The Female Partner of the Recovering Male Alcoholic
The Female Partner of the Recovering Male Alcoholic
A Comparative Review of Three Methods of Family Therapy, Including a Feminist Perspective.
Pat Jones, MS, RN, CS
Abstinence may be as hard or even harder than drinking for the alcoholic because it reveals so many problems that were obscured by the family's focus on alcohol. Denial remains as strong as ever as the family has to face the harsh realities of delusion, illusion and collusion that have dominated its reality during drinking and that are now revealed during the period of abstinence. In many families, the entire family system has been organized by alcoholism. Not every couple will or, for their own personal health should survive recovery. (Brown,1999). This could be a time of tremendous personal growth for all individuals involved or it could turn out to be a period of decline. It is this author's contention that the approach for the female partner is as important in examination as that of the alcoholic himself. As Carl Jung stated:
Seldom or never does marriage develop into an individual relationship smoothly and without crisis. There is no birth of consciousness without pain(Cambell 1971, pg.167).
Three focuses of therapy will be reviewed in this paper. The best known is the disease approach. Alcoholism is viewed as a disease and family members also have the disease of "codependence" (Cermak, 1986). In the disease approach, the family members are treated with therapy separate from the alcoholic. This therapy encourages the alcoholic, the spouse and the family to reach outside the family for help. The use of Al-Anon, Al-Ateen or Adult children of alcoholics groups is highly recommended as well as individual and group therapy to address various psychological issues. With this approach, family members should not actively intervene to attempt to change the alcoholic's drinking. They are encouraged to detach and focus on themselves to help with their emotional distress and to increase their skills needed to cope (The Al-Anon Family Groups, 1981, Laundergan and Williams, 1993).
The general focus of Al-Anon is getting free of the unnecessary pain and suffering that results from living with an alcoholic or drug dependent person. Group therapy is the necessary hub around which a person can heal their codependence (Lowinsin, Ruiz, Millman and Langrud, 1992). A focus on reducing the alcoholic's drinking and working on the relationships is the primary goal of the family disease approach(O'farrell and Feehan,1999). The focus of treatment for the recovering alcoholic is Alcoholics Anonymous, a long standing mutual-help organization whose purpose is to help the alcoholic sustain abstinence and in the process of working the 12 Steps, which are the core of the program, to experience personal and spiritual growth. It is a fellowship, that is, a "mutual association of persons on equal and friendly terms; a mutual sharing, as of experience, activity or interest"(Lowinsin et al, 1992).
Within the context of discussing codependency and its relation to the female partner of the recovering male alcoholic, there will be an exploration into the area of feminism as it relates to the therapy of the spouse. Marriage has been found to have a protective effect for men but a detrimental effect for women in terms of both mental and physical health (Sobel,1981). Women in marriage have been described as de- selfing themselves so as not to threaten men, although individual males complain that they do not feel powerful. According to Guilligan(1982), women's concern with relationships can be understood as the need to please others when one lacks power. From a systems approach, by viewing family members as equal interacting parts in recursive complementarities, differences in power, resources, needs and interests among family members is ignored. By ignoring gender differences, the therapist supports them(Hare and Marcode,1990).
The second treatment approach involves the use of the Bowen family systems approach. Family interaction behavior is attended to as it becomes organized around alcohol(O'Farrell and Feehan,1999). Family systems theory carries with it certain basic assumptions, the most basic of which is interdependence within the system. Family members are seen to interact in predictable patterns. A change in one person's behavior of necessity affects the entire system - and also how the family members relate to each other. The identified patient is usually the least powerful family member and the individual who is demonstrating the effects of anxiety for the family(Burgess, 1998).
The third approach is the behavioral approach, which assumes that family members can reward abstinence and that improved communication can in turn improve relationships and that this lowers the risk of alcoholic relapse(O'Farrell,1993). A review of research suggests that this form of treatment produces significant reductions in alcohol consumption and improves marital functioning(McKay, Longabaugh, Beattie, Maisto and Noel, 1993; McGrady,Noel,Abrams, Stout, Nelson, and Hay,1986; O'Farrell, Choquette, Cutter, Brown and McCourt,1993). This approach is geared directly to increase relationship factors conducive to sobriety. In this form of treatment, the alcoholic patient and family members are seen together to build support for sobriety, to increase relationship cohesion and to improve communication skills(O'Farrell and Feehan, 1999).