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Posted January 11, 2008

Fr. Joe

Relapse Prevention

by Reverend James Gordon

(Rev. James Gordon is a licensed psychologist and therapist at SLI)

Case Study: Fr. Joe

Fr. Joe, a religious order priest, has been ordained for 20 years and is the pastor of an active medium sized parish. It is important to him to be successful because this is his first pastorate. Prior to this assignment, he has held responsible positions in various ministries and has served in positions of leadership within the order. Fr. Joe has a history of alcoholic drinking and failed attempts at sobriety. Most recently, his order’s leadership team received reports from Fr. Joe’s parishioners that he was drunk in public and that they were worried about his safety and physical health. Following an intervention that included family members whom Fr. Joe loves and trusts, and under the threat of having his faculties removed, he reluctantly agreed to an evaluation at St. Luke’s.

Fr. Joe came to evaluation angry and resistant, reporting that the leadership team did not understand his situation and that he was being made a scapegoat. The evaluation team questioned whether Fr. Joe could make use of residential treatment. Over the years he had been through a previous inpatient treatment and continued to relapse. The evaluation team eventually recommended residential treatment. They also challenged Fr. Joe that he would have to work at understanding some of the psychological issues undermining his attempts at recovery. Fr. Joe was angry but agreed to stay for treatment, primarily in the hope of regaining his faculties so that he could continue in active ministry.

Fr. Joe’s treatment can be conceptualized within the framework of relapse prevention. In the past, he was able to maintain sobriety for discreet periods of time but never focused on underlying problem areas related to his alcoholism. For example, the order had received information that Fr. Joe engaged in sexually inappropriate contact with adults. Fr. Joe initially denied that this was an area of concern and began treatment denying that these sexual concerns had anything to do with his drinking. He also was resistant to exploring the connection between his anger, especially at authorities, and his repeated relapses after previous interventions and treatments.

Relapse prevention envisions relapses not as isolated events but as a process. People are less likely to relapse if they are able to name specific triggering events that put them at higher risk for relapse and to develop skills to cope with these situations in new ways. Studies have indicated that there are a number of internal and external variables related to relapse. Peer or social pressure seems to impact Fr. Joe, as he has little capacity to refuse the offer of a glass of wine at a dinner party because he feels shamed by the experience. Other potent variables relating to relapse involve negative emotional states that include depression, loneliness, boredom, and a lack of time structure as well as interpersonal conflict with significant others that result in anger and resentment (Donovan and Marlatt, 2005). An individual is much more likely to relapse if these issues are not addressed in therapy.

In the course of his residential treatment, Fr. Joe addressed family of origin issues, especially his anger and disappointment in his relationship with his mother. He always felt that his mother favored his siblings and that he was scapegoated in the family. He came to realize that his unresolved anger at his mother made its way into his relationships with authority figures. He could become enraged when he felt dismissed, overlooked, or scapegoated by those in positions of power within the order. Because these feelings were linked with his past, they could not be resolved in his current relationships. Fr. Joe often felt angry and misunderstood, and he soothed those feelings by drinking. In the course of treatment, he identified exchanges with authority figures and more specifically, the resultant anger, as key triggers in past relapses. As he brought to light family conflicts and worked the feelings in therapy, he was able to resolve current conflicts more adaptably.

Fr. Joe also realized that during adolescence he felt belittled by his older brothers about his sexual identity. They made disparaging remarks that were quite shaming, insinuating that Joe was not masculine enough. Fr. Joe felt a great deal of shame and, as a result, had never allowed himself to explore his own sexual identity. He entered religious life at eighteen and thought this commitment closed the door on his sexual thoughts and feelings. Later in life, while drinking, he began to act out his unintegrated sexual feelings. The only time that Fr. Joe allowed himself access to his sexual feelings was when he was drunk. Conversely, he would drink in order to allow himself these feelings. In therapy, Fr. Joe first found the courage to understand and explore the roots of his anger and his issues with authority. This, in turn, opened the door for him to address his sexual feelings in a way that lessened the shame he had so long experienced.

Fr. Joe now realizes that his long- standing unresolved angry and sexual feelings have triggered past relapses. In addition to his 12-step program, Fr. Joe used therapy to explore the roots of these difficulties. He now names conflicts and difficult feelings as potential relapse triggers and has incorporated strategies to deal with them into his relapse prevention plan. In addition, he has committed himself to chaste living and the ongoing work of sexual integration as part of his recovery.

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