Dr. Robert Navarra is a Master Certified Gottman Therapist, Trainer, Consultant, Speaker, and Certified as a Master Addiction Counselor. Dr. Navarra developed the Couple Recovery Development Approach, a relational model of addiction assessment and treatment based on his research. He designed the Roadmap for the Journey workshop for couples and the Couples and Addiction Recovery training for professionals.
Today, Dr. Navarra is interviewed by Chris Dollard, Editor-in-Chief of The Gottman Relationship Blog, to discuss the creation and components of his addiction treatment program for clinicians offered by The Gottman Institute: Couples and Addiction Recovery.
You created Couples and Addiction Recovery, which teaches a unique modality of therapy that combines Gottman Method Couples Therapy with addiction treatment methods. What led you to create this program, and is there a story or some kind of inspiration behind your work?
After about five years in private practice in my early years as a therapist, I noticed that 80% of my individual and couple clients had an issue or concern about alcohol or substances, and I did not know how to help clients with those concerns. My training in assessing and treating substance issues was very minimal.
So, I completed the Advanced Drug and Alcohol Training Certificate in 1987 at UC Santa Cruz. The surprise for me was that once I learned that addictions are treatable, that was the start of a new journey in the addictions treatment field that I initially had no interest in but came to develop a passion for.
I continued my training and clinical experience in addiction treatment, including affiliation with Dr. Stephanie Brown as an Associate in the Addictions Institute and taking a position as clinical director of a drug and alcohol treatment program. At that time Dr. Brown and Dr. Virginia Lewis co-directed the Family Recovery Project, the very first research study to ask the question, what happens to couples and family after beginning recovery?
Sponsored by the Mental Research Institute in Palo Alto, the study had three components. For one component, I used a qualitative research approach creating a developmental theory of couple recovery that I call Couple Recovery Development Approach. I continued to develop the model as a Research Associate at Mental Research Institute for the subsequent 15 plus years.
In 2005, my friend and colleague, Lynda Voorhees, told me that there was overlap in my research and theory development with Gottman Method Couples Therapy. I attended a Level 1 training with Dr. John Gottman, and during that very first workshop I immediately saw the fit and relevance to not only the theory of Gottman Method Couples Therapy, but the interventions were brilliant and could be easily applied or adapted to my theory of treating recovering couples.
Lynda invited me to co-present at a Gottman conference in Seattle about my research on couple recovery. I continued Gottman training and became certified in 2007, the same year my research was published in Alcoholism Treatment Quarterly. As I continued to integrate these models, John asked to collaborate on this relational approach to addiction, and I was encouraged to develop two workshops: Roadmap for the Journey, a two-day workshop for recovering couples, and a one-day training for therapists called Couples and Addiction Recovery, which I present nationally.
The goal of Couples and Addiction Recovery is to “help couples develop a Couple Recovery through increasing communication and understanding, establishing appropriate boundaries, and healing from the impact of addiction and recovery.” Can you explain the term “Couple Recovery?”
Most treatment programs separate partners to their respective programs and groups when a partner enters treatment, typically discouraging couples from addressing relationship concerns or issues. The thought is to help individuals focus on themselves and their recovery program and to strengthen appropriate boundaries by postponing attention to the couple or family relationships until individual recoveries are well established. This is how I was trained.
But it turns out that there isn’t any empirical support for this widely held belief. In fact, research supports exactly the opposite and to include the partner early in the treatment process.
Couple recovery begins with emphasizing the importance of establishing individual recovery, or self-care, but we don’t assume that individual care and relationship care are mutually exclusive. By addressing relationship care in the context of individual self-care, we are building recovery into the relationship.
Simply put, couple recovery addresses three recoveries concurrently: each partner’s recovery and relationship recovery. Family recovery is another component to consider. Beginning recovery is often traumatic for individuals and, as the couple relationship enters a new and unknown territory, we are abandoning couples at a time when they need support the most, at the start of recovery.
How does couple recovery relate to addiction recovery?
It is often stated that addiction is a “family disease.” If we play out what that really means, then it makes perfect sense to include the partner and the family in treatment.
Sometimes people assume that recovery means not using the substance anymore or stopping the compulsive behavior. Couple recovery takes into account much more than abstinence from the addictive behavior and includes addressing issues left unsaid during the active addiction, talking about the impact of recovery, and developing a roadmap for going forward with couple and family recovery integrated into family life.
We also know that a satisfying couple relationship is the single biggest predictor of successful long-term recovery. Families can create a legacy of recovery; a study that found that a family member with an alcohol use disorder is three times more likely to get into treatment when a first-degree relative is already in alcohol recovery.
Which specific theories or methods of addiction treatment did you draw from to create the methods taught in the Couples and Addiction Recovery program?
The article I just wrote for the Encyclopedia of Couple and Family Therapy is titled Systemic Addiction Treatment in Couple and Family Therapy. In my research for the article, I discovered that studies on the couple relationship in alcoholism treatment dates back to the 1930s, three decades prior to the evolution of the systemic family therapy models that emerged in the 1960s when pioneers like Claudia Black, Sharon Wegscheider-Cruise, and Edward Kaufman emphasized the importance of addressing couple and family issues in addictions treatment.
Best described as a collection of therapeutic models that can vary in biases and techniques, what systemic approaches share in common is the philosophy that effective addiction treatment emphasizes the importance of how the couple and family system functions and operates prior to addiction, during the addiction, and in recovery from addiction.
There is a direct reciprocal relationship between the family’s impact on the member with an addictive disorder and vice versa. Systemic approaches are designed to help couples and families move and transition from an “addicted system,” to a “recovering couple system.” Core goals in a systems approach include addressing communication patterns, roles, rules, boundaries, problem-solving, and managing the impact of addiction and of recovery.
Blending Gottman Method Couples Therapy with my own theory called the Couple Recovery Development Approach, we have what we believe to be a research-based, state of the art approach in a relational approach to addiction recovery.
Which specific assessments and interventions did you utilize from Gottman Method Couples Therapy, and how do they work within Couples and Addiction Recovery?
Every couple I work with goes through the same assessment that Gottman Method Couples Therapy uses, but beyond that, I include 15 assessment tools to screen for alcohol or other substance use problems, sexual addiction, gambling addiction, and a model for screening for addictions of all kinds. A particularly effective alcohol screen that we cover is called the AUDIT, which evaluates and differentiates problematic alcohol use from alcohol use disorder.
Some of the interventions are adaptations of Gottman method approaches that are designed specifically for couples in recovery. For example, a popular series of interventions utilizes the Couples and Addiction Recovery Card Decks. Partners draw from a deck full of conversation starters to talk about a specific aspect of recovery. I had developed a series of “process questions” but adapted the concept to the card deck idea from the Gottman toolkit. It creates an opportunity for partners to discuss how to integrate recovery into their relational life.
Another adaptation of a Gottman intervention is in the Recovery and Compromise Ovals Intervention. Like the Gottman compromise intervention, this intervention includes a decision-making process that helps partners to figure out areas of inflexibility, areas of flexibility, and adds a third circle, core recovery needs as another layer of decision making.
I also address helping couples manage trauma from addiction, develop rituals and routines in the relationship with a recovery focus, knowing the difference between codependency and interdependency, and managing conflict. I creating an intervention based on the Gottman tool Aftermath of a Regrettable Incident, and it is called Celebrating a Positive Event, which provides a structure for couples to talk about and process what worked instead what didn’t work.
This intervention has been included in the current treatment protocol for treating affairs in Gottman Method Couples Therapy. All these interventions are aimed at helping couples develop a couple recovery that supports individual growth, setting appropriate boundaries, and establishing healthy communication.
Gottman Method Couples Therapy emphasizes the importance of Rituals of Connection. How do Rituals of Connection help to prevent relapse for someone who is recovering from an addiction? And how do those rituals help the couple recovery overall?
This is a great question. It is crucial for all couples to develop rituals that provide predictability, consistency, and meaning in their relationship. Families and couple relationships without a sense of connection through rituals will feel like a ship adrift at sea. This is especially relevant for recovering couples given that rituals they had previously were lost in the progression of an addictive disorder.
In an active addiction, formal rituals like holiday celebrations or birthdays may begin well only to end very badly. With the unpredictability of behavior that comes with addiction, the partner can anticipate with dread whether, once again, the addiction ruins things. When couples begin recovery, this is an important part of the work.
Couples often need to develop new rituals to integrate into family life. I had one couple who had a ritual of connection by having an extended happy hour every night. When they both got into recovery they started an alcohol-free happy hour, which wasn’t working, so they started taking yoga. That became one of their new rituals of connection that worked very well. Families that develop rituals are less likely to pass on the legacy of alcoholism.
For those who are experiencing difficulties with addiction, either individually or in their relationships, what kinds of advice could you offer?
The challenge of getting people to seek help with a substance use disorder is overcoming the stigma associated with addiction. It’s been reported that only about 10% of Americans who need treatment for an addictive disorder are in treatment. If you or a loved one are struggling with a possible addiction, remember that addictions are classified as a disorder. It is not a moral failure, and it is treatable.
First, find a therapist who is trained in treating substance abuse disorders and other compulsive behaviors. There are also numerous mutual aid groups like SMART Recovery or Life Ring, and there are effective medications to help treat substance abuse and opiate abuse disorders as well. I strongly encourage anyone to reach out to these resources for evaluation, exploring alternatives, and getting the support you need.
If you are a therapist seeking training in treating addictions within couple and family systems, you can sign up here to learn directly from Dr. Robert Navarra at his Couples and Addiction Recovery workshops. The next workshop will be in Bellingham, WA, on June 11, 2018.
If you are seeking assistance with treating addiction within your relationship or family, you can find a Gottman-trained therapist near you by using the Gottman Referral Network.