-step work and sponsorees. This resulted in animated and unproductive arguments with Myanna. The bleak reality of the relationship with occasional addiction fueled disruptions may become more appealing than having hope rise from impassioned promises only to be crushed with disappointment with further addictive use or behavior. "The emotionally expressive couple style is the one most likely to lead to divorce. For people who choose this style, two guidelines are crucial—the man commits to not using an emotional confrontation as an excuse to act out and the couple establish boundaries for dealing with conflict" (page 283). In the midst of emotional reactivity, the partners are likely to make threats from verbal to physical. Threats between the partners have to be placed off limits, as well as using recent or prior addictive use or behaviors to lash out against the other. The therapist often needs to help the partners communicate more directly with feelings, but without threats.
The complementary couple style is also called a validating or supportive style. It is the most frequent and satisfying style as it balances each partner's autonomy needs with being an intimate couple. Individual needs are not in competition with intimacy needs. As they are balanced, the partners achieve greater and deeper levels of intimacy. If the couple can learn how to communicate in this manner, they reinforce each other's growing communication competency, mutually validate worth, deepen intimacy (including sexual), and improve their attachment. They learn how to establish and sustain appropriate personal boundaries. Personal boundaries do not however include keeping secrets about addictive use and behaviors or allowing their occurrence. Either partner can initiate communication, connection, and sharing. The best friend couple style may be ideal. Being able to share all feelings, thoughts, and vulnerabilities without any secrets from the partner is very stabilizing and builds greater security. It is a powerful style to deal with any challenge to a partner or the couple, including addiction. However, being best friends may not be within everyone's or every couple's capacity, especially after the damage incurred from addiction. Considerably less than best friends, the partners may barely be able to tolerate each other, struggling not to hate each other.
The therapist may consider the communication styles to be a developmental progression. A couple with one or both partners using conflict-minimizing styles will need to be challenged and prompted to address conflict. Working against their collusion to avoid issues, this could provoke the partners into a problematic emotionally expressive style. Whether this is a new style or their existing style, the partners inevitably attack, blame, and threaten passionately to the detriment of connection and intimate communication. While the communication is heartfelt, there is insufficient restraint and egos, attachment, and security is hurt. The therapist should train the partners to mute the volatility without losing feelings and expression. The complementary couple style of validation and support will be desirable but challenging. While it may not be as fulfilling as a best friend style, it is more realistic. It may also be sufficient to trigger change in the relationship and in the process of recovery. Becoming best friends may not be necessary and may be left to the stable couple with stable recovery to strive for on their own subsequent to therapy.
Communication skill deficits are not the problem per se. The failure to communicate clearly causes emotional injuries: pain, abandonment, rejection, loss, distress, and despair. These emotional injuries are the problem that corrupt and destroy the trust and love necessary for a healthy relationship. One or both partners often have difficulty expressing their vulnerability to the other and expressing validation of the other's vulnerable feelings. Denial, diversion, and minimizing are defensive communication habits that block hearing and validating the other person's feelings. Projection and accusations are offensive-defensive communication habits that dismiss and attack the other person when he or she is vulnerable. These unhealthy communication habits are endemic in the addictive couple's relationship. The therapist has to train the partners to express personal needs in a non-accusatory style. "I" statements need to be cleansed of blaming language or tones and demands or threats. The partners need to learn to sufficiently restrain their hyper-sensitive to paranoid anticipation of accusations so they can consider the message as possibly neutral or positive. They need to express their own emotional pain without triggering the other partner's defensiveness, and hear the other's pain without becoming defensiveness.
The partners need to learn how to express themselves in a genuine manner. This is often inherently difficult. The partners may have had limited communications skills in the first place. In addition, addiction can also cause or exacerbate poor communication skills. "Therapists have observed the development of constraining couple communication skills in consequence of a nascent sexual addiction (Tays et al., 1999; Schneider & Schneider, 1996). Furthermore, in an attempt to stabilize family functioning within the context of the addictive behavior, couples commonly develop maladaptive interactional patterns (Earle, Earle, & Osborn, 1995). The clinical observation is that, 'from a systems perspective, pathological family interaction' may represent an accommodation to addiction that can enable and 'maintain deviant [individual] behavior' such as sexual addiction (Earle et al., 1995, p. 9). The quality and function of marriage and family relationships is thereby distorted and compromised" (Zitzman and Butler, 2005, page 315). The addict has not been authentic often for years as he or she has presented a false sober or in control persona to everyone. Honesty would be admitting that many or most of the time his or her addiction was more important than the spouse, the children, and his or her self-respect. He or she is usually deeply ashamed of his or her genuine self- the lying deceptive addict. The co-addict has acted as the loving caring partner while caring secret resentments. Honesty would be acknowledging that experience after experience has shown that his or hope for the addict to change had been false hope. He or she is also usually deeply ashamed of his or her genuine self- the fool who has accepted the lies of the addict. Both partners have habitually lied to themselves so much that they may not know how to tell the truth. They may be unfamiliar with their authentic selves. As difficult as this may be, only new communications of genuine vulnerability and compassion can rebuild the trust and intimacy necessary for a stable relationship. In all damaged relationships, attempts to share and validate mutual vulnerability are complicated by accrued anger and resentments. For the partner of the addict, each use or acting out incident is a betrayal of trust. Each betrayal is a blow to vulnerability and intimacy. Consistent multiple repeated betrayals or blows cause more than a temporary hurt. They compile and build upon each other to create highly sensitive wounds. Any misstep intended or unintentional however slight can trigger intense pain. Therapy attempts to foster consistent repeated positive interactions that allow injuries to heal. However, the therapist does not and the partners may not know until in midst of the process, that temporary hurt had become a deep wound, which in turn may have become a crippling injury. The crippling injury may have destroyed the relationship beyond repair or healing.
The partners progress by being genuine and sharing vulnerability that builds or rebuilds intimacy and connection, and by working out accumulated grievances and resentment. The therapist has to not just teach and manage communication between the partners when dealing with resentments, but also address emotional reactivity from old deep pain and inadequate emotional management skills. If the addict is still actively using or acting out, his or her emotional volatility may still be quite high. His or her volatility will trigger a comparable emotional reactivity in the co-addict. The therapist has to manage, including possibly curtailing and blocking the partners slamming each other with the other's transgressions in therapy. Their ability to productively process the old injuries should increase with their overall growth and stability, which includes refraining from addictive use or behavior. The focus in early treatment should lean more to stabilization, the support system, self-care, and psycho-education. A key part of this process is the partners accepting that they do not have control of the other partner's use, addiction, or recovery. The instinct and behavior of the non-addicted partner is to be the cop that scrutinizes the addict's every movement and action. That has failed to work prior to entering therapy. "Education and intervention enabled these wives to psychologically externalize rather than personalize addiction in terms of how they related it to themselves and their husbands. Diane explained this process in detail: 'It is one of the hardest things to do- to put yourself outside of it. But when you realize this isn't about you, it is about him and how to help him, it is completely different. Not that my feelings don't count, but it is a whole different thing to talk about. When we are talking about [addiction, it] is over there. That helped a lot . . . But you have to take yourself out of it… That helped tons.'" (Zitzman and Butler, 2005, page 324).
Some partners more or less admit to failing to control the addict and ask the therapist for some new creative way to still control the addict, rather than actually try different strategies. In other words, trying to find a different way to try essentially the same thing, still keeps the co-addict in the dysfunctionality rather taking him or herself out of it. Control strategies that failed before will continue to fail despite the advent of therapy and the actions of the therapist. Mistrust did not work to stop addiction, while trust remains too risky. Progression in therapy is measured by trust in their honesty and communication first, before it can be measured by trust in the addict abstaining from addictive behaviors. When the partners have greater trust in reciprocal communication, deeper work becomes more likely to be successful later in the recovery process. Taylor says (2012, page 9) that, "The energy tied up in arguing, denial, and secrecy becomes available for creativity, intimacy, and joy. In this way recovery brings many positive benefits into the relationship, the family, work, etc." This is true also within the therapy process. Successful therapy should also benefit from more positive energy to deal with growth as the negative expended previously for negative use or behavior is freed.