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Restoring Hope in Couples Affected by Addiction

Believe faith hope

This week is National Addictions Awareness Week – a week to raise awareness about the impact of addictions on individuals, families and communities. Almost 5% of Canadians meet the criteria for substance use disorder[1], and more than half of these individuals are also coping with mental health concerns.[2] Substance use problems or behavioural addictions such as problem gambling have many adverse effects in areas such as health, mental health, finances, employment, parenting, and intimate relationships. When one partner has an addiction the relationship often has more conflict, higher rates of violence, and elevated risk of separation/divorce. I work with many couples greatly affected by addictions at the Centre for Addiction and Mental Health. These couples often have poor communication, little or no intimacy, high conflict, ruptured trust, financial stress, and little or no hope that things are going to get better. The couples are often stuck in perpetual cycles. The partner with the addiction often carries a lot of shame, feels devalued, criticized, and overwhelmed. The other partner often feels betrayed, alone, worried, and insecure. As a result, the couple is disconnected and each person uses protection strategies that may contribute to staying stuck in these cycles. The person with the addiction often withdraws and may also have angry outbursts to shut down difficult discussions. The other partner may be accusatory, controlling, and suspicious. When they come and see me, they are usually very apprehensive that couple therapy will be helpful.

So, how can we as couple therapists help couples in these situations get unstuck and start re-connecting and repairing relationships?

Build a strong therapeutic alliance with both partners

This may seem obvious to most couple therapists, yet it is something that can be very challenging since the partners come to therapy with conflicting motivations, different perceptions of the situation, and a lot of strong emotions that can trigger conflict quite rapidly. Validation and reflections are really important skills in helping each partner feel understood by the therapist. We have to also remember that a therapeutic alliance involves not only the bond or quality of relationship between therapist and client, but also the goals and means of achieving those goals in therapy. With couples stuck in unhealthy cycles, we need to help the couple find collaborative goals that meet each person’s needs. Goals are known as anchors of hope theory and essential in repairing troubled relationships. A couple’s level of hope is influenced by these questions: “Can we do it? How can we do it?” A therapist can help a couple see that they have the resources to be able to make changes.

Focus on Strengths

Highlighting individual strengths and strengths of the couple is such an essential part of building an alliance and helping the couple to feel more hopeful.

Make Meaning of Adversity

Couples coping with an addiction and often mental health concerns have had a long and very bumpy road. Help the partners understand that each one is impacted by the addiction, but the effects can be different. This can cultivate empathy, foster warmth and help the couple become more connected.

Safety

Creating a safe space in session is fundamental. Sessions will feel safer when conflict is contained as much as possible. It is also important to effectively manage disclosures, as well as moments of heightened vulnerability.

Resilience in these couples

The couples I see have been through many adverse experiences. Their stories are often laden with trauma and loss. My belief in their potential to recover and grow is an important part of therapy. While these couples have managed to forge through their difficulties using many of their own strengths and resources, they often focus more on the problems. I believe it is important to help them shift their focus to their strengths, values, and resources which will strengthen their resilience, and help them reconnect, rebuild, and recover.

[1] Pearson, Caryn, Teresa Janz and Jennifer Ali. 2013. “Mental and substance use disorders in Canada” Health at a Glance.September. Statistics Canada Catalogue no. 82-624-X.

[2] Mood Disorders Society of Canada. (2009). Quick Facts: Mental Illness and Addiction in Canada. Retrieved from http://www.mooddisorderscanada.ca/page/quick-facts

Toula Kourgiantakis, MSW,RSW,RMFT, PhD(c)

Centre for Addiction and Mental Health
33 Russell St. Toronto, M5S 2S1
Toula.kourgiantakis@camh.ca

About Toula:

Toula Kourgiantakis. smallerjpgToula Kourgiantakis is a Couple and Family Therapist in Behavioural Addictions at the Centre for Addiction and Mental Health (CAMH). She has been working with couples and families in various clinical settings for over 20 years and is a Clinical Fellow of the American Association of Marriage and Family Therapy. Toula’s doctoral research is comparing addiction treatment for individuals with and without family involvement. Toula is a part-time faculty member at the School of Social Work at Ryerson University and the Faculty of Social Work at Wilfred Laurier University.


November 17, 2014

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