9. Complications & Frustration - RonaldMah
Ronald Mah, M.A., Ph.D.
Licensed Marriage & Family Therapist,
Consultant/Trainer/Author
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9. Complications & Frustration
Therapist Resources > Therapy Books > Mine Yours Addiction- Cpl
Mine, Yours, and Ours, Addiction and Compulsivity in Couples and Couple Therapy
Chapter 9: COMPLICATIONS AND FRUSTRATION
Individuals vary in their emotional volatility whether they drink, use drugs, or have compulsive behaviors. The therapist may find individual temperamental, psychological, or cultural influences on emotional sensitivity that mitigate or complicate addiction. For example, for an individual with bipolar disorder, the therapist must assess for stability and medication compliance. Individuals with bipolar disorder who are medically compliant can often be relatively stable. However, in a manic stage the bipolar individual is exhilarated and active in ways similar to being in a stimulant drug state. In addition, when he or she crashes into deep depression, there can be great temptation to medicate the distress and despair. Despite the horrific depression, the individual may still crave the mania. Whereas, the addict will use and experience highs, the bipolar can purposely go off medication in order to experience mania- his or her highs. The therapist should assess if the client is from a cultural background where manic behavior is considered desirable or a socially acceptable expression of creativity. The cultural context of the behavior needs to be examined. Even when the behavior is culturally sanctioned, extreme behavior can still be functionally problematic. The focus should shift to the problematic nature of the behavior in life and the relationship versus its cultural acceptability. Is the partner (more typically, the woman) supposed to tolerate an occasional "wild" period of behavior as a condition of the marriage? If both partners accept the addictive behavior as normal, treatment becomes more complex again. The bipolar individual often really enjoys the feelings of mania: omnipotence and grandiosity. It is the inevitable depression… rebound lows that are so horrible. The craving for mania is similar to the addict's desire for his or her drug or behavior. There will be "continued use (experience of mania) despite adverse consequences," craving, have "repeated attempts to quit" (maintain chemical balance), and so forth. The partner of a bipolar or addict is often perplexed by his or her grandiosity and omnipotence and subsequent addictive behavior. It just doesn't seem to make sense to the partner for the addict to continue using or acting out or for the bipolar go into manic stages when there are so many negative consequences.
Addiction and perhaps, in particular "Sexual addiction also harms relationships by promoting development of an increasingly ego-centric or narcissistic attitude and preoccupation in the addict (Tays, Ralph, Wells, Murray, & Garrett, 1999; Wolfe, 2000; Young et al., 2000). Relationship orientation is replaced by preoccupation with personal gratification and palliation. Addiction's ego-centrism inherently opposes the other availability and responsiveness critical to secure attachment. Furthermore, in the face of evident harm to intimate others, adoption of self-justifying rationalizations serves to reinforce relationally destructive narcissism" (Zitzman and Butler, 2005, page 315-16). The self-righteousness of the addict for having used or acting out and to continue to do so may be a consequence of justifying use to avoid experiencing shame. On the other hand, it may be characterological narcissistic tendencies that contributed to the individual's vulnerability to addiction. Narcissistic superiority, grandiosity, omnipotence, and assertion of immunity from rules for others can cause one to ignore the "rules" of addiction risks. Once abusive or excessive use began, narcissism may cause the individual to hide it and allow addictive progression, while all the time claiming controlled use despite clear adverse consequences.
The therapist often experiences a great deal of frustration when working with someone with addiction issues. Challenging couple therapy suddenly becomes even more difficult when unexpectedly the therapist uncovers one or both partners with alcohol, drug, or self-destructive compulsive behaviors. The therapist can feel overwhelmed and incompetent juggling dysfunctional couples dynamics and addictive compulsions in not just one, but both partners. "…concordant couples may require longer treatment because cognitive-behavioral skills would have to be covered for both partners. In addition, we cannot assume that both members of the dyad will be equally ready to engage in treatment. There may be differences in the level of motivation for recovery. There is also the difficulty of both giving and receiving support from the partner while trying to curb one's own 'substance abuse.' The process of recovery is often long, difficult and painful. It may even be more so for the concordant couple. The degree of enmeshment in couples and families who are involved with 'substance abuse' is very high (Brown and Lewis, 1998; Juliana and Goodman, 1997). Disentangling this enmeshment can be both problematic and disruptive for couples and families. It is therefore not unusual to encounter substantial resistance to this process (Brown and Lewis, 1998). Within couples and families, 'substance abuse' can often become the central organizing principle within the relationship (Brown and Lewis, 1998). Life with drugs becomes predicable and even normalized. Attempts at recovery profoundly threaten this homestasis" (Cavacuiti, 2004, page 651-52). The partners may contradict their desire and work for recovery and health with erratic recovery and relationship harming actions. This may confuse and dismay the therapist. The therapist may have negative counter-transference issues from personal experiences with his or her own compulsive history or from family or other social experiences. The therapist may also have negative professional counter-transference issues from failed and chaotic therapy experiences with addicted clients. The therapist needs to be prepared for the following possibilities (Taylor, 2012, page 7):
1. Once (the alcoholic) gets into treatment, (his or) her life can change radically. Both (the alcoholic and co-alcoholic) can become more alive, truthful, authentic, and happier.2. This healing path takes time, discipline, and faith. The addict and co-alcoholic must come out of their personal and psychological isolation and find allies on the path of healing.3. The family 'enabling' system must also change… the co-alcoholic, must cease trying to get (the alcoholic) to change.4. Rarely can the alcoholic be persuaded that (he or) she needs help. (The alcoholic) begins to change when (he or) she finally realizes that alcohol is wrecking (his or) her life and the lives of those (he or) she loves.
There are often negative work, family, financial, health, and other life consequences that the addict, the partner, family, and household suffer from addiction. Any potential stressor or problem that a couple or family may experience may occur more frequently or disruptively when addiction is part of the couple. And, may be more intense, difficult, or complicated. For example, "Those treating concordant couples must remain vigilant to issues of domestic abuse within the relationship. A study in Memphis, Tennessee, found that in 94% of the domestic violence calls, the assailant had used alcohol alone or in combination with cocaine, marijuana, or other drugs within 6 h of the assault (Brookoff, 1996). About 43% of the victims in the Memphis study had also been using alcohol and other drugs" (Cavacuiti, 2004, page 652). Domestic violence, child abuse, suicidality, and potential harm or violence against others complicates both the couple therapy and treatment for addiction. Danger or harm to self or others necessarily and automatically draws the therapy's focus, away from couple's work and addiction recovery. Other problems or stresses complicate and are complicated by relationship dysfunction and by addiction. The therapist should not be surprised by "distractions," when in fact they are intrinsic to the couple and addiction. Such "distractions" should be anticipated.
ATTACHMENT
While addictions to different substances share characteristics, each substance addiction can also have distinction variations that the therapist needs to understand to conduct effective therapy. In addition, addictions to different behaviors also have distinctive characteristics important to therapy, as well as differences from substance addictions. For example, addiction to pornography with ready access via the Internet shares compulsive issues, craving, time and energy cost, secrecy, and potential financial problems with many other addictions. However, there is also "accompanying disruption, impairment, and endangerment of attachment in marital relationships affected by pornography. Increasingly as well, married couples are entering therapy and self reporting compulsive, addictive pornography consumption as their primary presenting issue, and are describing destructive individual and relationship effects (see also Schneider & Schneider, 1996, p. 116). As preoccupation with pornography consumption sets in, couples report experiencing deterioration of marital and family relationships and impairment of performance and productivity at work and at home (Carnes, 1992; Schneider & Schneider, 1996). Reported as well are repeated attempts and failures at discontinuing pornography consumption and associated sexual behaviors, in spite of awareness of significant negative effects. Dependency on the sexual experience to achieve an intense, preoccupying, altered state of conscious awareness, and its use a primary, maladaptive coping response for aversive intrapsychic and/or interpersonal experiences or conditions appears to be present for many" (Zitzman and Butler, 2005, page 312). Many of the issues are identical to those of other addictions, but the impact on attachment may be more direct and intense as artificial sexual arousal replaces real person-partner intimacy. "We view the sexual response cycle as an physiological process associated with powerful psychoactive effects- for example, intense arousal and euphoria generating cognitive diversion and preoccupation (escape); and promotion and reinforcement of an alternative view of self in relationship, social, and environmental context (fantasy self-concept)- which, like undisciplined substance abuse, can be employed maladaptively and in ways that precipitate psychological dependency. Escape and fantasy impair real-world problem-solving and functioning. We view pornography as a medium designed specifically to tap into these powerful physiological and psychological dynamics of human sexuality. By divorcing the sexual response and experience from the natural constraints of attachment relationships, pornography elicits and enables the development of addictive dynamics."
Secure attachment that provides physical, emotional, psychological, and spiritual availability and responsiveness is necessary for adult partners to bond. Pornography purposefully disconnects sexual arousal and satisfaction from adult attachment dynamics. The sexual experience in pornography occurs outside of a real relationship with a real person. This fosters physical, emotional, psychological, and spiritual detachment from the partner. Being attentive to the other person and responding to him or her, which are fundamental to secure attachment becomes unnecessary for sexual pleasure from pornography. The individual who may have insecure attachment prior to or in the relationship would be intensely impacted by a partner's pornography addiction. The addict who may have his or her own attachment insecurities would gain a corrupted semblance of satisfaction that precludes attempts to seek true attachment responses from the partner. "For many, a spouse's preoccupation with pornography also casts doubt on the reliability of their promise of emotional, psychological, and sexual fidelity. It should not surprise clinicians, therefore, that a spouse's viewing of pornography is experienced by some partners as an 'extramarital violation' that casts doubt on the attachment security and safety available in the marriage" (Zitzman and Butler, 2005, page 313-14). The partner of the individual with an addiction other than pornography can also experience the failure to stop as a betrayal of the relationship contract. The relationship expectations implicitly assume that a committed individual will resist, reduce, or stop behavior that is upsetting or disturbing to the other partner out of love and caring. Therefore, the failure to stop implies a lack of love and care. Pornography is a more profound betrayal as an addiction that directly replaces love and caring for the other partner with sexual satisfaction with a fantasy partner. As in an affair, the addict/betrayer has gone outside the relationship for sexual satisfaction that is supposed only to be satisfied within the monogamous relationship. The therapist would need to change or add to therapeutic strategy to include processes as if infidelity or affairs were present in the relationship.
COUNTER-TRANSFERENCE
The therapist's counter-transference issues tend to mimic how the non-addicted partner or family's feelings and how they deal with the addiction or compulsive behaviors. It is all so complicated and messy, which may challenge the therapist's sense of order… or alliance to some theoretical and therapeutic purity. A therapist who is wedded to a particular therapy would tend to look for what he or she expects. Theoretical confirmation bias may cause the therapist may fail to assess for alcoholism, drug dependences, or behavioral compulsions or addictions. This can occur despite the relative importance given to addictions in psychotherapy graduate programs. Or, perhaps inadequate assessment arises because psychotherapy has had limited applicability and success in treating addiction. Insufficient training, invalid theoretical conceptualization, and failure to assess bodes poorly when it is estimated that "Conservatively, one out of ten people, or one out of five couples in therapy, wrestle with addiction issues" (Taylor, 2012, page 7). The addict often is habitually defensive about his or her use or behavior, much less owning abusive, harmful, or addictive use. Rather than present use or behavior as a problem to address, he or she is more likely to hide it from the therapist. The substance abuser or addict or behavioral addict often has hid it from him or herself with a sophisticated layered denial system. The individual will present his or her honest "reality" to the therapist, because it is really what he or she believes is true. The partner or the enabler, co-alcoholic, or co-addict may have been bribed or intimidated from bringing up the problems, or may already be worn down from repeated failed attempts to stop the substance abuse or compulsive acting out. The therapist may collude with the addict's denial for one reason or another, including an honest concern to deal with "more urgent" issues in therapy: a job loss, sexual impotence, an affair, parenting issues, communication problems, and the like. Unless the therapist brings up addiction or problematic compulsive use or behavior, including identifying the other "urgent" issues as consequential to addiction, the couple may never address what may be a key or the core issue. One or both partners may direct the therapist away from considering addiction or compulsivity issues the therapist is already averse to addressing, and get him or her to join their conspiracy of denial.
If addiction or compulsivity is identified as important to address in therapy and as key to life and couple's dysfunction, therapy can and should change dramatically. However, there is a risk that the therapist may take clinical approaches that prove inappropriate or ineffective. This may be due to: 1) uneven training of unproven psychotherapeutic theories and techniques in graduate programs; 2 )the therapist's lack of familiarity with treating the addicted individual in therapy or in couple therapy; 3) a misfit between psychotherapy and the addict's need; 4) addiction treatment constituting distinct treatment from psychotherapy; 5) poor therapist skills; 6) dual diagnosis issues; 7) and other complications.
The failure of the therapist to make inroads using psychoeducation and other feedback is not necessarily because the therapist is ill informed however. Taylor (2012, page 7) points out that "alcoholism is, among other things, a disorder of thoughts. Drinkers dismiss our wise thoughts and interpretations out of hand. Research shows that alcoholics have brain chemistry and structures which make it difficult for them to assess the consequences of their behavior; therefore, threats will not work. Alcoholics don't fully understand the effects of their actions on themselves or others." The therapist may express psychodynamic, humanistic, cognitive behavioral, affective, attachment, or other theoretical orientations underlying his or her therapeutic choices. However, when presented with clearly dysfunctional harmful behavior, the therapist often defaults to behavioral approaches. Unfortunately, the behavioral approach is frequently telling the client to "Stop it!" Or, finding other words, techniques, and strategies to get the individual or the couple to change behavior as if it merely were a matter of finding the "right" or correct words, techniques, and strategies. The therapist may focus on prompting change quickly, while probably encouraging the individual and the couple to try again what has already failed. Or, imply to the partners that they had done it wrong previously and somehow the therapist's version of ineffective interventions will miraculously work. This process not only risks frustrating the individual, couple, and therapist, but also risks losing the therapist any credibility he or she had developed. The therapist needs to understand what should have worked would have worked… already. What should have worked had not and does not work means that the individual's use or behavior is highly compulsive or addictive. The individual and the couple have deeply entrenched compulsive behaviors. It is not "normal" behavior. Therefore, "normal" intervention and "normal" therapy will not and does not work to create change, especially quick or enduring change. The therapist's frustration can deepen the couple's hopelessness or trigger defensive reactions that threaten therapy and the relationship.
Fluctuating between "normal" and non-normative psychotherapy, so to speak may utilize the non-professional self-help or twelve-step programs available in the community. Some therapists have professional animosity towards non-professional or lay self-help programs and do not support clients' use of them. They may even consider clients choosing self-help groups as insulting to them as therapists given their extensive academic, professional, and licensed path. The therapist may discourage clients from seeking and attending AA (Alcoholics Anonymous), AA (Narcotics Anonymous), CoDA (Co-Dependents Anonymous), SLA (Sex and Love Anonymous), or other twelve-step meetings, and from researching pop psychology literature for relevant reading, for example. At the same time, traditional psychotherapeutic forays into the family-of-origin, attachment styles, potential traumatic events, or communication improvement for example may yield the same dismal results as before. No change. The individual continues to abuse substances or engage in compulsive behaviors and the partner continues to enable or otherwise play the role of the co-addict.
The therapist may be somewhat to highly confronting to the addict without having much effect. The addict is often highly armored against assaults on his or her addictive delusional system and self-preservation instincts. Information or predictions that challenges the individual's use or behavior simultaneously threaten his or her fragile sense of self. His or her use or behavior will often have been discouraged and condemned over many years. In order to continue using or acting out, the individual will have continually reinforced his or her self-justifying explanations, distractions, projections, and disconnections. As a result, "The therapist's pushing and prodding of the client rarely succeeds in shocking him/her into sudden awareness. The alcoholic has to 'bottom out,' which means really feeling the depth of injury he or she is creating. Or, the co-alcoholic has to make a strong statement such as, 'If you keep drinking, I will…' This is another form of bottoming out, when the partner of the alcoholic can no longer tolerate the suffering" (Taylor, 2012, page 7). The therapist may take the failure to change or incorporate therapeutic interventions and suggestions as the addict ignoring him or her. Rather than understanding addictive defensive mechanisms however, the therapist may take it personally- as a personal-professional rejection. This would be counter-productive to successful therapy.
"It takes a long time for a therapist to learn how to walk the line between denial and subtle coercion, but this balancing act makes working with these clients much easier." Recovery from addiction if it occurs at all often takes a long time. Relapsing is a common or normal part of recovery. Relapse can either be an incident or a return to the pattern of abusive or addictive use or behavior. The therapist who expects quick change, stable recovery, and continued abstinence is often not prepared for the frequency of relapse. If unprepared, the therapist is likely to become frustrated, angry, and judgmental towards the individual and couple for doing fundamentally what they have been doing for quite a while. As the alcoholic in twelve-step programs is directed to admit his or her helplessness with alcohol, the therapist must also own his or her helplessness to create quick or perhaps, any change. Clients ordinarily come to therapy committed to growth and change. In contrast for the addict, therapy is often a part of his or her negotiation process as to whether he or she really has to change… and how much… and which aspects of functioning. The therapist can become negative, basically thinking he or she has failed to facilitate the abstinence or recovery the individual and the couple came to him or her for. That might not have been the goal of therapy. The therapist, who is unaware or not sophisticated about this type of treatment rather than offering real change with the addictive couple or family system, has joined in the system's frustration, shame, anger, and recriminations. Whatever the therapist presents to the addict and the couple in terms of information, direction, and boundaries, they have probably already heard, tried, and been frustrated by. The lack of sophistication about addicts and addiction can lead the therapist to offer nothing different yet somehow hope against the individual and couple's experience that change will happen anyway.
SECRECY
Perhaps more than other presenting issues, the individual holds the keys to potential change of addictive behavior much more than the therapist. While the individual and the couple may want to stop the addictive use or behaviors, their motivation may be less invested than the therapist realizes. The individual and the couple may be asking the therapist to get them to change the compulsive self and relationship destructive behavior while leaving alone or keeping secret the underlying issues compelling the use or behavior. This would be comparable to asking the medical doctor to relieve the fever without addressing the infection, or asking the technician to repair the computer without any software diagnostics or opening the computer case. The therapist does not have to agree to the clients' conditions for therapy. The therapist can ask a direct question about whether substance use, compulsive behavior, or addiction is relevant in their relationship. While they may not answer directly, "Body language and tone of voice are cues. If there is no issue, both partners tend to say 'no' enthusiastically. If there is hesitation in the voice, or if the clients look at each other before answering, you should follow-up" (Taylor, 2012, page 9). When the therapist suspect addiction or compulsivity may be part of the couple, he or she may need to be even more cynical and distrusting of the clients' revelations than normal. Trusting an addict to tell the truth or to be open and candid may be the epitome of clinical ignorance or therapist arrogance.
The addict or the couple after sufficient self-destruction may be closer to hitting bottom on the other hand. Having given up at least one layer of self-deception, they might directly ask the therapist to help them stop the pattern of problematic use or behavior, or a specifically identified addictive behavior. The therapist may be flattered by the client's implied faith in his or her omnipotent skills. On the other hand, become flustered and pressured to do and be more than he or she can do clinically. The individual or couple may steer therapy to relatively safer or less uncomfortable areas. They effectively sabotage therapy by limiting, forcing or coercing focus on one or another emphasis: housing, financial, or other life challenges and emotional or psychological issues versus addiction. Or, communication work versus compulsivity. Or, trauma versus addiction. The focus of therapy may become all of the above plus other issues as well. The therapist has to negotiate the individual and couple's secrecy, denial or avoidance process, and/or ignorance, and a client and/or therapist desire for a reductionist or simplistic therapeutic approach. This therapeutic dance is comparable to the negotiations between the partners about how much drinking or drugs is acceptable: whether beer or wine versus hard liquor versus illegal drugs, how or when (socially versus alone, only on the weekends or after dinner, or only when with the partner). These vague contracts however are regularly violated without real consequences other than additional upset and despair for the co-addict. Whereas the co-addict deludes him or herself that compromises are meaningful indications of controlled use or behavior, the therapist needs to be cognizant that such negotiations at home and in therapy confirm the addiction diagnosis. It is part of addiction. The therapist holds and uses such awareness as is clinically appropriate and timely. The therapist not only has to walk the line, but balance as on a high wire line while juggling innumerable balls from the partners' childhood and life and in session cues. Plus, the therapist will often find that the individual or couple has kept secrets from him or her. Client "betrayal" can tweak therapist grandiosity and omnipotence. The therapist has to attend to how his or her expectations and frustration add to the high wire juggling act.
Addictive behavior is often more or less done in secret. Some addictions are subjectively easier to deny or to hide or keep secret. In the case of sexual addictions, "Internet, video pornography, magazine pornography, or specific paraphilia stimuli, access to sexual material has never been easier. In addition, interpersonal opportunities for compulsive sexual behavior—massage parlors, prostitutes, and high opportunity-low involvement affairs are readily available" (McCarthy, 2002, page 275). The sexual addict, for example a married man such as Daryl often minimizes or denies how compulsive his sexual behavior has become. He holds it as a compartmentalized secret world that is distinct from his wife and family. Marilyn and the children were not in this world and he asserted that they were not affected by his behavior. A very common delusion is that the addiction causes no harm because it is separated from the home. The partner or wife may be suspicious of him. There are unexplained bills or expenses, odd excuses, limited or uneven emotional or sexual intimacy, and inexplicably long periods of absence attributed to business trips, "hanging out," running chores, or being in front of the computer or texting. Daryl, as an addict was quick to belittle any suspicions as neurotic and unfounded. The harshness of this criticism shield may be effective enough for Marilyn as the partner to hold back confronting the inconsistencies. The addict can be very charming, adamant, and persuasive explaining apparent discrepancies that camouflage addiction. He or she would have years if not decades of practice lying to him or herself and others.
The addict is often so immersed in his or her addiction with layers and often years of denial and justification that he or she truly believes the use or behavior is benign or not significant. As a result, the addict may find confrontation unreasonable and unfair. The addict does not understand the partner's complaints and reactions. The addict may quite angrily demand that the partner not overreact and not threaten or lecture him or her. The addict might accuse the partner of trying to make him or her feel guilty and demand that stop as well. The partner may be concerned about the relationship continuing, legal concerns, health issues, and financial problems from the addictive behavior. The partner may threaten or blame the addict, but remain uncertain about his or her feelings and what to do. The partner may also feel shamed, guilty, and unclear about his or her role in the addiction. The partner looks to the addict for answers but the addict is often unable to identify with or feel empathy for partner. The addict's answers are incomplete, dismissive, diverting, and while plausible for short periods, do not bear close scrutiny over the long run.
The addict obfuscates, diverts, omits, and lies so frequently and consistently and for so long that he or she often is barely conscious of his or her habitual deceptions. As a man in power at work and dominant at home, Daryl had created his own personal mythology practiced so consistently and over so many years that it became his reality. Everything made sense. His "mistakes" whether it was a forgotten dry cleaning pick up or picking up a women at a bar for a one-night stand were logical. Samantha needed to focus attention on Dyson being the bad one even though he had owned his mistakes and changed his behaviors years ago. Keeping negative criticism on Dyson absolved her from the trauma of her life that was too overwhelming to feel. Dyson, not her became the "truth." The self-deception may be intentional but also may be the consequence of the unremitting stress and the burden of relationship conflict and pain, maintenance and recovery from substance abuse or behavioral excesses, and deep shame and guilt. Shame and secrecy are intricately linked in all addictions. For example, "Another problematic effect of sexual addiction, bearing on attachment quality, is the wall of secrecy between partners. It is theorized that as well as enabling addictive behavior, secrecy also is motivated by both partners' shame stemming from the sexual addiction (Schneider, 1989). Commonly, the addict's shame is based in part on feelings of hopelessness and loss of control. The shame a partner feels can be a result of her personalization of her partner's sexual addiction- self-attributing meaning-making. Whether secrecy is collusive or one-sided, it offers a deceptive promise of shame avoidance (see Young, Griffin-Shelley, Cooper, O'Mara, & Buchanan, 2000). When confronted about secrecy and/or deception- including minimizing, withholding, or lying- the addicted spouse frequently responds with irritation or defensiveness. Altogether, shame, secrecy, and deception readily lead to distancing and withdrawal, further compromising attachment availability and responsiveness" (Zitzman and Buler, 2005, page 315). While Daryl was the cheater, Marilyn was shamed to be the one cheated on. She resisted or was hesitant to confront Daryl from her own shame.
The therapist may need to be particularly alert to investigate potential non-substance addiction. Since there is limited visibility compared to being intoxicated or high and hung over or coming down from alcohol or drug use, non-substance addictions can be missed by the partner and the therapist. The addict may also not be aware that such behavior is addictive. If asked about compulsive behavior, the response "It's not like I'm drinking or doing drugs!" or "You don't see me getting drunk or high," are common disclaimers. The addict may direct assessment and discussion to "real" addictions, specifically naming alcoholism and drug dependence. To the extent the partners or the therapist accepts this, the addict avoids dealing with this core issue. For example, "To some extent the impact of Internet addiction remains 'under the radar' because its many adverse consequences, including social isolation, marital discord and financial problems, are out of the public's view" (Shaw and Black, 2008, page 354). Unless the therapist is aware of various addictions and their unique characteristics, other addictions may also be easy to overlook. The therapist may view Internet addiction in terms of pornography or excessive time spent on the computer but might miss other relevant variations. For example, Shaw and Black describe five subtypes of Internet addiction:
1. Cybersexual addiction: This occurs in individuals who are typically engaged in viewing, downloading and trading online pornography or are involved in adult fantasy role-play chat rooms.2. Cyber-relational addiction: This occurs in people who become overly involved in online relationships or may engage in virtual adultery. Online relationships become more important than real life ones, and marital discord and family instability may result.3. Net compulsions: This subtype includes a broad category of behaviours, including online gambling, shopping or stock trading. Significant financial losses may result, as well as relational and job disruptions.4. Information overload: The World Wide Web has created a new kind of compulsive behaviour that involves excessive web surfing and database searches. These individuals spend a disproportionate amount of time searching for, collecting and organizing information.5. Computer addiction: Most computers come equipped with pre-programmed games and people become addicted to playing them at the cost of work performance or family obligations.
The partner may not be aware that after he or she has gone to bed, the Internet addict may have spent hours into the wee hours of the morning surfing the web. Or, playing a massively multiplayer online game (MMOG) with thousands of players all over the world. Kat did not discover how much time Mitchell spent playing MMOG until he did that instead of looking for a job during a period of unemployment. Not only did the game take him away from the real world, it helped him avoid the frustration and rejection he experienced job hunting. He claimed it helped distract him from his pain. Compulsive spending habits or "shopaholics" often hide their spending from partners for a long time. At a certain point, hiding spending morphs into hiding debt into hiding unpaid bills, loans in default, calls and letters from creditors, and impending bankruptcy. When Shuman was away at another twelve-step meeting, alone at home unobserved Myanna had access to thousands of Internet shopping sites where she made frequent purchases. On eBay, she got a thrill whenever she "won" bidding against others for some item or the other. As little as ten dollars to purchases of about fifty-eighty dollars, they increased her debt as there was seldom a day when she was not bidding and "winning" something. It was a secret life she hid from Shuman. Demerling (2011) described another situation involving financial secrets.
"Joe began talking about his experience with trying to hide his financial situation from his wife because he was afraid that if she knew the depth of their situation, she would leave him. Before Joe got married, his wife knew he did not have a lot of money, but Joe never actually came out and disclosed every aspect of his finances. He simply assured his wife that if she married him everything would turn out fine. A few years into their marriage, Joe's business did not flourish the way he had hoped. Eventually his debt grew to be too much. However, to show his wife everything was fine, Joe continued buying her flowers, taking her to restaurants and buying her nice gifts. This worked for a little while until creditors began calling his home and his wife found out. He was fearful that she would leave, but instead she began helping him devise a plan as to how they can get themselves out of this. She actually admitted to Joe that she suspected this problem for a few years, but tried to make herself believe it wasn't happening. For that reason, she also assumed part of the blame. Over time, all of the members had come to develop techniques for concealing their compulsive buying and the debt that followed in an attempt to avoid a stigma or in some instances a double stigma. However, for many, by doing so, their financial situation only worsened because instead of facing their debt, they spent more money trying to convince others they did not have an addiction" (page 8).
The addict's habitual secrecy can be difficult to break down. It may not change to open honest transparency easily. In some couples, it may not be until recovery or near the end of therapy for honest communication to become normal. It has been "reported as the main obstacle to relationship healing during recovery. Wives reported experiencing lengthy periods of secretiveness and dishonesty from their husbands: 'He had kept it hidden for so long and had lied about things… I… asked him… point blank about how things were going and he would mislead me'" (Zitzman and Butler, 2005, page 321). It is often very frightening for the addict to be honest as much as it is terrifying for the co-addict to hear the unvarnished truth. "One husband explained, 'For the person [disclosing], not only is it embarrassing personally, but you don't want to hurt [your wife]. And the problem is that sometimes you get away with it [by keeping it a secret].'" Two types of openness and honesty are important between the addict and the partner. Personal-volition disclosure is communication that the addict offers without prompting. Respondent disclosure is not self-initiated but disclosure that is partner-initiated or prompted disclosure. When the relationship is open and transparent, the addict will tell the partner when he or she is craving or being tempted. Holding back these feelings or thoughts protects the addiction. This allows the partner to have fewer worries about the addict using or acting out and only finding out afterwards... if at all. When the partner is positive and supportive, it makes complete transparency less difficult. The addict is often afraid that being honest will further harm the partner's affection and confidence. When telling his or her story, the addict watches the partner's reaction. If the addict sees the partner trying to restrain his or her anger and trying to be receptive rather than accusing, it increases the addict's faith of the partner's commitment to the recovery process.
The therapist can bring these dynamics overtly into the therapy. The partner can be recognized and affirmed for trying to restrain anger and be receptive. He or she is validated for trying to change or improve their dynamics. The therapist also reinforces that the partner in being supportive of the addict's honesty and efforts is still not supporting the addiction. Supporting the addict's work at recovery does not minimize or deny the negative effects of addictive behavior. Being transparent, revealing secrets, being supportive, and making the effort are framed as an interactive joint process for abstinence and recovery. The addict may find being transparent and revealing previously hidden secrets however shameful may bring significant relief. Zitzman and Butler reported a client's explanation. "Adam explained, 'The hiding part was a huge factor in my guilt and caused more relapses than the addiction itself." He added: "I hated my addiction so much that I even tried to hide it from myself. I hated to think about it. As soon as it happened, as soon as I relapsed, I tried to convince myself that it didn't exist… it all just backfired. I couldn't be honest with Amy and I couldn't be honest with myself. Just getting over that guilt and being able to open up about it and being able to talk to Amy about it was definitely one of the… biggest hurdles that I had to get over.' Adam attributed his newfound ability to talk openly to conjoint therapy: 'It [conjoint therapy sessions] gave us a lot of opportunity to talk to each other... I think that if I would have come in alone, it would have just helped facilitate my hiding" (2005, page 327).
The greater the depth and complexity of self-deception, the greater is the stress upon the addict. With the greater the need to further obscure or hide use or compulsive actions, and the greater the pressure and stress to hid the hiding. Otherwise validating or esteem confirming feelings will be assaulted and depleted under the relentless psychic withdrawals caused by repeated compulsive actions as they reverberate through the addict's life and relationships. Yet, the individual and the couple may continue to insist that life and things are "not that bad." Denial serves as a firewall to keep away anxiety that would be otherwise become overwhelming. The therapist often trusts the client to be open and candid about his or her feelings, thoughts, and experiences. At the same time, the therapist should know that secrecy, deception, diversion, and minimizing can be so ingrained and automatic within the addict's personality and process that the addict's presentation of his or her "reality" may be quite contradictory to the objective truth. Yet, the therapist's instincts and/or therapeutic naïveté tell him or her to believe that the individual will be open and candid despite the therapist's theoretical knowledge of addict behavior- that the addict lies habitually and well.
