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Janessa, out of gratitude, invites Emma to stay for dinner. When Emma tells them she is looking for work, Abraham immediately offers her a job at his clothing workshop. He and David are pleased with Emma's work, and she becomes good friends with them. As Emma's baby's birth approaches, Blackie arranges for her to meet his friend Laura Spencer in the village of Armley. Laura needs someone to share household expenses, and Emma needs someone to look after her, so the match seems ideal.
The women become good friends, Emma moves in, and Laura gets her a job at Thompson's Mill. In March, Emma has a daughter and names her Edwina.
As Emma must work to support herself and her child, Emma's cousin, Freda, takes Edwina. After a year of working two jobs, Emma makes enough money to rent a shop in Armley. This shop is a success, and Emma's business expands to a second shop, then a third. Not expecting to see the Fairleys, she is horrified when Edwin's brutish brother Gerald visits; he had found her after seeing she worked at Thompson's Mill, now owned by his father. He tells her Edwin will soon be engaged and demands she tell him where the child is.
Emma refuses to admit there is a child, and after a violent confrontation, realizes she needs someone to protect her. Worried Gerald will return, she marries her landlord, Joe Lowther. They had become friends when he taught her how to do her own accounts. Soon after their marriage, he and Emma have a son, Christopher, nicknamed Kit. Emma's business continues to expand, with Emma going into business with the Kallinskis.
Unfortunately, her private life doesn't run as smoothly. Joe is killed in the Battle of the Somme and Laura, now married to Blackie, dies giving birth to a son, Bryan. Emma raises Bryan until Blackie returns from the war.
In early , Emma meets Paul McGill. They fall in love, and while their time together is short, it is a very intense affair. Paul is in the Australian army and returns to France after recovering from a leg injury. After the war, he goes home and, despite promising to write, never does. Emma, hurt and disappointed, especially when she discovers he and his wife have a son, turns to an acquaintance for consolation and marries again. She and her new husband have twins, Robin and Elizabeth, but the marriage is unhappy and ends when Paul returns.
Emma' husband, Arthur Ainsley, may be homosexual and certainly has a drinking problem. Paul has kept in touch with Emma's brother Frank, who informs him that Emma's marriage is unhappy. At Paul's request, Frank arranges a meeting between Emma and Paul. Emma is initially angry but calms down when Paul explains why he never wrote to her.
They start dating again, and she divorces her husband when she finds out she is pregnant with Paul's child. Emma has a daughter, whom they name Daisy after Paul's mother. In February , seeing war on the horizon, Paul goes to Australia to get his affairs in order, as he anticipates that once war starts travel will be difficult if not impossible.
While there, he is seriously injured in a car crash and almost dies. He survives but is disfigured, and is told he will be dead within a year. Data available at the time of publication is referenced throughout this TIP.
Connections are relationships that are healthy and supportive— mutual, empowering, and emotional resources. Disconnections create major difficulties for most women, such as lowered self-esteem, feelings of powerlessness, and lack of assertiveness.
The experience of relationships as connections and disconnections is a central issue in personality development, with repeated severe disconnections potentially having serious psychological and behavioral consequences. The Influence of Family Treatment providers should be sensitive to the relational history women bring into treatment, both positive and negative. For instance, the extended family often functions as a safety net that provides women with child care, financial support, and emotional and spiritual guidance Balcazar and Qian However, few studies have examined the role of the extended family in the development of substance abuse and recovery.
While research on the extended family tends to define its role as primarily protective, drinking and drug use in the family can contribute to the development of abuse.
Many women who abuse substances were raised in families where there was chemical abuse, sexual abuse, violence, and other relational disconnections. These family relationships form a basic model for the relationships women later develop with others. Women with a substance-using family background may develop adult relationships that mimic these broken family dynamics. Thus many women who have family members who used substances also may have a partner or friend who abuses substances.
Counselors should also help a client to explore her current relationships outside her family in the light of her substance use. Counselors may need to work with some clients to help them understand the negative effects these relationships can have. In addition, skills related to improving the quality of relationships—such as communication, stress management, assertiveness, problemsolving, and parenting—can be an important part of treatment.
Family therapy is a more essential approach in substance abuse treatment for women. Treatment programs can help women connect with natural supports in the community—friends, work colleagues, and significant others Knight and Simpson Further, a high degree of social support is positively related to better treatment outcomes Laudet et al. Advice to Clinicians: Relational Model Approach Beginning in the s, a number of theorists started to examine the importance of gender differences in psychological development.
Carol Gilligan, a developmental psychologist, gathered empirical data on fundamental gender differences in the psychological and moral development of women and men Gilligan The three major themes in relational theory are: Cultural context. Traditional developmental models of growth emphasize independence and autonomy. Pathways to growth. The relational-cultural theory affirms the power of connection and the pain of disconnection for women, with repeated disconnections having adverse consequences for mental health Covington and Surrey ; Jordon and Hartling As a result, the approach requires a paradigm shift that has led to a reframing of key concepts in psychological development, theory, and practice.
More than men, women find an activity more satisfying and more pleasurable when others are involved. Therefore, for women, relationships directly affect their feelings of empowerment, self-worth, and self-esteem. Substance abuse treatment often provides a woman her first opportunity to establish new, healthy relationships—especially relationships with other women.
Partner Relationships Many women drink and use substances to maintain relationships and cope with the pain and trauma of lost relationships. Some women feel they are expected to maintain relationships at all costs, even if those relationships are undermining, abusive, or otherwise detrimental.
Women may stay in harmful relationships because of economic or social dependence. Treatment providers sometimes unknowingly reinforce this expectation by focusing on the importance of relationships to the exclusion of helping their clients increase their feelings of autonomy, healthy solitude, and individuality— also important needs for women.
They recommend starting with a thorough assessment after a woman has identified her partner s and given permission to involve the partner in treatment.
As women become healthy through participating in treatment and developing appropriate relationships, and as other supports e. When women decide to end significant relationships, counselors should realize that ending these significant relationships is a real loss that must be mourned while new attachments are being created.
However, some women often choose to continue to participate in, or may be unable to escape, destructive relationships. Thus, any relationship that enables a woman to continue to abuse substances or threatens her safety becomes a therapeutic issue between a counselor and a female client.
However, if a client is in danger of being victimized, the counselor should primarily be focused on ensuring her safety. Initially, staff should take immediate measures to increase physical safety in the treatment environment— in both outpatient and inpatient settings. In addition to validating her experience, it is important to help facilitate a safety plan that may necessitate additional referrals to domestic violence hotlines and shelters.
If the client does not feel safe involving her partner, the emphasis should change to safety planning. Is there a history of impulsivity with client or partner? Has there been a history of violence outside the relationship, in previous relationships, or with children?
Is there a recognizable progression of violence in the relationship? Has the history of the relationship been centered upon using or providing drugs and alcohol?
How often are alcohol and other drugs used when engaged in activities with each other or during sexual intimacy? Is the client or partner worried about having sex without being under the influence of substances?
Has the client left prior treatment experiences prematurely due to this relationship? Is the client worried that her partner is going to leave either as a result of her use or of her treatment? Does the client acknowledge that her use has impacted the relationship? Is she able to describe how her substance use has affected the relationship?
Has the partner been arrested, charged, or convicted of alcohol or drug related offenses? Accessibility: Does the partner have the financial resources and transportation to attend treatment?
Are there potential barriers that limit physical attendance, such as distance from program, transportation, work schedule, financial resources, childcare responsibilities? History of mental illness: Are there any known mental health issues with the partner or client that have or will impact the relationship? Relationship support of the partner: Has the partner been emotionally supportive throughout the history of the relationship?
Does the partner play an essential role in childcare?
Does the partner provide financial support? Has the partner ever threatened to leave, withdraw financial support, or threaten the custody of the children? Commitment to relationship: Is there a current commitment to maintaining the relationship? Sexuality represents the integration of biological, emotional, social, and spiritual aspects of who one is and how one relates to others. In addition, sexuality is one of the primary areas that women say change the most between substance abuse or dependence and recovery and is a major trigger for relapse Covington a , a , Women and men are socialized into different gender roles.
For example, many men are taught to seem knowledgeable about sex and be comfortable with their bodies. In contrast, women struggle more with body image and are socialized to be less assertive sexually or risk being labeled as promiscuous. Women who use substances are perceived as being more eager for sex and more vulnerable to seduction George et al.
This is reflected in the stronger stigma against women with substance use disorders, which is often expressed in sexual terms and labels women as promiscuous or sexually loose. Sexual terms are rarely used to describe men with substance use disorders. Recovery and healing goes beyond abstinence from alcohol or drugs to developing relationships with others. Many women will need to explore the connections between substance abuse and sexuality, body image, sexual identity, sexual abuse, and the fear of sex when they are alcohol and drug free.
The following are some of the sexual concerns that women report during early recovery: Sexual identity. Counselors may need to help a woman determine her sexual identity as a heterosexual, lesbian, or bisexual person. Substance abuse during adolescence can interrupt the healthy development of sexual identity. Circumstances such as prostitution or incarceration may lead women to participate in sexual activity with other women. Some women use drugs to suppress their sexual feelings toward other women.
Others use drugs to act on their erotic attachment to other women and may feel confused about their sexual identity when in recovery. Fear of sex while abstinent. Many women enter treatment with little or no experience of sexual relationships without being under the influence of substances.
For women with a history of sexual trauma, using alcohol and drugs to manage emotions while having sex may have served as an important coping mechanism. Subsequently, women may become fearful of having sex without the assistance of substances Covington , Trauma survivors may view sex as taboo or hurtful and their sexual responses as bad.
In addition, sexual relationships sometimes can trigger painful memories of past abuse that can create difficulties for women, particularly in early recovery Covington ; Finkelstein Sexual dysfunctions. Alcohol and drugs interfere with sexual sensitivity and enjoyment in many ways. Women with substance use disorders have the same kinds of sexual dysfunctions as those without the disorder lack of orgasm, lack of lubrication, lack of sexual interest, etc.
Sexual and interpersonal violence. Sexuality often is associated with violence and abuse for female clients with histories of trauma. Consequently, they may be fearful, angry, and distrustful, and have difficulty functioning sexually.
Given the association between substance abuse and sexual abuse Ullman et al. This can create a spiraling relationship where many women use substances to alleviate the sexual difficulties they are experiencing. But the alcohol or drugs only exacerbate the problem.
Women who are under the influence of drugs are at greater risk for sexual and physical aggression Blume ; Testa et al. Sexually transmitted diseases STDs.
There are three primary reasons for this increased risk. When drunk or high, many women neglect to protect themselves against STDs or to make sure they do not use contaminated needles Evans et al. Often women with substance use disorders find themselves in relationships with men who are also chemically dependent, thereby increasing the risk that their partner may have STDs or are HIV positive.
In addition, rates of other infectious diseases among women with substance use disorders tend to be higher than among other female populations CSAT c ; Grella et al.
Notably, preliminary findings suggest that women who inject illicit drugs and have sex with other women exhibit increased HIV infection and risk behaviors in comparison to other people who use injection drugs Young et al.
Clinical Activity: Exploring the History and Influence of Relationships: Sociogram Using a simple diagram referred to as a sociogram that was pioneered by J. Depending on your goal, you can have the client focus only on the men or women who have been most influential in their lives.
Generally, the exercise provides more clarity for the client if you focus on only one gender at a time. If the woman is having a difficult time connecting with other women in treatment, it may be helpful to start with a history of her female relationships. Even though there are other ingredients that influence how a woman relates to and views other women namely gender socialization , a sociogram that begins with the history of female relationships may enhance awareness of the issues that impede her ability to relate to other women.
At other times, it may be more fruitful to focus on the history of male relationships with women due to clinical issues that involve men.