Book Review – Starting Again

Also entitled “the Relate Guide to Starting again”, by Sarah Litvinoff.
Sarah Litvinoff is a well respected writer, therapist and life coach. You can find out more about her here [click]

“Starting Again” by Sarah Litvinoff, ISBN 9780091856670.  “How to learn from the past for a better future” – 249 pages (1993 – reprinted 2001)

“It does what it says on the tin”

 “When a relationship finishes it can feel like the end of the world – but it is also a new beginning. ‘Starting Again’ can help you deal with your feelings of separation, grief and recovery, and will help you to start looking to a positive future.” Relate book review

The book is easy to read, contains practical tips for working out issues in relationships from a psychodynamic standpoint – what happened, why it happened and why it is still happening.  From a CBT standpoint it discusses what you can do differently in future having brought patterns of relating into awareness.

The first section talks about reasons behind breaking up, whether it is ‘necessary’ and how the breaking up might have occurred.  It looks at how a couple is communicating, taking a historical viewpoint.  They might have had specific familial ways of relating which they then bring to the relationship, which could lead to being drawn to someone who matches these relating patterns, which aren’t healthy.  This is a psychodynamic approach looking at how patterns from the past impact the present.  By bringing these into conscious awareness a couple can learn to relate differently, or take these new tools in the next relationship and build a more satisfying relationship.

Litvinoff cites many cases to illustrate her theories.

She discusses coming to terms with loss, a backwards look at issues that emerged in the relationship.  Some relationships end with no warning, sometimes there is violence and child abuse, or a partner leaves for someone new.  Little can be done to save these relationships.

Litvinoff looks at the impact a breakup can have on children.  Much is made of how children would prefer to have both parents together, that the impact of arguments in a family affects the children far less than it does on the couple having the arguments.  She also discusses the fact that young children can regress, fall behind on school work (if applicable) and have behavioural issues.  Much of this appears to be based on anecdotal evidence, and I would question some of her conclusions, whilst not denying the huge impact that separation and divorce can have on children.

A book published by the Open University (Barnes, 2000) illustrates that relationship conflict has a greater effect than separation and divorce; children suffer psychological repercussions into adulthood, and are felt differently by boys and girls.  This implies it is more complex than Litvinoff suggests.

Children who grow up with parents in an abusive relationship often repeat the pattern as adults: male children of abusive husbands can grow up to abuse their own wives, and daughters of abused wives could end up as victims of domestic violence, their background has shown this is “normal.”  (see here for more information).

Part two contains “tasks” to help individuals realise their positive points and how they can use these to move forwards.  These tasks could be used within a therapeutic alliance, helping an individual move closer towards an internal local of evaluation.  An example is cited of one lady who appeared very well presented and confident yet hid inner feelings of inadequacy, low self esteem and felt negatively viewed by others.  She learned to look at the areas of herself that weren’t as bad as she felt others made out and through exploration and completing various written tasks, this client began to develop her own internal loci and subsequently dressed more casually!

Litvinoff discusses various ways in which we can move forwards in gaining confidence, addressing the parts of us we don’t like, how to say “no” to things for our well-being’s sake and how to address feelings that we have suppressed owing to upbringing and then subsequently being with a partner that may have compounded our patterns of relating.  These could fall into a CBT way of changing behaviours, but also raising awareness of the different patterns could be a TA exercise.  “I should”… behave in a certain way or we are deemed unlovable, for example.

There is a section on challenging patterns where she addresses how we come to expect certain behaviours from our partners, often based on our past and how we saw our own parents behaving.  We might take these behaviours as the barometer of normality, when in fact they were unhealthy patterns of relating.  She implicitly alludes to the concept of transference; we might choose a partner who is similar to our parents, and then when they don’t behave as “expected” we are surprised.  This is perhaps helpful for many who might be working out why they were attracted to their partner, especially when they don’t meet expectations.  The reverse could also be true; these people possess the very characteristics that we didn’t like from our upbringing, yet we are drawn to them because of their familiarity.  That which we most crave we are more likely to push away because we are not used to it.

Litvinoff’s tasks and quizzes may help people see where they are now, the impact that others have had on them in the past and the impact they have on those whom they meet.  I feel this could be a TA stance on how we relate to others, based upon our life scripts and how we felt the need to behave in order to be loved whilst growing up.  These patterns can be so entrenched in us; these quizzes could help bring this into conscious awareness helping deal with future relationship issues.

In the final section Litvinoff acknowledges the wider impact of separation and starting again.  In some cases the social circle will have changed dramatically, yet the world is open to make new friends.  It is a case of putting the past behind and moving towards a new, more enlightened future.

Some people are affected adversely by relationship breakdown, some less so.  Litvinoff deals with the problems facing men and women at different levels and for different reasons.  She addresses real life issues such as the impact of redundancy on men and men’s apparent lack of attention to their emotional states.  She discusses women and the fact that they tend to draw more upon emotional support and loss of “status”.  [generalisation?]

Litvinoff discusses the new life ahead, dating again, and “dating etiquette” and gives advice “it is best not to have sexual partners to stay the night…” (p205), after a paragraph on how new partners can affect the children.  This area is huge!

She mentions rebound relationships and transitional relationships.  This is an interesting if brief section on why people choose a transitional relationship; which frequently surrounds unfinished business with a previous partner  or patterns in relating before being able to move on wholly.  They can leave their mark in terms of another “failed” relationship.  It is possible to take unfinished business from the previous broken relationship into the new one.  Litvinoff therefore cites “grieving” time from a serious relationship and that 1 – 2 years is “normal”.

The final section is designed for the new couple starting again.  It uses the material from the previous chapters in that if you have worked on your difficult areas, etc. then you can begin to put some of the tools into practice in a new relationship.  This might sound very clinical but in some respects it is very practical advice.  Dealing with issues when they arise, making time for each other and each other’s feelings.

I like the way Litvinoff brings some real life stories in; couples who came together after a failed relationship and how they handled new issues.  Addressing current behaviours commensurate with a previous unsatisfactory relationship, (a man’s wife leaves him for another man, and with the new lady becomes over-protective due to unfounded fears of her running off with another man.)

She talks about the “Relationship Bank Account” (which reminds me of the TA version of “Stamp collecting”).  When things are going well, you make “deposits” that keep the relationship healthy.  When things are not going well, we tend to withdraw more from the “balance”, thus putting the relationship into the “red”.  Some might save up resentment like “stamps” when in actual fact it is healthier to mention troubles at the time they occur, thus ultimately restoring credit in the account.

What makes you feel loved?  We all have different needs and wants that make us feel loved if our partner does them for us.  (“The Five Love Languages” – also a book by Gary Chapman is worth a look).  Finally Litvinoff acknowledges that a healthy relationship is healing, but not without a brief mention of a new partner’s children and the wider familial circle which could perhaps be the subject of another book.

Keywords are:  “acknowledge the emotion”, “accept yourself for who you are” and “own your feelings”.  Understand the impact you can have on others whilst simultaneously understanding the impact they have on you, based on your patterns of relating.  Be aware, be conscious and be open to learn.  Understand the wider social impact of broken relationships and families and be aware of your own part.  “You can if you want to”.  Escape the “blame game”.

I felt the book addressed a lot of areas that are important for people in a relationship crisis, although perhaps many of them could be termed “obvious” given where I currently am in training.  I felt the tools, tasks and quizzes very helpful for client work.

More attention could be paid to mental health issues surrounding relationship breakdown.  Perhaps it could be argued this was for reasons of brevity and accessibility of this type of book.

A study in the January 2004 issue of the Journal of Epidemiology and Community Health found that while marriage was more beneficial for women’s mental health, co-habiting was more beneficial for men’s.  Women were more adversely affected by multiple partnership transitions compared to men and took longer to recover mentally from partnership splits.

Many people going through relationship breakdown can turn to self medication [alcohol] to help them cope, or use anti-depressants during a period of anxiety and / or depression.  This could have been attended to in the book when discussing the break ups and feelings of loss.

The loss of a partner due to divorce is not unlike bereavement; the difference is that they are still walking the earth and likely to impact further if the split had been acrimonious.  The loss can also be likened to potential loss in childhood, if a parent had died, been unavailable or also divorced from the other parent.  An individual might think they are unlovable.

Anger is discussed – which can lead to mental health issues.  Litvinoff mentions constructive ways of dealing with anger but doesn’t discuss it in relation to mental health.

Litvinoff draws attention to how couples were brought up as a child from a psychodynamic and learned behaviour perspective; but perhaps one needs to consider the wider social picture of family and friends.  These aspects make up a person’s life and can affect decision making.  Lack of support can be felt in a family that doesn’t accept divorce.

This book is meant to be a simple off-the-shelf self help book for couples seeking some basic guidance on how to cope, and offers practical assistance in relationship conflict and starting again.  Many couples in conflict resolution rarely seek help.  It does suggest that counselling is useful tool to help couples; with case studies contained in the book.

If you have read this book, or would like to read it as a result of this review, please do feel free to email any comments directly to me by using the “contact me” form on the contact page!

REFERENCES
“Starting Again – how to learn from the past for a better future”, Litvinoff, S.  Copyright Sarah Litvinoff & Relate, published by Vermillion, 2001

“Personal, Social and Emotional Development of Children”, Barnes, P.  The Open University, 1995 (pp 114-5)

https://www.relate.org.uk/relationship-help/self-help-tools/book-shop/starting-again-how-learn-past-better-future
http://www.faqs.org/health/topics/8/Gender-roles.html
http://www.fivelovelanguages.com
http://www.eap.partners.org/WorkLife/Relationships/Healthy_Relationships/Relationships_and_Mental_Health.asp
Journal of Epidemiology & Community Health. 58(1):53-58, January 2004. Willitts, M 1; Benzeval, M 1; Stansfeld, S 2 –   (http://pt.wkhealth.com/pt/re/jech/abstract.00004773-200401000-00013.htm;jsessionid=L11LlP1kp0xd3hgvSW3kZHnFhkC6ylFyw40RncPrGxSCJdtT894x!1740794799!181195628!8091!-1)

Book Reviews

 With thanks to Eileen Rowley for posting this:

(2005). Psychoanalytic Quarterly, 74:912-917

THE HEART OF ADDICTION. By Lance Dodes, M.D. New York: Harper Collins, 2002. 258 pp.

Review by: Martin A. Silverman Author Information

In a field rife with misinformation, obfuscation, intimidation, and exploitation, this book represents a bright beacon of light that can pierce the fog and help save lives. It is full of good sense, accurate information, and helpful guidance for those who would like to free themselves from addictive behavior involving alcohol, gambling, prescription or nonprescription drugs, food, sex, shopping, and the like. I recommend it wholeheartedly.

Lance Dodes is a psychiatrist and psychoanalyst with a wealth of experience working in or running programs dealing with alcoholism, substance abuse, and compulsive gambling. He also treats addicted individuals in private practice. What he has learned from his experience is epitomized in his assertion that:

 

‘Virtually every addictive act is preceded by a feeling of helplessness or powerlessness. Addictive behavior functions to repair this underlying feeling of helplessness … because taking the addictive action (or even deciding to take this action) creates a sense of being empowered of taking control—over one’s emotional experience and one’s life.’ [p. 4, italics in original]

 

Dodes goes on to say that “rage at helplessness … is the nearly irresistible force that drives addiction” (p. 5, italics in original). The addictive behavior, he emphasizes, is not to be looked at as reprehensible weakness, but, on the contrary, as an effective, albeit destructive, action that serves to restore a needed sense of power by providing the capacity to do something. Dodes grants that Alcoholics Anonymous and its offshoots can be helpful to some people, but he seriously questions the usefulness of requiring people to declare that they are helpless and have to turn themselves over to an external power to control them. He cites studies indicating that only a very small percentage of people who join AA stay with it and remain sober. For the rest, he advocates the use of a therapeutic approach that coordinates exploring each patient’s unique personal history with recognizing that addictive behavior is a reaction to an infuriating sense of helplessness. He decries the tendency in some programs to label alcoholism or other addictive constellations as “diseases” afflicting people whose individuality and uniqueness are then discounted.

 

The book is written in a very personal and personable, conversational style that makes it as convincing as it is easy to read. In one chapter after another, Dodes introduces the reader to people whose stories are informative and illustrative of his observations about the meaning of addictive behavior. He makes a strong case for defining addiction in psychological rather than in physical terms. He points out, for example, that people become addicted to such activities as gambling, eating, exercising, and shopping, and that they often switch back and forth between behaviors involving physical substances and ones in which no such substances are involved. He cites experience with returning Vietnam veterans, ninety percent of whom stopped their use of hard-core narcotics after their military service had ended:

‘Addiction is a burning problem that resides in people, not in the drug or in the drug’s capacity to produce physical effects. For the returning soldiers, even when they had used drugs as physically addictive as heroin … once they were out of their abnormally stressful setting, addictive behavior could not be created in them.’ [p. 73, italics in original]

 

The author encourages his readers not to succumb to exploitation by drug rehabilitation programs that moralistically seek to depict them as weak, helpless individuals who lack willpower and therefore need to be taken over by the programs’ directors and staff as their new slave-masters. He urges them instead to regain the self-respect they have lost; to acquire understanding of the depression, self-denigration, disempowerment, and impotent rage within them that have pushed them toward addictive behavior; and to become able to find new and better ways of obtaining power over their lives.

 

Dodes punctures various myths about addiction. Among these is the idea that addiction is genetic or is the result of faulty brain chemistry. He disputes the idea that people with addictions are necessarily self-destructive, have to “hit bottom” before they can recover, have an “addictive personality,” and can be successfully treated only by someone who personally has been an addict. He maintains that it is a fiction that it is the external substance or activity that has the power to turn someone into an addict:

‘An addiction may be directed at nearly any object or activity, so long as … [it] can serve as the displaced focus for the drive behind the addiction. The Internet or shopping are perfectly good candidates. So are eating, exercising, playing sports, or many other activities … virtually anything may become the focus of an addiction because it is the person who endows the object of activity with the property of being “addictive.” In truth … what is being described is not “addictiveness” of the activity at all but its attractiveness’. [pp. 116-117, italics in original]

 

The author does not neglect the role of physical addiction in making it difficult to free oneself from the psychological phenomenon of being addicted to certain substances:

‘Anyone can become physically addicted to those drugs capable of producing physical addiction if those drugs are used in large enough quantities over a long enough time … [Although] physical addiction cannot “hook” a person into having a true addiction … the presence of cravings, or a fear of withdrawal symptoms—both due to physical addiction—while not “hooking” people in the popular sense of rendering them helpless, clearly does make it more difficult to stop using those drugs that are capable of being physically addictive.’ [p. 104]

 

There are chapters in the book that deal with couples, teenagers and their parents, sexual addiction and the relationships (and interrelationships, at times) between compulsions and addictions. These chapters are informative, heuristically stimulating, and quite practical, even if they are somewhat too short to satisfy the professional reader. The book is intended to be read primarily by those who are struggling with addictions, rather than by those who treat them, so this is understandable. Dynamic explanation is one of the book’s strengths, while genetic formulations, as variable and complex as they tend to be, are rather skimpy, which is, again, appropriate in a book aimed largely at a lay readership. Neglect and abandonment by unavailable or totally self-absorbed parents and siblings, deep feelings of narcissistic injury at the hands of abusive family members, and alexithymia as a result of emotional impoverishment during the formative years all receive mention, albeit with the provision of relatively little detail.

 

My first professional job was in an alcoholism clinic, as a parttime group therapist, while I was a senior resident in psychiatry at the University of Rochester. I was struck by how few of the patients I was assigned to work with were there primarily because of alcoholism. Almost all of them impressed me as having more fundamental emotional difficulties, of which the drinking problem was only one of multiple symptoms. This has been so with regard to the many people with addictions whom I have helped since then.

I also realized as I read this excellent book that a very large percentage of the patients I have been treating since I have been in practice either have had addiction problems as a part of their clinical picture, or have been significantly affected by the addiction problems of spouses or other family members, past and present. Addiction is pervasive and pernicious. This volume, which contains eminently sensible and practical observations and conclusions, is a very welcome addition to the literature on the topic.

 

It is appropriate to mention that I have successfully treated a number of addicted individuals who have made excellent use of the kind of dynamic psychotherapy that Dodes espouses, but for whom psychotherapy alone was not enough. They have experienced so much neglect and so much abuse at the hands of parents, siblings, and spouses that the concern, caring, respect, and willingness to be of assistance as fellow human beings that can be found within the right AA group has proven invaluable to them, in addition to what they were able to gain from individual therapy. For them, the combination of the two has been very effective. I expect that Dodes would agree.

 

The only question I have about this book involves the extent to which it might neglect or minimize the importance of the very serious and deadly primary addictions that contain elements of truly genuine self-destructiveness. There are drug addicts, alcoholics, and gamblers whose core depression is so strong and whose rage is so deep-seated and intense that they are determined to destroy themselves, and, Samson-like, pull down others with them. They are not likely to avail themselves of the kind of assistance that Dodes offers. I have tried in vain to help such people.

There are also the hard-core addicts whose inadequate personalities and deficiencies of psychological structure make it impossible for them even to understand what Dodes is getting at. Methadone programs can keep some of them from ending up dead or in prison, but others are beyond assistance. The Heart of Addiction is not addressed to these unfortunate people, however; its appeal is to those who do have the capacity to reach inside themselves and make use of good treatment to restore their self-respect and dignity, as well as true control over their lives. It is they who will benefit from reading this book.

Silverman, M.A. (2005). THE HEART OF ADDICTION. By Lance Dodes, M.D. New York: Harper Collins, 2002. 258 pp.. Psychoanal Q., 74:912-917