Issues Treated in Therapy:

Codependency

Codependency is a personality style characterized by passivity, feelings of low self-worth, and a need to constantly “help” others, especially one’s primary partner, and especially a person addicted to alcohol or drugs. Codependent people usually put aside their own needs in order to try to meet the needs of another person or other people. Although they may report how much they dislike this role, they are actually gaining a sense of importance, relieving loneliness, and/or avoiding working on their own issues and needs. On the other hand, some codependent people will report that they enjoy their role, but in fact are chronically unhappy, anxious, or addicted to drugs or alcohol themselves. There is a great deal of literature written on this subject, as well as many support groups in most cities. Al-Anon, a 12-step model group for the families of alcoholics or addicts, is centered on the issue of codependency, and on helping members break their cycles of dependency.

Signs of Codependency
Psychotherapy for Codependency
Codependency in the Diagnostic and Statistical Manual of Mental Disorders (DSM)
Working on Codependency through Therapy and Al-Anon - Case Example

Signs of Codependency

Characteristics of codependency may include:

Consistently focusing on others needs even at your own expense.
Being unable to receive help from others; feeling uneasy when others focus their attention on you.
An sense of self based entirely on being a "helper.”
Much of your time and energy spent taking care of someone who abuses drugs or alcohol.
Unable to be alone or not in an intimate relationship.
Feeling responsible anytime someone close to you suffers.
Seeming very competent on the outside but actually feeling quite needy, helpless, or numb.
Having experienced abuse or emotional neglect as a child, or having grown up with an addicted or alcoholic parent or parent.
Rarely expressing your true thoughts, needs or feelings because you fear they would displease others, and perhaps taking pride in this fact.

Psychotherapy for Codependency

People who experience codependency benefit from treatment that addresses loss of self. Codependency is usually rooted in childhood. The family of origin may create an environment in which an individual first develops codependent behaviors. Children of abusive or neglectful parents may develop patterns of servitude and ingratiation in order to survive, thus sacrificing their own needs and desires. Survivors of sexual abuse may never develop their own sense of sexual identity and satisfaction, always putting the needs of a sexually manipulative and controlling partner first. Psychotherapy can help people understand why they overcompensate, fulfill everyone’s needs but their own, or put themselves last. Whatever their symptoms of codependency are, they can be discovered through therapy. Once identified, a therapist can help an individual understand why they developed these behaviors and what consequences they have had on their lives and the lives of those around them. This is the first step in transforming emotional reactions and behaviors. Cognitive behavioral therapy, trauma therapy, and other psychotherapies that aim to address both emotional and behavioral responses are highly effective forms of treatment for codependency.

Codependency in the Diagnostic and Statistical Manual of Mental Disorders (DSM)

Codependency is not a stand-alone diagnosis in the DSM-IV; however, codependency may be related to the diagnosis of 301.6 Dependent Personality Disorder. Dependent Personality is marked by a pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

1. has difficulty making everyday decisions without an excessive amount of advice and reassurance from others

2. needs others to assume responsibility for most major areas of his or her life

3. has difficulty expressing disagreement with others because of fear of loss of support or approval. NOTE: Do not include realistic fears of retribution

4. has difficulty initiating projects or doing things on his or her own (because of a lack of self-confidence in judgment or abilities rather than a lack of motivation or energy)

5. goes to excessive lengths to obtain nurturance and support from others, to the point of volunteering to do things that are unpleasant

6. feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for himself or herself

7. urgently seeks another relationship as a source of care and support when a close relationship ends

8. is unrealistically preoccupied with fears of being left to take care of himself or herself

People with codependency may also experience clinical depression, chronic anxiety, and/or drug or alcohol addiction. Addiction is common for at least three reasons:

People with codependency often get into relationships with addicts so that they have someone to take care of, and this leads to using drugs themselves.
Codependent people often have trouble meeting their needs, they feel low or numb much of the time, and drugs provide some relief from these unpleasant feelings.
Spending time with addicts may give a person with codependency a sense of belonging.

Working on Codependency through Therapy and Al-Anon - Case Example

Charlene, 49, presents with a chronic, mild depression, with a sudden increase in symptoms. She identifies her live-in boyfriend as the source of her recent emotional downturn, reporting that he is emotionally abusive and drinks to intoxication every day. Charlene says that she knows they “love each other” and, upon investigation, reports that “the whole thing is my fault”. The therapist recognizes codependency, and acts accordingly. She refers Charlene to Al-Anon, which she tells Charlene will help with “dealing with an alcoholic partner.” She gives Charlene plenty of opportunity to express her feelings and needs, and encourages Charlene to do so, validating Charlene’s experience and allowing her freedom to cry, laugh, and verbalize her thoughts.The therapist reality checks Charlene’s beliefs about herself, her boyfriend, and relationships generally, pointing out that Charlene cannot possibly rescue her boyfriend, and that people are responsible for their own behavior. And the therapist helps Charlene discuss her childhood, and identify patterns of behavior and emotions that began there. Thus Charlene begins the road to recovery.

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