4. Threatening to Abandon Therapy - 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 4: THREATENING TO ABANDON THERAPY


When therapy investigates the possibility of addiction, the addicted partner will often give very clear signals that he or she does not want the therapist to continue with the line of inquiry.  He or she will try to distract, coerce, and even intimidate the therapist to stop with anger or the threat of abandoning therapy.  This may be basically what he or she does and has done one way or another with the partner.  For example, Daryl declared, "I didn't come here to talk about my drinking.  It ain't like I'm some alcoholic or something.  We're here to talk about our fighting.  I don't want to waste time on a few drinks."  When his sexual affairs were broached, Daryl raised his voice and declared, "That is old.  I told you I was sorry.  It was a mistake.  And I promised it wouldn't happen again.  We already have through all that.  If all that old crap is what you want to talk about, we don't need to pay so damn much for therapy!"  Marilyn got nervous and said, "It's not that big a deal.  Yes, let's talk about our communication."  The threat was not verbalized, but implicitly meant "Stop or else."  Marilyn responded to the "or else," in order to hold onto her tenuous hope that Daryl would change.  The therapist also hears the "or else!" and if motivated to keep the partners in therapy at all costs may be manipulated.  During this interaction, the therapist should be attentive to his or her counter-transference- anxiety, threat, and so on.  These become cues to the dynamics between the partners.  The therapist should carefully observe the non-verbal messages and reaction of the partner.  Often the therapist will see the partner such as Marilyn getting tense or nervous.  The partner may be anticipating the addict's angry reaction he or she had experienced so often at home.  On the other hand, the partner may get excited that the therapist has broached the taboo topic.  The partner had been banned from bringing it up, but had been dying for it to be exposed.  A more cowed partner might interject and make excuses for the addict or substance abuser.  He or she however may do so too quickly and with observable anxiety.  The more assertive partner may virtually stand up and cheer that the therapist has introduced addiction as an issue, and receive a flash of anger-a dirty look from the addict.

Once the topic is broached, the more explicit questions of how addiction became a part of their lives and how it affects the partners and the relationship can be examined.  The therapist can ask about their social context of alcohol use, for example.  Each partner socializes with some peer group with attitudes or values about drinking alcohol.  "An individual's perceptions about how others think about alcohol use can also be related to alcohol consumption.  This 'other' person (i.e., the referent) may be anyone that the individual has contact with and has some form of a relationship (e.g., romantic partner, close friend, coworker, etc.).  The referent could also represent the perceived norm of a group (e.g., a racial/ethnic group, a particular community, a particular religion, etc.).  In a sample of college students, Wood, Read, Palfai, and Stevenson (2001) found that perceived peer norms regarding alcohol use was significantly associated with alcohol use" (Homish and Leonard, 2007, page 1428).  Each partner has his or her personal family, as well as peer models of alcohol or drug use and of dealing with distress and conflict.  Depending on the models or experiences, the addict or the co-addict may perceive compulsive use or addictive behavior as normal rather than a problem.  Or, they may consider any problems from use or behavior as normal issues in a couple or family.  Someone who gets excessively intoxicated, becomes non-functional, or transgresses significantly occasionally or regularly may be accepted as a normal part of the individual or an unfortunate unassailable aspect of the relationship.  As drinking and excessive drinking is familiar, the addict may accuse the therapist or partner of making something out of nothing- of making trouble.  After all, it (the use or behavior) was what the whole family, neighborhood, or gang did.  Both Daryl and Marilyn for example had experiences and models in their families of origin of compulsive behavior, control, and secrets that made their dynamics feel familiar.  The therapist should recall that the  root word for "familiar" is "family."

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