Sabotage – Counseling’s Unexpected Outcome

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.

© Copyright 2008 by Edward Wilson, Ph.D., MAC, therapist in Rolling Hills Estates, California. All Rights Reserved. Permission to publish granted to GoodTherapy.org.

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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  • Jeni

    Jeni

    August 3rd, 2008 at 2:26 PM

    This is very interesting. I think that for many they are so comfortable in their roles as “rescuer” and the one without the serious alcohol problems that they are unsure of wht their role should be once the partner or family member stops drinking. I can easily see how they may unconsciously enable them to begin drinking again so that they too will be able to slip back into the role which feels the most comfortable to them. Might not be the right thing but I can see how this happens.

  • Steve H

    Steve H

    August 4th, 2008 at 11:45 AM

    The maybe there need to be more rehab programs that offer counseling to the entire family instead of always focusing solely on the one with the substance abuse problem. That might help to curb many of these problems.

  • Michael

    Michael

    August 5th, 2008 at 3:01 PM

    It says so much about a relationship when one person is more interested in maintaining a controlling role rather than simply wanting his or her spouse to get well. That is scary.

  • Ed

    Ed

    August 6th, 2008 at 4:18 AM

    Dr. Barnes and I always find it interesting to try and sort out the various family dynamics which ultimately determine outcomes. It doesn’t really come as surprise that the one who “volunteers” for treatment isn’t the only one with a problem – or even the one with the bigger problem.

    Treatment is certainly more effective when problems are seen in their totality but clients tend to bolt when the focus becomes inclusive rather than focusing on “the problem person.”

    We do find that it works better when we use our model of working with clients together. When the two of us work with a couple it prevents the usual triangulation that clients’ almost universally feel in any triad. Our combined approach doesn’t always work, of course, but it does reduce the number of easy escape excuses.

  • Jeanette

    Jeanette

    August 7th, 2008 at 5:21 AM

    This seems to be a departure from treatment programs of the past but definitely more of a move in the right direction. When you sit down with the family members do you find that there are those who will take no ownership of the problems and view it as only the problem of the person who is abusing? How can they continue to feel this way when quite obviously this is not a problem which one can solve alone?

  • Ed

    Ed

    August 7th, 2008 at 7:37 AM

    Perhaps not surprisingly, spouse and family reactions vary considerably. Many spouses are primarily interested in the “problem person” being punished; others are genuinely interested in looking at the whole picture and what can be done to resolve underlying difficulties. Of course some clients are only interested in getting people off their backs which is another whole problem.

    Again, successful behavior change, regardless of the behavior, is a product of motivation, support, and decent counseling. Whatever contributes to this results in better outcomes. Of course determining client’s actual goals, as opposed to their stated ones, is always a challenge. But that’s why we get the big $$$$.

    :-{)

  • Maggie

    Maggie

    August 10th, 2008 at 4:32 AM

    Why is there the mindset that the person with these problems needs to be punished? That is doing no one any favors except to let those who have been abused perhaps have an outlet for their anger. This is even more of a reason why the entire family in these situations needs a treatment plan and not just the one who uses alcohol or drugs. There is often so much pent up frustration and anger in these familites that many times they do not know what to do with it once the substance abuse ends. At least when someone is abusing they feel justified in having so much anger but when that stops those who are still angry have no idea what to do with those negative emotions which still linger.

  • Ed

    Ed

    August 10th, 2008 at 3:30 PM

    Absolutely agree – which is why we use the model we do, one that allows for all of the dynamics to be addressed. Too much so-called treatment involves even more isolating of the “problem person” both during and after treatment which simply fuels even more – and justified – resentment. Of course creating real solutions requires real skills far beyond those of chemical dependancy “counselors.” That’s where the current problems have existed for the past 30+ years.

  • Susan

    Susan

    August 11th, 2008 at 10:08 AM

    I am so glad to hear that there are treatment programs now available which allow help for all family members. When my family and I went through this when I was a child we all sat by while my dad was the only one doing any real work. The rest of us simply got to sit around and continue to blame him for everything bad in our lives and never had to take responsibility in any way for the roles we played. It took a long time to rid ourselves of the anger and remorse. I am hopeful that programs such as yours will do a better job for families across the board.

  • Hooper

    Hooper

    August 12th, 2008 at 10:53 AM

    For me I know that in the past I have even sabotaged my own progress by allowing feelings of guilt over what it might be doing to others in my life take control. It took a tough decision on my part to realize that it was no longer about others but that I had to work on me and that is when the self sabotage stopped.

  • Ed

    Ed

    August 12th, 2008 at 2:17 PM

    Thank you. We appreciate the comments and perspective.

    We find it unfortunate that individual’s problems are frequently co-mingled with those around them, but treated in isolation with many of the results you mention. We adhere to a biopsychosocial model that looks for the interconnections which will facilitate or hamper client progress to full recovery. Of course this presupposes that clients can recover, a stance few therapists and virtually no addiction treatment programs support. Unhappily this latter perspective becomes self-fulfilling, as it’s intended to.

  • Jon P

    Jon P

    August 15th, 2008 at 4:38 AM

    I guess ultimately so many of these residential treatment programs are in it for the money so why would they actually do everything they could to treat the person? That loses them business in the long run. You have to keep recidivism high in order for them to continue to make money.

  • Ed

    Ed

    August 16th, 2008 at 8:05 AM

    Unhappily that’s true – in 1983 I was terminated at the end of my probationary year by a well known Minnesota program because my clients weren’t relapsing. Nothing has changed in that “industry” in the years since. While it is more obvious in drug treatment, it’s hardly an unknown factor in most areas of counseling. We see many many clients who have been seeing individual therapists for years on end with no productive results, nor and treatment plan that’s apt to result in any.

  • Libby

    Libby

    August 18th, 2008 at 5:20 AM

    I have to say I find all of this very disappointing. We are in the industry to help people, not make them so dependent on us that they can never live without treatment. I know there are programs and counselors who feel this way but from my point of view I do what I do to help people take control over their lives and to be able to go on living a healthy normal existence. I do not want clients relapsing- I want them to leave me with the strength and courage that they need to face reality every day on their own and to make something positive happen in their lives. Maybe I am of the minority opinion of those who feel this way but I certainly hope not. I truly hope that therapists, counselors, and doctors who feel that clients or patients need to relapse in order for them to stay in business are few and far between.

  • Jenn

    Jenn

    February 28th, 2011 at 2:41 PM

    I love this article, thanks!

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