What treatment is available to Codependents?

In America the most widely adopted means of treatment for codependency is attendance of regular meetings at self-help groups such as Co-dependents Anonymous. These groups are organised and run by people who have experienced the particular condition (in this case Codependency). The participants support each other through sharing their experiences and emotionally being there for other group members. Nobody has to register so their anonymity is largely protected and it’s free.

Beattie who is considered as a guru of the Codependency movement is an advocate of the Twelve Step program which has been adapted from the Alcoholics Anonymous twelve step program for Alcoholics. She feels that groups provide a medium through which people with Codependency can air their experiences and feelings without fear of not being accepted because everybody else feels the same way and has gone through similar experiences.

The Twelve Steps program defined on the Co-Dependents Anonymous website are:

  1. We admitted we were powerless over others – that our lives had become unmanageable.
  2. Came to believe that a power greater than ourselves could restore us to sanity.
  3. Made a decision to turn our will and lives over to the care of God as we understood God.
  4. Made a searching and fearless moral inventory of ourselves.
  5. Admitted to God, to ourselves, and to another human being, the exact nature of our wrongs.
  6. Were entirely ready to have God remove all these defects of character.
  7. Humbly asked God to remove our shortcomings.
  8. Made a list of all persons we had harmed and became willing to make amends to them all.
  9. Made direct amends to such people wherever possible, except when to do so would injure them or others.
  10. Continued to take personal inventory and when we were wrong, promptly admitted it.
  11. Sought through prayer and meditation to improve our conscious contact with God as we understood God, praying only for knowledge of God’s will for us and the power to carry that out.
  12. Having had a spiritual awakening as the result of these steps, we tried to carry this message to other co-dependents, and to practice these principles in all our affairs.

There has been distinct criticism of self-help groups from mental health professionals. Katz and Liu believe that groups working to a Twelve Step program are harmful because they do not promote the possibility of a full recovery, personal responsibility or self reliance. Instead the groups encourage life long membership in fear that the Codependent will not have learnt their lessons and are able to help themselves through any future difficulties. In contrast to this view they explain that many people who experience addictive or destructive behaviour do not go for treatment or to self-help groups, that they manage to break free of their behaviour via their own volition and commitment to getting better. They feel that recovery can only be made possible by a person’s realisation that they have suffered enough and their own self motivation/commitment to their recovery. Once they have made the choice to get better the mode of treatment is not necessarily the most important factor in recovery.

They also stress that many people who join self-help groups “are not true addicts. They are people with problems who need guidance and support and acceptance, but they are not powerless. They can recover completely. They can achieve self-reliance. For these people self-help programs may provide the best way to begin the recovery process but in the long run they do more harm than good.” (Katz and Liu pg. xiv -xv of Introduction).

Katz and Liu also argue that self-help groups do not place enough emphasis on the conditions that members experience as being a result of their own choices and actions. That in self-help groups they are told “something” has happened to affect the individual, that someone or something else was responsible. “The overriding lesson of the Steps is not personal responsibility and morality, but conformity and dependence.” pg. 48. They compare self-help groups to cults who “maintain that salvation lies in the ability to give yourself up to a Higher Power. But that the real key to salvation is not relinquishing the control to a treatment program or guru or your Inner Child. The highest power lies within your own fully developed Self.” pg. 23. They also identify through a number of patient cases that sometimes the groups views are so ingrained in the minds of its members that it appears like brainwashing. Members can rattle off chapter and verse of the Twelve Steps program and treat anyone who does not wish to succumb to its teachings/help as being in “denial”.

They also feel that the Codependency movement places too much emphasis on relationships in the home being the only factor in creating people with behavioural/addictive problems. They do not look at wider influences such as friends, colleagues or the media. They highlight that studies have also shown that growing up in a dysfunctional family doesn’t necessarily mean a child born in to it will grow up requiring psychological treatment in adulthood. That sometimes things work out all on their own and the adult is able to work out their own issues to build a happy life for themselves.

Katz and Liu further criticise self-help groups for perpetuating “disease theory” and unnecessarily pathologising people who are essentially normal but may need a little guidance to help them get through stressful situations and bad times. They state the groups help to keep members in the past, focusing on the need to control old behaviours that may or may not appear again in the future. The repetitive nature of the discussions they have in groups keeps the memory of how it felt in the past when someone abused them in the forefront of their minds and as a result members will relate to those feelings in all future relationships. They argue that this doesn’t promote self-reliance because people are still clinging to old situations, old partners, old feelings etc. where they were reliant on something or someone else.

All people are different; they react differently to different events and to different treatments. Some psychologists have concerns that self-help groups do not provide individual treatment. Katz and Liu advise that other conditions and issues are not discussed in self-help groups concentrating on a specific area and as a result even minor incidents can linger as a “reason” for the pain. In addition the Twelve Steps were adapted from guidelines to help those specifically suffering from Alcoholism a very different condition at a time when religion was still prevalent in society.

One of the most obvious and damming criticisms of self-help groups are that they are not regulated by an official body. There is no measure of the standard of care that participants are receiving as a result of “working the program”. The groups are not lead by professionally trained Therapists. Usually the only requirement to being a group leader is that you have experienced the condition personally and that you are knowledgeable in the workings of the Twelve Steps program. Katz and Liu maintain that just because someone has experienced the same conditions and feelings as you doesn’t necessarily mean that they are the best people to guide you through your recovery. They feel that people who have themselves been successful in areas you are not are probably in a better position to be able to do this.

The second option open to a Codependent is therapy. By this means Katz and Liu feel a person is more likely to receive a non biased evaluation of their condition from a trained professional who is objective (hopefully having a healthy sense of Self and a respect for others) and can provide them with individual treatment to address their problems and issues. They are also more likely to get help that is focused on self-reliance as opposed to dependence on a group dynamic for future support. They do accept that mixing a group dynamic with Therapy can be beneficial in allowing the patient to identify with others who have gone through similar experiences but they do not see self-help groups as being a suitable long term treatment.

Medication can also be prescribed by a doctor for symptoms that a Codependent experiences such as depression, high blood pressure etc. in conjunction to any other therapy that is chosen.

What Can a Codependents Do To Help Themselves?

A Codependent can get better! This is achieved when they accept that they can only find happiness and success in bringing about change in themselves and not by changing the behaviour of their partner, friend, family member etc. through their help, advice, support and strength (which are a means of control).

In order to combat Codependency Beattie explains that it is necessary for the Codependent to detach themselves from others and their problems, to stop reacting impulsively/instinctively as rescuers. In this way the Codependent becomes an actor in control of their own destiny and that anyone who comes along for the ride is an addition to their Self and not a replacement for their Self. In this way the loss of a partner would not be so great if they decided not to continue the journey of Self awareness and improvement taken by the Codependent.

It is necessary to “mentally, emotionally, and sometimes physically disengage ourselves from unhealthy (and frequently painful) entanglements with another person’s life and responsibilities, and from problems we cannot solve” Beattie pg. 62. This allows other people to be who they really are, to grow. This requires the Codependent to live in the reality of a situation, to accept that there is nothing they can do to change others but that they can make their own lives better.

Beattie stresses that detaching doesn’t necessarily mean the end of a relationship or that people should stop caring but that sometimes physical detachment can be the only answer. She recognises that there will be people out there who provoke Codependents to react because it makes them feel important. When a Codependent stops reacting these people are left frustrated because they have lost their control and power over the Codependent.

Below is a summary of how Beattie pg. 73-74 suggests Codependents learn to detach:

  1. Learn to recognise when you’re reacting, when you are allowing someone or something to push your buttons.
  2. Make yourself comfortable. restore your level of serenity and peace.
  3. Examine what happened. talk about your feelings. Take responsibility for them.
  4. Figure out what you need to do to take care of yourself. Make your decisions based on reality, and make them from a peaceful state.

She explains that it is important for Codependents to accept the reality of the situation they are in. They should seek to inform themselves of the options open to them and pick the one they see as most beneficial to themselves and anyone who is truly dependant on them. Sometimes it’s hard to know what reality is when they have partners or people who are significant to them lying to protect themselves.

Once they work out what reality is it doesn’t necessarily mean that action has to be taken or that they should accept the hopelessness of their situation, particularly when physical and sexual abuse are occurring. In these circumstances it is important to recognise and accept that abuse is occurring and act to ensure that it stops – even if that means getting out of the relationship as quickly as possible.

This means that at some point the Codependent is going to have to let go of their dreams, their hopes for the future, the “happy ever after” that will one day be fulfilled. They’re going to have to accept that they can’t fix everything or make someone else be something they can’t or don’t want to be. This works on all levels not just in love, for example, a manager with Codependent tendencies may force their staff to do their job a particular way regardless of the employees feelings or skills. They are unlikely to accept that there may be different ways to do something that works just as well or that the particular staff member will never be able to perform well in the job they are currently doing. They would much rather pummel away at enforcing the change in behaviour they seek.

Without the acceptance of reality a Codependent is unlikely to change and make things better for themselves. The process through which this is classically achieved is the grief process. The five stages of the process are summarised below:

  1. Denial – The person is usually in a state of shock, numbness or panic and they usually refuse to acknowledge the reality of the situation they are in. The person is usually afraid or experiences anxiety and often represses their feelings.
  2. Anger – After they pass through denial they usually enter a stage where they lay blame and lash out (whether this is justified or not).
  3. Bargaining – When they calm down and try to fix/stop what is happening they try to bargain their way out. They say “if you do this, I’ll do that then we won’t have to loose.”
  4. Depression – The bargaining usually doesn’t work and as a result they experience sadness, they mourn and it can be painful. At this point they must allow themselves to grieve and seek support where necessary.
  5. Acceptance – once the first four stages have been traversed it is possible to get to the final stage of acceptance. It doesn’t necessarily mean that they are happy it means “We are at peace with what is. We are free to stay; free to go on; free to make whatever decisions we need to make.We have accepted our loss. we are comfortable with our present circumstances and ourselves. we have faith that all is well, and we have grown from our experience.” Beattie pg. 137-138.

She reminds us that we will continue to make mistakes throughout our life as we work towards taking care of ourselves. As a result we need to remind ourselves “We are okay. It’s wonderful to be who we are. Our thoughts are ok. Our feelings are appropriate. We’re right where we’re supposed to be today, this moment. There is nothing wrong with us. There is nothing fundamentally wrong with us. If we’ve done wrongs, that’s okay; we were doing the best we could.” Beattie pg.122.

She also recommends enrolment in a self-help group like Co-dependents Anonymous.

In an alternative approach Katz and Liu argue that self-help groups focus on the use of negative labels to asses how people fit in to the world and that these labels do not promote self-esteem. They suggest a more scientific, objective and logical approach to dealing with the resolution of problems which they explain are specific, tangible facts or events that occur within a relationship in the immediate term. That this will work towards resolving some of the subjects issues which are interpreted analysis of their perceived general behaviour in the past. They believe that people can go on to make a full recovery as independent, self-reliant and happier individuals.

In the last half of their book they describe an eight-point plan to working towards a complete recovery these are summarised below:

  1. Define your problems without labeling yourself – This involves stepping back from your problems and changing the way you resolve them by systematically listing the problems (not issues) you are facing now and prioritising them into those that are harmful to your physical and mental health, those where an immediate decision is required, where they cause guilt and shame, those that may attract comments or criticism from others, those that lead to illegal or immoral conduct.
  2. Recognise the many different influences that have shaped your life – once you have identified your problems it is necessary to understand where those problems have evolved from i.e. family, biology, culture and society.
  3. Remember the past, don’t live it – once you have determined the major influences in your life you must analyse connections between your past and your present, challenge your memories and the distortions of time or other peoples opinions to get an accurate reading of what happened to make you the way you are but do not dwell on it.
  4. Accept responsibility for your own choices and actions – weigh up the consequences of the options you have open to you, ensure you keep your feelings of inadequacy and high expectations of yourself in check, recognise that you have options and make a choice.
  5. Focus on the goal rather than the process of recovery – ensure you are committed to changing yourself, identify the obstacles to recovery then strive for attainable recovery goals.
  6. Tackle your problems one at a time – identify specific goals, brainstorm possible solutions, evaluate the solutions, select one solution and one contingency solution. When you get going re-evaluate the problem, plan how you will do what is necessary, guard against self-sabotage, Implement your plan and monitor progress and plan to prevent recurrence of the original problem. When you have reached your goal move on to another one.
  7. Select a treatment program that nurtures self-reliance, not dependency – whether that is counselling, psychotherapy, medication, self-help groups (in the short term for specific problems) or mutual support groups.
  8. Develop your personal strengths and resources – believe in what you can do, build a support network of friends, family and hobbies that will help to see you through bad times, take on new challenges that will help you to grow and develop self-esteem, dare to be hopeful about the future.

This suggestion sounds straightforward but Katz and Liu recognise that change is a difficult process, that sometimes people get stuck and need guidance that helps them back to the road of self-realisation and independence.

If you would like to read more on codependency you may find the websites or books on codependency useful.