Editor’s note: Susan Heitler, PhD is a clinical psychologist specializing in healthy conflict resolution and the author of The Power of Two, a workbook for couples. Her continuing education presentation for GoodTherapy.org, titled Narcissistic Habits: Couples Therapy Treatment Techniques, is scheduled for 9 a.m. Pacific Time on September 19, 2014. The event is available at no additional cost to GoodTherapy.org members and is good for two CE credits. For details, or to register, please click here.
Codependency as a personality diagnosis is a label with significant limitations. Having emerged initially from the world of alcohol and drug treatment, codependence neatly describes the husband who makes excuses to his wife’s friends to cover for his wife’s evening drinking binges. In that context, the husband is acting as a codependent in the sense of fostering his wife’s alcohol dependency. For use beyond the arena of alcohol and drug dependency treatment, however, the term needs an upgrade.
For instance, Jack who is married to a quick-to-anger woman with narcissism, strengthens his wife Julie’s narcissism when he self-smothers his inner voices lest he say something that might arouse Julie’s ire. Similarly, a corporate assistant, Brenda, fosters her boss Peter’s self-defeating workaholic tendencies when she consents to work late hours to help him tackle too many tasks. While Julie’s narcissism and Peter’s work excesses both create problems, the narcissism and workaholic patterns are not “dependencies” in the sense of a drug dependence. So describing Jack or Brenda’s enabling behaviors as codependent stretches the term excessively.
The term enabler—commonly used as a synonym for codependent—may be a more fitting alternative. Jack functions as an enabler when he smothers his own preferences, fostering his wife Julie’s narcissism. Brenda functions as an enabler when she too often works late to help her boss Peter complete the excessive number of work projects he has taken on.
The True Nature of Codependency
Although codependence may be better labeled as enabling, the phenomenon merits further clarification. To this end, I have coined four additional terms that clarify the internal experience of “codependent” enabling: excessive altruism, appendagitis, wishful thinking, and misplaced locus of focus.
While I speak these terms with my tongue somewhat in my cheek, diagnostic language is clinically useful to the extent that it guides therapeutic interventions. These terms, for me, pass that test.
What’s more, the new terminology brings an added bonus to treatment. Clients almost always chuckle when I tell them with exaggerated seriousness, “I’m afraid that you have a quite serious case of wishful thinking” (or either of the other three terms). Humor relaxes them so they are more open to accepting feedback on these self-defeating phenomena.
What Is Excessive Altruism?
Giving feels good. By contrast an excessive inclination to help others through giving—that is, giving more time, money, energy, or affection than feels do-able—incurs a sense of burden.
In healthy partnerships altruism is a two-way street. Hopefully each partner gives and receives ample affection and appreciation, the ultimate contributions of value in relationships. The contributions needn’t be identical: One partner may cook, the other may wash dishes and take out garbage, so long as the contributions are subjectively felt to be of similar value.
When the overall traffic of giving and receiving feels approximately equal from both sides, goodwill prevails. Excessive altruism and/or selfishness, by contrast, unbalance the giving and getting, inviting resentment.
What Is Appendagitis?
Appendagitis characterizes an attachment in which one person serves as another person’s additional appendage. This psychological diagnosis is not to be confused with Epiploic appendagitis, a self-limiting inflammatory process of the epiploic appendices which are small, fat-filled projections along the surface of the colon and rectum.
Psychological appendagitis occurs when individuals shed their own preferences, life goals, and voice, and instead devote all their energies to another, such as a spouse, boss, or friend with needy or narcissistic tendencies. This shift usually is motivated out of a mixture of love and fear that without this shift they may incur the other’s anger and/or lose the relationship.
What Is Wishful Thinking?
Wishful thinking is the cognitive habit of believing that others will change when there is no realistic basis for this hope.
Brenda wishes her boss would become more appreciative of her efforts. She devotes ever-increasing efforts to please him in misplaced hope that someday he will change into a person who expresses gratitude and praise.anger, but when Jack tries to discuss these concerns with her, Julie immediately erupts in anger, turning on him with blame that the problems are in fact his fault. Julie’s blaming responses indicate that the likelihood of her making changes is very low.
What Is Misplaced Locus of Focus?
A locus is defined as a place—a center of activity—where something occurs. Misplaced locus of focus means that someone’s attention is riveted to reading another’s thoughts, feelings, and facial expressions, periferalizing their awareness of their own thoughts and feelings, and assuming or guessing what the other person is thinking instead of asking.
Brenda, for example, stayed late at work three nights in a row. When her boss, Peter, was surprised to find her still in the office, she explained, “I thought it would make you less stressed, more relaxed, if I could get this report out before the weekend. I’m here working late because I thought it would make you happy.”
“Actually,” Peter responded, “I want to wait a month before sending the report out. I have more information coming in over the next few weeks that I’ll want to include in it.”
Brenda was disappointed to discover that she not only failed to anticipate Peter’s needs, but also neglected the needs of herself and her friends with whom she had cancelled plans in order to fulfill her boss’s needs.
When Is Helping Others a Good Thing? When Is It Excessive?
Codependent-like behaviors have their healthy variants. Infants and young children for instance depend upon the consistent attentions of parents to stay alive. Parents’ responsivity, attunement, and nurturance contribute positively to the survival and thriving of young children.
At the same time, even parents can go overboard on attending to their young, allowing attunement and nurturing to slip inadvertently into appendagitis. Jack, the devoted husband and dad of four young children, often gets overwhelmed at breakfast time when he asks his wife and each of their children, “What would each of you like for breakfast today?” Bacon for this one, scrambled eggs for that, a fried egg for another, sunny side up with pancakes for the fourth, and French toast for the next. What’s wrong with this picture?
In other large families, parents put cereal and bowls on an accessible shelf where even the younger children can reach the boxes and pour their own, adding fruit, nuts, and milk. Maybe Mom or Dad cooks toast and eggs, and sometimes even pancakes, but only one kind of food is on the menu for everyone.
By catering to each individual’s daily preference, Jack’s excessive altruism is training his children in unrealistic expectations. He is fostering dependence and narcissism instead of training his children to become increasingly independent, to adapt to living as part of a group, and to be considerate of their dad’s time and energies.
Behaviors like altruism become problematic when people dedicate their energies to another person (1) to their own detriment, (2) to the detriment of the receiver and (3) when the other does not want the help.
For instance, Brenda suffers unhealthy appendagitis to the extent to which she allows her contribution of extra work hours to be exploited. Does she get paid? Does she really want to devote these additional hours to work? Also, while she believes she is helping her boss Peter, Brenda may actually be harming him by encouraging his tendencies to take on more and more until he is ready to collapse from stress and fatigue.
What Causes Excessive Altruism, Appendagitis, Wishful Thinking, and Misplaced Locus of Focus?
The all-about you attachment stance of people with the four enabling tendencies described above inadvertently attracts individuals with narcissism who love being the focus of someone’s attention and adulation. A hallmark of narcissism attachment patterns is an all-about-me stance that allows the coupling of enabling and narcissistic habits to seem, initially at least, to dovetail beautifully.
In enabler-narcissist partnerships, all-about-you habits may then be sustained because they seem to attenuate the narcissistic partner’s quickness to criticism, controlling behaviors, and anger. For someone trying to live in relative harmony with a narcissistic partner, these seemingly self-defeating habits may in fact help.
Family of origin can also play a role in creating a template for enabler interactions. Most often, individuals who develop excessive altruism, appendagitis, wishful thinking, and misplaced locus of focus are repeating patterns they observed in their parents’ marriage relationship. A child learns to speak French by hearing French spoken at home. We learn interaction and survival habits the same way, by hearing and observing our parents.
Children also may become highly skilled at enabling habits in order to cope with a narcissistic parent. Parents with narcissism insist that their children ignore their own preferences and become instead what the parent wants them to do and be. The development of enabling habits, like appendagitis, offers children of narcissists less animosity and more positive attention than if they were to interact with the parent in a more emotionally healthy manner. Children learn to do whatever contortions they must to retain the necessary positive attentions of their caretakers. Survival of the bond with the attachment figure is a first priority.
Treatment Implications for Each of These Terms
Excessive altruism, appendagitis, wishful thinking, and misplaced locus of focus each exacerbate the other, creating a vicious downward cycle of circular causation with ever-increasing anger, depression, and relationship dissatisfaction. What can reverse this cycle so that the spin switches upward toward ever-more positive feelings?
Excessive altruism leads to feeling over-burdened and resentful toward those on the receiving end of the giving. Folks with excessive altruism therefore need to learn to balance their giving to others with self-care.
Similarly, people with appendagitis need to refocus their attention on themselves. They need to turn up the volume on their own thoughts and preferences so they can hear their inner drummer. They then need to learn to speak up tactfully and still effectively about what they feel and want. Lastly, they need to learn win-win ways of making decisions so that the partner with narcissisism is less likely to feel disempowered, wrong, or like a loser.
Wishful thinking creates a faulty personal guidance system. Therapy that clarifies the realities regarding the other person’s repeated motivations and behavior patterns enables the development of better life decisions. The narcissistic partner may someday change, but often only after the wishful thinking partner first has begun making decisions based on reality.
Misplaced locus of focus can be reversed with practice drills on utilization of new sentence starters. For example, each time clients use the sentence-starters such as “I feel … ,” “My concern is … ,” and “I would like to … ,” their locus of focus must switch to their own inner feelings and thoughts in order to complete the sentence.
A change of habits seldom comes with a “Get Out of Jail Free” card. As Jack ceases to foster Julie’s narcissism, it therefore is vitally important that Julie be included in the treatment process, preferably in a couples therapy treatment format, so that the two spouses can change and grow simultaneously. If so, Julie and Jack are likely to end up feeling increasingly loving toward each other and happier within themselves. If not, they are likely to end up divorced.
As to Brenda, if she embarks on therapeutic change Brenda may lose interest in continuing to work for Peter. On the other hand, Brenda’s growth could free Peter as well, so that he may enjoy a fuller life less clogged by work.
Words have power. Naming a phenomenon helps to clarify what a phenomenon is and does, and how to attenuate its negative impacts. Each of the playful terms introduced in this article can help therapists to guide their codependent/enabler clients to awareness and correction of the technical mistakes they have been making, leading them toward the more positive emotions and fulfilling relationships that they have come to therapy to discover.
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