5. Abuse Substance Abuse & Addiction - RonaldMah

Ronald Mah, M.A., Ph.D.
Licensed Marriage & Family Therapist,
Consultant/Trainer/Author
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Roles, Rigidity, Repair, and Renovation in Relationships and Therapy
Chapter 5: ABUSE, SUBSTANCE ABUSE, & ADDICTION
by Ronald Mah





Certain client presentations or issues reflect inherent structural dysfunction and thus, may conceptualized and well served with structurally based therapy.  Abuse is fundamentally about violations of boundaries, roles, trust, and relationships.  Abuse can be seen as occurring when the structure of a mutually caring relationship is shaken or broken.  Or, of responsibility and respect a caregiving relationship has been shaken or broken by the caregiver.
Physical abuse:  Physical abuse occurs when the perpetrator (particularly but not limited to the adult parent or other adult in authority) engages in physical touch that violates the boundary of pain.  The physical interaction also crosses the boundaries of a relationship without intimidation and fear.  Physical abuse violates the trust in the more powerful role of the caregiver to protect rather than harm the person.

Sexual abuse:  Sexual abuse occurs when the perpetrator violates the boundary requiring permission to engage in sexual intimacy and touch.  Children because of developmental immaturity do not have the emotional, psychological, and intellectual maturity to give informed permission.  Sexual abuse by an adult of another adult violates the boundary of mutual consent required for sexual intimacy.  Sexual abuse also violates the boundary expectations of mutual benefit since it is exploitive and dismissive of harm to the victim.  Sexual abuse of children violates the trust in the more powerful role of the caregiver to protect rather than harm the person‚Ķ and to facilitate or permit eventual healthy adult intimacy relationships.

Emotional Abuse:  Emotional or psychological abuse occurs when the perpetrator engages in communication and actions that pushes individuals across boundaries of self-esteem.  Rather than engaging in informative or nurturing communication or behaviors as expected of peers, caregivers, or authoritative figures, they communicate distain, insult, and attacks.  It injures the individual's sense of worth.  Rather than empowering or supporting the individual, emotional abuse humiliates him or her.

Neglect: Neglect violates the role and boundaries of the caregiver to give succor to dependent individuals.  Rather than nurture or empower the individual, neglect communicates the inherent lack of importance or worth to him or her.

Domestic Violence:  Domestic violence violates the boundaries of mutual support and trust between partners.  It violates the boundaries of security and safety within the relationship.

Elder and Dependent Adult Abuse:  Elder and dependent adult abuse violates the role and boundaries of the caregiver or adult child to give succor to dependent individuals.  Rather than nurture, support, or protect the vulnerable individual, such abuse in addition to emotional and physical abuse and neglect can include financial exploitation.

Alcohol abuse, drug abuse, and other addictive behaviors are fundamentally about inability to hold boundaries among recreational or social use, abuse, and dependent use.  Two considerations are important to such abuse or problematic behavior.

Harm:  Continued and increased substance use or behaviors beyond some sensory benefit (mild buzz or high) or benign or insignificant effects that results in harm to health (emotional/psychological or physical), occupation or academics, and/or relationships, crosses a basic self-care boundary.  The household, workplace, and school have explicit boundaries violated by substance use (being high or drunk) and addictive behaviors (internet surfing).  Substance use or addictive behaviors violates relationship, couple, or family members' expectation that the relationship is of higher importance than the desire for the use or behaviors.

Legal and illegal:  Illegal substance use or illegal behavior violates societal laws created for individual and the common good.

These issues or presentations may be successfully approached with theories or therapies other than structural therapy.  Successful change or intervention of these issues or presentations however would almost inevitably mirror the achievement of same goals of structural approaches: effective hierarchy; well-defined roles, healthy communication, appropriate boundaries; appropriate alignments; growth, well-being, and individual and mutual benefit.  Directly or indirectly, purposely or intuitively the therapist will often apply structural principles to presenting issues involving poor boundaries, inconsistent relationships, confused authority‚Ķ essentially, virtually to any therapy situation.  Some boundaries are overtly expressed and enthusiastically owned, but the individual, couple, or family may have significant and highly problematic exceptions to them that allow for transgressions and violations.  For example, treating the partner with kindness and respect is a firmly held boundary, but an individual may allow oneself an exception if the other person has hurt one first.  Then, vicious purposeful vengeance is acceptable if not also an entitlement.  Another example would be to drink only for relaxation, but allowing oneself the privilege of drinking to intoxication and stupor when feeling rejected by a love interest.  Or, sexual intimacies outside the committed relationship are forbidden but if one's partner cheated first, then a revenge affair is justified.  Exceptions and nuances need to be brought into the relationship concretely.  Boundaries need to be reasserted and repaired for many individuals, couples, or families.  In some situations, when old boundaries are ineffective, then significantly new or different models may need to be asserted.

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