INTEGRATING

ADDICTION TREATMENT
IN DEVELOPMENTAL
COUPLES THERAPY

SU E DIAMON D POT T S M . A .
 TABLE OF CONTENTS
Introduc)on ....................................................................................................................1

What Drives Addic)on? ...............................................................................................2

Is It Addic)on, Dependency or Disease?..................................................................4

Trea)ng the Addic)on ..................................................................................................4

The Issue of Trauma ......................................................................................................7

The Psychological/Cogni)ve Dimension of Addic)on..........................................8

The Connec)on Between Addic)on & Rela)onship Problems ........................10

Taking a Collabora)ve Approach. ............................................................................10

Developmental Stages. ..............................................................................................12

The Role of the Partner. ............................................................................................13

Q&A ............................................................................................................................... 15

References ....................................................................................................................24
 INTRODUCTION BY DR. ELLYN BADER
ELLYN: I am super excited and delighted to have the bonus call with Sue Diamond Po:s. It's
on couples and addic=on and while some therapists don't like to work with couples and some
don't like to work with addic=on, Sue is one of those courageous ones whose put it all
together and has a passion really for both of these topics and types of issues and she does the
work really elegantly.

Many of you know Sue because you’ve read some of her responses to your ques=ons on the
blog or you may have interacted with her live on some of the phone calls over the years. But
others of you will be mee=ng her today for the first =me and so I believe that you're really in
for a treat. Sue has a very unique ability to ins=ll hope and very much posi=ve energy with
her clients while simultaneously not being pollyanna and confron=ng them on their denial or
their addic=ve thinking pa:erns and really being able to hold up that mirror that shows how
they're being self-destruc=ve. I first got to know Sue about 20 years ago when she a:ended
the two-day workshop I did in Minneapolis and then soon aJer came out to California for a
four-day intensive workshop.

And since then she has trained with me extensively and now gone on to teaching the
Developmental Model in Vancouver. As you know, she's assisted me in the on-line course.
Recently she just founded her own center, The Good Life Therapy Center and the super extra
bonus for me as she's going with us to Kenya this summer to help on our school building
project in the new refugee community where we're puTng a new school. So I'm looking
forward to that =me Sue, you and I will have together.

SUE: Yes, me as well and thank you, Ellen. This is a huge topic to cover and there's a lot of
material so I'm going to just jump right in. We'll leave some @me at the end for ques@ons.
I've included a quote from Rumi,

"Some&mes what looks like a demoli&on is actually a renova&on."

And I thought it was fiEng for the topic because when people are in addic@on they can
either be burning their life down rapidly or pulling down the house one 2X4 at a @me.
And yet, if they're able to turn it around it can be something incredibly wonderful. Having
just gone through a renova@on in my own home, I have a clear image of how something
can go from looking awful to being very beau@ful. So, I invite you to keep that in mind in
your work with addicts.

When I think of addic@on, I conceptualize it as:

1. a primary illness
2. a symptom of post-trauma@c stress or developmental trauma disorder
3. a systems disorder that is symbio@c in nature.

There are factors that increase the likelihood of dependency and there's a growing body
of evidence of structural vulnerability of brains to the effects of addic@ve substances and
some of those factors include gene@cs. For example, if you’re a male and you have an

© 2017 The Good Life Therapy Centre 1

alcoholic rela@ve, you’re 4x’s more likely to become alcoholic if you're a female you're
3x’s more likely - and that's even if you aren't raised by your biological parents. Another
factor is early developmental influences and environmental factors and especially early
neglect and trauma and intergenera@onal addic@ve paVerns.

Also, considered are the effects of stressful events across the life cycle. For example,
combat experience or divorce or death of a loved one, especially a tragic death. These
can all be triggers for the addic@ve use of a substance or behavior later in life. And lastly,
mental disorders - especially depression and anxiety.

WHAT DRIVES ADDICTION?

1. There's a difference in the neurochemistry and structure of brains vulnerable to
addiction. Fundamentally, there is an imbalance in the dopaminergic pathways in the
brain that trigger an increase in the neurotransmitter dopamine which basically
communicates a feeling of "I've got to have it". This happens without a combined
increase in another neurotransmitter called serotonin, which is the soother or the anti-
impulse agent which communicates a feeling of "Aha, I've got it." So there's a drive,
there's a driven-ness; where it feels like ‘something's missing’ and that leads to a
seeking system that's constantly on high alert for novelty; for that something that will
satisfy the itch; provide the hit or the high.

If the neurobiology could speak, it might say, "I need something more. It's not right or
it's not enough."

The other thing that perpetuates the addiction is an abnormal reaction based on the
addiction. Some people have different reactions to the same substances based on
neurophysiological vulnerabilities. What that does is strengthens the reward of using
that substance or behavior and it strengthens the addictive neural pathway. For
example, opiates for most people are distasteful and cause mental fogginess and
vomiting. However, some people experience a feeling of wholeness and peace in the
world when they ingest opiates because they have a particular mu or opioid receptor
site gene. And so people who have that gene have a very different experience of an
opioid than other people.

"Normal" people who have an adverse reac@on to something wouldn't want to go

back to it any more than they want to put their hand on a hot stove again. However,
the people who have these genes will want to go back because of the feeling it
induces in them.

Another example is with alcoholics who tend to be low in GABA (gamma-aminobutyric

acid). GABA is an amino acid which prevents nerve cells from firing too fast. It squirts
down from the frontal cortex on to the amygdala in the emotional brain and it creates a
calming effect. GABA deficiency is a primary predictor of alcoholism because when
alcohols drink, it increases the amount of GABA in their brain and so they automatically
feel better. After a few drinks "normal" people start to feel woozy and out of control

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 and they don't like that feeling. So they stop drinking or might switch to a non-alcoholic
drink, recognizing they’ve had enough for one evening.

When alcoholics drink something completely different happens. They feel powerful
and in control. This is rewarding on so many levels and sets up this craving for more.
They can't stop.

2. And the other thing that drives addiction is underlying emotional neglect, trauma or
abuse. The implications of the neurobiology of addiction is that it's a complex and
genetically vulnerable condition. A compromised brain is vulnerable to addiction and
early trauma and/or neglect compromises resiliency is so many ways. Children who are
unwanted, used as pawns or left to fend for themselves, cannot grow optimally and
show indicators of emotional and learning deficits. For the most part, people who
develop addiction have underlying trauma that fuels the need to ‘self-medicate’ by
using addictive substances or behaviors. This can start very early in life.

3. Finally, as the brain attempts to compensate for the imbalance of dopamine flooding
into the system, it becomes even more compromised. A process of ‘down-regulation’ of
receptor sites leaves the person without the requisite amount of motivation and energy
to function without the substance or behavior onboard. Thus, begins the addictive
cycle and why so many addicts want to stop and find they cannot. It’s ‘cunning, baffling
and powerful.’ As we begin to recognize the complex interactions that are occurring
over time, science is helping us to understand that addiction is a chronic progressive
condition and therefore, it will require lifelong management.

4. Science does not support the idea that there is a quick fix to this problem and that one
episode of treatment will suffice for the majority of addicts. What we're probably going
to see more of is the idea that it's a lifelong process and it can include many attempts at
recovery. Some people will have relapses or they'll switch addictions. What will be
required, in the long run, is the development of a whole new way of life. So, recovery
means a long-term approach to retraining the brain, reconditioning it to function in the
absence of the drug or behavior of their choice.

© 2017 The Good Life Therapy Centre 3

 IS IT ADDICTION, DEPENDENCY OR DISEASE?
Addic@on can be compared to other condi@ons such as type-2 diabetes, chronic
hypertensive disease, obesity or asthma. These involve a complex of physiological and
behavioral health components. Labeling someone is less important than stressing the
features of what it is that they are suffering with. So, if someone has a hard @me with the
term "alcoholic", I might talk to them about 'crossing a line into addic@ve use of alcohol'.
Or, I might say, 'you have crossed a line into dependency on alcohol' and we must
address this.

For me the two defining features that indicate that somebody has crossed the line from
some type of recrea@onal or heavy use of substances or behaviors to a full-on
dependency or addic@on is:

1. Some loss of control; Example: “I'm just going out for two” and blacked out or home
the next day. This doesn't necessarily have to happen every time but it does happen
enough. This type of behavior is rarely, if ever, seen with recreational users.

2. The inability to stop en&rely despite nega&ve consequences.

I par@cularly like this last one because it fits

right in with our work with couples. A good
reason to stop is to rescue your rela@onship and
be emo@onally present for what's going to come
up. People who are addicted to a substance or
behavior aren't emo@onally present, so it’s
cri@cal. And we'll come back to that later when
we're working with it in the sessions - how to
handle that if people are struggling.

TREATING THE ADDICTION

1. Assessment

The first thing you want to do is assess if there is a problem and if so, to refer them for
addic@on treatment. I use the AUDIT and CAGE assessment tools for substances. It's a
very simple test. It only takes a few minutes and it gives us very reliable data and an
objec@ve measure of whether the person is addicted to alcohol or drugs.

Objec@ve measures help you go from personal opinion to something that has more
credibility. If you're dealing with online pornography or any kind of sexual addic@on, the
Center for Healthy Sex website has online tests. You can either send the person there to
do it him/herself or do it in the session with the person. Again, they’re quick and easy
and they deal with sex and love addic@on and then you send the answers in and they
come back with an indicator of whether there's a problem or not.

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2. A plan of ac1on

Once you know, then you can work with the client about what they want to do about it. I
recommend referring them to 12-step recovery which research shows gives people the
best chance for long-term contented recovery.

A lot of people don’t want to do that. They don't want to go to 12-step mee@ngs. There
are some other op@ons. There's something called Smart Recovery which is a CBT
(cogni@ve-behavioral therapy) program similar to the CBT component of 12- step
programs without the community and spirituality components. It is usually run by a paid
facilitator. There's inpa@ent treatment and outpa@ent programs. Once you have a plan in
place, the ongoing therapy with you includes check ins with them. You are looking for
both progress and setbacks regularly.

Case Example: I am working with a long-term

conflict avoidant couple. The wife is an “over
func@oner” and very, very driven. They're in
their mid-40s with 3 kids. The European flair
that James had that was so aVrac@ve to Carla
ini@ally had completely soured to the point
where she finds him disgus@ngly unmo@vated,
lazy and useless.

She's very angry and wants results now, puEng pressure on me to fix their problems
quickly. She's a typical “type A” personality but answers in the couples ques@onnaire,
indicated a few other red flags. For example, he said, "We fight more when we're
drinking" so I knew I would have to address the issue at some point. I asked if they would
be willing to stop drinking for the next three months or so while we’re working on their
rela@onship? They hadn't thought about it as a problem so they were a liVle surprised. I
did some educa@on and there was an agreement. And they did stop for a while and it
seemed okay. They were working hard in couples therapy and I felt they were making
progress. Then they went on vaca@on and they drank a lot. He was upfront with it and
said, "We want to keep our promise to you."

I could have predicted a relapse since neither had acknowledged that they have a
problem staying stopped. They seemed more concerned with ‘leEng me down’. I spent
more @me educa@ng them on why they might want to do this for themselves. I wanted
them to see how it's connected to their overall success in therapy. He admiVed at that
point that he felt he was addicted to alcohol. She said that she felt like she wanted to get
back to abs@nence because it was interfering with her ability to func@on and she needed
to func@on being the sole provider for the family. She was mo@vated for that reason.

Neither of them wanted to explore a recovery program so we started the process of

creating goals for each of them to commit to abstinence while they were in therapy and
learning to grow emotionally. Shortly thereafter, they dropped out of therapy, and
while I don't know for sure, I can speculate that the addiction won over their desire for
greater intimacy.

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3. Address impact on the rela1onship/spouse

You want to address the impact of the

addic@on on their partner and the
rela@onship. And obviously if there is an
ac@ve addic@on or lots of relapsing, it can
be a major focus in therapy. You will be
spending lots of @me, mostly because of
the defensiveness and the crises that are
constantly coming up because of it - the
lying, the minimizing, the secrets. If the
spouse is unhappy and sees it as the main
issue for therapy, then that's going to take
up most of your @me with them, at least
un@l something shiks. I will oken do individual work with both. I will try to get more
trac@on with the partner who's using the substances and trac@on with the spouse in
terms of how they can cope more effec@vely, if the addict is refusing recovery. My work
with couples is to help them get clear on how to proceed, nego@ate a plan moving
forward that will work for both.

Case example: I have a client who I've been seeing for about two years who was sent by
his wife because of his alcoholism. I did the AUDIT test; he passed with flying colors. He
knows he's addicted to alcohol but he refuses to stop. He wants to prove that he's
different - that he can manage, control and enjoy his drinking. The problem with
alcoholics is if they're controlling their drinking, they're not enjoying it and if they're
enjoying it, they're usually not controlling it. He spent the beVer part of the last two
years trying to do this. I've seen him and his wife together and tried to help them define
exactly what they each want and where the limits are. Like many partners, the wife
doesn't understand addic@on and she wants him to just have a couple of drinks with her
at dinner or on a social night out.

He can do that some@mes and so if he can do that she's okay with it. If he's going out
drinking with the boys they've got an agreement that he doesn't come home. She doesn't
want to see it. She doesn't want the kids to
see it. For now that's what they agreed they
were willing to do. Basically, what you're
doing is you’re integra@ng addic@on
counseling with the couple's therapy
because there's lots going on with a couple
like this. There's just a ton of stuff that isn’t
ever going to be addressed. You are star@ng
somewhere and geEng agreement on what
is acceptable or not – then you are trying it
out to see if it works. Oken it doesn’t, as
was true with this couple, and then you go
to the next step.

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 THE ISSUE OF TRAUMA
I wanted to talk about the underlying trauma and loss because in my experience there's
usually a lot of that as well. And the deficits are on every level; on the emo@onal level,
social, cogni@ve and rela@onship.

On the social level for example, you might have somebody who's extremely intelligent
and financially successful but doesn't have any social intelligence. I have a new client who
is recently back in recovery. He was sober for five and a half years before he recently
relapsed. He's never been in therapy despite the fact he's in his mid-fikies and he was
referred to me by a colleague of his that's also a client of mine. He’s a CEO of mul@ple
companies so he's wealthy. He's smart. He's charisma@c. He's also quite narcissis@c and
he men@oned to me that he doesn't only have an addic@on to alcohol; he has what he
called an ‘addic@on to affairs’ as well as a shopping addic@on.

He's got a lot of things going on in his life

and, needless to say, his rela@onship with his
wife isn't great. He treats his staff terribly
which he will admit - he's condescending and
cri@cal. He is a workaholic. He doesn't have
any capacity to connect with other people in
an equal and respecnul way. There's a lot of
deficits in all areas. By now some of you may
be familiar with the infamous Toronto Mayor,
Rob Ford, who made headlines in the U.S. as
well as Canada, and He was made fun of on
one of the late-night talk shows. He was a raging alcoholic and crack addict, yet
somehow thought that’s ok while being the Mayor of the largest city in Canada. I think
that he was a glaring example of these deficits and how blind the alcoholic or the addict
is to the reality that everybody else is living in. They're delusional - living in their own
self-serving reality. They just can't see it and that's what you're up against. And in the
case of famous people, poli@cians or movie stars, there is a lot of denial in their
supporters as well, who then reinforce that there is not problem, when there is.

When trea1ng couples with addic1on issues it's important to go slow because recovery
is a developmental process as well as neurobiological, social and emo1onal. There are
always mul1ple fields of interac1on at any given 1me.

You're not going to do the kind of deep work emo@onally with somebody who might be
in the first few months of their recovery that you will do aker they've got stability, maybe
a year down the road.

One of the important things is to create stability in the rela@onship, in their lives and one
of the ways to do that is to try to delay any major life decisions and just help them cope
more on a day to day basis - geEng systems in place and geEng some predictability; just
helping create small shiks that make the family and the couple feel beVer. As a therapist,

© 2017 The Good Life Therapy Centre 7

you are going to have to wear many hats and be comfortable with that because you're
some1mes educa1ng them and teaching them and referring them and other 1mes
you're doing more tradi1onal psychotherapy, analyzing the rela@onship or their
individual dynamics -you might be confron@ng one minute; you might be their
cheerleader the next.

So there's a lot of things to do and they're all part of the treatment. And again you're
integra@ng the addic@on work with the couple's work. And one of the things, I think is
important and Ellyn touched on this is, you have to be firm about what you know to be
true about addic1on with them and keep holding that mirror up and being clear about
how problema1c it is.

At the same time, be flexible; find a script that works for them. How do they want to talk
about it? How do they want to see it? It doesn't matter what they call it if they understand
the bottom line of what's happening to them and what they must do to get well.

THE PSYCHOLOGICAL/COGNITIVE
DIMENSION OF ADDICTION
The four major cogni@ve deficits in addicts and alcoholics are:

‣ An incredibly nega@ve world view.

‣ A lot of self-loathing.
‣ A lot of black and white thinking.
‣ An orienta@on towards catastrophizing.

So these are things that have been researched and found to be true across the board and
so that nega@vity is like always seeing the glass half empty. What the neuroscien@st, Rick
Hanson, has helped us to understand is how the brain has a “nega@vity bias”, meaning
that we're always looking for what's wrong so we can protect ourselves. In this
popula@on, you're dealing with it in spades. As a therapist, it's crucial to counter this by
being posi@ve and showing them, "Hey, there's another way to look at this. Have you
thought of this?” Or giving lots of strokes and constantly trying to push them to reorient
to the posi@ve. You can think of this as the CBT of addic@on treatment – turning their
nega@ve thinking to posi@ve thinking so they can begin to resonate with what “emo@onal
sobriety” is about.

What to avoid:

‣ Don't minimize, ignore or collude with either partner in any way sugges@ng that
there isn't a problem when there is. You'll get lots of this and many of you have
talked to me about it and that's what makes this work so challenging.

‣ Don't suggest that it's a maVer of willpower because it's not.

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 ‣ Don't forget the partner’s role in the whole dynamic. There are so many times when I
found that the partner who isn't the active addict undermines the process because
there's a part of them that wanted to stay the way it is and if you don't address that
part they will do things that will undermine the treatment and they leave prematurely.

‣ Don't let countertransference issues play out, without no@cing and geEng help.

Example: I did a supervision with a therapist who I used to share an office with. I
knew her history and I knew her family. She called me to talk about what she was
no@cing. She was aware of a freeze response she was having with a client. The client
was asking her whether she should confront the addict husband about his using.
The therapist couldn’t be objec@ve – she couldn’t help her. As we talked she
realized that the reason she couldn't be impar@al was because her sister had died a
horrible death from a drug addic@on and the last @me she saw her there had been a
confronta@on. She had confronted her sister about her drug use and was seEng a
hard boundary around it. That night her
sister died of a drug overdose. She was
stuck in her own guilt and fearing that
the interven@on in her own family was
linked to her sister’s subsequent death.
That might be an extreme case and I'm
stressing the importance for us to know
what we might be packing with us
because we've all been affected by
addic@on in some way or the other.

What not to avoid:

‣ Do bring the issue up and do keep it on the table.

‣ In your check-ins, you want to be asking them how they have followed through and
made recovery a priority. That may seem obvious and yet what I found in working
with couples like this is they have so much going on, it can be very easy to get
wrapped up in any number of crises that are happening in their lives and not get to
the addic@on. There is oken a lot of reac@vity because of the emo@onal immaturity
and all these things are geEng acted out in front of you. The whole session can go
by and you think, "Huh, we didn't address that."

‣ So just remember - keep bringing it up, keep it on the table and keep educa1ng
them. Help them understand the difference between social using, heavy use and
dependency and addic1on. And if you don't know just have places to refer them
to, whether that’s books or online resources or places in your community that they
can go and find out more because informa@on is powerful and it can help people.

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 THE CONNECTION BETWEEN ADDICTION &
RELATIONSHIP PROBLEMS
Do keep emphasizing that their addic@on issues are connected to the rela@onship
problems that they're experiencing. They will have other problems they are coming to see
you for because they are unaware that substances or behaviors are problema@c.
Some@mes they are in complete denial that there is even an addic@on to treat. And the
boVom line is, in 95% of cases it's going to have a nega@ve impact. The only @me it may
not is if they're both using and colluding with one another to keep the behavior going.

TAKING A COLLABORATIVE APPROACH

The last thing that is important to do is to ask for collabora@on, and this is the key. Once
you have established there may be a dependency you want to ask them if they're willing
to put the behavior aside for a @me while you do the work as a couple.

You explain to them how it interferes with their ability to build emotional muscle and I say,
“When you're done I want you to leave knowing that you've done this work yourself - that
you haven't had to rely on something outside of yourself to get you through it." There's an
incredible feeling that comes from that; the resilience, the understanding that you've done
it yourself. And so, that's how I frame it with people as I want them to think about growing
up emotionally - learning how to face themselves and bump up against some tough issues
inside that they won't do if they're turning away by self-medicating with their addiction.

The worst-case scenario is that you don't get any collabora@on. They refuse to address
the addic@on as the central problem and couple’s work is stuck. Best case scenario; full
collabora@on. They stop their use while working on their rela@onship issues with you or
they come in and they're already in recovery which supports the work you're going to do.
Oken, there is a par&al collabora&on. It’s a process of trial and error; you do some
nego@a@on while you're working on couple's issues. There are some relapses or you get
one partner that's on board and the other isn't.

Example of no collabora1on: Ron came in sta@ng he wanted to stop using cocaine. The
reason was because his girlfriend, who he didn't want to lose, was completely fed up with
him and if he didn't get a handle on this behavior, his rela@onship would be over. I
worked with him over a couple of sessions geEng a picture of his life history, his drinking
history, his drugging history, and a liVle bit of his family background. It was clear that he
was drinking daily and he had a real party lifestyle. Ron told me he had 400 friends and
had a sense of grandiosity in how he described his popularity. In those first few sessions
what I understood is that he only used cocaine when he was drinking, which meant
alcohol was his gateway drug. He never used cocaine if he wasn't already inebriated.
When I pointed the obvious out to him, he was adamant he didn't want to stop drinking.
He told me, "No, that's not why I'm here. I just want to stop the cocaine."

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 I said to him, "You're asking me to help
you do something that's impossible to do
and the reason is this - the man that's
siEng in my office right now wan@ng to
stop using cocaine is not the same man
aker a few drinks. Because aker you have
a few drinks you start to feel powerful
and in control. You have an abnormal
reac@on to alcohol and then you're going
to think that doing cocaine is a good idea."
And while he completely understood what
I was saying, he lek therapy that day and
I've never seen him since.

And that's a decision that he made and hopefully one day he'll be ready to do the work
that he needs to do so that he can have the life he wants.

Example of full collabora1on: Joanne grew up in an alcoholic home and she drinks
regularly. Her alcoholic home was violent and neglecnul - extremely abusive. She came to
treatment in her 50's; having done a lot of therapy in her past. Due to in@macy problems,
she can't seem to stay deeply connected to another person. She has uncontrollable
ea@ng paVerns.

I did an assessment, going slow with her over a few weeks and eventually I said to her,
"You've been in therapy a lot and I'm assuming at this point in your life you don't want to
be in therapy for another 10 years. So, I'm going to ask you to do some things differently
now than you've done before. One of those is that I'd like you to stop drinking while
we're working together and I'd like you to aVend OA. You are convinced that your main
drug of choice is food - I’d like you to go to Over Eaters Anonymous.”

Then I gave her some ar@cles to read and she came back a week later and she said to me,
"I can't believe how hard this last week was. I wanted to drink 20 @mes. I had five really
difficult episodes and I gave in once. When I wasn't drinking, I was going to food. I ate
everything in the house. I read all the ar@cles that you gave me and I can relate to it all.
I'm sold. I went online and I checked out OA for mee@ngs. I realize I'm going to have to
make @me in my life for this." That's the best case scenario.

Example of partial collaboration: Judy and Bill are a long-term conflict avoidant couple
with the wife having extreme outbursts of anger and a lot of early regression. They've been
in a sexless, loveless marriage for many years and one day I asked about their drinking.

It never was on the radar - it turns out that he didn't have a problem with it but she said,
"I have a glass of wine every night." And that doesn't sound like a lot to some people –
one may think, "Oh, no big deal, a glass of wine every night." However, I knew her history
and her history included that both of her parents were alcoholic and her brother at the
@me ... he's since passed ... was dying from cirrhosis of the liver from his alcoholism. But
she says to me, "Yes, but if I needed to stop I could, for a good reason, I could stop

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any@me." And so she fed right into my hand and I said, "Well, that's great because I'd like
to ask you to stop because I think you have a good reason. Your marriage is on the rocks
and you both need to do a lot of emo@onal growing to get on beVer ground, so not
drinking would help immensely."

When she came in again two weeks later she told me that her withdrawal symptoms
were so bad that she went to her doctor and asked him to do a liver func@on test to see
if she had cirrhosis - which she didn't. But it was interes@ng to me, it was shocking to me.
It was not anything I was expec@ng because she said she was having one glass of wine so
it didn’t add up.

I'm not exactly sure what it was but what I will tell you is that she struggled with staying
stopped. This is how we assess for addic1on – an inability to stop. She went on a
vaca@on with her mother who s@ll drinks well into her 80’s and she began drinking again
and she told me very defensively, the last @me I saw her, that she intended to drink one
or two glasses a week. For her, this was way down from what she used to drink, and she
doesn't think it's a problem. So, while she’s down in quan@ty, it’s clear there is a
dependency and a defensiveness and all of this will impact the treatment. It will be
something that we will be addressing in an ongoing way.

DEVELOPMENTAL STAGES
If one or both partners are in an untreated addic@on they'll probably present as a
symbio@c couple and they can be hos@le dependent or conflict avoidant. The challenge
for you is the defensiveness. I'll give you an example of a couple that I've been seeing for
a few months. They're both teachers who met online and they've been married for 10
years. They recently, in the last few years, have both had mul@ple motor vehicle accidents
and that's triggered some unresolved trauma from their past. It's resulted in the slow
deteriora@on of their bond which is why they came to see me. They're a hos@le couple.
She's very hos@le and blaming, “He's no fun anymore - why should I stay?"

He has real difficulty handling her anger and her degrada@on and he's been very passive -
although now he's star@ng to blow up a lot more. I saw them twice as a couple and then I
saw them individually and worked on some trauma issues from their family of origin.
Then I saw them again and in the third session her complaints completely changed from,
“he's lazy and useless and does nothing” to “he's drinking every day and smoking pot”.

So now it's out on the table and we begin to explore it. I find out that they get high every
weekend on pot as it's the only way that she can not be furious and instead have a
connec@on with him.

They watch a movie; they laugh together and enjoy one another. She quickly and
defensively tried to convince me that she doesn't have a problem because it's only
weekends, whereas he clearly has a problem because he's doing it every day. I talked to
both about how their use of substances has taken on greater propor@ons probably
because of the unresolved trauma and that it will interfere with them resolving the

© 2017 The Good Life Therapy Centre 12

trauma. They're using these substances to self-medicate and to emo@onally regulate and
it will interfere with the work that they want to do as a couple. They were re@cent to give
it up and so we're in a period of nego@a@ng what they want to do about that.

ELLYN: Sue, can I add something in?

SUE: Yes.

ELLYN: I mean what you're describing is

something that I often talked about which is
that in a lot of these couples the symbiosis
gets organized around the substance. And so
ironically either, the fights, the avoidance or
the connection are all in many ways
organized around whatever the substance
abuse pattern is. And you just did such a
good description of that in terms of that's the
only way she can be with him. That's how
they can spend time together, that's where
they connect and then they don't have any of
the other mechanisms for connecting

SUE: Right and the tricky thing is you see that you want to help them but it really is about
collabora@on. If they're not willing to do it, your hands are kind of @ed.

ELLYN: Absolutely, if there's no mo=va=on or very low mo=va=on it puts the therapist in a
parental role trying to mo=vate people who may be very unmo=vated.

SUE: Yes, exactly. So just a couple of more things--

THE ROLE OF THE PARTNER

The spouse, being the one who's not in recovery, can be undermining the work because
s/he sees the recovery as a threat. You might want to educate a liVle about this. When
the person gets sober let's say, and they start going to mee@ngs and they start geEng a
life, and they start wan@ng to take care of themselves in new ways, it's going to change
everything. It's going to feel scary to the partner who's wan@ng to fuse and stay
symbio@cally enmeshed. One of the things the spouse might do in that case is to push for
them to give up their abs@nence; "Come on, let's have a drink. I'm sure you can have just
one." Or, they refuse to look at how that behavior is enabling - their lack of clarity, their
wishy-washiness with the alcoholic. "Well, I don't want you to drink but okay, if you
won't drink too much that'll be okay." They cannot have their cake and eat it too.

The “paren@fied” partner is enac@ng a parent-child dynamic where the spouse is

controlling and over-func@oning and being a parent with the addict. That needs to stop
for the rela@onship to grow. I might see them both separately and work on and figure out
the family of origin issues. I also want to validate the fear that they have of loss of control

© 2017 The Good Life Therapy Centre 13

because everything is going to change now. It’s important to circumscribe in the sessions
these behaviors when you see them - when they are pulling for that symbiosis. Then
assist by providing alterna@ve responses and pushing for growth.
So now, obviously, if both partners are in recovery and are working hard on recovery,
then our work as the couple’s therapist is much easier, it's much more rewarding and
fulfilling because we're pushing for them to have a higher level of emo@onal sobriety
which means more differen@a@on and more emo@onal interdependence.
Example: I have a couple, Brenda and Brian, and he's in AA and she's in Al-Anon. They are
in a symbio@c rela@onship. They're very hos@le-dependent and both have a lot of early
trauma that they haven't done a lot of work on. They have done some work but now that
he's sober, it's going to another level. I find that we can make a lot of progress in the work
that we're doing because they are already in a process of growth and change. They can
use the interven@ons to build more empathy. They take more ownership because their
recovery is suppor@ng that, especially because they're working a 12-step program. They
can not only take ownership but they can make amends easier. They can apologize for
bad behavior and they have a spiritual connec@on where they can go for some relief and
a belief that there's something bigger going on than just this liVle fight. So, it can support
the work that we're doing.
Now, lastly, I just want to say in conclusion, treatment is complex and demands that we be
flexible but also understands the seriousness of the client's condition. This is a life-or-
death situation. I had a couple return to me recently. She had a baby. She came in about a
year-and-a-half ago stating she was 4 months pregnant and I didn't see them again after
that. They had the baby and I got a call from him right after. About two weeks later, she
relapsed and ended up in the psych ward for a couple of months. She got out and relapsed
again. She went into treatment, came out and relapsed. So it's been this constant battle and
he's been a single parent and they've just been in hell for about 4 or 5 months.
So, she said to me. "I can't believe how hard it is to stay off the pills." She's can't believe
how powerless she is to stop it. She's in incredible turmoil. She wants to be there for her
baby and can't. It is ... it's a very serious condition. We have to hold up the truth and we
have to continue to push for reality to prevail because addiction is steeped in fantasy and
delusion. Delusion is different than denial. Denial is, “it's not that bad”. Delusion is, “I don't
have a problem”, and they are not living in the same reality as other people.
Our work is to move between the demands of ac@ve recovery, the behavioral change -
one day at a @me and the developmental healing, which takes longer. It’s important for us
to stay calm because through personal neural resonance, we become a brain that can
provide a healthier baseline for clients to resonate to. Stay hopeful and communicate the
possibility of a brighter future, free from addic@on. They need somebody to hold a vision
of what is possible and to keep nudging them towards it and that's our job - in a nutshell.

© 2017 The Good Life Therapy Centre 14

 Q&A
DOUGLAS: This was concise and with a lot of informa=on. One thing that you touched on
but I wonder about is how much you work on it, also it's in a very important part is like the
codependency part and encouraging people, encouraging the partners to get into recovery
themselves just to sort of underline that.

SUE: Yes, for sure and again like I said, if the partner is willing to look at their part in it
and that there is always a part and recognize that they have a need for recovery, it's so
much beVer.

I just saw a woman recently who’s in her 40's and just sobered up. I mean she just
became alcoholic in her 40's and drank heavily for a year, almost killed herself and then
sobered up. I met with her husband and he doesn't think anything was wrong with the
rela@onship.

I brought up the issue of him going to Al-Anon and he ... I mean you could feel the hair
standing up on his neck and the door just shut closed and it all changed. You have to
keep bringing it up because they have a way beVer chance, a hope for success if both
par@cipate. She said, “I don’t put him on a pedestal anymore." Once she's sober, she
starts to see everything differently. Of course, that means the rela@onship dynamics are
not at an impasse.

DOUGLAS: Right.

SUE: And so, what is that going to mean for their rela@onship when she stops bowing
down to everything that he is demanding.

ELLYN: Sue, one thing I'd be interested in because this is in a couple that I currently see
where the husband is now in ac@ve recovery and has been for a few years, and the wife
is very commiVed to individual therapy and as a couple they're being willing to work on
the emo@onal issues but she says, "Look, I don't want to be in a 12-step program and I
don't see myself as having an issue with the substance." which she doesn't seem to.

How important you think it s@ll is to get somebody who's a partner in that case because
they are doing work, it's not like they're avoiding work.

SUE: Yes. I don't push it especially if they're not doing things that are undermining the
recovery. I think people have a choice at some point ... was she brought up in an
alcoholic family?

ELLYN: Yes. I mean she is an ACA and she's done quite a bit of work on that.

SUE: Yes, and if she's done a lot of work and she's feeling emo@onally healthy and she's
doing work with the husband and it's all going well, I think I wouldn't push it too much. I
mean I'd encourage her, but if they don't want to do it, they don't want to do it.

© 2017 The Good Life Therapy Centre 15

ELLYN: Yes.

DOUGLAS: It's also interesting to recognize that having them both in recovery and both in
their own programs is a way of understanding, mutual understanding and joining in the process
but also, it's a differentiation process because they're both in different programs in a sense.

SUE: Right.

DOUGLAS: But, it’s a powerful part of the work if it can happen.

SUE: Yes.

DOUGLAS: I have one other ques=on though which is about the 12-step programs and
people's resistance to the program. You men=oned its success and it's the only game in town
and it's a very powerful program for certainly many people. But for many people, they can't
seem to connect with it for lots of reasons including the term religious or spiritual aspects and
there's a level of ... I think they use it as an excuse to some extent but also, I just wonder how
you have found a good way to encourage and keep you poin=ng to the program?

SUE: Well what I do is and I've included it in the references but thanks for bringing it up. I
have handouts that I give people for what it's worth. I have a few and I've forgoVen one
so I'm going to have to send that reference later. It's called the 'Neurobiology of the 12
Steps. How the Rooms Rewire Us.' The second one, '12-step groups: 12 objec@ons and
12 responses'. Bill Harry, has wriVen a great ar@cle on what the main objec@ons are. And
then, I wrote an ar@cle which is on my website which I hope you guys will visit. Its
www.goodlifetherapy.ca. It's on long-term contented sobriety and it talks about George
Valliant’s research as a psychiatrist who studied alcoholics his whole career - on why AA
gives them the best chance at long-term contented sobriety. It covers all areas - external
supervision, new love rela@onships, alternate dependency and the spirituality of the
program. So, I have all those references there and I just generally give people informa@on
and then try to nudge them towards making a good decision.

Being able to again provide a reframe for how it can be one of the best things they ever
do in their lives and they're going to meet some of the best people they ever meet in
their lives.

ELLYN: Yes. No that was great when you said that on that call. Let's go to Danny's
ques@on?

DANNY: In a nutshell, is long-term recovery sobriety? Is it essen=al in the end and if not, if it
is then, how do you know when enough is enough? When to say treatments ineffec=ve?

My educa=on and training is now decades-old in this and I'm back from the days of maybe
it's s=ll true when the debate was a so-called mental health versus the addic=ons community
and the addic=ons community seemed to be saying you're nuts if you try to do the treatment
for sobriety, emo=onal psychological.

SUE: Oh I see ... yes, I remember those days.

© 2017 The Good Life Therapy Centre 16

DANNY: So, if that's not true, if you say "Well, there's a way to keep using and have a decent
rela=onship." that's what I'm curious about and if not, if the goal is to guide the addicted
partner to sobriety...

SUE: Yes.

DANNY: Then what?

SUE: Well, it depends. Like I said, I'm s@ll seeing this guy two years later who's trying to
control and enjoy his drinking and, he has made a lot of progress in terms of some of the
other issues he's working on. His life isn't going to change fundamentally though un@l he
lets go of the addic@on for a lot of reasons. I think you can do both. I think you can work
the edge of both things where you're constantly trying to nudge them but knowing that
it's limited in terms of what they can do with their emo@onal growth, if they don't let go
of addic@on.

ELLYN: Well I think one thing that Sue talked about at a different @me but makes a lot of
sense to me is that, with some couples, you may be seeing them for a while, while the
addic@on is s@ll going on because you're strengthening the system to enable both to go
into recovery and be able to support that, and understanding that and geEng them to a
place where neither is undermining the other one. That can take a lot of solid work
before they're ready to do that.

SUE: Can I say one thing about that Danny just quickly? When I was working up north for
a First Na@ons community years ago and I was doing some workshops on cultural
genocide, this guy came in and he was clearly drunk. He sat at the back of the room and I
thought he was going to cause a s@nk. I was wri@ng these things on the board and I was
asking for par@cipa@on. He spoke up. He was following everything I said and he was
par@cipa@ng. With some of the people I trained with back then in those early days, they
recognized that in na@ve communi@es, they can't let go of the addic@on oken un@l
they've done some healing because the trauma is so intense. They can't cope with it.

DANNY: Thank you.

KATHY: I also come from the background in addic=on work and I've been ... I'm happy to
hear the talk today because I have found the challenge of integra=ng addic=on work and
couples work to be a major focus of my interest just because I felt that these couples didn't
get good care. One challenge that I run into is, when I have a couple come in and I'm working
with them and I have one, the addict, who is willing to do some work either to become
abs=nent or to reduce their use. They need a lot of help and it might be at the point in
therapy let's say, whether going to 12-step yet or maybe they're in and out of 12-step, not
really using it yet, maybe they're shy about all those kinds of issues.

What gets to me is a feeling ... a li:le bit of a feeling of overwhelm because I'm trying to
balance doing work with the couple and helping that individual get enough tools to not fall
flat on their face within the next seven days. So, that's the thing that I find very challenging.
Since I've been in this program, in Ellyn’s program and saw how powerful couples work can
be, its influenced me to feel that keeping the couple's work is so important and valuable, but I

© 2017 The Good Life Therapy Centre 17

find that being split between teaching tools and balancing. Helping a couple get somewhere
in that session is very difficult, that's my biggest challenge now.

SUE: You're absolutely right. The more they are doing outside of the session to work on
their recovery, the less work you have to do in the sessions. And so, you're right.

It is a balance and sometimes you're it. They're not going to go to 12-step, they're not going
to recovery and so, you're it. You could maybe see them alone for 20 minutes of the session
depending how long you see them in total - an individual session or just have some one-
on-one time with them and then use the couple time to work on other issues.

ELLYN: I think what you said earlier Sue is so important about the flexibility. There's no
one right way with addic@on in couples work but, it's the flexibility of moving in and out
of the therapist. GeEng enough support for yourself, using a peer group or using this
group but also at the same @me integra@ng some couples and individual but not seeing
yourself with the significant addic@on. The more support systems that you can bring into
that couple and not carrying the whole load yourself can make a big difference as well.

ANNE: I appreciate this talk. It's been really informa=ve. I'm just wondering if we could talk a
li:le bit about ... I've had several couples who, one of the partners is a drug addict, an
alcoholic, whatever their substance of choice. But, then in the process of being in recovery
and even some that have come to me aJer they're in recovery for their substance, now I'm
seeing a lot of this behavior that's moving into their sexuality and into their ea=ng so we have
a … those addic=ve process is moving over there, and it is ac=ng out. It’s easier for me to get
them to see that but the ones who I'm having trouble with or some of them who are like ...
they've been so very restric=ve, becomes very restric=ve in their ea=ng or very restric=ve in
their sexuality. You don't talk about ... can we talk about that a li:le bit and...?

ELLYN: So Anne let be sure that I'm clear what you're asking, that some@mes what you
see is that they give up the drug or the alcohol and move into almost an anorexic style of
ea@ng or start refusing sex or being what?

ANNE: Yes being very restric=ve about it or having very rigid rules about it so they're not
ac=ng out compulsively like they're not having affairs or some of those things that you
classically would associate with like moving to a sexual addic=on but becoming very rigid and
restric=ng it.

ELLYN: I mean I can tell you how I would think about it I haven't seen anybody who's
done exactly that myself so, but then ...

ANNE: I have two right now, I'm going "Wow, really?"

ELLYN: What stands out to me from what you're saying is that these are both people
who by experiencing the loss of control previously, they're now moving into trying to
manage s@ll probably some of the underlying trauma by control. By crea@ng that kind of
rigid control must be experiencing a lot of fear of being out of control again and what
would it be like to be out of control. And so, that sense as I hear something, 'I really can
control' can become very powerful. I probably would approach it somewhat by looking at

© 2017 The Good Life Therapy Centre 18

how is that serving them? I mean it's a good example, a good situa@on almost to do some
two-chair work where you put in one side - the side that wants to @ghtly control the
ea@ng or @ghtly control sexuality, and what the other side is saying? What's that voice on
the other side saying if they didn't control it so @ghtly? What would that be?

ANNE: That is a great idea, yes.

ELLYN: When you get to see what's underlying the use, I mean those drugs and alcohol
both disinhibit people's behavior and it's an opportunity in that developmental process,
don't forget, because their recovery is developmental two, is what's showing up first on
how do you work with that, understand what that means to them.

ANNE: Right. So from what I'm hearing from both of you that I'm somewhat on the right
track in thinking that these restricted behaviors probably are s=ll very much connected with
their whole journey into recovery, and that developmental process that happens there and
that having moved to someplace else where they're trying to control or trying to feel powerful
or trying to manage from.

ELLYN: Well I mean both the things you're describing unless they really are anorexic but
if they're not, both of those are beVer than the addic@on.

SUE: Right.

ELLYN: So it's not that they're where you want them to be but they're beVer than when
they were abusing.

ANNE: Right. They've moved from one coping strategy to another that define some
improvements and can change possibility for work, yes.

SUE: Anne, I would just add to that one last thing and that is to encourage them to be
pa@ent with themselves and with each other so that they don't use these things to beat
each other up but that they really ... you help them understand that this is what's going to
happen, this is what it's going to look like and things are going to show up and can you
support each other and be a team moving forward?

ANNE: That's helpful. Thank you so much.

ELLYN: Sue one other thing, okay it's two other things but one I'd love to hear you talk about
is the issue when one partner is in recovery, the other person is not addicted and that partner
would s=ll like to have a glass of wine at home at night or a drink every now and then when
they go out and the partner in recovery is saying, "I really don't want you to drink around me."

SUE: Sure. That’s a problem and the problem is with the addicted partner that in some
ways …it's something they must work out as a couple and as the therapist, you help them
figure out how they're going to do this... if she can s@ll be who she is - let's say, if she can
s@ll have a drink if she wants a drink and he can feel like he's not being compromised. I
don't know if you've got somebody like this but is it somebody who's in recovery or just
stopped drinking?

© 2017 The Good Life Therapy Centre 19

ELLYN: Well, this is now. This is somebody who's in recovery but has had two significant
relapses in the last five years. He's now back in recovery and been sober completely for about
a year again - but he finds it very stressful s=ll for her to have a glass of wine when she's with
him. She'll go for long periods of =me where she doesn't bring any wine in the house, doesn't
drink around him. Then she starts feeling like she is struggling with the control that she feels
he has, when she can manage it and doesn't want to have it very oJen - but would like to
occasionally. So they kind of go round and round on that.

SUE: Well, I would say that there's something that's missing in his recovery, if he's feeling
that fragile. In addic@on, alcohol isn’t the problem, it's the symptom. And so, in his own
recovery, once he gets right within himself, once he accepts that he has a condi@on and
that means that he can't drink, it doesn't mean that other people can't. The other people
who don't have the condi@on can drink fine. Their lives don't get destroyed by it.

For example, I've used this example before. If you're allergic to strawberries; does that
mean nobody can eat strawberries around you? They don't have an allergy so if they
want to have strawberries, why can't they have them? You can’t and if you can accept
that truth and you're at peace with that, that you can let others have strawberries. Why
would that be a problem? There's room for each person to be who they are in the
rela@onship. Now, that would be different if she were drinking excessively or abusing
alcohol but it doesn't sound like that. It's sounding like she wants to have a glass of wine
here and there.

ELLYN: I mean she probably likes to drink a glass of wine when she's making a big dinner for
company coming over. So one =me, she likes to drink.

SUE: Right... I think I would be pushing for him to be able to manage whatever that brings
up for him because I don't know if it's tripping him up, and I think if it is then there is
something that he's not doing in his recovery. Or, he is just wan@ng her to be like him
and playing the similarity card. "If I can't drink, you can't drink."

ELLYN: No, that’s good. That's helpful and just in =me for me to go back to him and asking
that more carefully.

SUE: Yes, because somebody who's in recovery from alcoholism or addiction and knows
and understands and has accepted and is at peace with ‘who they are’, they should have
absolutely no problem allowing people to be who they are and that includes having a drink.

ELLYN: Okay.

SUE: I don't recommend people being around people who are substance-abusing. That
would not be something that would be helpful but that's not what we're talking about.

ELLYN: Right, not at all.

Okay the other issue that I think would be good to touch back to, was the one that you
brought up around the prac=cing symbio=c couple.

© 2017 The Good Life Therapy Centre 20

Where one partner ... in fact maybe, the sobriety and recovery process is undermining the
symbiosis and feels threatened by it. In some ways that side can be easier to see and feel
when you're siTng in the room with a couple like that because you can probably feel the
anxiety and fear that they have, that they're losing control of the rela=onship and the
partner.

But the other thing I've seen and this is with some 12-step work and not all by any means, but
I've seen some partners who get into recovery and have done a lot of 12-step work as very
much celebrating their independence and their relationship with their sponsor and the life of
they're now living and they still don't have much capacity for differentiation…but they think of
themselves as the much healthier partner. They also help to unbalance the system because they
don't make themselves available or don't push for differentiation work to go on within the
couple and they just want the partner to adapt to the high level of independence that they've
now attained. I don't know if you ever see that or if you want to speak to that at all Sue.

SUE: I see it all the @me and I'm glad you brought it up because I forgot to men@on that,
that “prac@cing” is without a lot of differen@a@on and that's the work with the couple - to
find that balance because really, good recovery does not mean that you abandon your
family, that you abandon your commitments to your rela@onship. In fact, it means the
opposite. It means that you have a whole lot of making up to do and showing your
partner that you're different and that you can be present and be emo@onally present and
be caring and empathic. These are difficult for somebody who's been in the throes of
addic@on for a long @me.

Addicts tend to be self-centered by nature and they have liVle awareness of their self-
centeredness. And so, that's part of the confronta@on in the sessions, is being able to
help promote the differen@a@on so that they get ... like you said Ellyn, it's not just about,
"Here's who I am." It's, "I want to know who you are and what you want and how I can be
a beVer partner to you."

ELLYN: Right, definitely.

SUE: It happens oken... you will hear this a lot, this disgruntled partner that hates 12-
step program because they've taken their spouse away.

And that's not good recovery by the way and if there's a good direc@on being given, that
will happen.

ELLYN: And that's I think one of the real values of having a solid therapist in addi=on to the
12-step, that a solid therapist can help balance that in a more construc=ve way.

SUE: Yes, for sure.

ELLYN: Well, ... how about if we do this Sue. I'm going to end, in a minute I'll ask Michelle just
to open all the lines and people can say whatever they want to you as we finish up but I
really, really appreciate your talk today and I think, like Douglas said, I think you did a great
job summarizing a lot and highligh=ng so many of the issues and the reality that this work is

© 2017 The Good Life Therapy Centre 21

a challenge but that you can s=ll be hopeful within it and be able to do things that give their
clients a sense of direc=on, which is so important.

CONNIE: This was extremely helpful. One point perhaps if I could. In this couple that I'm
working with, a lot of what she brings up is fairness and the hopes is around her having ... or
when I talk to her about doing Al-Anon work, very much around feelings that he is
disengaging from the family as he recovers. And so, I can now address this be:er. Thank you
for that. The other piece is this fairness, this fairness around her - she feels it’s unfair that she
would have to do Al-Anon work, any thoughts on that?

SUE: You can just be more and more curious about what else she's feeling and I might
tend to say, "Why don't you try it?" Try it for six months and see if it can be helpful.
Maybe what looks like a demoli1on is really a renova1on. Maybe it feels unfair right
now but there may be some benefits for you that you're not even aware of now. Why
don't you just give it a try and see what happens? Or you can just encourage her to
reframe it in a way that there may be some things in there that end up being the best
thing that ever happened to her.

I mean most people don't go into 12-step program with open arms and all joyful about it.
Most people go in ha@ng it, dragging their heels and feeling like a failure somehow. But
it's through the experience of the connec@on to the people and the bond of the common
problem and the common solu@on that it changes. They actually feel beVer. Dr. Rudin
says in his book, The Craving Brain, that when people sit in 12-step mee@ngs, the
primi@ve part of the brain that wants to be in the middle of the herd gets ac@vated and
they feel safe. And when they feel safe, serotonin is released in the brain and it's soothing
and so they feel beVer. So, there's a lot of reasons why it works for people, that’s
supported by neuroscience. I'm not saying it's going to work for everybody and it's her
choice in the end but, the more you can try to encourage her to thinking about it
differently and frame it differently, you can encourage her to try it.

ELLYN: Another way that I think about the fairness issue is when you have one partner
who's complaining that it's not fair, it usually means, "It's not fair that my partner brought
into this marriage something that I now have to deal with." The reality is, that we all bring
things into our marriages that the other person has to deal with and yes, it's not fair. In
the ideal world, we would have all chosen perfect people but we don't and there aren't
any. So, it just is.

CONNIE: The reframe that I've done for her, this is not work you're doing for him, this is work
you're doing for you so...

SUE: Yes, and I like what Ellyn said because it's like poin@ng the finger and saying,
"You've done this to me." but she's brought things too.

It's a 50-50 thing and that's what partners oken don't want to see. They don't want to
turn the mirror on themselves. They want to say, "This is what you've done to me."

ELLYN: And addiction makes that easy especially if the addiction's bad because it's so glaring.

© 2017 The Good Life Therapy Centre 22

ALLAN: I just want to thank you for giving such a comprehensive overview of this. I'm just
all too slowly trying to think about how it applies to some of my cases here. So, thank you
very much.

DANNY: I just want to say thank you so much for your ... not just the content there but the
kind of the aTtude I was looking at your support and concern about the other nega=ve bias.

It comes so clearly, the sort of the installa=on of hope along with the reality and stuff so
thank you.

SUE: You're very welcome.

For those who are interested in more informa@on about the training and supervision I
provide, please go to my website: www.goodlifetherapy.ca.

© 2017 The Good Life Therapy Centre 23

 REFERENCES
Audit/Cage Test: hVp://[email protected]/[email protected]

Twelve Step Programs and Neurobiology: How the Rooms Rewire Us:
hVp://www.recoveryview.com/Topic/TabId/107/ArtMID/657/Ar@cleID/1096/Twelve-
Step-Programs-and-Neurobiology-How-the-Rooms-Rewire-Us.aspx

12 Step Groups: Twelve Objec&ons and Twelve Responses: hVp://www.billherring.com/

ar@cle/12-step-groups-twelve-objec@ons-and-twelve-responses

© 2017 The Good Life Therapy Centre 24