Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

544 V. TREATMENTS FOR ADDICTIONS1. Shift extremes of behavior from rigid complementarity to greater symmetryor more overt complementarity (improved complementarity for the specificrelationship).2. Help the couple/family to resolve issues of power and control.3. Directly address the pride structures of both partners, so that new forms ofrole behavior are permitted without the need for alcohol.4. Help the couple to achieve whatever level of closeness and intimacy is desirablefor them. (pp. 135–136)See Bepko and Krestan (1985), O’Farrell (1993), Fals-Stewart and colleagues(2005), and O’Farrell and Fals-Stewart (2000, 2002) for detailed discussions oftherapeutic methods used to implement these and related goals.Davis (1987) also emphasized that therapists must help family members toreconsider and redefine the substance abuser’s role in the family at this stage oftherapy. Old expectations and behavioral patterns, based on living with addiction,must be replaced by new adaptive ones. For example, a family that hasgrown used to an alcoholic husband/father may continue to withdraw everytime he shows a hint of anger, leave him out of family decisions, and disregardhis parenting efforts. In this stage of therapy, the father must learn to deal withhis anger, to participate in making responsible decisions, and to function as afather, and the family members must let him change.In the treatment of a family with a young addict during this stage, the therapyevolves beyond Stage 4 crisis management and toward other issues, such asfinding the recovering addict gainful employment and a place to live away fromhome (Stanton & Todd, 1992). Family therapists work to involve parents inthese “launchings,” so they will share the addict’s eventual success. Over time,it becomes increasingly possible to shift the parents’ attention to other siblings,grandchildren, or retirement planning, thereby allowing both the parents andthe recovering addict to let go. Should marital issues surface, as they often do,family therapists try to keep young addicts out of their parents’ marriage issues.Berenson focuses his work in this stage on the couple’s relationship, withthe aim of increasing emotional closeness within the couple, without a returneither to drinking or to discussions centered on alcohol (Stanton, 1981b). Inconjoint sessions with couples and/or multiple-couple groups, Berenson andother family therapists often focus on the severe sexual problems that are commonin such marriages (Stanton, 1981b) and teach new skills for dealing withstress and conflict (Bepko & Krestan, 1985; Fals-Stewart et al., 2005; O’Farrell& Fals-Stewart, 2000, 2002). Therapy sessions with the extended family arescheduled when relatives or in-laws are disruptive (Speck, 2003; Stanton &Landau-Stanton, 1990).Finally, it is also during this stage that a number of family therapists (e.g.,Bowser, Word, Stanton, & Coleman, 2003; Coleman, Kaplan, & Downing,1986; Horwitz, 1997; Reilly, 1975, 1984; Rosenbaum & Richman, 1972) dealwith the often unexpected and unresolved losses and deaths that so many