Looking at a new framework for working with couples in recovery
By Jake Brennan
The ASCENT Approach is a therapeutic framework work that was developed by Dr. Jeremy Frank and Chantal Jauvin. The approach focuses on couples in recovery from substance use and addiction. Whether one partner was using or drinking or both were, the ASCENT Approach views recovery as a joint process.
The main drive of this approach is that in order for a relationship to heal and grow after the trauma of addiction, both partners must be involved in the work of healing and growth. Rather than identifying “the sick partner” who is getting sober as the person that needs to change, the ASCENT Approach recognizes that 1) both people are impacted by addiction, 2) both people need to do work to move forward, and 3) the relationship itself needs to become the priority and the thing to work on, as opposed to one person’s addiction being the sole focus.
The ASCENT Approach is comprised of six main areas, meant to be addressed together rather than one at a time. The ASCENT approach is not a roadmap for how to do couples therapy. It is more of a holistic reflection on what is needed to help couples heal and grow after addiction. Embedded throughout the ASCENT Approach is the transtheoretical, evidenced based concept, stages of change.
There is perpetual work to be done in recognizing what is needed as partners in a relationship. If a couple is not ready to address something, this acknowledgment is part of the process. When they are ready, they can collaborate on how to address it. The idea is that healthy relationships require maintenance, and the ASCENT Approach offers a vision of what some of this maintenance work looks like.
A- Assess readiness to change– This is a two-part process. First, couples identify what the areas are that they need to work on. This could be a joint area, like sex and intimacy or doing more activities together. It could also be one person recognizing they need to follow through on something, like gardening or individual therapy, as a solo activity that will ultimately help that person be able to show up the way they want to in the relationship. The second part is figuring out how ready the couple is to address each issue. For example, the couple might recognize sex as an issue to work on, but might also agree that they are not yet ready to be intimate. Acknowledging how ready we are to work on something relieves pressure to “hurry up and get better.” It also opens the possibility to work on something in small steps. For instance, we’re not ready to have sex right now, but we’d be willing to talk to a sex therapist together.
S- Structure your time- Here, couples make plans together and separately. This helps “talk” turn into action. It also helps promote accountability, both at the individual level and together. Having structured time promotes transparency, which can help rebuild trust when it has been ruptured during an addiction. It creates opportunities for couples to plan together, as well as to share and see more of what the other is interested in doing. Dr. Frank notes, “it also provides couples with a some simpler problems to solve in the early stages of recovery. For example, it may be easier to have conversations about planning date nights and how to divide and conquer driving the kids around while attending to work, exercise and hobbie routines than it is to tackle issues like whether to buy a new house, switch careers or address unacknowledged feelings of betrayal, trauma or sexual intimacy. Those conversations may be more appropriate as the couple becomes more ready in later recovery.”
C- Create community– A fundamental step in addiction recovery is recognizing you don’t have to do it alone. At the individual level, both partners need to have people they can talk to, have fun with, practice healthy boundaries with and rely on. Addiction can leave one partner in an unhealthy relationship with a substance and the other isolated from that relationship. When both partners use, the substances become a necessary mediator that makes the relationship possible. Creating community as a couple in recovery allows them to open up rather than wall off, and to strengthen connections rather than cut them off. Creating community involves examining the community social supports consisting of family, friends, partners and other social opportunities for both the individual and the couple together and identifying ways in which building community and social support might be beneficial to couple recovery.
E- Engage in your life– The biggest myth of addiction is that by simply stopping the drug use, drinking, gambling or whatever else the problem is, everything will get better. What “stopping” does is free people up to address their needs in healthier ways that promote growth. The couple here takes responsibility for what they need, what they want, what they desire. They start to do more both on their own and together. They find ways to live their values. Dr. Frank points out,“There is an expression among recovering communities that, ‘We used to live and we lived to use.’ Isn’t one of the main reasons to seek recovery- to reduce or stop substances- so that people can better engage in their lives? It is a far more enticing incentive to consider what is gained from sobriety or recovery than to wallow in or grieve what may be lost in giving up a dependence on substances.”
N- Nurture your spirituality– This is the part of the ASCENT Approach that most resembles traditional 12-step work. However, it does not require finding a higher power. Spirituality is essentially a shift from being the center of our own universe to understanding ourselves as a part of something larger. What “something larger” is, is for personal definition. Addiction leads to isolation, either literally being alone or being inaccessible even when with others. Couples can find ways to cultivate inner peace together, or encourage one another in their individual pursuits of spirituality. Regardless of being religious, agnostic or atheist, there are many ways one can explore spirituality. Outside of religion, some find it through yoga and mindfulness. For others, spirituality might be found through nature, walking, hiking, exercise, artistic endeavours, reading, creativity or other hobbies.
T- Treasure your partnership– In addiction, the relationship between a couple is often strained and taken for granted. In recovery, there is an opportunity for the opposite to occur. The relationship becomes something to foster, to nurture, to value, and to express gratitude for. Individually, each partner may reflect on why they love the relationship they are in. Together, partners can express gratitude, complement each other, and make plans to honor what they create by uniting as a couple. This could be anything from taking a longed-for trip together, to making time to sit and hold hands while watching a movie. It may also involve the investment of time and money into couples, individual and family therapy.
The ASCENT Approach is not itself an evidenced based practice, but as a framework it draws directly from evidenced based modalities. The six aspects outlined are not meant to be completed one following the other. They are fluid and complement each other, and require regular maintenance. A healthy couple will likely embody all six aspects of this approach, whether they are in treatment or not.
Addiction and recovery work requires a multi-modal approach. Working on deep issues from a psychodynamic lens may help get to core emotional issues that drive addiction. AND, some Rational Emotive Behavioral Therapy (REBT) skills-work might be needed first to create stability and improve daily functioning enough to tolerate deeper work. Twelve or other recovery-oriented meetings might be recommended to supplement extra support. Getting a gym membership, buying a bike or joining a walking club can all be fundamental aspects of early recovery work. ASCENT honors that addiction treatment cannot be one-size-fits-all. Further, it recognizes the need for both partners in a relationship to do the work, to do it together, and with practice, to find joy in doing the work.