At the September luncheon, Dr. Robert Navarra gave us some of his insights from his research and work with a therapy population that has rarely been studied: couples in long-term recovery from alcoholism. He began by giving an overview of the impact of addiction on family functioning, including:
 

• Poor boundaries (overly rigid or overly disengaged)
• Alcohol as an organizer of family roles and behavior
• Claudia Black's "don't talk, don't trust, don't feel" family rules
• "Wet systems" (when the alcoholic is actively drinking), which usually cause more family stress and alternate unpredictably with "dry systems." However, some families operate better when the alcoholic is drinking (i.e. when the drinker becomes more mellow, passes out, or disengages)

Summarizing the results of his own research and that of Stephanie Brown and Virginia Lewis, Navarra discussed early recovery as a period of destabilization of the entire family system, including the couple. This collapse, while painful, is a prerequisite to recovery. And this destabilization continues long after sobriety begins.

Once organized around alcohol, now recovery is the new family organizer. Contrary to the happy (and often unrealistic) expectations a couple may have about recovery, this reorganization traumatizes the family system. There is a kind of freeze in working on couples issues while the alcoholic and family member are encouraged to separately "work their own programs."

If successful, the couple moves through stages of recovery, which Brown and Lewis have labeled as drinking, transition (when the person believes they may have a problem), early recovery (when they become committed to abstinence), and ongoing recovery. The couple's navigation of these stages may depend on a number of factors, including their couples typology (Brown typed couples based on whether one, both or neither member is in recovery).

After studying transcripts of a monthly focus group of couples in long-term recovery that met for five years, it was concluded that in long-term recovery couples begin to maintain individual and couple recoveries concurrently. The researchers saw on-going couple development begin to be addressed, and identified three main components of this development:

• Shifting: a dramatic movement toward the centrality of the couples relationship, and shifting of identities, roles, and boundaries from what they had been prior to recovery
• Intergenerational Reworking: An increased awareness of and filtering out of harmful "old tapes" from family of origin, leading to "shedding" of current destructive patterns
• Attending: The ability to attend to one's own needs AND be available to one's partner

This model, labeled the Couples Reciprocal Developmental Approach (CRDA), is a way of conceptualizing couples in recovery, and can be used within a variety of therapy treatment approaches to assess and treat these couples. When treating couples with this model, it is helpful to:

• Ask yourself and your couple: where does the couple stand with each of these three components?
• Normalize these components to clients as part of the rocky road of healthy recovery
• Delay working with relationship and intimacy issues until after early recovery is successfully navigated
• Remember: movement through recovery stages is very slow and typically non-linear; in fact, the average amount of time between when an alcoholic acknowledges s/he has a problem and when s/he does something about it is two to three years. Therefore, we therapists need to be VERY patient!

Robert Navarra, Psy.D., MFT is the Clinical Director of the Center for Couples in Recovery, which is associated with the Mental Research Institute in Palo Alto.

Review by: Barbara Griswold, MFT