We work with clients very intensively – four or more hours a day for five to seven days – and with a well defined presenting problem – alcohol abuse. Following this initial treatment phase, during the ninety days of follow-up, we frequently see family members sabotage progress once clients return home. Undermining progress is rarely intentional, but nonetheless it is the second most common factor in clients reverting to old behaviors. Only clients’ self-sabotage is more destructive. Combine the two and any progress will be stopped dead in its tracks.
Why do spouses in particular, but other family members as well, attempt to drive clients back to their old drinking behaviors – behaviors they claimed they wanted changed, and whose elimination they frequently demanded? The answer is that, unhappily, we all tend to find that we really like what we refer to as “the security of familiar miseries.”
The biggest problem with any significant life change is that the outcome is unpredictable. Most of us quickly learn that unpredictability creates more anxiety than even negative, but predictable, behaviors. Sadly, most of the time we all prefer knowing what’s coming, even if it’s a train wreck.
Other factors also come into play. When one person is the “designated client” who has a well defined “problem” the other spouse and/or family members have probably been spending years using the “problem” as a way of avoiding looking at their own problems. When the client makes progress it starts disturbing their comfortable, and saintly, role. Few family members, particularly spouses, are up for having a role reversal thrust upon them. Adolescent children usually aren’t too happy about a parent who suddenly develops consistency and an accurate memory either.
We spend a lot of time preparing clients for re-entry home and sometimes astonishing receptions. After ten days one woman recently flew home to find that her husband had thoughtfully purchased and stocked the refrigerator with a half dozen bottles of her favorite wine. Another wife literally dragged her husband out of treatment when the combination of Naltrexone and cognitive behavioral therapy actually stopped his drinking in its tracks. She wasn’t about to lose her controlling, self-righteous, manipulative role.
The outcomes can also be mutually positive. One couple, learning that his drinking paralleled her eating, and that the same loneliness underlay both habits, have successfully worked with us to modify their lives in ways which address both “behaviors” and the underlying issues without wasting time on blame. Happily, our inclusive approach creates this type of outcome more often than not.
It is important to remember that sabotage, both intentional and unconscious, will always be a factor in any client’s progress regardless of the therapeutic issues. Addressed openly it can be mitigated and clients can be supported through the first difficult months while everyone adjusts to a new equilibrium. Ignored, it will doom clients who otherwise could be healed.