The first few weeks of recovery were occupied with finding AA and NA meetings in which she felt comfortable, choosing a sponsor, and solidifying her parents' support for the treatment plan. She was enthusiastic about meetings generally, rejecting some, choosing those with a preponderance of young people, attending approx 7 per week, doubling up when she had to miss. She chose a sponsor carefully, an older woman, an artist and recovering alcoholic with 5 fears sobriety with whom she met or spoke 2 or 3 times per week. Caroline worked full-time. Her pattern of substance use shifted: During the first month she used no cocaine and drank on three occasions. In each of months 2 and 3 Caroline had a relapse involving both cocaine and alcohol, following phone calls from her parents. She has not used cocaine since the third month of recovery. The combination of AA,NA and therapy was more successful in keeping her from drinking after month three with only one relapse in each of months 4,5 and 7. Caroline felt that the last two relapses followed sessions in which I neglected an important issue or made comments which were off the mark. I saw these sessions differently, as passive into active testing of me. In both cases, she came to the next session anxious, and mildly mistrustful of me, but wanting to talk about what was bothering her. For example, following a discussion about casual sex which she called "fun sex", she drank, had sex with a stranger, and returned the next hour concerned that I did not want her to have sex even within meaningful relationships nor enjoy sex nor have fun generally in life. Initially, I thought perhaps, I had missed something, but I came to feel that my telling her that I wanted her to have a good life and all its pleasures but that fun sex, unsafe sex, and drinking were not good for her, was a way of demonstrating for her my ability to reject false accusations.
Caroline had no relapses with cocaine after month 3 and no relapses with alcohol after month 7.
In months 2,3 and 4, one of the key foci of the therapy was Caroline's feeling confused and upset by the mistrust of psychotherapy voiced within AA and NA, as well as by her sponsor, who expressed concern for Caroline's recovery, warning, "Don't let those shrinks get ahold of you." Her responses in our discussions varied from "I can't tell who is right, you or my sponsor." to "I hate it when they pooh pooh therapy," My general response to her confusion and distress was to point out that she needed and deserved both meetings and therapy; a sponsor and a therapist, and that we could all work together to support her. Following this kind of comment in one hour, Caroline remembered how even mild disagreement could not be tolerated by her father, who often lectured her with a blaming and sometimes violent tone, accusing her of being "irresponsible", "wild", and "up to no good," for questioning his views. On other occasions, Caroline reported feeling that "therapy is just a frivolous luxury, most people can't afford it. They (most 12 steppers) do without it. I'm just a whiner, a spoiled, wimp." She felt selfish and greedy on the one hand, or on the other frightened that she needed so much help. I said that fighting and competition for scarce supplies rather than cooperation was the way her family had felt, but that her getting healthier didn't really hurt her parents or her sisters. Along with interpreting her guilt about having more, I also gave her low-fee referrals for some of her friends, after which in month 2 she told me her college drug history: that she had progressed from using alcohol and drugs on a "regular but controlled basis" which she explained meant approx. every other weekend in her jr. year to being "out of control with drugs and sex" most of her senior year. This apparently coincided with the breakdown and fall from grace of the older sister and subsequent attempt by father to turn to Caroline as the golden girl, beginning in her jr year, offering her trips to Asia with him on business, as well as phone calls from home. (Previously, the parents had complained that she called too often.) In the midst of this downward spiral, her prior therapist, who she described as "goodhearted and benign," had told her that her drinking would clear up on its own if they "got to the bottom of her problems with her parents."
Although my general stance was one of mutual collaboration with Caroline's entire support network, there were those occasions when Caroline brought up differences which could not be handled with a broad stroke,-no substantive differences here, manner. These were times when I felt Caroline needed protection, and that to avoid saying so would be harmful to her. She had chosen for her sponsor, an older woman who spoke with great authority and charisma like her father, who was an artist of some success, and who had, in an appealing lifestyle surrounded herself with other artists and recovering addicts who admired and looked up to her. Caroline was very drawn to this "family" as her sponsor called it, where others seemed to get so much caring and support, and Caroline did as well, especially early on. As I have said, the vast majority of the time, I could enthusiastically support her relationship with her sponsor. When it became clear to me that certain of the sponsor's suggestions were not in her best interests-such as the intense, confrontative, unfacilitated encounter weekends which her sponsor organized at her ranch, I said something like, "that may be very helpful to some people, but it's important for you to use your own judgment; you have told me that you feel unable to protect yourself from blame on these weekends." Caroline replied, "I feel like they are always saying move on, move on, let go, stop wallowing in self pity; we've heard your story about your parents enough. They leave out the thing I like best about the (AA and NA )meetings-that people believe me; they gasp and groan when I tell about my father like they think my father was worse than I even thought." The area in which I most commonly felt she needed protection was that of sexuality. As time went on I heard more about the sponsor and some of her friends' intense interest in men and explicit talk about sex, along with Caroline's growing discomfort. At certain meetings there was much flirting which often led to partying after meetings and frequently ongoing dating, followed by girl get-togethers to discuss each and every aspect of the men involved. Her sponsor and friends were stunned and sometimes critical that Caroline rarely accepted the many advances she received. I told her I thought that these anatomical discussions scared her because they replicated her parents' lascivious and inappropriate traumatization of her around sex as well as, her mother's disturbing obeisance to her father. We had many discussions about this, and often, in that first year, Caroline said to me some version of "Maybe you are the one who is out of it thinking that sexuality isn't that big a deal; maybe my parents were right." We talked often about what makes for good intimate relationships and when sex functions in the service of intimacy vs. when it functions differently, for self-esteem, etc. as it had for her parents. Over time, she became able to say to her sponsor and her friends that she wasn't interested in telling about her sexual activities with her boyfriends, or hearing about theirs.
Because active support for all aspects of her recovery program were crucial, and because Caroline had been seriously neglected and unprotected by her parents, I showed great interest in the daily business of her recovery-how her sleeping and eating were going; how meetings went, was she doing her laundry yet? etc. Feeding herself regularly was the most difficult of the daily tasks of living. Only with great encouragement, was she able first to buy enough food and then to prepare meals for herself; although she became an excellent cook, she could cook only for company. It took a year and a half before she could overcome the guilt she felt about enjoying food alone or buying more than one day's groceries at a time; I remember clearly the session in which she told me with great delight that she had been able to buy the most basic kitchen implements she had been depriving herself of for many months.
One of the most striking revelations of the treatment came at the point, 7 months into treatment, when Caroline had finally attained a solid plateau of sobriety and had had some very real success in battling the key issue of disloyalty to her parents. She suddenly recalled that her father had himself had a drug problem with Valium. She remembered him pulling out a little pill vial and choosing from assorted pills whenever he was under stress. She recalled both parents encouraging her drug use as a teenager, acting so eager to hear about her experimentation with the latest drug fad. Caroline's identification with her father in becoming addicted came to be understood by both of us as a means of avoiding exposing the pathetic, insecure part of her father which needed so much propping up. Similarly, my comments about her sexual promiscuity being born of a desire to protect her parents from appearing deviant were followed directly in one hour, and in subsequent hours, by memories of both parents' intense and inappropriate interest in sexual matters -both parents had taken the children to nudist camps each summer where they and others engaged in "free sex" without protecting the children sufficiently from hearing and seeing it, and where men made inappropriate comments about her body. In addition, both parents engaged in sexual innuendo with each other in front of the children, using nicknames for each others' genitals as well the girls' genitals, as well as regularly having sex in such a way that the children could not avoid hearing. In addition, mother expressed an inappropriate interest in Caroline's body from early in latency; in order to please mother and be one of the girls, Caroline told me she knew she was supposed to enjoy looking sexually arousing and having big breasts. Caroline reported her parents made fun of her body in a very mean way, calling her fat, when she wasn't, and in other ways "objectifying her body," as she put it, telling her repeatedly she was "lucky to have a small, curvy tush." Both parents seem to have had an intense need to prove themselves sexually, which, along with father's various affairs, explicates more fully Caroline's pathogenic belief that her parents needed her to act self-destructively, with sex as well as drugs, and alcohol.
Another important development emerged at this 7 month mark, Caroline had gained more trust in the combination of therapy and meetings. No more relapses. At this point, however, she became suicidal, and was so off and on, in varying degrees, for the next 3 years .Suicidal bouts as well as, promiscuous sex often followed her parent's efforts to contact her. Initially, Caroline did not feel comfortable telling me she felt suicidal, nor asking me for help. She did not feel entitled to complain about much of anything in her life. She said she did not feel there was room to run any risk of being a burden to me. She did not think I would want to hear nor could I bear the intense pain she was in; She reported expecting I would become inundated with anxiety as her mother had, or blame and punish her as her father had. As she tested out these pathogenic beliefs with me, she found that, contrary to her expectations, both she and I could tolerate the depression and she subsequently became able to use emergency phone calls to relieve the worst bouts. During the blackest moments of her depressions, I would sometimes say to her, "Just being born gives you the right to live and have a good life." On occasion she would elicit this kind of a stance from me by saying, "I think we need to get back to that stuff about having a good life."
Her parents occasional requests for contact were excruciating for her she reported feeling that she was the most ungrateful daughter and the most screwed up kind of person that she could imagine. She knew she was causing them immense pain, both because she worried them and because she heard they were ashamed to tell their friends and the rest of the family that she was out of communication with them. It was only as the choice became clear it was either them or her; contact with her parents made her suicidal; her life really was at stake, it was only then that she came to feel deserving enough to keep herself alive and to insist upon minimal contact. In the past 3 years she has returned 4 or 5 phone calls and 4 or 5 notes about things like grandmother's death. She continues to feel that she cannot see them or speak with them comfortably; she feels too vulnerable and not yet able to defend herself internally from their old accusations towards her.
To summarize, the central themes or core pathogenic beliefs against which she struggle during the first year included: 1) Caroline's conviction that having a healthy life, free from addiction, compulsive sex and crippling anxiety, would damage and expose her parents, and secondly, 2) Caroline's feeling of responsibility for her parents' difficulties in parenting her she blamed herself saying she must have been such a difficult child. She would cry when I said she must have been a very lovely and special child who deserved to feel that she was a great gift to her parents. Progress toward overcoming these fears and changing these beliefs constituted the main work of the first year.