An overview of the prevalence and challenges of codependency, how it affects our clients, and how codependency in counselors can negatively impact our quality of service.
2. • Definitions
• Types
• Characteristics
• Origin/Facts
• Challenges
• Patterns
• Development
• The Codependent Counselor
• Diagnosis/Treatment
• Strengths
• Two Stories
• Q+A
3. Codependency is a condition or state of being, that results
from adapting to dysfunction (possibly addiction) in a
significant other.
Codependency is a learned response to stress which, over
a person’s lifetime, can lead to the development of the
following characteristics:
• External Focus
• Repressed Feelings
• Comfort with Crisis
• Boundary Conflicts
• Isolation
• Stress related illness
• Compulsive Behavior
4. “Codependency is a pattern of thinking,
feeling, and behaving.
If you are codependent, you are unable to
identify and follow your own needs, wants and
feelings.
It’s as if you have grown antennae, and you
wave them as you move through life, straining
to pick up vibes from others.
If you are codependent, you are not powered
from within; your quest for power is through
controlling others.
In fact, you’re so focused on another, you may
not even know how you think or feel.”
(Sowle, 2015)
5. Interdependency
• Mutual dependence between people
• Healthy Intertwining
Codependency
• One sided – mutation of interdependency
• Balance between dependency & autonomy has not been achieved
• Needs reflection of himself in another to know he is okay
8. • Term emerged from AA in 1960s to describe enabling relationships.
Satir & Bowen - psychological problems can be connected to family systems
• 1 in 5 people in U.S. have a parent who suffers from alcoholism/addiction
• 50% of individuals have a close family member who suffers from some form
of addiction
• That means 20-50% of your future clients may be affected
• Putting this In perspective – prevalence of other mental disorders we study:
• OCD 1%
• Bipolar Disorders 2.6%
• PTSD 3.5%
• ADHD 4.1%
• Major Depressive Disorder 6.7%
• Anxiety Disorders 18%
• Codependency 20-50%
(Sowle, 2014; NIMH, 2013)
9. Characteristics and behaviors may develop that can
seriously affect personal relationships & quality of life:
• Increased likelihood of developing an addiction: 50 – 90%
• Damaged worldview, including serious issues with boundaries, trust,
shame, self-esteem, fears and perfectionism (Lancer, 2012)
• Higher rates of mental disorders and depression, marriage to addicted
partners, and divorce (Sonnenberg, 2011)
• May negatively affect critical areas of life including romance, career,
parenthood and financial matters (Sonnenberg, 2011)
• Increased physical illness – ACE score
correlations for trauma & future health
10. 5 Major Patterns & Examples:
• Denial
• Low Self-Esteem
• Compliance
• Control
• Avoidance
11. By young adulthood, failure/negative resolution of stages may lead to –
OUTCOMES
Stage 1 – Infancy TRUST vs. MISTRUST Learns not to trust
Stage 2 – Early Childhood AUTONOMY vs. Shame & doubt over parent’s behavior
SHAME & DOUBT
Stage 3 – Play Age INITIATIVE vs. GUILT Guilt over inability to change parent’s behavior
(+ responsibility for their behavior?)
Stage 4 – School Age INDUSTRY vs. Feels inferior due to diminished self-concept
INFERIORITY
Stage 5 – Adolescence IDENTITY vs. Confused about who they are
IDENTITY CONFUSION
Stage 6 - Young Adulthood INTIMACY vs. Isolation due to lack of trust
ISOLATION Belief that no one would listen/understand
Chooses toxic partners, reinforces inability to trust
Seeks good parent they did not have in partners
(Whitaker & Rivinus, 1988)
13. Areas where unresolved issues may negatively impact our
responses to client and quality of service/care:
SHAME & DENIAL
LOW SELF-ESTEEM
GUILT
FEAR
BOUNDARIES
CARETAKING & CONTROL
What we avoid in ourselves, we avoid in others.
14. DSM Diagnosis –
Not recognized as diagnosable mental health condition in the DSM-5
Type of Disorder –
Referred to as a syndrome, but closest to a personality disorder
Related Diagnoses –
Anxiety, chronic depression (PDD), chronic trauma/PTSD, addictions
Prognosis –
If left untreated, codependent symptoms will worsen (Lancer)
Culture –
Recognized in western/individualistic cultures, may not apply to clients
from collectivistic or other cultures
15. Types of treatment
• Individual therapy – the 4 “A”s – abstinence, awareness, acceptance + action
• Family Therapy
• Healing Shame
• 12 Step Support Groups
• Medication for associated disorders
Treatment Goals
1. Increase understanding of codependency/relationship issues
• Accept that codependency is causing their problems
• Identify underlying issues
• Take steps toward dealing with issues and applying new skills
2. Correct irrational thinking leading to the codependency or relationship issues
• Identify specific areas of cognitive distortion
• Challenge irrational thoughts with reality
3. Address areas of potential concern for future relationships
• High risk people, places, or situations
• Old patterns which may emerge
16. Empathy –
• Exceptional listeners, great friends/teachers/counselors, advocate for the underdog
Independence –
• Like to be in control and work independently, hard workers, entrepreneurial
Creativity –
• Sensitive, heals through creating, uses their art or craft to speak their truth
Resiliency –
• Survivors, positive coping skills too, driven toward healing
• Relationships – married consciously into happy, healthy and/or strong families
Calmness in Chaos –
• Difficult to shock, tough, calm exterior (Eden)
Initiative –
• More likely to take control
• Used to being caretaker/keeping things together
20. • Dayton., Retrieved from: http://www.huffingtonpost.com/dr-tian-dayton/adult-children-of-
alcoholics_b_1835677.html
• Eden., Retrieved from: http://guesswhatnormalis.com/2007/05/play_to_your_st
• GoodTherapy. Retrieved from: http://www.goodtherapy.org/therapy-for-codependency.html
• Lancer, D., Retrieved from:
http://www.camft.org/AM/Template.cfm?Section=Home&ContentID=14161&template=/CM/Content
Display.cfm
• Lancer, D., Retrieved from: http://psychcentral.com/lib/problems-of-codependents/00011982)
• Lancer, D., GoodTherapy webinar
• Sonnenber, 2011, http://www.beliefnet.com/healthandhealing/getcontent.aspx?cid=14242
• Wilson Schaef, A. (1986). Co-dependence: Misunderstood, mistreated. New York, NY: HarperCollins.
• http://www.nimh.nih.gov/health/publications/the-numbers-count-mental-disorders-in-
america/index.shtml#MajorDepressive
• http://www.coda.org/tools4recovery/patterns-new.htm
• http://www.wellmont.org/Health-And-Wellness/Health-Library/ ?eid=14242& lang=1033
• http://www.goodtherapy.org/therapy-for-codependency.html
• http://en.wikipedia.org/wiki/Codependency
• Treatment Plan Overviews Codependence, http://www.insightandoutlook.com/tp-codependency.php#mg1
• http://www.whatiscodependency.com/what-is-codependency/
Notas do Editor
LMK
Each stage builds on the mastery of the previous stage. Stage failures or patterns in childhood may result in codependency traits later in life (Sowle, 2014).
Maybe use some of this below -
Dr. Ackerman references Erik Erikson‘s Eight Stages of Development to illustrate the problems that can or will occur when children‘s emotional and developmental needs are not met. Dr. Ackerman discusses the first stage of Trust vs. Mistrust and is especially concerned for this is the foundation of the rest of the child‘s development
“The family life of the daughter of alcohol is not to trust anyone for fear of disclosing too much which can be used in the future to hurt her. A daughter of alcoholism trusts too easily or not at all. As the stages of Erikson continue, these daughters are overly controlled and learn shame and doubt of their own abilities. The daughter‘s questions were avoided or deemed unimportant so they feel guilty. They are not as important as the alcohol; their achievements are rejected or ignored. They believe it is not who they are that is important but what they do; they feel unlovable and have low self-esteem. Their identity is confused and unclear and they find it hard to feel as though they belong. The daughters of alcoholics have intimacy problems, they have been rejected and retreat to isolate themselves or give too much, thinking eventually they will receive something in return. In the final stage, the daughter of alcohol finds herself dissatisfied and unhappy with who she has become and tries to blame others around her.”
Dr. Ackerman states, “To be a good child of Alcoholism, you were called upon to deny the alcoholism and other family problems, subjugate your developmental needs, hide your emotions, please others, pretend you were happy and be a ‘perfect daughter‘.” (Perfect Daughters, Ackerman, 1989)
http://forumonpublicpolicy.com/spring2010.vol2010/spring2010archive/dehn.pdf
(Whitaker & Rivinus, 1988) - ages%20of%20development&f=false
https://books.google.com/books?id=bajrAgAAQBAJ&pg=PA208&lpg=PA208&dq=acoas+and+erikson%27s+stages+of+development&source=bl&ots=2febmNqKuc&sig=hukZz4N5lkPwOUOsEGXzfLlE6Cc&hl=en&sa=X&ei=EOoSVY28HIaiNu3lg5gJ&ved=0CCQQ6AEwAQ#v=onepage&q=acoas%20and%20erikson's%20st
LMK
We all adapt to some degree in order to sustain the level of emotional attachment that we are comfortable with.
Anxious – need to be close and love the intimacy, but very sensitive to small cues of threat in the relationship. This is anxiety-provoking, may have difficulty with self-soothing so look externally
Avoidant – want to be in a relationship, but uncomfortable with too much closeness – it is viewed as something that interferes with their independence
Both are unconscious of their styles, which may sabotage loving and secure adult connections
Parenting style – authoritarian parenting style in fathers is correlated with higher levels of codependency in sons and daughters
http://healthland.time.com/2011/02/13/mind-reading-how-the-new-science-of-adult-attachment-can-improve-your-love-life/
http://www.breakthroughatcaron.org/sites/breakthroughatcaron.org/files/ann_smith_-_10_10_powerpoint_final.pdf
http://www.whatiscodependency.com/change-your-attachment-style/
http://eric.ed.gov/?id=EJ513099
Codependency Scale - http://courses.ttu.edu/jfischer/Questionnaires%20Inventories/codependency%20scale.htm
