Understanding and Counseling the Alcoholic by Howard J. Clinebell, Jr.
Howard J. Clinebell, Jr. Is Professor of Pastoral Counseling at the School of Theology at Claremont, California (1977). He is a member of the American Association of Marriage and Family Counselors, and the American Association of Pastoral Counselors. He is a licensed marriage, child and family counselor in the State of California. His personal website is http://members.aol.com/clinebellh/index.htm, and his email address is clinebellH@aol.com. This book is the Revised and Enlarged Edition published by Abingdon Press, Nashville, 10th Printing, 1990. Used by permission. This material ws prepared for Religion Online by Richard V. Kendall.
Chapter 11: Helping the Family of the Alcoholic
My husband is an alcoholic, but will not ask for help. He thinks he can work it out for himself. Heís not doing it, but what can I do? Is there anyone in the world who can help us or will try to? Please, for Godís sake, can you help me? 1.
-- Letter from the wife of an alcoholic
This letter came to the clearinghouse for the Al-Anon family groups which are an outgrowth of AA. The words are familiar to a pastor -- words that he hears when the spouse of an alcoholic comes in despair seeking help.
A Major Pastoral Opportunity
The average parish pastor has considerably more opportunities to help members of families of alcoholics, than he has to help alcoholics. There are two reasons for this. One is the numerical factor. There are usually several people in the circle of chaos and concern clustered around an alcoholic. This means that around the five and one-half million alcoholics there are probably at least twenty million with a direct concern for them. One authority puts her estimate of the size of this group at twenty-five million. 2. When we recall the variety of types of relationships represented by those close to alcoholics who have come -- in my case for instance this includes a husband, wife, daughter, son, mother, father, fiancée, nephew, sister-in-law, neighbor, intimate friend -- we realize that this estimate may not be far from accurate.
The other reason why the pastor has more opportunities of this kind is the fact that members of the family are often accessible to him when the alcoholic is not. Frequently, they are more open to help by a minister. Deterioration often hits the home before other areas of the alcoholicís life. Because the family is less defensive than the alcoholic himself, they are more likely to come to the minister before the final stages of the illness have developed. Work with the family, therefore, represents an opportunity for prevention through early detection. One of the Yale ministers reported, "Families ordinarily will work with the minister to better advantage than the alcoholic himself." This has been the experience of many clergymen.
Working with the families of alcoholics represents multiple opportunities. It is sometimes an indirect way of helping the alcoholic. One of the Yale ministers told of helping to sobriety an alcoholic whom he had never had an opportunity to see, by helping the wife to change her attitudes toward him. It is probably not very often that an alcoholic problem can be completely solved through a relative, but such an approach can certainly contribute to a solution. Although it is important for the family to see their role in the situation which produces alcoholism, they should usually not be led to believe that they alone can lead the person to sobriety. This expectation would only complicate the interpersonal relations of the family and lead to guilt when they fail. Another side of the pastorís opportunity lies in the fact that members of an alcoholicís family often need understanding counsel as much as the alcoholic. Anyone who has not lived with an alcoholic can hardly appreciate the shame, loneliness, and despair that develops in such an atmosphere. Truly, as is often said, "Alcoholism is a family disease." What is more, studies have shown that the mates of alcoholics are often almost as disturbed, anxious, and in need of treatment as the alcoholic. For example, at the Cornell University Medical College, New York Hospital, alcohol research project, the psychiatrists found it as essential to treat the families as it was the patients themselves. 3.
The various facets of the clergymanís opportunity in helping the family could be summarized as follows: (a) Bringing the hidden alcoholicís family out of hiding. This may be accomplished by using the same methods as those described in Chapter 8 for bringing the hidden alcoholic out of hiding. (b) Sustaining and guiding the spouse and children during the period before the alcoholic seeks help. (c) Increasing the likelihood that the spouseís way of relating to the alcoholic will hasten rather than retard his becoming open to help. (d) Helping the spouse respond constructively during his treatment. She can help or hinder his chances of success. (e) Educating the congregation to fulfill its pastoral care function in relation to the alcoholicís family. It is clear that this dimension of ministry is a rich and challenging one.
Preparation for Counseling the Family
Oneís general preparation for counseling alcoholics is also useful in counseling the families of alcoholics. In addition, an understanding of the dynamics of the interpersonal relationships in the alcoholicís family and the effects of alcoholism on these relationships is important. Fortunately, there are a number of articles written by social scientists on the subject. Several of these are listed in the references at the end of this chapter. 4.
Beyond this a pastor will need to have an acquaintance with what has been written concerning helping the families of alcoholics to meet their problems constructively. Here is a list of books and pamphlets which will be useful in this regard. Those with an asterisk are suitable for loaning to the family.
*Living with an Alcoholic, with the Help of Al-Anon (New York: Al-Anon Family Group Headquarters, 1960). This is a basic book for the family and for the pastor in helping the family. It is for the family what the Big Book of AA is for the alcoholic. Included is a series of illustrative case histories of families who found help.
*AlAnon Faces Alcoholism (New York: Al-Anon Family Group Headquarters, 1965). This book contains statements about Al-Anon and the family problems created by alcoholism. The statements are by professionals who
work with families of alcoholics and by "those who live with the problem." 1 The working principles and history of Al-Anon are also included.
*The Dilemma of the Alcoholic Marriage (New York: Al-Anon Family Group Headquarters, 1967). This is a guidebook for the alcoholic spouse. It includes a chapter on applying the Twelve Steps to marriage problems.
^New Primer on Alcoholism by Marty Mann, in a chapter on "What to Do About an Alcoholic," has sections entitled "If You Are the Wife of an Alcoholic" (206-13), "If You Are the Husband of an Alcoholic" (213-17), "If You Are the Son or Daughter" (217-19), "If You Are a Friend" (219-21), and "If You Are the Employer" (221-24).
*"The Alcoholic Husband, A Message for Wives" and "The Alcoholic Wife, A Message for Husbands" are two pamphlets produced by AA. They seek to help the person understand the problem of alcoholism, AA, and how he may help get his alcoholic mate into AA. The Big Book of AA has a chapter on "The Family Afterwards" (122-35).
*These pamphlets are produced by Al-Anon: "Al-Anon, You and the Alcoholic," "Al-Anon Family Groups at Work," "How One AA Wife Lives the Twelve Steps," "Alcoholism, the Family Disease," "To the Mother and Father of an Alcoholic." Alateen pamphlets include: "Itís a Teen-Age Affair," "Youth and the Alcoholic Parent," "Operation Alateen," and "For TeenAgers with an Alcoholic Parent." (Al-Anon and Alateen literature is available from Al-Anon Family Group Headquarters, P.O. Box 182, Madison Square Station, New York, New York 10010.)
These resources are useful for the person counseling with the family of alcoholics: Pastoral Psychology, Vol. 13 (April, 1962), No. 123, special issue on "Counseling with the Family of the Alcoholic"; John E. Keller, Ministering to Alcoholics, Chapter VI, "Counseling the Spouse," pp. 124-37; Thomas J. Shipp, Helping the Alcoholic and His Family (Englewood Cliffs, N.J.: Prentice-Hall, 1963), Chapter 12, "Helping the Alcoholicís Family," pp. 120-32.
In his preparation for helping the family, it is important for the minister to acquire a firsthand understanding of how Al-Anon and Alateen groups function. It is also helpful, for purposes of referral, to become well acquainted with several key Al-Anon members. The most efficient method to prepare oneself in both of these ways is to attend Al-Anon meetings with regularity fot several months. The time and place of nearby meetings can be ascertained by calling the number listed in the phone book for "Alcoholics Anonymous." 5.
Alcoholism as a Family Crisis
It is important for the pastor to have an appreciation of the manner in which the nightmare of alcoholism engulfs an entire family. Joan K. Jackson, formerly a research sociologist, department of psychiatry, University of Washington School of Medicine, did a three-year study of the wives of alcoholics, the results of which are reported in "The Adjustment of the Family to the Crisis of Alcoholism." 6. In this article she gives a picture of the cumulative nature of the family crisis, as it develops from stage to stage.
Stage 1: Incidents of excessive drinking begin and, although they are sporadic, place strains on the husband-wife interaction. .
Stage 2: Social isolation of the family begins as incidents of excessive drinking multiply. The increasing isolation magnifies the importance of family interaction and events. Behavior and thought become drinking-centered. Husband-wife adjustment deteriorates and tension arises. The wife begins to feel self-pity and to lose her self-confidence as her behavior fails to stabilize her husbandís drinking. There is an attempt still to maintain the original family structure, which is disrupted anew with each episode of drinking, and as a result the children begin to show emotional disturbance.
Stage 3: The family gives up attempts to control the drinking. . . . The disturbance of the children becomes more marked. There is no longer an attempt to support the alcoholic in his roles as husband and father. The wife begins to worry about her own sanity and about her inability to make decisions or act to change the situation.
Stage 4: The wife takes over control of the family and the husband is seen as a recalcitrant child. Pity and strong protective feelings largely replace the earlier resentment and hostility. The family becomes more stable and organized in a manner to minimize the disruptive behavior of the husband. . .
Stage 5: The wife separates from her husband if she can resolve the problems and conflicts surrounding this action.
Stage 6: The wife and children reorganize as a family without the husband.
Stage 7: The husband achieves sobriety and the family . . . reorganizes to include a sober father and experiences problems in reinstating him in his former roles. 7.
This developmental scheme is important to the pastor because his approach as a counselor will depend in large measure on what stage of deterioration or reconstruction the family is in when he encounters the situation. He will usually encounter them when they are in Stage 2, 3, or 7. Should it be Stage 1, the family will be absorbed with attempts to deny that a problem exists. In Stage 2, the effort will be to hide the problem from the outside world, coupled with desperate efforts on the part of the family to control the alcoholicís drinking by any and all means. Stage 3 represents family disorganization in which a spouse begins to adopt a "V/hatís the use?" attitude. In Stage 4 the wife, mother, or husband may become protective and masochistic in a way that makes the relationships unhealthy for all concerned, including the alcoholic.
If one omits the happy ending of Stage 7 (which Joan Jackson could include because her study was done in an AA wifeís group), and translates the language of the social scientist into the parlance of everyday living, one has a picture of the starkest interpersonal tragedy. The picture includes the familyís attempt to adjust to a person who lies and is least responsible when he most needs to be, who is unbearably irritable and egocentric, who embarrasses them in front of friends and spoils their holidays by being on a binge, who spends money they need for necessities on whiskey, and who seems completely oblivious to their welfare or their pleadings. The picture includes the dark spiral of drinking, nagging, drinking, remorse, promises, drinking ad infinitum. Fear pervades the entire picture -- fear of violence to herself or the children, fear of loss of family status, fear that others will find out, fear of insanity, fear that she will return home to find him drunk. Sexual relations within the picture, reflecting the interpersonal conflict, are usually very unsatisfactory. Heartbreak hangs over the picture like a dark cloud. In the midst of the chaos and insecurity is the crowning tragedy of what is happening in the emotional life of the children. Into this picture of sick horror the pastor is sometimes able to bring a ray of light.
In one sense, the family crisis of alcoholism is more difficult than a crisis such as bereavement because it is an unstructured crisis. When death strikes a family circle, there are socially prescribed patterns of behavior and feeling which help the persons involved cope with the crisis. Alcoholism, in contrast, is a crisis for which there are no socially structured responses. In this way it is like mental illness and death by suicide. All are forms of social deviation which do not elicit community support of the family. Since most of us do not expect them to happen to our families, we are unprepared emotionally for their rude intrusion. The family response is to feel alienated, baffled, and stigmatized.
Getting Inside the Familyís World 8.
V/hen the spouse of an alcoholic ventures out of hiding, it is important that she 9. experience a high degree of empathic understanding. The more the pastor can feel with her, the more he can share the agony of her inner world, the better are the chances that she will stay out of hiding and in the helping relationship.
Here is a fragment of a pastorís first session with Mrs. John R., a middle-aged parishioner:
Mrs. R.: Iím not sure I should be here talking about this problem, pastor. But Iíve tried everything to help John, and nothing seems to work. He says that his drinking is nobody elseís business, including mine. (Pause) Itís started to affect the older boyís schoolwork. (Pause) I feel I just have to help John, but everything I do seems to backfire and make his drinking worse.
Pastor: It wasnít easy to come, but your situation is getting so difficult you decided you had to seek some help. Iíll be glad to help in any way I can.
Mrs. R.: I thought perhaps you could tell me how to approach John so as to help him see what heís doing to himself and his family. If I even mention his drinking, he flares up and stomps out of the room. I donít think heís an alcoholic, but heís been coming home drunk several times a week lately, and he often canít make it to work on Mondays. One of these days his manager is going to get wise to his excuses.
Pastor: The drinking is getting heavier and affecting his work, but heís so sensitive about it you canít discuss the matter with him.
Mrs. R.: I thought when he changed jobs last fall and got out from under some of the pressure that things would get better. But he seems to be worse. Last night he came in after midnight. First he insisted on waking up the children to give them a bawling out about leaving their bicycles in the way in the garage. Then he got sick and made a mess right in the middle of the living room -- in front of them. Heís home sleeping it off today. I canít understand it -- heís so different. All he thinks about is himself and liquor.
Pastor: Itís hard on you and the children when he is so inconsiderate.
Mrs. R.: Yes, (eyes filled with tears) his temper is terrible when heís drinking, and he seems to pick on the older boy especially. I try to protect him, and John gets furious. (Pause) I try to keep the kids from irritating John, but you know how children are. Whatever I do seems to be the wrong thing.
Pastor: It gets very frustrating when you feel blocked whichever way you turn in trying to help.
Four facets of Mrs. R.ís inner world are evident in these opening statements. First, she communicates some of her feelings about coming for help. It was important for the pastor to recognize and respect these feelings. Otherwise the person may be reluctant to trust the minister with other painful feelings. It usually suffices to say, as this minister did, "It wasnít easy to come."
A second aspect of Mrs. R.ís inner world is her picture of what constitutes her problem. As she now sees it, her husbandís drinking is the problem. Closely related is the question of why she came for help now -- the crisis the night before. The pastor was probably correct in not following the lead presented by her reluctance to apply the label "alcoholic" to her husband. Her understanding of the nature of his problem will be an important goal of subsequent counseling, but the early part of the first interview is not the time to explore or educate. It is the time for the counselor to concentrate on disciplined, intensive listening.
The third facet of her inner world is her picture of the kind of help she needs and wants. Wives are usually at one of three stages when they seek help: (a) "Do something to help my husband." (b) "Help me to help my husband with his drinking problem." (c) "Help me with my problems and those of the children." In my experience, 90 percent are at stages one or two. To Mrs. R., the purpose of counseling is to help her help her husband. She does not think of herself as being in need of counseling for her own sake. Her limited picture of what kind of help she needs is an expression of her frantic desire to change her painful situation and a defense against her guilt. She cannot realize, at this point, that her obsession to help her husband makes her do the very things that allow him to excuse his drinking. Because she feels so responsible and guilty, she will be threatened by even a hint that what she fears is true -- that she is contributing to her husbandís problem and that she is also disturbed and needs help.
Yet Mrs. R. does need help in her own right. She is disturbed, in spite of her façade of competence. Whatever personality problems she brought to the marriage (and these may be great or small) have been magnified tremendously by the family trauma of alcoholism. She needs help with these problems and in coping with the impact of Mr. R.ís drinking. She needs this help for her own sake and for the childrenís sake, whatever Mr. R. does or does not do about his problem. Furthermore, Mrs. R.ís chances of relating helpfully to her husband also depend on her learning to handle her own inner problems more adequately.
The fourth aspect of Mrs. R.ís inner world is her own painful feelings and experiences connected with the family crisis of alcoholism. In his third response, the pastor encouraged her to ventilate these feelings. (A somewhat better response would have been, "It must be very hard for you and the children in such a situation.") This process continued in his fourth (and subsequent) responses. In this way the minister helped her move toward an awareness of her own need for help. If a wife is reluctant to turn in this direction, it is usually because she is sitting on a volcano of explosive feelings which she fears may erupt embarrassingly and expose her as the weak person she feels she is. The façade of self-sufficiency, however, is a burdensome defense. After a tearful torrent of pent-up resentment, fear, and confusion came gushing forth in a dark tide, one wife said: "Iíve felt I had to be so strong because he was so weak. I didnít dare let myself go before." The safety of the counseling relationship had allowed her to relax her defenses.
Through sensitive listening and responding, the minister encourages the wife to ventilate her feelings concerning the private hell in which she has been living. This helps to accomplish four things: (a) Rapport is established through significant communication on a feeling level. She knows that the pastor is with her in her nightmarish problem. As in other counseling, the quality of the relationship is the essence of helping the alcoholicís family. (b) She experiences relief from the pressure of her mountainous burden of negative and frightening feelings. (c) This unburdening enables her to cope with her life situation more constructively. Her anger toward her husband will not distort her relationships with him and the children so severely because she has worked out part of it through counseling. (d) Through sensitive listening, the pastor forms a tentative picture of the nature of the problem. His diagnostic impressions should include his clinical hunches concerning whether he is dealing with true addictive alcoholism or with non-addictive problem drinking. It may be that Mr. R.ís drinking is mainly a response to the pain of a deep, but hidden problem in the R.sí marriage relationship. If so, and if he has not yet lost his ability to control his drinking (become addicted), skilled marriage counseling may allow him to return to moderate drinking by healing the source of pain in the relationship. If the minister suspects, in the light of his discussion with Mrs. R., that this may be the case, he should recommend marriage counseling, though probably not in the first interview. Should R. be addicted (as the initial facts about his drinking seem to suggest), changes in his marriage will either not occur or, if they do, they will not reduce his drinking significantly.
When the alcoholicís or problem drinkerís wife comes to the minister, his first job is to help her and through her, the children. He may never have an Opportunity to counsel with her husband, but she is there in his study pouring out her problem. But she sees her "real problem" as her husband. Somehow she must be helped to make the difficult transition from the role of "helper" to that of one who is also being helped. By gently encouraging her to look at her own feelings and reactions, the pastor can help her become aware of how her own needs as a person are not being met. By allowing her to experience a helping relationship, he may assist her in coming down from her lonely pedestal of "helper" to accept help for herself.
Ascertaining the Alcoholicís Motivation
During the early phases of counseling with the spouse, the question of her husbandís degree of openness to help should receive attention. Obviously the kind of help she needs depends in part on whether or not he can be helped at this point. Equally important, an inquiry about the husband is a way of connecting with the "presenting problem," as seen initially by the wife. If, unlike Mrs. R., a wife does not volunteer information about the husbandís view of his problem, a simple question such as, "Does your husband feel he has a problem with alcohol?" will open up this area. While the wife should realize that wanting help is a precondition to receiving it, she also needs to see that wanting help is usually mixed with a degree of not wanting it.
In sizing up the husbandís motivation, it is wise for the minister to remember that the wife may be unaware of certain of his feelings, because of his defensiveness toward her. If it is possible to see the husband, the pastor may be surprised to discover openness to help which is hidden from his wife. The husband will reveal these feelings to the minister only if he sees the minister as genuinely concerned for him and not primarily as the wifeís representative.
Supportive Crisis Counseling
Suspecting that Mr. R. might be more open to help than Mrs. R. thought, the minister contacted Mr. R. by phone. It should be emphasized that this was done only after receiving permission from Mrs. R. to make the call and say that she had been in for a talk concerning her relationship with her husband, about which she was worried. The minister offered Mr. R. an opportunity to come in for a talk, if he wished to do so. Mr. R. rejected the invitation curtly, saying that he felt they could handle their family problems themselves.
Counseling with the spouse or other relatives of an alcoholic who is not yet open to help, is essentially crisis counseling. Its method should be primarily supportive-adaptive (following the "revised model" described in the last chapter) rather than insight-oriented. Helping Mrs. R. with her problems in coping does not mean attempting to dig for insight concerning the subsurface levels of neurotic interaction with her husband. She is too disturbed by the destructive emotional tornado in which she is living, and too threatened by awful feelings of failure, to look deeply within herself. To try to do one-sided marriage counseling with a drinking alcoholicís wife is something like attempting to discuss the redecoration of his living room with a person whose house is on fire. The living room may need redecorating, but the discussion is ill timed. The realistic and constructive goal of pastoral care with the family of a drinking alcoholic is to help them deal constructively with the runaway family crisis in which they are emotionally entangled.
Just as alcoholism is best approached as a "runaway symptom" (Tiebout), the familyís problem is approached most effectively when seen as a runaway adaptation to the crisis of alcoholism. As in the case of alcoholism, the very mechanisms which came into being in response to the crisis tend to intensify it. For example, the family increasingly isolates itself, as alcoholism develops, in an effort to protect itself from social disapproval. But this very isolation produces intense feelings of alienation and even greater fear of "what others will think." Supportive-adaptive counseling aims at reversing this out-of-control adaptive mechanism which has become maladaptive to the familyís coping with the crisis. They are cut off from supportive and perspective-giving relationships with friends and relatives, at precisely the time they need them most. By encouraging the family to reestablish social relationships -- with Al-Anon, Alateens, and with the fellowship of the church -- the pastor can help them interrupt the vicious cycle of isolation, at the same time he helps them increase their supply of interpersonal satisfactions.
The supportive-adaptive approach is based on the premise that there are only certain kinds of "insights" that a person in crisis can use. In the case of Mrs. R., these include an understanding of the nature of alcoholism (as it eventually became clear that Mr. R. is an alcoholic), the futility of her attempts to coerce him to stop drinking, and the importance of her changing her assumption that any improvement in the family situation is totally dependent on his sobriety.
One important aspect of supportive crisis counseling is to help the wife cope with the pressing practical problems that face her and threaten to overwhelm her. Enabling her to handle acute problems constructively will usually help her to reassemble her shattered self-confidence. By assisting her in reducing the pressures of her external situation, her inner crisis is lessened and her resources for coping released. As one wife put it, "I feel that my head is above water and I can swim now, even though Iím still in the whirlpool."
This phase of counseling often is closer to first aid than basic therapy. But, as in a battle or accident situation, first aid sometimes can be a life-and-death matter. Even when it is not, it may save the person from much suffering and prepare him for other therapies.
V/hen Mrs. B., a woman in her early thirties, phoned, the pastor sensed that he must arrange to see her at once. In the interview, he learned that Mr. B. had become increasingly destructive and violent during his sprees in recent months. The day before, his cruelty toward his wife and children had included brandishing a gun in a threatening manner. Mrs. B. was nearly paralyzed with fear and indecision. The minister saw his role as that of helping her face the implications of what she already knew -- that she and the children were in a dangerous situation. As she began to think more clearly, with the support of the ministerís understanding, she was able to examine the alternative courses of action, as she saw them. She finally decided that a legal separation, coupled with moving temporarily to a relativeís home in another city, was the safest approach.
The spouse often needs such help in making decisions and in planning direct action to meet practical problems realistically. Effective counseling often involves referral to specialized community agencies which complement and supplement what the minister is equipped to bring to the situation. The counselor needs to know the mental hospital commitment procedures in his state to help the family of an alcoholic with severe mental disturbance. But he will also need to help the family see commitment as a step toward rehabilitation rather than a "betrayal" of its loved one.
Where there is no immediate danger to life and limb, it is wise to encourage the spouse to postpone a decision about leaving her husband until she has had an opportunity to get a broader perspective on her situation through counseling. It is well to remind a wife who faces cruelty that no one really has to put up with such behavior. When an alcoholic understands that his wife means business about calling the police or taking other direct action, he will usually desist (unless he is psychotic or has a severe character disorder).
Knowing and Facing the Facts
If the wife is to halt the runaway family crisis, it is essential that she become acquainted with the facts about alcoholism. The educational phase should begin in the second half of the first interview or as soon as the minister is reasonably sure that he is dealing with alcoholism. The wifeís understanding of alcoholism provides a solid foundation for realistic decisions and attitudes on her part. The matter can be introduced by saying, "It will be helpful to you in handling your situation to learn all you can about the problem." A primary goal in exposing her to the facts about alcoholism is to help her accept the fact that her husband is suffering from a compulsive-addictive illness of which she is not the basic cause. The sickness conception, if accepted, has tremendous guilt-reducing potential. It is not easy for most families to accept this conception as applied to one of their members. It seems to be a blow to the familyís self-image to think of one of their number as an "alcoholic" and as one who is not fully in control of his behavior. The counselorís task is to help them work through their emotional resistances to accepting what is, for them, a distasteful fact.
When the family comes to face the fact that their member has a chronic, progressive illness, they will be in a position to insulate themselves to a degree against some of its destructive effects. (As long as they cling to the futile hope that "maybe heíll lick it by himself this time," they are vulnerable to bitter disappointment.) Acceptance of the facts will prepare them to relate to the alcoholic in ways that may eventually contribute to his becoming open to help.
Certain kinds of knowledge are especially useful to the family. For example, it helps to know that the alcoholicís almost unbearable egocentricity and dishonesty are really desperate attempts to cope with deep feelings of chaos, fear, and worthlessness. As one wife said, "It takes some of the sting out of his obnoxious behavior." Knowledge that his symptoms such as blackouts, nameless fears, and secretive drinking are common among alcoholics often has a reassuring effect. To know that alcoholism is incurable but highly treatable is important in that it revives realistic hope. The pastor should acquaint the family with AA and other treatment resources that are available so that, if and when the alcoholic becomes open to help, they may know how to proceed. Timing is important, and the family, being on hand, can sometimes be the key if they are alert for an opening on the alcoholicís part and know the resources for help. A visit to an open AA meeting may help to prepare the family to contribute to his rehabilitation through understanding.
The sickness conception should not be presented too early in the first interview, since its effect may be to cut off the wifeís catharsis of resentment and anger. The danger that this conception will stimulate the wifeís maternal impulses leading to pampering can be minimized by frank discussion of the danger. When a counselor raised the question of possible overprotection, one wife responded, "After all, if Frank had pneumonia, I would make all kinds of allowances for his actions." To counter this faulty analogy, the pastor can point out that alcoholism (and other emotional illnesses) is different from pneumonia in that one of the surest ways of keeping the person from becoming open to help is to reward his illness by pampering him.
At the close of the first interview, the educational phase of the counseling can be expedited by lending the wife one of the books or pamphlets listed earlier, or a copy of Alcoholics Anonymous. 10. New windows of understanding often open between sessions. The person may return with a comment such as, "I feel as though I have a solid foundation under my feet for the first time. Things are beginning to make sense."
"Releasing" the Alcoholic
As suggested in Chapter 9, the most salutary thing the wife of a drinking alcoholic can do is to "release" him. A member of Al-Anon said, "When I got out of the driverís seat, it took a terrific load off of me." She told how her determination to get her husband sober had become a passion into which she had poured herself. The more she failed, the more frantically and obsessively she tried. Somehow her sense of worth as a person had become bound to her husbandís sobriety. He sensed this, and it gave him tremendous power over her. Finally, after years of futile struggle, she gave up, accepting the fact that nothing she could do could make her husband get sober. In a real sense, she "hit bottom" and "surrendered." For the first time in years, she felt a sense of inner serenity. (There is a remarkable parallelism between this kind of experience and the surrender experience of the alcoholic.)
Facilitating this kind of surrender is a major goal of pastoral care of the alcoholicís spouse. This surrender invariably produces beneficial results in the lives of the wife and children, insulating them emotionally from much of the destructiveness resulting from the alcoholicís drinking. Frequently it produces a positive turning point in the alcoholicís openness to help. One wife reported:
"My husband told our minister that he had to join AA to figure out what had happened to me in Al-Anon." What had happened was that she had succeeded in releasing her husband.
Releasing the alcoholic means letting go of him emotionally, giving up all attempts either to control his drinking or protect him from its consequences. A wife is able to release him because she has had a surrender experience and because she recognizes the futility of her attempts at control. She has, in effect, cut the power which he had over her by no longer needing or attempting to control him. The change in her responses to his behavior often shocks the alcoholic by changing the interdependency pattern in their relationship. Her surrender may hasten and facilitate his surrender.
The alcoholicís psychic economy often depends on perceiving his wife as a mother figure. The more he regresses into alcoholism, the more he needs to keep her in that role. He sees her less and less as the "good mother" who gives and cares for him, and more and more as the "bad mother" who controls and deprives. This seems to him to justify his angry drinking. By thus attacking her, he maintains his grandiose illusion of self-sufficiency. The more the wife attempts to "help" him, the more she reinforces his conviction that she is a bad, controlling mother. When she is able to release him, this neurotic interaction pattern is interrupted. He is deprived of his method of avoiding responsibility for his behavior by blaming his wife.
Put in terms of Eric Berneís structural and transactional analysis, what is interrupted by the wifeís release is a Parent-Child game. 11. The wife gives up parenting her husband, which upsets his half of the game. Often he will try frantically to force her back into the parent role by acting even more irresponsibly. An insightful portrayal of the dynamics of an alcoholic marriage was in the movie Country Girl, which many readers may recall. It showed clearly the manner in which each person fed the neurotic needs of the other. The alcoholic, being immature, craved mothering. The wife, having a dominant, protective personality, fell naturally into the mothering role. The more she accepted the responsibility for running the family, the more dependent and irresponsible he became, as well as resentful and alcoholic. The more irresponsible he became, the more she felt she had to manage everything for the family. Thus a vicious, self-perpetuating cycle developed.
The general principle which should guide the family is this: Avoid both punishing and pampering. On the one extreme, some families make the mistake of attempting to coerce the alcoholic by continual threats and recriminations. This succeeds only in giving the alcoholic an additional rationalization for his drinking. By taking the nagging, punishment approach, the family only brings more suffering on itself. Tactics such as pouring the liquor down the drain or hiding it from the alcoholic are forms of parenting which are no more effective than trying to hide all water from one with a hand-washing compulsion. The alcoholicís craving is so powerful at times that nothing short of actual incarceration will keep him from getting alcohol. Furthermore, he responds to parenting attempts to control his behavior with childish rebelliousness which produces increased drinking.
An even greater error, at the other extreme, is protecting the alcoholic from the painful consequences of his drinking, which is a form of "cruel kindness." In such cases, the pastorís greatest service is to help the wife discover the specific ways in which she is coddling the alcoholic, often without realizing it. The way to do this is by examining in detail a particular drinking crisis and how she responded to it. By "withdrawing the props" which protect him from reality, she may help him to hit bottom and become open to help. The pattern of overprotection is difficult to break because the spouse is usually protecting herself, the children, the family reputation, and perhaps the family income, as well as the alcoholic. She reasons: "If I donít take care of him, heíll cause me more embarrassment, heartache, and expense." It is not until the wife realizes that as long as she protects him from the consequences of his behavior, he will have little incentive to accept help, that she may be willing to release him in this way. Seeing release as an act of concern rather than rejection may also help her release her husband. Furthermore, it is important for her to see that this may be of help in protecting her children from the worst emotional damage of their fatherís illness.
The book Alcoholics Anonymous contains an example, written by the wives of early members, of how a wife might avoid overprotecting the alcoholic:
Frequently, you have felt obliged to tell your husbandís employer and his friends that he was sick, when as a matter of fact he was tight. Avoid answering these inquiries as much as you can. Whenever possible, let your husband explain. Discuss this with him when he is sober and in good spirits. Ask him what you should do if he places you in such a position again. 12.
The pastorís goal in counseling with the family is to encourage any tendency in them, however weak, to make the alcoholic face the reality of adult life and of his drinking. In order to be helpful, the family must be firm with the alcoholic, walking the middle ground between recrimination on the one hand and pampering on the other. This is something like walking a tightrope, and they will need all the help they can get both from the pastor and from Al-Anon. Walking the middle ground is possible only if the spouse has released the alcoholic to an appreciable degree and resists the temptation to slip back into the mothering role.
It is possible for the minister unwittingly to block rather than facilitate the wifeís release of the alcoholic. In the play The Pleasure of His Company by Samuel Taylor and Cornelia Otis Skinner, Mackenzie Savage is asked by his daughter, "You were never very happy with mother, were you?" He replies, "Your mother was a saint who made our home an outpost of heaven. Itís why I spent so much time in saloons." The message of this fictional fragment -- that behind the alcoholic is a wife who subtly "drives him to drink" -- is a common theme in the folklore of our culture. It is a feeling that both the minister and the alcoholicís spouse (as well as the alcoholic) have somewhere within them. The ministerís knowledge of certain research findings may confirm this feeling for him. In her review of the professional literature on alcoholism and marriage, Margaret Bailey concludes: "Most students of the problem have found in some or all of their cases this interactive pattern of the dependent, inadequate alcoholic male married to a dominating woman who is usually seen as maintaining a semblance of adequacy only at his expense." 13.
The effect of this influence on the minister is to tempt him to make the focus of counseling the wifeís hidden neurotic needs which allegedly find satisfaction in the husbandís continued alcoholism. This approach tends to block rather than facilitate her releasing of her husband. She already suspects that she is somehow driving him to drink. For the minister to imply that she has unconscious needs which contribute to his drinking increases her guilt and her frantic, futile struggling to change things or change her husband so that he wonít drink as he does.
There is little doubt that some wives find neurotic satisfactions in being married to weak, dependent, drinking alcoholics. One study showed that when marital bonds are dissolved by death or divorce, the wives of alcoholics frequently marry another alcoholic. 14. Some wives of alcoholics hold tenaciously to their masochistic, martyrish, controlling postures. I recall one case where separation from the alcoholic husband was clearly indicated in order to protect both the wife and the children from physical and emotional harm. The wife consistently refused to consider leaving him. Her reasoning was simply, "How would he get along without me? Someone has to take care of him when heís drunk." In some cases the spouse or parents of an alcoholic justify overprotective behavior on religious principles -- "going the second mile" -- failing to see that such cruel kindness is anything but redemptive in its effects. Various psychological studies have shown that the presence of a mothering figure in his immediate interpersonal world is one of the most characteristic aspects of the alcoholicís picture. This is often the most difficult factor in helping the alcoholic, and it may be the key to helping the family help him. If the wife of the alcoholic derives satisfactions from her power as head of the family while he is drinking, she will have ambivalent feelings about his getting sober. In extreme cases, wives of alcoholics have developed psychosomatic or psychological illnesses after their husbands achieved sobriety.
Being alert to the possibility that some wives may attempt to sabotage their husbandsí sobriety does not mean that one should use this as a general approach to helping the family. There are tremendous differences among alcoholics, their wives, and their marriages. For many wives, factors which militate against the husbandsí sobriety are either practically nonexistent, or they are offset by other needs for strength in their husbands. Let us assume that a particular wife does have self-punishing and controlling tendencies which contribute to her mothering behavior with the alcoholic. Focusing on her neurotic tendencies or .searching for their causes will usually make such a person guiltier and more anxious, and therefore more self-punishing and controlling. This will make releasing her husband more difficult for her. To be able to release him, she must be helped to feel less responsible and guilty, not more so. If she can release him, the influence of her neurotic tendencies will be neutralized to a considerable extent; this is because the neurotic interaction which strengthens these tendencies will be interrupted.
As studies by Joan Jackson have shown, the personality disturbances of many wives come directly from the runaway crises in which they are caught. In counseling, the minister should proceed on the assumption that the wifeís disturbance is the result of the crisis. What appears to be a marked personality disorder may clear up as the husband gets treatment or the wife neutralizes the impact of his behavior by releasing him. In any case, it is therapeutically unproductive to try to correct deep inner problems in the midst of a crisis.
Here are some implications of this approach, by way of summary: (1) Focusing on why the wife married an alcoholic or a potential alcoholic is definitely contraindicated. This kind of awareness is available only through long-term psychotherapy in depth. Her crisis will be intensified, in most cases, by attempts to search for such insight. (2) It is equally unwise to encourage her in her futile search for the magic key to handling her husband so as to stop his drinking problem. This is parenting, and the opposite of release. The futility of the "home treatment" -- pleading, threatening, moralizing, coercing, nagging -- should be emphasized. (3) The counselor should emphasize the medical nature of the problem of alcoholism, pointing out that if her husband had diabetes she would not feel an obligation to cure him. This approach often helps reduce her exaggerated, unrealistic, and unproductive sense of responsibility for her husbandís drinking problem. By reducing her irrational guilt, it can help her release him. (4) The counselor should describe the meaning of "releasing" and help her work though the feelings of guilt and inappropriate responsibility that keep her from moving in this creative direction. He can point out that release does not necessarily mean separating from the alcoholic, since it is a psychological process, although in some cases it may be well-nigh impossible without a separation. (5) The pastor can help the wife discover ways in which she can make real progress in handling her problems, in spite of the husbandís continued drinking. At the same time she is told that she canít do anything to reform her husband, she must be helped to see that there is something very important that she can do: to work on her own attitudes and problems in living. After she has released the alcoholic and gained some sense of serenity, usually she will begin spontaneously to look into the adequacy of her own life as a person.
Developing the Familyís Maximum Potentialities
A vital ingredient in the release process is the refocusing of the spouseís energy on increasing the adequacy of her own inner life and of her relationships with her children and friends. In order to do this, the wife must have relinquished her assumption that any improvement in the family is dependent on her husbandís achieving sobriety. Her holding to this assumption, in effect, makes it true. Only when she lets go of it and begins to develop her own potentialities and those of the family does she discover its fallacious nature. The Big Book of AA recommends to wives of still-drinking alcoholics:
Be determined that your husbandís drinking is not going to spoil your relation with your children or your friends. They need your companionship and your help. It is possible to have a full and useful life, though your husband continues to drink. We know women who are unafraid, even happy under these conditions. Do not set your heart on reforming your husband. 16.
Developing her own potentialities as a person helps to make life more satisfying and her self-esteem more robust. Both of these factors help make it possible for the wife to function more adequately as a need-satisfying parent. They also help her to tolerate the inevitable frustrations of her husbandís drinking and the inadequacy of the marriage.
The long-range role of the church in this process can be vitally important. Once the minister has helped the family over the crisis stage, his function broadens from pastoral counseling to the more inclusive function of pastoral care. He maintains a steady, dependable relationship which helps to sustain them through what may be an extended period of time before the alcoholic becomes open to help; this makes the minister readily available for additional counseling when crises recur. Much of the sustained-supportive ministry to the family is provided by the corporate worship and group life of the church. The pastor should encourage the family members to find group relationships that are satisfying to each of them. If a pastoral care team 16. has been selected and trained by the minister, these laymen can be invaluable allies to him in providing the ongoing supportive ministry to the alcoholicís family. Certainly every team should include at least one male and one female Al-Anon member. These persons will have a special entrée to the alcoholicís family and can therefore be of help in relating the family to both the church and to Al-Anon.
Abundant Use of Al-Anon
Early in the counseling relationship with the alcoholicís spouse, the minister should recommend that she visit the local Al-Anon Family Group. Helping her work through her fears and resistances to attending Al-Anon and then arranging, with her permission, for a stable Al-Anon member to take her to a meeting are strategies for helping her to relate to this excellent helping resource. Attendance at Al-Anon should parallel pastoral counseling in most cases. It is, for the family member, what AA is for the alcoholic. In order to coordinate these parallel therapies, the pastor should take an active interest in her Al-Anon experiences.
There are now over three thousand Al-Anon groups with more springing up each month. "Purposes and Suggestions for Al-Anon Family Groups," published by the Al-Anon Family Group Headquarters, describes the groups as follows: "The Al-Anon Family Groups consist of relatives and friends of alcoholics, who realize that by banding together they can better solve their common problems. Both before and after the alcoholic joins AA, there is much that the families can do to help the alcoholic, and themselves." The primary focus of the groups is to encourage each person to apply the Twelve Steps of AA to his own problems in living. Any two or three relatives of alcoholics can start a Family Group. Most groups begin in the living room of the wife of an AA member and are conducted somewhat like AA closed meetings (for instance, centering on the discussion of how one of the Twelve Steps has helped or might help the persons present). The groups follow the principle of allowing no criticism of an alcoholic partner in the meetings. Instead, newcomers are encouraged to make friends with more experienced members with whom they can discuss their personal difficulties in private.
The Al-Anon group can serve a valuable function both before and after the alcoholic is in AA. Fellow Al-Anon members give massive emotional support to the wife during the lonesome, dreary days when the alcoholic refuses help. They have the special empathy of those who have "lived in the same squirrel cage." Like AA members, they are bound together by the common crisis through which they have all gone or are going. Al-Anon participation will bring the wife out of her lonely, frightened shell and help her to a feeling-level acceptance of her husbandís illness. It will encourage those attitudes which make possible her surrender and the emotional release of her husband. (The term "release" was coined by Al-Anon members out of their experience.) Her fellow members will help her identify the subtle ways in which she is overprotecting her husband; they will help her learn how to handle all sorts of practical problems by sharing their own experiences. Participation in Al-Anon will stimulate personal growth and self-awareness through the application of the Twelve Steps to her own life. After she has released her husband, she will be able to look at her own life and the changes she needs to make in the marriage without its stimulating inappropriate guilt and controlling behavior. The Twelve Steps will assist her in maintaining her release of her husband -- through the first step in which she admits she is powerless over his use of alcohol. Most important, practicing the Twelve Steps in Al-Anon will help her find spiritual resources, through relationship with a higher Power, which she will need in coping with her problems in living and her existential anxiety.
How the Family Can Help the Alcoholic Accept AA
For a wife to nag her husband to go to AA is an almost foolproof method of keeping him away. Because of the hostility in their relationship, resulting in his need to thwart her, she has given him another reason for not going. Even if a wife is successful in getting her husband to AA under duress, the chances are that he will not "get the program." In fact, most of the interviewees, in my study who had had a time gap of more than a year between contact with AA and active participation in it were those who had been pushed in by well-meaning but misguided relatives.
A wife or other relative often can help the most by keeping a hands-off attitude or by working indirectly. Clifford Earle gives an example of how this was done in one case:
A lawyer whose wife showed unmistakable signs of alcoholism included several AA pamphlets and other suitable literature in a stack of papers on his desk at home. Then he had his secretary phone her for information she could get only by going through the things on her husbandís desk. In this way he was able to get her to read selected literature on alcoholism that she would have resented and rejected if he had given it to her directly. The method was devious but successful. 17.
The technique of leaving AA literature around where the person will find it, without making it seem that it was planted, is a subtle way of informing him concerning the help that is available, without threatening his ego. Some pamphlets which are useful for this are: "Is AA for You?" "This Is AA," "AA, 44 Questions and Answers About the Program of Recovery from Alcoholism," "Medicine Looks at Alcoholics Anonymous," "AA for the Woman," "Young People and AA." All are obtainable from a local AA group or from the General Service Office of AA, 305 East 45th Street, New York, New York 10017.
If an alcoholic has a trustful relationship with his physician, it is sometimes possible for the family to enlist his help in getting the alcoholic to AA. The family members may describe the problem, as he sees it, to the doctor and ask if he would broach the subject with the alcoholic, should the opportunity arise. This approach is effective only if the doctor is favorably disposed toward AA.
The use of any indirect method should be considered only if a frank, aboveboard approach has failed or is nearly certain to fail. The weakness of indirect methods is that they are manipulative. Even if such a method does not backfire (as it will if the alcoholic discovers what is occurring), it tends to compromise the openness and mutual trust that should characterize marriage and family relationships. The fact that such a method is used usually indicates that such trust and openness do not exist in the relationship. The question that must be asked in such cases is whether the end (getting the person in contact with AA) justifies the means.
The familyís fundamental contributions to helping the alcoholic accept help from AA or any other treatment resource consist of releasing him, as described previously, and of accepting the sickness conception themselves. A psychiatrist, speaking at the Yale Summer School of Alcohol Studies, declared: "Iíve very seldom convinced an alcoholic that he has a disorder until I have convinced the family that he has a disorder." 18. Until the emotionally significant people in his life accept the sickness conception and apply it to him, it is difficult for the alcoholic to do so. Until he does accept it, he is unlikely to become open to the kinds of help he needs.
There is, of course, no reason why the spouse should hide her desire that the alcoholic get help. A part of the firmness of attitude, which is neither pampering nor punishing, is the attitude on the familyís part that lets him know that they expect him to get treatment and what will happen, as far as they are concerned, if he does not. This should be done without nagging and certainly without empty threats. The tone should be that of holding up reality, emphasizing particularly what steps the family intends to take if the alcoholicís self- and other-destructive behavior continues. In this way the spouse and other family members can exert a steady pressure on the alcoholic to accept treatment. Unless the marital relationship is thoroughly disintegrated, such reality pressure can help to motivate the alcoholic. This is an additional source of pressure, along with the pressure that results from external circumstances to which the alcoholic is exposed when the family stops "covering" for him.
A discussion which may prove helpful to a person who is attempting to interest a mate in AA is that written by the wives of the first hundred AAís. Derived as it is from their experiences, it includes many practical suggestions as to how one may approach alcoholics who are in different stages of the illness and who have varied attitudes toward getting help. This discussion is in Chapter 8 of the AA book and is entitled "To Wives."
Helping the Family During Treatment
The attitudes and behavior of the wife can constitute either a barrier or a bridge to sobriety for the alcoholic who is in the early stages of treatment. The counselorís goal is to help her make these attitudes a bridge. He can do this in several ways. First, the wife who has not been in contact with Al-Anon prior to her husbandís entry into AA should be encouraged to affiliate with Al-Anon and to attend open AA meetings with her husband. This will help her understand the AA approach and support his striving for sobriety. Second, the pastor can sometimes help the wife by interpreting what is happening in the particular treatment program (AA or otherwise) in which her husband is receiving help. Third, the pastor can emphasize the importance of letting him make the decisions concerning what shall be told friends and neighbors about his problem. Closely related is the importance of not attempting to "protect him from temptation," which, like other forms of overprotection, usually backfires. He must learn to live in a world where liquor is available. It is unrealistic for the wife to believe that she can really protect him in this way, and, more important, the recovering alcoholic usually resents being treated in this manipulative and sub-adult fashion.
If the pastor senses that a wife is unconsciously blocking her husbandís attempts to get help, he has the difficult task of trying to help her see what she is doing. I recall one wife who consistently planned for her husband to do something else on the night when AA met in their town. This was in spite of her conscious eagerness for him to achieve sobriety. It was not until her unconscious sabotaging was explored and diminished that she was able to support his participation in AA.
The pastor should stay close to the entire family during the early stages of treatment for other reasons also, including supporting them if the alcoholic slips. By helping the spouse understand the uphill struggle her husband is going through, he will enhance her appreciation of his progress and cushion her disappointment at the occasional setbacks. Emphasizing the importance of patience has a salutary effect on the family. It can be pointed out that it took the husband an extended period of time to develop his addiction and it may require several years for him to achieve stable and productive sobriety. The AA motto "Easy Does It" is good advice for the family.
The "suggestions for newcomers" in an Al-Anon brochure can be used by the pastor with families of alcoholics. Here are some of them:
Remember that the alcoholic is an emotionally sick person. Try to stop nagging and causing scenes.
Take a personal inventory of your own faults and make a sincere effort to overcome them.
Try to learn all you can about AA and alcoholism.
Cooperate actively with the alcoholic in his or her AA work. But do not push. The alcoholic has a far better chance when the family really understands and follows along.
Be gracious about the alcoholicís closed meetings and 12th Step work. To overcome the alcoholic obsession will require an equally strong AA obsession.
Some alcoholics are much sicker than others. Donít be discouraged if progress is slow. The AA seed has been planted. Growth is slower in some soils than others.
When AAís assume an attitude of superiority, donít be dismayed. This is a perfectly natural reaction from their previous tragic inferiority . . . spiritual growth usually levels off this attitude. Then real partnership becomes possible, for there will be neither superiority nor inferiority.
Above all donít expect too much too quickly. Because of distorted relationships, directly or indirectly resulting from drinking, both you and your AA partner will have many personal problems to solve.
Finally, have faith in the AA member of your family. The AA program has been successful in thousands of cases. So it can be in yours. 19.
The Family After the Alcoholic Is Sober
If all the troubles in the family of an alcoholic were the direct effects of alcoholism, it would be reasonable to assume that, given a certain period of time after sobriety, most of these troubles would disappear. As a matter of fact, they often do not, and the pastor does well to keep close to a family even after the alcoholic member has achieved sobriety. It may be that he will be able to render valuable help during period of readjustment.
We have already mentioned the wifeís personality problems as one cause of interpersonal difficulty when the husband is sober and attempting to assume the normal role of an adult male in the family. On the alcoholicís side of the problem is the fact, emphasized by sociologist Selden D. Bacon, 20. that the same kind of personality problems which tend to make one susceptible to alcoholism also give rise to marital discord. Merely removing the inebriety does not solve these problems. Rather than thinking of the problems of an alcoholic family as entirely the effects of alcoholism, it is well to remember that an inadequate marital adjustment can be as much a cause as an effect of inebriety. For example, the immature male who cannot accept the demands of his role as husband and father, may retreat into alcoholism to escape the anxiety of adult responsibility. His inadequacy and the attendant problems are aggravated by alcoholism, but the basic problems are there when inebriety is removed.
All this makes it doubly fortunate that AA is, in a real sense, a family program. Long before there were Al-Anon Family Groups the wives of AA members were taking an active interest in the program. Beginning with Lois W., wife of co-founder, Bill W., AA wives have shared the sense of belonging and the resultant re-socialization of the AA group. Very early they realized that they could well apply the Twelve Steps to themselves. In the chapter "To Wives" in the original edition of the Big Book, the wives of the first hundred AAís wrote to the wives of other alcoholics: "If God can solve the age-old riddle of alcoholism, he can solve your problem, too." 21. The husband and wife who together try to live the AA program will have a great advantage in the business of solving their family problems. One of the valuable functions of the Al-Anon Family Groups is that of giving wise counsel concerning the problems of adjustment after sobriety. Further, these groups fill an important need by helping to re-socialize the mate, giving her a strong sense of belonging similar to that provided by AA. This is especially important for, as the Family Group brochure puts it, "When your alcoholic partner goes on AA business, Family Group activities will cure that lonely and left-out feeling."
One of the most helpful descriptions of the marital problems that beset the alcoholic family after sobriety and how they can be met, is in the Big Book, Chapter 9, entitled "The Family Afterwards." The pastor who has occasion to counsel with such a family will do well to read and absorb the insights of this chapter which was written by alcoholics.
This chapter suggests, among other things, that the family may be helped in its readjustment by establishing or reestablishing their connections with a religious organization. By encouraging the family who have gotten away from the church during the nightmare of alcoholism to reenter the Christian fellowship, the pastor can render valuable service to them and to his church. He can help them try their new social wings in a non-alcoholic circle and can put them in touch with all the resources and opportunities for service represented by the church. On the other hand, as the Big Book puts it, in discussing the alcoholic who returns to church, "He and his family can be a bright spot in such congregations. He may bring new hope and new courage to many a priest, minister or rabbi." 22. All this is contingent on the willingness of a congregation to accept an alcoholic and his family into the fellowship, without reservations. Sad to say, this is not always the case. But where it is, the pastor will find that a vital resource for helping the families of alcoholics is very near at hand -- in his own church.
If involvement in AA, Al-Anon, and the church program do not suffice in helping the alcoholic and his wife make the marital adjustments which will undergird productive family life, the pastor should help them obtain marriage counseling. If he is trained in marriage counseling and has the time to invest in this function, he may decide to offer his help to them. If not, his role is to help them find a competent marriage counselor. One of the most encouraging methods of helping alcoholics and their spouses with marital problems is that of group marriage counseling in which five or six couples meet under the leadership of a group counselor or, in some cases, two co-counselors. 23.
Helping the Children of Alcoholics
In its advanced stages, alcoholism crushes the interpersonal relations of family life like a heavy boot on a delicate spider web. It is in the intricate interdependencies of the family that the agonies of alcoholism are devastatingly felt. Family life is the most intimate and therefore the most demanding of all human relationships. The very qualities which make possible a growth-producing family -- tenderness, compassion, emotional maturity in parents -- are in short supply or are early casualties of the illness of alcoholism. It is not surprising, therefore, that few, if any, children of alcoholics escape without emotional scars. The dependable supply of emotional nutrition which children need to grow strong, resilient personalities is not available in most alcoholic families.
The damage to the children varies, depending on a number of factors -- the strength of the nonalcoholic parent, the age of the child at the onset of the most destructive phases of the illness, the nature of the relationship with the alcoholic parent, and the social class level of the family. On this last point, middle-class, status-seeking families seem to be disturbed the most deeply by parental alcoholism. In families where the father is the alcoholic and the mother has received help, damage can be minimized. Where the mother is the alcoholic, damage is often deep. One husband told of the response of his young son to finding his mother in an alcoholic stupor. He said, "Mommy is dead." Emotionally, she was dead to him, in that she was non-giving and non-available to him when he needed her. The childís involvement in the husband-wife conflict was reflected in these words to his father: "We donít like Mommy, do we?"
There are at least four factors in the alcoholic family which are disturbing to children and teen-agers: 24.
1. The shift and reversal of parental roles in an unpredictable and confusing way is the first factor. When the father is drinking, he abdicates his parental role which is taken over by mother. This distorts her functioning in her unique role as mother. During periods of sobriety, the whole family tries to adjust. The lack of a strong male with whom a son can identify and thus achieve a sense of his own emerging maleness is a serious deficiency. The same can be said for the lack of a male figure who is both loving and strong with whom a daughter can discover a sound way of relating to males. When the mother is the alcoholic, the identity problems are reversed, and they are compounded by the limitations of the alcoholic motherís ability to give to her children.
2. The inconsistent, unpredictable relationship with the alcoholic is the second disturbing factor. The alcoholic may be alternately cold and rejected, and sentimentally overindulgent for reasons that are not apparent to the child. Attempts by the child to grasp the pattern of how to relate to the parent so as to obtain the security, approval, and affection he needs are continually frustrated by the unpredictable nature of the alcoholicís responses.
3. The nonalcoholic parent is unable to relate in a need-satisfying way with the child because of her disturbance. The wife is obsessed with her husbandís drinking and filled with fears which make parenting roles very difficult. Her own needs are not being met in the marriage, thus leaving her lonely and frustrated. This makes it increasingly difficult for her to satisfy the emotional needs of her children. One response to loneliness may be to exploit the children by attempting to derive emotional satisfactions from them which she should be getting from the marriage. She may unwittingly use the children in her struggle with the husband. Divisive alliances -- mother-son vs. father-daughter -- are frequent and damaging to the emotional health of the children.
4. Increased social isolation of the family is the fourth factor. The family turns in upon itself; interaction is too intense. The family loses the supportive relationships with friends and community which are so vital to its health. Family morale rises and falls with the alcoholicís drinking behavior. The childís peer relationships are distorted or eliminated. He feels, "I canít bring my friends home because Dad might be drunk and embarrass me in front of them." He may withdraw from peer relationships in an effort to protect himself from the discovery by his peers of the family stigma. The more the family turns in upon itself, the more its problems feed upon themselves and grow.
What can the minister do to help the children? The most important way of helping the children is by helping their parents. Even if the alcoholic parent resists treatment, the nonalcoholic spouse can, through the approach described in this chapter, change the emotional climate of the home and make her relationship with the children more need-satisfying.
In addition, the pastor can do these things to provide direct help to the children: He can encourage them to stay actively involved in the church school and youth groups within the church, resisting the temptation to withdraw into protective but harmful isolation. Church school teachers, adult advisors to the youth groups, or youth within the groups can be enlisted as allies in the effort to surround the children of alcoholics with a supportive network of relationships. This must be done without breaking the confidences which the family may have with the pastor about the nature of their problems.
The minister can encourage the adolescent sons and daughters of alcoholic parents to participate in an Alateen group. These groups help the teen-ager to understand the nature of his parentís illness, to experience the group support of peers who share many of the same problems, and to apply the Twelve Steps to their own problems of living in an alcoholic home. The opportunity to talk openly about painful experiences that were formerly kept in secrecy surrounded by feelings of shame has an unburdening effect; feelings of self-confidence are strengthened by group acceptance. In these and other ways, Alateen groups do for the adolescent what AA does for the alcoholic and Al-Anon does for the spouse.
If the children show signs of serious disturbance -- . -- either the inward retreat of withdrawal or the outward attack of aggression and delinquency -- the minister should recommend and assist the parent in obtaining professional help for the children at a child guidance clinic. If the alcoholic is still drinking, the nonalcoholic spouse may have to handle making these arrangements; but certakily the alcoholic should be informed that his children are disturbed and why. If the family is intact, it may be that some form of conjoint family therapy 25. will prove to be the most efficient way of helping the disturbed child by alleviating the disturbance in the total family of which the childís problems are expressions. Marriage counseling for the parents, conjoint family therapy for all the members of the family, or psychotherapy for the disturbed child and the parents at a child guidance clinic -- all these can be effective ways of healing the emotional wounds suffered by children in the chaos of the alcoholic home.
A final way in which the clergyman can help the children is by establishing a strong, accepting relationship with them himself. This does not require large investments of time, in most cases. What is required is for the pastor to be interested in them and to express warmth and caring in his contacts with them. Such relationships between a pastor and children can have a qualitative meaningfulness, on both sides, that far outweighs the investment of time. To the extent that a relationship of this kind helps satisfy the childís need for stable, loving adult identity figures, it is a long-range investment in the childís future mental and spiritual health.
I. Jerome Ellison, "Help for the Alcoholicís Family," The Saturday Evening Post, CCXXVIII (July 2, 1955), 48. Used by permission of the author.
2. Marty Mann, New Primer on Alcoholism, p. x.
3. Joseph Hirsch, The Problem Drinker (New York: Duell, Sloan and Pearce, 1949), p. 111.
4. S. Futterman, "Personality Trends in ĎWives of Alcoholics," Journal of Psychiatric Social Work, XXIII (1953), 37-41; T. Whalen, "Wives of Alcoholics. Four Types Observed in a Family Service Agency," QJSA, XIV (December, 1953), 632-41; S. D. Bacon, "Excessive Drinking and the Institution of the Family," Alcohol, Science and Society, pp. 223-38; Margaret B. Bailey, "Alcoholism and Marriage, A Review of Research and Professional Literature," QJSA (March, 1961), pp. 81-97; D. E. Macdonald, "Mental Disorders in Wives of Alcoholics," QJSA, XVII (June, 1956), 282-87; K. L. Kogan, W. E. Fordyce, and J. K. Jackson, "Personality Disturbance in Wives of Alcoholics," QJSA, XXIV (June, 1963), 227-38; "Some Concomitants of Personality Difficulties in Wives of Alcoholics and Nonalcoholics," QJSA, XXVI (December, 1965), 595-604; K. L. Kogan and J. K. Jackson, "Stress, Personality and Emotional Disturbance in Wives of Alcoholics," QJSA (September, 1965); R. C. Ballard, "The Interaction Between Marital Conflict and Alcoholism as Seen Through the MMPIís of Marriage Partners," The American Journal of Orthopsychiatry, XXIX (July, 1959), 528-46; M. B. Bailey, Paul Habennan, and Harold Alksne, "Outcome of Alcoholic Marriages: Endurance, Termination or Recovery," QJSA, XXIII (December, 1962), 610-23.
5. If no number is listed, AA and Al-Anon meetings can often be located by contacting a clergyman who has been in the area for several years. Information about the nearest Al-Anon group and about the Al-Anon program in general can be obtained by writing the Al-Anon Family Group Headquarters, P. 0. Box 182, Madison Square Station, New York, New York 10010.
6. QJSA, XV (December, 1954), 562-86. See also Jacksonís article, "Alcoholism as a Family Crisis," Pastoral Psychology (April, 1962), pp. 8 ff.
7. "The Adjustment of the Family to the Crisis of Alcoholism," pp. 568-69.
8. Much of the material in this and subsequent sections of this chapter is adapted from the authorís article, "Pastoral Care of the Alcoholicís Family Before Sobriety," Pastoral Psychology, XIII (April, 1962), 19-29.
9. Since there are at least four times as many wives as husbands of alcoholics, the words "she" and "wife" will be used generally throughout this discussion. However, much that is said will apply to other close relatives of alcoholics who seek help -- husbands, parents, grown children, etc.
10. (New York: Alcoholics Anonymous Publishing, 1955).
11. For a discussion of Berneís Parent-Adult-Child ego states, see his book Transactional Analysis in Psychotherapy (New York: Grove Press, 1961). The game of "alcoholic" is discussed in Berneís book Games People Play (New York: Grove Press, 1964), pp. 73-81.
12. Alcoholics Anonymous, pp. 115-16.
13. "Alcoholism and Marriage," p. 85.
14. From a report read by Gladys Price at the Cleveland Symposium on Alcoholism, reprinted in the first issue of QJSA.
15. Alcoholics Anonymous, p. 111. Used by permission of AA General Service Headquarters.
16. For a description of how such a team can be selected and trained, see Clinebdll, Basic Types of Pastoral Counseling, pp. 287-91.
17. How to Help an Alcoholic (Philadelphia: The Westminster Press, 1952), p. 61.
18. Lecture by William Wade, Yale Summer School, 1949.
19. From "Purposes and Suggestions for Al-Anon Family Groups." Used by permission of Al-Anon Family Group Headquarters.
21. Alcoholics Anonymous, pp. 129-30.
22. Ibid., p. 132.
23. For a description of one approach to group marriage counseling see Genevieve Burton, "Group Counseling with Alcoholics and Their Nonalcoholic Wives," Marriage and Family Living, XXIV (February, 1962).
24. A relevant paper on "The Effect of Parental Alcoholism on Adolescents" was presented by Herman E. Krimmel and Helen R. Spears at the National Conference on Social Welfare, Los Angeles, California, May 26, 1964.
25. For a discussion of the application of family group therapy in pastoral counseling, see Clinebell, Basic Types of Pastoral Counseling, pp. 120-30.
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