Therapy with Couples with Addiction

325 Pages·2016·0.96 MB·English

Institute for Clinical Social Work

Therapy with Couples with Addiction: A Psychoanalytic Perspective

A Dissertation Submitted to the Faculty of the

Institute for Clinical Social Work in Partial Fulfillment

For the Degree of Doctor of Philosophy

By

Jamie L. Loveland

Chicago, Illinois

March 2016
Abstract

This study explored therapists’ experiences in treating couples with
substance addiction (SA) to understand and identify psychoanalytic therapeutic factors.
The study was qualitative, using Interpretive Phenomenological Analysis. Four licensed
psychoanalytic couple therapists were interviewed in depth about their experiences when
working with SA couples. The eight major findings were:
1. The categorical reminder of the role of countertransference.

2. The complexity of SA symptoms and defenses, and underlying causes.

3. Psychodynamic couple therapy with SA couples is dynamic.

4. Generally, research participant couple therapists do not distinguish the manner

in which they conceptualize couples with SA, and couples without SA.
5. The psychoanalytic, behavioral, and disease model of treatment are all

interrelated when treating SA couples.
6. Psychodynamically, research participant understanding of SA couple

therapeutic factors are not distinguishable from those deemed therapeutic
when working with non-SA couples.
7. Psychodynamically, research participant understanding of the markers of

change in SA couples is not distinguishable from those of non-SA couples.
8. Conceptualizing and treating SA through a narrow lens is restrictive.

Conclusions and recommendations based on the findings were offered.
ii
To my fellow colleagues who work with couples with substance addiction

iii
Acknowledgements

It is with great appreciation that I acknowledge my dissertation committee: Karen
Bloomberg, for slaying dragons, an unending enthusiasm for couple therapy, and
organizational skills beyond belief. Connie Goldberg, for thoughtful responses and an
eye for detail and content. John Ridings, for method, design and formatting. Carol
Ganzer, for candid discussions, unwavering support, and being able to see it like it is.
And George Youngblood, for expertise on the subject of substance addiction, and for
sharing passion and commitment in providing the highest level of care to those who
suffer.
A special appreciation to Paula Ammerman for her direction, warmth, support and
friendship.
To my family, especially Anne, David, Summer, Truly, and Papa Gene for their
patience, love and generosity.
And finally, to my husband Mark, who inspires me to be the best person I can be
each and every day. You are my hero.

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Table of Contents

Page

Abstract……………………………………………………………………………..……ii
Acknowledgements…………………………………………………....………………...iv
List of Tables…………………………………………………………………………….ix
Chapter
I. Introduction ……………………………………………………………….......1
General Statement of Purpose
Significance for Clinical Social Work
Problem Formulation and Specific Objectives of the Study
Epistemological Foundations
II. Literature Review……………………………………………………………16

The Biopsychosocial Model
Therapeutic Factors/Action
Substance Addiction Research
Individual Substance Addiction Treatment
Couple Substance Addiction Treatment

v
Table of Contents-Continued

Page
Chapter

III. Methodology……………………………………………………………...…82

Rationale for Qualitative Design

Rationale for IPA

Data Collection Methods

Data Analysis

Ethical Considerations

Issues of Trustworthiness

IV. Findings……………………………………………………………………104
Introduction to Participants
Presentation of Findings
Summary
V. Discussion……………………………………………………………...……185

Personal and Professional Journey
Conceptualization of SA
Therapeutic Action
Markers of Change
Trial and Error
Revisiting Assumptions from Chapter I
Summary of Interpretation of Findings
vi
Table of Contents-Continued

Chapter Page

VI. Conclusions and Recommendations…………………………………...…250
Therapist Personal and Professional Experiences in Working with
SA Couples

Therapist Conceptualization of SA
Therapist Experiences of the Therapeutic Actions when Working with
SA Couples

Therapist Experiences of the Markers of Change when Working with
SA Couples

Therapist Experiences of Factors that Impede the Process of Working
with SA Couples

Recommendations for Psychodynamic Couples Therapists
Recommendations for Schools of Clinical Social Work
Recommendations for Consumers
Recommendations for Further Research
Study Limitations
Personal Reflections
Conclusion

vii
Table of Contents-Continued

Appendices Page

A. Email Script……………………………………………………….…….…263

B. Participant Informed Consent…………………………….….……….….266

C. Study Questionnaire…………………..………………….………….……271

D. Interview Schedule………………………………….…...…………….…..275

References………………………………………………………….............…..279

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List of Tables

Page
Table

4.1. Sample Characteristics…………………………………………….………105

4.2. Summary of Findings……………………………………..……………….111

5.1. Therapeutic Action…………………………………………..…………….225

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Chapter I

Introduction

General Statement of Purpose
The purpose of this phenomenological study was to explore couple therapists’
experience in treating couples with substance addiction (SA) to understand and identify
psychoanalytic psychotherapeutic factors. Utilizing a phenomenological design to better
understand and describe the therapeutic elements, study participants were licensed
therapists with a minimum ten years’ psychodynamic experience treating couples, a
minimum five years’ experience in treating SA couples, and a minimum three months
active engagement in working with at least one SA couple over the past year. For the
purpose of this study, substance addiction is defined as a “physiological and
psychological dependence on a substance” (Barker, 2003, p. 7). In keeping with World
Health Organization (WHO) recommendations in terminology, the term substance
addiction will be interchanged throughout this study with the expressions substance
dependence, alcohol dependence, substance use disorder(s)(SUD’s), alcohol use
disorder(s)(AUD’s), and alcohol and/or chemical dependency (Kalant, 2009).