Course Description

“Codependency” is used to describe the condition where a person becomes the “caretaker” of an addicted or troubled individual. The individual can be addicted to alcohol, drugs, or gambling. Or, he or she can be troubled by a physical or emotional illness. Codependents can be this individual’s spouse, lover, child, parent, sibling, coworker, or friend.

Codependency is not a word you would find in many dictionaries, nor is it a concept that is easy to define. Codependency has been described as an addiction, a disease, learned behaviors, a psychosocial condition, and a personality disorder. The term has been widely applied to define spouses of chemically dependent or otherwise dysfunctional persons. More generally, codependency has been applied to individuals who suffer from constantly focusing on the needs and behaviors of others. Many professionals argue that individuals addicted to alcohol, work, food, sex, and shopping all suffer from the malady of codependency. Codependent individuals become so preoccupied and focused on the needs of others that they neglect their own needs. Some authors even argue that codependency is the most common of all addictions. Is it possible that under every addiction lies elements of codependency? There are numerous definitions of codependency, and experts in the field do not agree on any specific definition.

Perhaps the reason codependency is hard to define is due to the fact that the term has emerged within recent history. Originally codependency was aimed to describe family members and spouses of chemically dependent individuals. Today the term is used more generally. Codependency refers to maladaptive behavior that results from a stressful preoccupation with another individual’s life. Without treatment, codependency leads to dysfunctional relationships.

Some of these common characteristics are so broad that it can be argued that in one aspect or another nearly everyone could be codependent. Relationship difficulties are often a result of codependency. Codependency is a progressive disorder, but even in advanced stages it is important to remember that codependency is treatable.

Codependency can be viewed as an illness with both psychological and physical implications. Certain psychological disorders are often associated with codependency. Some of these disorders include avoidant personality disorder, dependent personality disorder,obsessive compulsive personality disorder, mixed personality disorder, dysthymic disorder, anxiety disorder, post traumatic stress disorder, and addictive disorders. Recognizing the disorders that are often associated with codependency are important in diagnosis.

Physical illnesses may start to emerge during middle and advanced stages of codependence. Many codependents experience insomnia, heart arrhythmia, sexual dysfunction, self neglect, fatigue, suppressed immune functioning, and headaches. In later stages of codependency individuals may feel lethargic, depressed, or experience an eating disorder. The ramifications of codependency go beyond psychological symptoms.

Below are typical roles that codependents play:

	Enabler allows the person to continue his or her self-destructive or troubled behavior, or denies that the person has a problem.
	Rescuer makes excuses for the person’s behavior, or saves the person from unpleasant situations, i.e., putting an alcoholic to bed after he/she passes out.
	Caretaker takes care of all household and financial chores which hold the family together.
	Joiner rationalizes that the person’s behavior is normal by simply allowing it to take place or by taking part in the same behavior as the addicted or troubled individual.
	Hero becomes the “super person” to preserve the family image.
	Complainer blames the person and makes him or her the scapegoat for all problems.
	Adjuster withdraws from the family and acts like he/she doesn’t care.

Most codependents do not realize they have a codependency problem. They focus more energy on another’s actions and needs than on their own. They think they are actually helping the troubled person, but they are not.

v Questions to Ask

Do you do 3 or more of the following? 

	Think more about another person’s behavior and problems than about your own life.
	Feel anxious about the addicted or troubled person’s behavior and constantly check on that person to try to catch him or her in a bad behavior.
	Worry that if you stop trying to control the other person, he or she will fall apart.
	Blame yourself for this person’s problems.
	Cover up or “rescue” this person when he or she is caught in a lie or other embarrassing situation related to his or her addiction or other problem.
	Deny that this person has a “real” problem with drugs, alcohol, etc., and become angry and/or defensive when others suggest there is an addiction or other substance abuse problem.

Note: You may not be truly codependent, but you should become aware of how your behavior may be enabling an addicted or troubled individual.

 

Source: M-Care, University of Michigan.

             www.mcare.org/healthathome/codepend.html 

 

 

Codependency:

General Mental Health Issues

Codependency is a learned behavior that can be passed down from one generation to another. It is an emotional and behavioral condition that affects an individual’s ability to have a healthy, mutually satisfying relationship. It is also known as “relationship addiction” because people with codependency often form or maintain relationships that are one-sided, emotionally destructive and/or abusive. Many times a couple experiencing sexual problems may have much bigger problems at hand. Sexual problems may merely be a symptom of a much larger relationship issue. That larger relationship problem could be codependency.

The disorder was first identified about ten years ago as the result of years of studying interpersonal relationships in families of alcoholics. Codependent behavior is learned by watching and imitating other family members who display this type of behavior.

v Who Does Codependency Affect?

Codependency often affects a spouse, a parent, sibling, friend, or co-worker of a person afflicted with alcohol or drug dependence. Originally, codependent was a term used to describe partners in chemical dependency, persons living with, or in a relationship with an addicted person. Similar patterns have been seen in people in relationships with chronically or mentally ill individuals. Today, however, the term has broadened to describe any codependent person from any dysfunctional family.

v What Is a Dysfunctional Family and How Does It Lead to Codependency?

A dysfunctional family is one in which members suffer from fear, anger, pain, or shame that is ignored or denied. Underlying problems may include any of the following:

	An addiction by a family member to drugs, alcohol, relationships, work, food, sex, or gambling.
	The existence of physical, emotional, or sexual abuse.
	The presence of a family member suffering from a chronic mental or physical illness.

One key sign, perhaps vague, is that our attitudes or behaviors or feelings are somehow out of proportion to what is happening in our lives in the present. We may feel we are “less than,” inherently flawed or shameful. We may feel sad or angry or scared or just plain lonely most of the time. We may try to escape with alcohol, drugs, or various other addictive or compulsive behaviors. Even if we succeed in changing these behaviors, we may still feel “not quite right.”

Dysfunctional families do not acknowledge that problems exist. They don’t talk about them or confront them. As a result, family members learn to repress emotions and disregard their own needs. They become “survivors.” They develop behaviors that help them deny, ignore, or avoid difficult emotions. They detach themselves. They don’t talk. They don’t touch. They don’t confront. They don’t feel. They don’t trust. The identity and emotional development of the members of a dysfunctional family are often inhibited.

Attention and energy focus on the family member who is ill or addicted. The codependent person typically sacrifices his or her needs to take care of a person who is sick. When codependents place other people’s health, welfare and safety before their own, they can lose contact with their own needs, desires, and sense of self.

v How Do Codependent People Behave?

Codependents have low self-esteem and look for anything outside of themselves to make them feel better. They find it hard to “be themselves.” Some try to feel better through alcohol, drugs or nicotine_and become addicted. Others may develop compulsive behaviors like workaholism, gambling, or indiscriminate sexual activity.

They have good intentions. They try to take care of a person who is experiencing difficulty, but the caretaking becomes compulsive and defeating. Codependents often take on a martyr’s role and become “benefactors” to an individual in need. A wife may cover for her alcoholic husband; a mother may make excuses for a truant child; or a father may “pull some strings” to keep his child from suffering the consequences of delinquent behavior.

The problem is that these repeated rescue attempts allow the needy individual to continue on a destructive course and to become even more dependent on the unhealthy caretaking of the “benefactor.” As this reliance increases, the codependent develops a sense of reward and satisfaction from “being needed.” When the caretaking becomes compulsive, the co-dependent feels choiceless and helpless in the relationship, but is unable to break away from the cycle of behavior that causes it. Codependents view themselves as victims and are attracted to that same weakness in the love and friendship relationships.

v Characteristics of Codependent People

	An exaggerated sense of responsibility for the actions of others
	A tendency to confuse love and pity, with the tendency to “love” people they can pity and rescue
	A tendency to do more than their share, all of the time
	A tendency to become hurt when people don’t recognize their efforts
	An unhealthy dependence on relationships. The codependent will do anything to hold on to a relationship, to avoid the feeling of abandonment
	An extreme need for approval and recognition
	A sense of guilt when asserting themselves
	A compelling need to control others
	Lack of trust in self and/or others
	Fear of being abandoned or alone
	Difficulty identifying feelings
	Rigidity/difficulty adjusting to change
	Problems with intimacy/boundaries
	Chronic anger
	Lying/dishonesty
	Poor communication
	Difficulty making decisions

v Signs of Codependence

Codependence is most often evident in our relationships with people who are important in our lives, be it at work, in our family, with friends, or with those in authority. How we behave and feel in these settings may indicate if we have a problem.

The following statements are designed to acquaint you with some of the common signs of codependence. If you identify with some of these specific or the more general signs mentioned in the prior section, you may wish to investigate further. Please talk to a mental health professional or contact your local chapter of Codependents Anonymous.

Low Self Worth

	I feel like I’m different from other people.
	I don’t see myself as a lovable, worthwhile person.
	I’m uncomfortable when others compliment me or give me gifts.
	Criticism and disapproval easily hurt me.
	My desire to do things perfectly leads me to procrastinate.
	I feel lonely even when I’m with people.
	I frequently feel either less than or better than others.
	I feel empty, like I have a “hole” inside me.
	I frequently “beat myself up.”
	I often judge myself harshly; nothing I do is up to my expectations.
	I often compare how I feel about myself with the outward appearance of others.

Controlling Behaviors

	I have difficulty expressing certain kinds of feelings (grief, love, anger, fear).
	I judge people and things as right or wrong, good or bad.
	I let people know only what I think is “safe” for them to know about me.
	I have trouble having fun without drinking or getting “high” first.
	I have a hard time accepting my mistakes.
	I have difficulty asking for help.
	I have trouble balancing work and recreation.
	I like to “numb out” to relax (watch TV, sleep, eat, fantasize), often to my own disadvantage.
	I have a fear of being out of control.
	I sometimes rage in order to get my point across.
	My self worth increases when I solve other people’s problems.
	I become resentful when others do not take my advice or will not let me help them.

Pleasing Behaviors

	I compromise my own values and integrity in order to be accepted by others.
	I feel guilty when I say “no.”
	Often I have sex when I don’t really want to.
	I volunteer to do things I really don’t want to do.
	I spend a lot of time pretending things are “fine.”
	I believe that doing things to care for or please myself is selfish.
	I put other people’s needs before my own.
	I usually do what my friends/partner want, rather than what I want to do.
	I rarely let people know when I’m angry.
	I won’t say how I really feel, because I’m concerned about how others may react.

Relationship Issues

Codependence often turns up in our relationships. Following are additional signs which may help you to see if you or someone in your life needs to find out more about codependence.

	I believe in love at first sight.
	I find people that are nice to me seem boring.
	I believe that if I can get my partner to change, my problems would be solved.
	I can’t feel good about myself when my relationship isn’t going well.
	I accept sex when I really want love.
	I feel that I’m incomplete when I’m not in a relationship.
	I believe that other people can make me feel angry, happy, sad, etc.
	I want to have good relationships, but they never seem to work out.
	I have trouble being alone without keeping busy.
	I feel responsible for other people’s feelings.
	I have trouble getting close to or trusting people.
	I often feel anger that is out of proportion to what is happening.

v Questionnaire to Identify Signs of Codependency

This condition appears to run in different degrees, whereby the intensity of symptoms are on a spectrum of severity, as opposed to an all or nothing scale. Please note that only a qualified professional can make a diagnosis of codependency; not everyone experiencing these symptoms suffers from codependency.

1. Do you keep quiet to avoid arguments?
2. Are you always worried about others’ opinions of you?
3. Have you ever lived with someone with an alcohol or drug problem?
4. Have you ever lived with someone who hits or belittles you?
5. Are the opinions of others more important than your own?
6. Do you have difficulty adjusting to changes at work or home?
7. Do you feel rejected when significant others spend time with friends?
8. Do you doubt your ability to be who you want to be?
9. Are you uncomfortable expressing your true feelings to others?
10. Have you ever felt inadequate?
11. Do you feel like a “bad person” when you make a mistake?
12. Do you have difficulty taking compliments or gifts?
13. Do you feel humiliation when your child or spouse makes a mistake?
14. Do you think people in your life would go downhill without your constant efforts?
15. Do you frequently wish someone could help you get things done?
16. Do you have difficulty talking to people in authority, such as the police or your boss?
17. Are you confused about who you are or where you are going with your life?
18. Do you have trouble saying “no” when asked for help?
19. Do you have trouble asking for help?
20. Do you have so many things going at once that you can’t do justice to any of them?

 

Copyright National Council on Codependence, Inc.

Reprinted with permission.

 

How Is Codependency Treated

There are three main approaches to treating codependency: self help, group therapy, and individual psychotherapy. Numerous codependency self helpbooks are available at local bookstores, some of which are more comprehensive and current than others. In addition, the formation of self help groups orientated towards assisting codependents in their recovery have been established. These meetings are usually free of charge and last about one hour. One of the more popular self help groups is Codependents Anonymous. This group participates in a twelve-step program that seems to have successful results.

Group therapy is also a popular treatment approach. The ideal size of a group participating in this type of therapy is about eight or nine. Weekly fees are usually a part of group therapy and the fee ranges from a sliding scale to fees that are consistent with community standards. Individuals planning on participating in group therapy need to make a sincere effort in therapy. Participants must be willing to have patience, persistence, and courage. Oftentimes it may take years for an individual to feel ready to terminate group therapy.

Individual psychotherapy is another treatment option for codependent individuals. When more recovery time is needed than the time available in group counseling, intense individual psychotherapy may be needed. Individual psychotherapy might also be a better option for individuals that are not comfortable speaking about personal issues in a group setting. In addition, individuals combating issues outside of codependency may benefit the most from individual psychotherapy. Unfortunately, individual psychotherapy is the most expensive treatment alternative, therefore it would not be a plausible option for many people.

Because codependency is usually rooted in a person’s childhood, treatment often involves exploration into early childhood issues and their relationship to current destructive behavior patterns. Treatment includes education, experiential groups, and individual and group therapy through which codependents rediscover themselves and identify self-defeating behavior patterns. Treatment also focuses on helping patients getting in touch with feelings that have been buried during childhood and on reconstructing family dynamics. The goal is to allow them to experience their full range of feelings again.

During the recovery process, some common road blocks do exist. Just being aware of these blocks makes it easier to recognize them when they come up in recovery. Many recovering codependents fear the unknown. Some additional road blocks are: 

	skipping therapy sessions
	lacking knowledge about the recovery process
	fearing criticism
	battling low self esteem
	having difficulty trusting
	experiencing difficulty with commitment
	placing blame on others
	lacking appropriate finances for therapy

Many professionals recommend reviewing the common blocks in recovery when an individual begins to sway from therapy.

The definition of codependency is broad and unclear. Professionals still disagree on whether or not codependency is an illness, a phenomenon, a psychological construct, a personality trait, an addiction, or a disease. Identifying codependent individuals is not an easy task. Codependence emerges through various personality roles. It can be viewed as an illness with both psychological and physical symptoms. The treatment options for codependent individuals are usually long term and the success of these programs is not clearly determined. Codependence is treatable, and with appropriate treatment there is hope for individuals that are struggling with this disorder.

v Self-Care Tips

Most codependents are not in touch with their codependency and may need help to see it. The following self-help tips are general suggestions. For many people, these are not easy to do without the help of a counselor.

	Read books on codependency. You can find these in the library and bookstores. You may find you identify with what you read and gain understanding.
	Focus on these three C’s:

             ¡ You did not cause the other person’s problem.

             ¡ You can’t control the other person.

             ¡ You can’t cure the problem. 

	Don’t lie, make excuses, or cover up for the abuser’s drinking, drug, or other problem. Admit to yourself that this way of living is not normal and that the abuser or troubled person has a real problem and needs professional help.
	Refuse to come to the person’s aid. Every time you bail the abuser out of trouble, you reinforce that person’s helplessness and your hopelessness.
	If you or your children are being physically, verbally, or sexually abused, do not allow it to continue. There are shelters for victims of domestic violence.
	Know that there are many support groups which help codependents. Examples are self-help groups for family and friends of substance abusers such as Al-Anon, Alateen, and Children of Alcoholics Foundation (COAF) . Other self-help and support groups are offered through community health education programs.
	Continue with your normal family routines. For example, include the drinker when he/she is sober.
	Focus on your own feelings, desires, and needs. Negative thoughts may be brewing just below the surface. It’s important to vent them in healthy ways. Begin to do what is good for your own well-being.
	Allow children to express their feelings openly. Show them how by expressing your own feelings.
	Set limits on what you will and won’t do. Be firm and stick to these limits. It’s natural to want to take care of those you love, but in this case, it doesn’t help.
	Engage in new experiences and interests. Find diversion from your loved one’s problem.
	Take responsibility for yourself and others in the family to live a better life whether your loved one recovers or not.

v When Codependency Hits Home

The first step in changing unhealthy behavior is understanding it. It is important for codependents and their family members to educate themselves about the course and cycle of addiction and how it extends into their relationships. Libraries, drug and alcohol abuse treatment centers and mental health centers often offer educational materials and prorams to the public.

A lot of change and growth is necessary for the codependent and his or her family. Any caretaking behavior that allows or enables abuse to continue in the family needs to be recognized and stopped. The codependent must identify and embrace his or her feelings and needs. This may include learning to say “no,” to be loving yet tough, and learning to be self-reliant. People find freedom, love, and serenity in their recovery.

Hope lies in learning more. The more you understand codependency the better you can cope with its effects. Reaching out for information and assistance can help someone live a healthier, more fulfilling life.

For More Information:

Contact your local Mental Health Association, community mental health center, or:

National Mental Health Association
1021 Prince Street
Alexandria, VA 22314
Phone: (800) 969-NMHA
TTY: (800) 433-5959
http://www.nmha.org

Codependents Anonymous
PO Box 33577
Phoenix, AZ 85067
Phone: (602) 277-7991

Family Resource Coalition
200 S. Michigan Ave.
16th Floor
Chicago, IL 60604
Phone: (312) 341-0900

Source: M-Care. University of Michigan.

www.m-care.org/healthathome/codepend.htm 

 

 

Are You Troubled

By Someone’s Drinking?

by Al-Anon Is for You!

Millions of people are affected by the excessive drinking of someone close.These 20 questions are designed to help you decide whether or not you need Al-Anon.

¡ ¡ 1. Do you worry about how much someone else drinks?
¡ ¡ 2. Do you have money problems because of someone else’s drinking?
¡ ¡ 3. Do you tell lies to cover up for someone else’s drinking?
¡ ¡ 4. Do you feel that if the drinker loved you, he or she would stop drinking to please you?
¡ ¡ 5. Do you blame the drinker’s behavior on his or her companions?
¡ ¡ 6. Are plans frequently upset or canceled or meals delayed because of the drinker?
¡ ¡ 7. Do you make threats, such as, “If you don’t stop drinking, I’ll leave you”?
¡ ¡ 8. Do you secretly try to smell the drinker’s breath?
¡ ¡ 9. Are you afraid to upset someone for fear it will set off a drinking bout?
¡ ¡ 10. Have you been hurt or embarrassed by a drinker’s behavior?
¡ ¡ 11. Are holidays and gatherings spoiled because of drinking?
¡ ¡ 12. Have you considered calling the police for help in fear of abuse?
¡ ¡ 13. Do you search for hidden alcohol?
¡ ¡ 14. Do you often ride in a car with a driver who has been drinking?
¡ ¡ 15. Have you refused social invitations out of fear or anxiety?
¡ ¡ 16. Do you sometimes feel like a failure when you think of the lengths you have gone to in order to control the drinker?
¡ ¡ 17. Do you think that if the drinker stopped drinking, your other problems would be solved?
¡ ¡ 18. Do you ever threaten to hurt yourself to scare the drinker?
¡ ¡ 19. Do you feel angry, confused, or depressed most of the time?
¡ ¡ 20. Do you feel there is no one who understands your problems?

If you answered yes to any of these questions, Al-Anon or Alateen may be able to help you.

Source: www.al-anon.org

You can contact Al-Anon or Alateen by finding a local number in the Meeting Info section of this website, checking your local telephone directory, or by calling 1-888-4AL-ANON (888-425-2666), 8am to 6pm ET, Monday through Friday.

 

Copyright Al-Anon Family Group Headquarters, Inc. ©1980

Reprint with permission.

Family Members

Codependency Questionnaire

Check box if answer is “Yes.”

¨ 1. My relationships often involve people who need my help or are somehow dependent on me.
¨ 2. When I feel I’ve helped someone, I experience a “high,” a sense of success.
¨ 3. It is important to be needed.
¨ 4. I often find myself “in the middle,” giving advice, counseling others.
¨ 5. On several occasions people have become angry when I have tried to help.
¨ 6. I seem to know when bad things are about to occur.
¨ 7. I spend a lot of time thinking through or replaying scenes, trying to figure out what I can do to effect desired outcomes.
¨ 8. I seem to have difficulty starting and maintaining healthy relationships.
¨ 9. It’s difficult for me to receive praise or care from others.
¨ 10. I do not like to let myself get angry. When I do, I often lose control.
¨ 11. It’s difficult for me to say “No.”
¨ 12. It’s difficult for me to ask for things that I need. (Work, home, family.)
¨ 13. I often over-commit my time or over-promise myself.
¨ 14. It is hard for me to act silly, have fun or relax.
¨ 15. If I’m not productive, I feel worthless.
¨ 16. It’s difficult to believe that someone could truly love me.
¨ 17. I am afraid of really allowing myself to love.
¨ 18. I am afraid of being abandoned or being alone.
¨ 19. Sometimes I think I expect to be hurt.
¨ 20. I find it easy to criticize and blame others.
¨ 21. I seem to justify or make excuses for others’ actions when they have hurt me.
¨ 22. When I know a relationship is about to end, I will stay in it. I will stay until I can begin another dependent rel ationship.
¨ 23. It is easy to make me feel guilty and accept blame. I will take responsibility for others. Somehow things end up being my fault.
¨ 24. I am not sure what normal is.
¨ 25. I often take a stand in a relationship and then go back on what I said I would do. It seems as though I get sucked in again and again.
¨ 26. My circle of friends seems to have diminished.
¨ 27. I am not aware of what I want. I ask others what they want.
¨ 28. I tend to be sick a lot. I can’t seem to fight off infection.
¨ 29. There never seems to be enough time to do things just for me; things I would enjoy doing.

If you have checked “Yes” to 3 or more of these statements, you probably have a problem with codependency.

Source: www.alcoholicsforchrist.com

Addictive and Codependence Relationships

Relationships in sex addiction often have one of two common patterns. The first is that of an addict and a codependent, and the second is that of a “love addict” and an “avoidant” individual. Below is a description of them and how they play out in recovery. No model is going to be accurate for any particular relationship, of course, but it can be helpful to look at the patterns.

Source: Dr. David C. Bissette, Psy.D.

Alexandria, VA

www. HealthyMind.com

 

 

Addicted To The Addicted

by Dalene Entenmann

The first rays of morning sun filtered through the blinds of the bedroom window. After another long sleepless night, with head pounding and a queasy stomach tied up in knots, I had the most amazing thoughts.

I have what feels like a hangover, only I haven’t been drinking.

No, once again, I had spent the night in a state of frenzied insomnia worried and angry about the loved one in my life who was out drinking all night. The same obsessive, primary focus alcohol has in the alcoholic’s life, I have for the alcoholic in my life. The same dedicated commitment of time and energy the alcoholic has for consuming more alcohol is the same amount of time and energy I have to educating myself about alcoholism and the origins of alcoholism and what to do about alcoholism. The same love/hate relationship the alcoholic has with alcohol, I have with the alcoholic.

As many times as the alcoholic gets fed up and burnt out with the consequences of his drinking, swearing off alcohol with “this is the last time I am going to do this”, is probably the same number of times I have sworn off the alcoholic with those same words. In those times when I actually left the alcoholic in my life, banishing him as the source of all my inner pain and anguish, I became acutely aware of having withdrawal symptoms. Life felt disorganized and empty. Of course, eventually I began again with the alcoholic, the same way the alcoholic begins again with alcohol. It’s always rosy in the beginning. Those first days. Just like that first couple of drinks. This time it will be different. Right?

Addicted to the addicted, oh, what could possibly be sadder? At this realization, all I wanted to do was pull the covers over my head and disappear from the world. But then, that is what I had already done, long ago. I had focused all my thoughts, feelings, sense of responsibility and energy on another human being for so long, that I had ceased to exist as a primary figure in my own life. The alcoholic loses himself in a bottle of booze, I lose myself in the alcoholic.

Back on that morning, I couldn’t have told you what I was attempting to medicate within myself with someone outside myself or what I was trying to avoid. In a feeling of absolute desperation that those amazing thoughts created for me, I did know I wanted and needed help. It has been and continues to be interesting, and I won’t kid you, at times highly uncomfortable. Change is.

If you find yourself one morning having similarly amazing thoughts, here are some of the things I did to begin to heal:

Alcoholism Aficionado

 am a walking Willamina World Book of encyclopedic knowledge when it comes to the disease of alcoholism. I didn’t suffer from the consumption of alcohol as an actively drinking alcoholic, the alcoholic(s) in my life did and it occurred to me that perhaps they were the ones who should, if they ever decided to, acquire some in-depth understanding of the complexities of the disease. Unless I am going to become a health professional working in the recovery field or someone creating an educational documentary about alcoholism, a simple working definition about alcoholism will suffice and it might be best to focus on the more personal matters at hand. I could take on the same focus and quest for knowledge and understanding about the addictive process I expressed through my being that I once applied to the lives of others. I began to read about codependency and other addictions that I appeared to be manifesting all on my own. Which led me to:

I’m Always the Last to Know

While I was beginning to become aware of the character defects and attributes someone who is other-oriented, like me, exhibits, and the addictive levels these defects can take, I couldn’t relate most of them to me. I sure could see them in the other people in my life. I found myself discovering all kinds of neat information I felt compelled to share with those I knew were affected by these character defects. Thankfully, I did not act out on this, or I probably wouldn’t have any friends or family left on speaking terms with me now.

Instead, I adopted this belief. If I can see it in someone else, it is a part of me. When I have a desire to “help” someone else with all this newly-developed focus and insight, I need look no further, as Dorothy said, than my own backyard. There’s no place like Kansas and Kansas is me. Anytime I observed a character trait in someone else I admired, I reminded myself that I wouldn’t be able to recognize it unless I already “knew” it, therefore it was also a character trait I possessed within my character. If I truly esteemed a particular trait in someone else I could spend time developing and nurturing that trait within me. I applied this, as well, to the character defects I noticed in others. I accepted the perspective that I could only see “it” if I already “knew” it, that the defect was also part of who I had become. If the defect of character trait in another person was truly appalling or repelling to me, I could go to work on finding a way to take a negative and turning it into a positive within myself.

Years ago, I remember taking a test to determine if I had an entrepeneurial personality. I scored rather high on it in areas of independence, ability to work alone, self-directed, confidence in decision-making ability, persistence and perseverance. These traits, when applied to the entrepreneurial business world were a positive. These same traits, when applied to personal relationships, had been a negative.

However, emotionally having to admit to any aspect of my character being undesirable was extremely difficult for me to accept. Which led me to:

What Do You Mean, I’m Not The “Good One”

I kept telling everyone, including myself, that my overwhelming control was an act of love and concern. In reality, this need to control is a mere ruse for avoiding inner terror and chaos that will surface if there is a pause in my all-encompassing need to escape myself by focusing on others. I was cheerfully helpful. I had advice. I had the answers. I had the solutions to other people’s problems. I knew which way to go. Of course, in order to dispense this advice, supply answers and give directions, I needed to gain access to most of the intimate details of other people’s lives. Nothing was sacred. I was often judgmental and critical. My need to feel superior and capable caused me to diminish others value or respect their right to being.

In the back of my mind, I know the world sees me as the “good one” and the alcoholic(s) in my life, whose actions I am victimized by and suffer through, as the “bad one”. I don’t have to do anything to gain this status, except stand next to the alcoholic. In reality, I express many of the same defects of character as the alcoholic. I am more the “same” than I am “different” or “better than.” We are two sides of the same coin. However, society rewarded and esteemed my long-suffering behaviors without seemingly holding me accountable for the part I might be playing in it. I didn’t do anything to correct this misconception.

Did I see myself doing any of this? Sometimes. Did I allow myself to remain focused on this fleeting glimpse of reality? No. I couldn’t, which led me to:

I Don’t Really Want To Do This Alone Anymore But

Swirling through my head at lightening speed came these objections to breaking through the barriers of self-imposed isolation: If I expose my weaknesses then my weaknesses will be used against me at some point; if I reveal myself and my inner thoughts and feelings nobody is going to understand and everybody is going to reject me; people will find out who I really am and what I have been up to; they’ll just say it’s my fault so I should be able to get myself out of it.

I got stuck here for awhile _ living in my head.

Facing My Fear

Living in my head might be safe but it wasn’t getting me ahead. Although my inner survival instinct told me I had everything to lose, a smaller quieter but growing voice was telling me I had nothing to lose and everything to gain in reaching in and reaching out. To risk is to change, to change is to grow. Which lead me to:

Connecting To Self and Others

This is where support groups became beneficial. It gave me a place where I could open myself to others and also get feedback and encouragement to move towards healthier behaviors. Support groups are a safe place. I began to focus less and less on others and focus more and more on myself. Becoming involved in support groups led me to:

I Quit

I quit! I quit! I quit! believing I am the center of the universe. I don’t want to run the whole show anymore. I don’t want to be the “one,” good or bad. I want to embrace the imperfection and feel a part of the whole. I accept that there is a magnificent power far greater than me in charge of everything that lives and breathes and all I have to do is let go. Which led me to:

Spirituality

God. Not the God of my childhood. A benevolent God I can trust for the highest good of all concerned. Now, each night when I rest my head on my pillow and call it a day, I can sleep well, knowing that I am not responsible for everything and everyone else, nor the comings and goings, nor the decisions and actions of others, and the world is being cared for without any opinion or direction from me.

This article is a collection of snippets from personal stories reflecting some common themes and perspectives presented in a single feature article by Dalene Entenmann.

www.hopeandhealing.com

Copyright © Dalene Entenmann.

Reprinted with permission.

 

Detachment: How Did We Get Here?

How Do We Get Out?

 

by Dalene Entenmann

 

there is a you i remember that many today may not see there is a you that i will love because love remains love i knew you and somehow through it all i know you still there behind the hideous mask of alcoholism that you wear as one with a sweet caring soul a generous spirit a gregarious smile a quest to share joy with open heart when drinking was something everybody did you drank different from the very begininng and you continue to drink in the face of all conclusion that it is more than just a casual social affair… i accepted on faith the promises of change to better days and then watched you increase your consumption of alcohol drowning all our hopes and dreams i railed against the injustice  and i cried out against the hopelessness and i grew numb listening to another skillfully woven lie and i beat my fists against the sky arguing with what i thought was a silent God while you put into question the sanity of MY demeanor acting as if nothing was wrong that i was over-wrought and over-reacting to imagined realities you didn’t see till my spirit felt like it was going to shatter into irreparable pieces as you questioned the sanity of my responses to you I kept asking myself How did we get here? How do we get out?

Detachment is about knowing you are not the cause of, nor the cure for, another person’s addictions. Detachment is about knowing that you can care about someone without taking care of them in inappropriate ways that prevent that person from also becoming a responsible person. Detachment is about knowing what we have the power to change and what we do not have the power to change. Detachment is having the courage to change the things we can and seeking the wisdom to know the difference. Detachment is about not knowing what the future holds and having the comfort of knowing who holds the future.

The family and friends affected by someone else’s drinking are, and have always been, some of the most remarkably loving and lovable human beings among us. Common is a deeply developed sense of commitment, selflessness, empathy, compassion, tenacity, determination, a wisdom of the heart, courage in the face of seemingly insurmountable obstacles, an immeasurably universal strength of goodness and the ability to see the capacity for goodness in others.

And they retain these, the highest quality of human characteristics, despite a disease that, often times, renders them helpless and full of despair. Which is stunning if you consider the eroding devastation that alcoholism brings into lives affected by the disease of addiction.

At first, detachment can sound like an odd concept and in direct conflict with these qualities of humanness. It is not. Detachment is what will loosen the grip and render powerless a disease that acts like an opportunistic spiritual predator that takes goodness and twists it to serve its own corrupted purposes.

Detachment is about being able to go and stay, at the same time. It is having the wisdom not to jump in the water with a drowning man to keep him from drowning but throwing him a line to grab onto so that he can pull himself to the safety of the shoreline.

I met a woman at an AA/Al-Anon speakers meeting, who, after 25 years of marriage to a man who drank to excess on a daily basis, finally said “Enough is enough.” Enough of my failed attempts to affect positive change. Enough of my internalizing my husband’s drinking problem. Enough of thrashing around out here in the deep waters with him. I am not going to save him this way and we are both going to drown. She swam to the shores of Al-Anon. The years of anger, bitterness, resentment and disappointment began to dry up and evaporate. She felt a lightness of being. She began to feel joy and hope. She told me,

I stopped saying anything to him about his drinking. I simply left my literature and books about Al-Anon and AA laying around the house. I stopped cleaning up after his drinking episodes. I stopped rescuing him from the consequences of his drinking. I adopted the attitude that if his drinking got him into a mess he could get himself back out of it. I stopped making excuses for him. If the children asked, “Where is dad” I simply said, “You will have to ask him when you see him. I don’t know the exact reasons.” If someone called the house asking after him because he was a no show I answered the same way. “I don’t know, he will have to explain it.” I stopped making plans that hinged on his being there. I began to create a life around him and at the same time made sure that he knew about it if he wished to be a part of it. I learned to treat him with the same respect and kindness I would give to even a stranger. I stopped reacting to the negativity with anything other than a positive response and became active in my own life. I started to remember the dreams I had left behind so long ago and decided to resurrect some of them. I realized I could make many of my dreams come true. I discovered joy and serenity. It was wonderful.

 

ump in the water to save the drown man. i’m here if you need me. ability to go and stay, at the same time

Two years later her husband began his recovery in AA. On the day I talked to her, they had over twenty years of recovery from the disease of alcoholism.

Detachment is not apathetic to the suffering of another nor does it mean walking away from a drowning man. Detachment is the lifeguard training in spiritual rescue.

www.hopeandhealing.com

Copyright Dalene Entenmann

Reprinted with permission.

 

 

Battered Women With Chemically – Involved Partners

• Codependency and Effects of Victimization: Similarities and Differences • Implications of Codependency Treatment for Victims • Recommendations for Substance Abuse Treatment Counselors • Limitations of Codependency Model in General • Relational Model (Self-in-relation Model)

v Codependency and Effects of Victimization: Similarities and Differences

An abuser’s involvement with substances can have a significant impact on victims of domestic violence. One of the ways in which victim safety is often inadvertently compromised is when victims participate in services designed to address the needs of family members of chemically- dependent persons.

One of the difficulties in talking about codependency treatment is that it often means different things to different people. In fact, several different definitions of codependency circulate within the field, each of which has different implications for intervention. For example, if codependency is understood as family members’ situational responses to the presence of a chemically-dependent person in their midst, interventions are likely to be based on behavior modification approaches. If, on the other hand, codependency is understood as a pattern of behavior that is most often learned in the family of origin, then interventions are likely to include helping clients gain insight into family of origin roles to facilitate behavior change in the present.

Rather than trying to gain consensus about which definition of codependency is the “right” one, it may be more useful to focus on the behaviors or characteristics that the framework of codependency was intended to describe. Common behaviors and characteristics associated with codependency include:

	being preoccupied with partner, what he does, where he is, etc.
	being other-focused
	making others’ needs more of a priority than one’s own needs
	being unable to define one’s own needs
	taking responsibility for others
	denial
	enabling behaviors, i.e., covering up for, making excuses for, supplying the drug
	having unclear boundaries; not setting limits with others’ behavior
	defining mood based on other peoples’ moods
	being reactive rather than proactive
	putting self down
	suffering somatic illnesses

For the most part, the behaviors and characteristics that describe codependency also describe the very behaviors that many victims of domestic violence adopt to survive.

	Being “other-focused” can be a survival tactic. Being highly attentive to an abuser’s mood can help a victim identify potential cues of violence to come.
	Putting the abuser’s needs, wants, and desires ahead of one’s own is a logical, rational response to victimization. If an abuser is placated and happy, a victim may be safer. In fact, it is common for a victim’s mood state to be directly influenced by her abuser’s mood state. “If he’s happy, I’m safe.”
	“Enabling” behaviors may also be safety-related if you’re a victim because a victim’s failure to comply with an abuser’s demands may very well result in an escalation of coercion and violence. If a victim’s abuser wakes up in the morning hung over and tells her to call the boss and tell him that he has the flu, she’s likely to do it. If he tells her to go to the corner store and buy a six-pack of beer, she’s likely to do it.
	Victims of domestic violence often learn the hard way that setting limits with their abusers results in increased coercion and violence.
	Victims of domestic violence often seek treatment from the health care system for a wide variety of somatic complaints, often illnesses that result from the stress of living with a violent partner.

Being in a relationship with an abusive partner requires considerable skill and resourcefulness and has a predictable effect on a victim. Victims learn to do and say those things that will help keep them and their children most safe. Becoming highly attuned to the pleasure and displeasure reactions of the abuser is a survival strategy. A victim’s own needs, wants and desires become irrelevant because what will help keep the victim most safe is intimately connected to the abuser’s mood, wants, likes, and dislikes. As a result, victims may know more about the abuser than they do about themselves. In fact, victims will often adopt these survival strategies regardless of whether or not their partners are involved with substances.

v Implications of Codependency Treatment for Victims of Domestic Violence

Just as there is a lack of consensus about the definition of codependency, there is also great variance in the methods used to “treat” it. Twelve-step programs such as Al-Anon, however, are typically an integral part of codependency treatment plans. It is important to take a look at what can happen when a victim of domestic violence becomes engaged in a twelve-step program.

If a victim of domestic violence begins to “detach” from her abusive partner and get self-focused, or if she attempts to set limits with her partner and to define her boundaries, she faces a significant risk that her partner will respond with increased violence and coercion. Abusers are typically very resistant to their partners’ attempts toward independence of any kind. Abusers may respond to their partners’ changes in behavior by reestablishing their control through the use of intensified violence and coercion.

In addition, victims have misinterpreted many of the Twelve Steps of Al-Anon and tried unsuccessfully to apply them to their lives with their abusive partners; for example, steps four and nine to “make a searching and fearless moral inventory” and to “make amends.” It’s not difficult for anyone to identify personal flaws, failings, and mistakes they’ve made in their intimate relationships. For victims of domestic violence whose partners have blamed them for the violence and reinforced their belief that they are somehow responsible, applying these steps may further intensify their sense of responsibility for their partners’ violent and coercive behavior.

It can also be damaging to engage victims in codependency treatment that encourages them to examine their family of origin and identify their roles in the family as a way to understand their behavior and their relationships now. As a general rule, victims of violent crime need, first and foremost, safety-related assistance, not therapy. When mental health approaches are used as the primary response to a victim’s victimization, the concrete safety-related needs of victims are often seen as secondary or overlooked altogether.

In addition, a codependency model can encourage victims to look inside for an “explanation” of why they are in a relationship with a violent partner, implying they are somehow to blame and that, if they had a better sense of self-worth or were more assertive, they would sever the relationship. Such an approach pathologizes victims, blames them, potentially endangers them, and ignores the fact that family of origin is not a risk factor for adult victimization.

The message a victim might get from other Al-Anon members when what she’s doing doesn’t seem to be working is often “Keep coming back.” Words intended to encourage family members of substance abusers to continue to learn and find help and support through Al-Anon can encourage victims to keep coming back looking for a solution to the violence, even when their attempts to work a 12-step program aren’t helping or are making things worse. Many victims “keep coming back” to work the program harder, to try to work it better, in the hopes that the violence will stop.

When victims of domestic violence are encouraged to stop the behaviors associated with codependency, enabling, caretaking, over-responsibility for a partner’s behavior, not setting limits or defining personal boundaries they are, in essence, being asked to stop doing the very things that may be keeping them and their children most safe. These behaviors are not symptomatic of some underlying “dysfunction,” but are the life-saving skills necessary to protect them and their children from further harm.

The survival behavior of victims should therefore not be understood as “enabling” their partners either to use substances or to use coercion and violence. “Enabling” implies that the victim gave her power up and can therefore take it back. Battered women can’t take their power back from an abuser because they didn’t give it up in the first instance. Their power was taken from them through the use of coercion and violence and efforts they make to take it back will likely endanger them.

Twelve-step programs were designed to provide help, encouragement, and support to people who are affected by someone else’s substance abuse problem and they have been very successful at achieving that goal. But because resources such as twelve-step programs and codependency groups were not designed to meet the needs of victims of domestic violence, there is no assurance that victims will get accurate information about domestic violence. In fact, the kinds of behavior changes encouraged in such forums may well result in an escalation of abuse, including physical violence.

This doesn’t mean that victims of domestic violence can’t be helped by participation in twelve-step groups. Many battered women report that their participation in Al-Anon was a tremendous help in breaking down isolation and building a support system. In addition, many abusers who will not allow their partners to attend a battered women’s support group will let them attend twelve-step groups because they perceive it as something the victim does to support them in their recovery.

What’s vitally important is that victims be given accurate and complete information about the available sources of help, what they were designed to do, and what their limitations are, so that they can make informed decisions that best meet their individual needs.

v Recommendations For Substance Abuse Treatment Counselors

In providing assistance to victims of domestic violence whose partners are involved with substances:

	give priority to safety and explore safety-related options;
	provide referral information to the local domestic violence service provider as a resource designed primarily to assist with safety-related needs;
	provide complete and accurate information about the purposes of twelve-step groups and codependency groups and the potential limitations of these forums as sources of help regarding safety-related concerns;
	provide referral information to Al-Anon and other resources designed to provide help for family members of substance abusers; and
	offer opportunities to become educated about chemical dependency independent of her partner.

v Limitations of Codependency Model in General

In addition to the specific safety-related concerns attached to using a codependency framework to understand and respond to victims of domestic violence, there are some concerns about the codependency model in general and its consequences for women that are relevant here.

Gender socialization in our current culture can be limiting to both males and females. There is still social stigma attached to “feminized” male behavior such as crying, being the primary caretaker of children in a two-parent household, and having a stereo typically female job such as a secretary. There is also social stigma attached to women who are assertive, childless, or who are mothers who have full-time employment.

There is, however, a particular catch-22 for women in our culture. When women enter a clinical setting, they are often confronted with a framework that tells them that the very behaviors that they are required to adopt to secure social acceptance_nurturing, responsibility for family, caretaking, defining themselves in terms of their relationships_are “dysfunctional” behaviors. The standard for health that is often adopted within a clinical setting is based on culturally defined male traits such as assertiveness, self-determination and emotional detachment. As a result, female patterns of behavior that result from social and cultural conditioning are transformed in a clinical setting into individual pathology.

Not only is there little acknowledgment of the extent to which our culture values typically socialized characteristics as good, there is also little acknowledgment of the price women pay when they move from being “socially acceptable” to being “clinically well.” Our culture is not very accepting of women who exhibit behaviors and characteristics that are perceived to be “masculine,” just as our culture is not very supportive of men who engage in “feminine” behaviors.

When we work with anyone in a clinical setting, it is important to understand and value the real-world context in which the client lives, works, and plays. In the case of women, it is particularly important to value and support their choices to be nurturing and caretaking. In and of themselves, these qualities are not bad nor are they necessarily harmful. If and when they become liabilities for any individual, that needs to be explored. Their presence alone, however, is not an indication of pathology.

v Relational Model (Or “Self-in-Relation” Model)

The acknowledgment of the relational context of women’s lives has influenced the development of new treatment approaches over the past decade. There is growing consensus within the substance abuse treatment system that the most effective treatment approaches for women are based on a relational, or self-in-relation model. The relational model stands in stark contrast to the codependency framework. Advocates of the relational model raise the following concerns with codependency. ⁽¹⁾

	Most of the characteristics ascribed to codependency are aspects of the traditional female gender role, thereby defining societal conditioning as pathology.
	Seeing the root of codependency as the dysfunctional family overlooks the politics of subordination in a racist, sexist, and heterosexist culture.
	Codependency “treatment” encourages personal responsibility while ignoring the reality of how a woman copes in a cultural context in which she has a limited range of options given her traditional gender role socialization, her subordinate status, and the alternatives she perceives herself having in a family and culture that are sexist and oppressive to women.
	Codependency “treatment” encourages women to define themselves as “sick,” “addicted to relationships,” and powerless over their “disease” rather than acknowledging the “sickness” of the social and cultural context and empowering women, within that context, to make constructive changes in their lives.

In the codependency construct, health is represented by the autonomous, individuated, separate self, and pathology as fusion or embeddedness in relationships, ignoring the fact that most women are socialized to define themselves in a relational context.

As an alternative to codependency, the relational model suggests that:

	women typically seek mutually empathic connections in relationships;
	women develop as a part of relationships and in interpersonal connection and interaction, making the goal of development enhanced connection;
	women’s response to disconnection from mutually responsive and mutually enhancing relationships is often depression, anger, isolation, confusion, increased striving for connection, and a diminished sense of well-being (as in the case of victims of domestic violence); and
	the solution to women’s disconnection is not the development of an autonomous, individuated, separate self, but rather creation of a societal context within which growth-producing relationships can flourish. Domestic violence is a context of coercion and control in which women are trapped in disconnected relationships and are therefore unable to flourish.

The U.S. Department of Health and Human Services Center for Substance Abuse Treatment also promotes the relational treatment model for women.

“Because many factors affect a woman’s substance abuse problem, the purpose of comprehensive treatment, according to the CSAT model, is to `address a woman’s substance abuse in the context of her health and her relationship with her children and other family members, the community, and society.’ An understanding of the interrelationships among the woman/client, the treatment program, and the community is critical to the success of the comprehensive treatment approach. The intent is to consider the holistic needs of women..” ⁽²⁾

Endnotes

(1) Collins, Barbara G. “Reconstruing Codependency Using Self-in-Relation Theory: A Feminist Perspective.” Social Work, Volume 38, Number 4, July 1993.

(2) Practical Approaches in the Treatment of Women Who Abuse Alcohol and Other Drugs, p. 67. Rockville, MD: Department of Health and Human Services, Public Health Service.

Source: http://opdv.state.ny.us

 

 

The Codependency Idea:

When Caring Becomes a Disease

by Robert Westermeyer, Ph.D.

The now tenacious attachment of the disease model and 12-step philosophy to caring behavior, commonly known as codependency, represents to me the most confusing, and iatrogenic ideas in the realm of clinical psychology. This popular construct is shunned by research psychologists and behaviorally-oriented clinical psychologists, particularly for its lack of empirical support. The allure of codependency is demonstrated by the sales of books on the topic (the only resources on codependency come from self-help sections and fluffy journals). Millions of codependency books have been sold over the past ten years. One of the more popular ones, Codependency No More, by Melody Beattie, has sold over three million copies (according to the publisher). This one is also available on audio cassette, for those codependents on the move.

v From Where Did Codependency Come?

Co-dependent, or co-alcoholic, was originally defined in the late 1970s and early 1980s to help families and spouses of individuals with alcohol and drug problems. Mostly in line with family systems ideas, the model addressed the family members, especially wives, who “interfered” with the recovery. It was suggested that their behavior made it less difficult for the addict to continue drinking or using drugs. The idea was that the caring behavior manifested by family members and spouses actually “enabled” the addict to continue using. At first glance, the emphasis on the family was certainly a welcome step. Regardless of theoretical orientation working with a substance abuser in isolation, who is in an intimate relationship, is missing a rich opportunity to recruit more players into the change agenda.

Unfortunately, from the mid eighties to the present, the codependency idea has become bastardized, and with each new self-help book the symptoms of codependency mount. It is literally impossible for anyone walking the planet, with a fourth grade English reading capacity, to finish one of these books and not consider the possibility that he or she is a codependent. What began as a term to help spouses of addicts encourage sobriety and not inadvertently make it easy to continue, the codependency movement of the 80s and 90s has thrown the baby out with the bath water: Not only is all caring manifested by the spouse of an alcoholic deemed pathological, but the very act of compromising one’s needs to aid a loved one is now deemed symptomatic of a progressive disease processes, a relationship addiction.

I’ve read a fair amount of what the popular press has bequeathed upon us regarding the codependency idea. The three books I scrutinized the most were the most popular. They were Facing Codependency, by Pia Mellody, Codependency No more, by Melody Beattie and Codependency, Misunderstood, Mistreated. by Anne Wilson Schaef. It is my understanding that the majority of people who consider themselves “versed” in the codepen-dency idea gained at least some of their knowledge from one or more of these three books.

Below is my understanding of these authors’ conceptualizations:

Codependency is a progressive disease brought about by child abuse, which takes the form of anything “less than nurturing.” Codependency is epidemic (maybe all of us are codependent) and defines a vast array of psychological and physical symptoms. The caring manifested by codependents is an unconscious effort to keep repressed pain at bay, and the codependent actually contributes to the addictive behavior of their loved ones by enabling. Enabling keeps the loved one addicted so the codependent can go on caring to gain a sense of self worth. Recovery from codependency requires drastic attitude and lifestyle change (detachment) and a lifelong commitment to the 12-step regime.

Why would a psychologist wish to criticize the codependency idea? Many people claim to have been helped by codependency books and codependency self-help groups. I don’t wish to take away anyone’s belief that they are better for having integrated the codepen-dency idea into their lifestyles. But it definitely isn’t for everyone. Codependency is a nebulous idea, born not of science but of the gut feelings of counselors and frustrated lay people. Its black and white requirements for recovery, though seeming reasonable on the surface, are not in line with empirical research and have dangerous implications with regard to the most human of attributes, caring. My two primary concerns with the codependency idea are:

¨ The codependency idea pathologizes the natural tendency to care for others.

¨ The cure for codependency mandates action which is not necessarily in line with prosocial values.

v Why the Allure?

Lots of different people buy codependency books. For the most part I’ve found that people who buy them are having problems being assertive in their relationships. I imagine that a fair number of people are able to extract a few tips from these books which help them feel more confident, more able to voice their needs appropriately and more efficient at carrying them out. However, these three books are about more than just being unassertive and needing a few tips toward being more independent . What is conjected is an underlying disease process, a progressive malady which will end in death if gone untreated. They also list symptom after symptom after symptom which weaves a net large enough to include just about any reader.

Do people want to be included in this net? I think many do. What is so attractive about being a victim of a disease? Simply, it renders one in control. Crazy as it sounds, when relationships aren’t panning out and life is riddled with pain, anxiety, loneliness and poor decisions regarding our intimate partners, nothing quenches thirst better than an all-inclusive diagnosis. Enduring negative emotional states or repeated life upsets are no longer deemed maladaptive habits, skill deficits or the function-distorted principles and styles of thinking, but diseases.

Accountability for our happiness is a scary thing. Codependency allows one to relinquish responsibility for our frustrating lifestyles. Plus we can dump all the blame on our parents, something the psychodynamic people have been advocating for almost a century.

v Alternatives

¨ Caring for an Addicted Person is Not Synonymous With Pathology

After reading these 3 books I felt quite gloomy. I kept conjuring images of women in very difficult situations trying desperately to make order in their lives, receiving the message that their compassion and caring are character flaws, needing to be abandoned for overall psychological health. I’ve heard anecdotes from clients who report that they were told by addiction counselors that they had to evict their child, or spouse in order to help them, that there is absolutely no way that they could aid in helping their family member change other than complete detachment. Or I imagine people who are selfish already and unhappy with their lifestyles coming to the conclusion after reading one or two of these books that they meet the criteria for codependency (a sociopath would find enough criteria in Beattie’s book).

I’ve been to parties and had acquaintances report that they were working on “codependency issues” and almost inhaled my pate. Some of these folks need a dose of codependency! Selfish people aligning themselves with the codependency idea certainly makes sense, because it affords license to be more selfish. But this isn’t as much of a concern to me as the people who have the capacity for genuine empathy and have instilled strong values for kind treatment toward others getting the message that to act on it (unless it’s reciprocated in equivalent allotments) is wrong. Empathy is good and caring is good. Friendships which last are usually based on mutual caring and even occasional self-sacrifice. Melody Beattie’s idea that relationships should always be equitable reflects the temperament of a five-year-old. And with regard to the notion that being in a relationship with someone who is addicted is synonymous with pathology, absurd. There is no empirical data to support the belief that being a member of a family in which there is addiction warrants diagnosis of a personality disorder (e.g., Gomberg,1989).

No more flagrant was this mind set that caring for an addicted person is an illness articulated than in Ann Wilson Shaeff’s book. She recklessly articulates that mental health practitioners are, by definition, codependent by her words: “The mental health field has simply not identified the addictive process and the syndrome of codependency because people in the field are non-recovering codependents who have not recognized that their professional practice is closely linked with the practice of their untreated disease.” I hope my colleagues share my belief that helping people as a profession brings tremendous feelings of agency and is in no way a flaw. What would these authors recommend that mental health professionals do to address this untreated ailment? I hope it is not the same advice non-professionals are offered, detachment.

¨ The Idea that the Caring Partner is Somehow Responsible for the Endurance of the Addictive Behavior

Judith Gordon and Kimberly Barret, in an excellent critique of the codependency movement, write that this mind set presents a “divide and conquer attitude toward addictive families. Schaeff, without a page of empirical data to back it up, recklessly suggests that alcoholism is a “family disease.” She conjects, “The entire family is affected and each member plays a role in helping the disease perpetuate itself.” Moos, Finney and Cronkite (1990) found that, contrary to the idea that caring for an addict perpetuates the addiction, families with a broad range of supportive behaviors actually correlate with success in maintaining sobriety.

A case from several years ago comes to mind involving a caring mother whose 27-year- old daughter had been abusing prescription opioids and benzodiazapines for ten years. The daughter finally made the decision to try methadone detox, following two months of methadone maintenance. The MD at the methadone clinic recommended that she taper the benzodiazapine, which wasValium (methadone doesn’t cover non-opiate drugs). The mother was very invested in her daughter’s change efforts and subsequently flew in from out of state to live with her while she detoxed. She agreed to dole out the Valium because the daughter felt that she could not do it on her own without relapsing. The mother hid them in her car and stood watch over her daughter during the first three weeks of her transition. The patient voiced that her mother’s presence was imperative for relapse prevention at this time. The mother voiced that it made her feel as though she was finally doing something to help the daughter which was panning out. She felt so good about her efforts that she went to an Al-anon meeting. She was literally attacked by three attendees who deemed her behavior enabling and, in addition to deeming her responsible for her daughter’s enduring problems with substances, instructed her to go back to her home immediately and let her daughter grapple with her troubles on her own. One said, “She’s an adult, and a time comes when you have to let them leave the nest or you’re just perpetuating the illness.”

Thankfully, this woman had enough conviction and confidence in her values to blow off the advice. Many people don’t have this much tenacity to their standards. Many are given such guidance and are left in a complete quandary. The mother’s contention was that her daughter was completely responsible for her choice to use or not use. She recognized that her daughter had crippling problems with anxiety and panic and had used the drugs to medicate these states. Though her daughter made the choices, she felt that there was a way she could help her daughter follow through with her motivation to better her life. She knew that if she went back home, her daughter would relapse and that relapse at this point would be devastating to her daughter, who had tried just about every method of quitting imaginable. She fathomed that her daughter might discount the whole methadone choice and revert to prescription drug abuse again.

Alternatives to the enabling idea are:

1. No one can cause another person’s addictive behavior. Addictive behaviors are learned habits fueled by expectancies that following through with the behavior will bring about ease, comfort, or the reduction of something negative.
2. Caregiving is not enabling. Caregiving is fueled by the capacity to experience empathy and the desire to make the lives of our intimates more happy. One of the most robust indicators for a positive outcome from most psychiatric maladies is social support.
3. What works in one relationship will not necessarily work in others, and what used to work in one relationship may be ineffective given new circumstances. This does not mean that the previous behaviors need to be abandoned, or viewed as pathogenic. It means that those in a relationship with an addicted person need to evaluate whether modification of one or several behaviors would aid in the motivation to change on behalf of the addicted person.

¨ The Idea That “Less Than Nurturing” Experiences Are Necessarily Traumatic

We expect relief_quick relief. We are fortunate to live in a time when quick relief for many of the discomforts of life is available, often at a very low price. We not only have remedies for such nuisances as a headache, we can choose between ibuprofen, acetaminophen or aspirin, depending on your preferred means of pain relief. We live in an age in which people believe that life should be fair and comfortable. You don’t have to go back very many decades to be assured that things are pretty fair and comfortable these days relative to the lifestyles of our ancestors. I imagine if one of these codependency books was published a century ago there would be very few who would have taken it seriously. Imagine a family migrating west in the 1800s, just barely surviving. Imagine an exhausted wife and mother bouncing along in a horse-led wagon, face chapped from the sweltering midday heat. She opens up Pia Mellody’s book as she breastfeeds her infant while leaning on a loaded shot gun and nursing her husband’s wounded arm. Her eyes open wide. She says to herself: “What? A disease of caring? “I need to relive the `shame’ of my childhood and hold all the `bad’ people accountable, detach and learn to live for myself because I don’t have to take care of anyone but myself?” You can bet Beattie’s book would be fire bait that cold desert night.

The codependency idea offers an easy route to relief in this age of quick cure. In fact, Melody Beattie says “It is not only fun, it is simple.” At last people who are angry, frustrated, bored, unhappy, clingy, irrational, or guilt-ridden can have a diagnosis. What’s even more fun is we get to reexamine our childhoods, our families. As Wendy Kamminer writes in I’m Dysfunctional, You’re Dysfunctional, codependency mandates a poignant story. We get to ask, “How did I become codependent?” Mellody will respond, “Carried feelings.” She will offer an electrical circuit analogy. You, the child, because of your ill- developed boundaries were literally a conduit for the intense feelings of shame which were discharged by your parents. As a child you incorporated these into a “shame core” which is manifested in your “shame attacks” today. You will pass on shame cores to your children unless you unleash the bottled up pain today.

It is recommended that codependents do an inventory of all “less than nurturing” experiences of childhood. Pia Mellody asks that you look at your life from birth to age 17 and identify all the people responsible for “abusing you.” No attempt should be made to make excuses for the offenders in our lives or to tell ourselves that they didn’t mean it, even if they didn’t mean it. These perpetrators include, first and foremost, our mothers and fathers, but also siblings, extended family and members of the community, such as neighbors and teachers and angry garbage men.

Melody Beattie recommends that we grieve. The purpose of “grief work” is to “separate the abuse from the precious child.” This is an actual mandate for recovery. “We must purge from our bodies the childhood feeling reality we have about being abused. The only way we can connect the feeling reality to what happened is to know what happened.”

I think few, if any, events rival physical and sexual abuse in terms of the horrible effects that can plague the victim in later life. Talking about these events, identifying the offender and disputing the victim’s ideas that she is responsible are integral to adult psychological health. However, these authors are talking about more than physical and sexual abuse. In fact, they pay lip service to the horrors of child abuse by deeming any event in which our parents were harsh, impatient or unfair as abuse. All of the events mentioned in the books having to do with humiliating a child, name calling, yelling at a child and threatening a child are instances of poor parenting; they may even be associated with ongoing suffering and marred interpersonal relationships. But they don’t necessarily make a person a victim of child abuse.

These authors suggest that negative events necessarily lead to pathology, as though the caregivers of our past now hold puppet strings on our continued existence. If you are unhappy, you must examine what happened to you and identify the perpetrators and assign all the unhappiness you experience now to these ghosts. As Wendy Kamminer proclaims in her witty and erudite I’m Dysfunctional, You’re Dysfunctional, “The trouble is that for codependency consumers, someone else is always writing the script. They are encouraged to see themselves as victims of family life rather than self-determining participants. They are encouraged to believe in the impossibility of individual autonomy.”

The mandate that we assume the role of damaged victim in order to get better is contrary to not only a century of existential philosophy and fiction-in which tragedy is discussed as opportunity for transcendence, clarity and strength-but also to a fair number of empirical studies which have suggested that the way people construe past events, not the events themselves, will determine later functioning. These findings are completely opposite of the non-scientific recommendations of codependency authors.

For example, in a recent study by McMillen, Zurvin and Rideout (1995) a large sample of adults sexually abused as children were interviewed and asked if they felt that they had benefited in any way from the experience. Forty-seven percent said that they had. Responses ranged from “growing stronger as a person,” “feeling more adept at protecting their children from abuse,” “increased knowledge of sexual abuse” and the belief in one’s ability to self-protect. In turn, regardless of quality or duration of the abuse, those who saw some benefit scored higher on a number of adjustment.

Not just sexual abuse has been evaluated in this regard, those who experience natural disasters, serious health problems and personal tragedies have been found to have common perceptions of benefit such as positive personality changes, changes in priorities and enhanced family relationships (e.g., Affleck, Tennen, and Rowe (1991).

The whole basis of cognitive therapy is to help individuals learn to recognize and dispute exaggerated, biased and overly negative automatic thoughts, beliefs, values and standards. The attitude of the codependent authors is “Jr. Psychoanalyst.” Somehow “events” in their pure form are stored in the labyrinth of one’s unconscious and need to be purged and experienced in all their horror in order for the person to get beyond them. As said, people’s ongoing unhappiness is not a direct result of the negative events which befell us, but rather the way the negative events are appraised, or the meaning assigned to the events by the recipient. People vary tremendously in terms of their appreciation of the same event. The mandate that we catastrophize, then detach, appears to me more a prescription for a phobia than recovery. As opposed to taking a victimization inventory, the most healthy thing to do would be to conduct a coping inventory, in which negative events of the past are re-evaluated in a manner that makes you stronger, more resilient. There are opportunities to learn and grow from the tragedies and mishaps in our pasts…or there is a quagmire of despair, deception, bad, bad mommies and daddies and precious little lambs with throats extended. You pick.

¨ The Idea That 12-Step Groups Are Necessary for Those Involved With an Addicted Person

Whether they commit themselves to the idea that codependency is a disease or not, the three authors are adamant about codependency being a lifelong illness which doesn’t go away, rather goes into remission (if you’re lucky), like diabetes or schizophrenia. Like neuroleptics and psychosis, codependency and AA-like support groups are intimately linked by these authors. Psychotherapy is deemed insufficient by these authors. Melody Beattie, by way of an “invisible boat” story, implies that therapy is fine for starters, but that the journey will end, and given the fact that codependency is progressive, one will need the 12-steps to continue on course. It is stated in all three books that one has to be a codependent to understand what is gong on with the codependent. That kind of reasoning is as absurd as me firing my rheumatologist, who is chief of staff at a respected hospital in San Diego, because he doesn’t have any swollen joints. Some painful knees would be a better qualification than board certification. I should ask a patient in the waiting room if they wouldn’t mind taking over my case because of his or her capacity to feel the same throbbing joint pain as me.

The 12-step philosophy endorses the relinquishing of control to a higher power. Though claiming that its spiritual emphasis is not religious, and that virtually anything can be one’s higher power, this is really a clever bait and switch. Twelve-step groups are more like going to a prayer group than anything else. For many, this forum is commensurate to existing needs and values. For others, it is the antithesis of stable world views. As is the case with alcoholics and drug dependent individuals, you are hard pressed to find alternatives to the 12-step approach. Those desiring help who find the mentality of AA irrelevant or offensive are deemed “in denial” or “into their disease.”

Most disturbing is the fact that codependency authors are unaware of the volumes of empirical data backing up non-Twelve-step methods of change for the symptoms delineated in codependency books (anger control problems, depression, anxiety, communication problems, to name but a few of those symptoms listed in Beattie’s book). Also behaviorally oriented family therapists have developed methods for helping families in which addiction occurs without the use of Twelve-step mentality (e.g., O’Farrell, et. al.).

One Step at a Time

It’s probably “codependent” of me to believe that I alone can strike the term codependency from the English language. It’s entrenched in the addiction vernacular, and though defined in many, many ways depending on which symptoms a person selects from the vast lists, it has been implemented into the self concepts of many. I’m sure the codependency books critiqued in this essay, like all self-help books, were written with good intentions, the hope that people’s lives would be improved. If your life feels better for having read and followed through with the recommendations of these authors, who am I to try to take that away? My article was written primarily as a caveat, a warning, that what appears right and good on the surface may have unhealthy ramifications in the long run if taken on too aggressively, a warning that just because a self-help author mandates one path to happiness doesn’t make it accurate.

As opposed to swallowing the codependency idea whole, I encourage those struggling with problematic relationships or a family member’s addictive behavior to use the basic advice of AA, “one step at a time.” The codependency idea is so broad that it is possible to extract useful principles and guidance from it. Given the lack of scientific drive behind this concept it behooves you to examine all aspects of your life which are being addressed by this concept. Just because one component of the codependency mind set hits home, it doesn’t mean you have to engulf the entire world view.

1. Leave the term in the realm of addiction. The codependency idea was designed to help spouses and families of alcoholics and drug users. In this realm it appears to have some implications. Some of the advice in these books may be useful in helping to make sobriety easier for the addicted person . However, with regard to the use of the term for people who have relationship problems or who have difficulty putting themselves first, or who are dysphoric, there are many more specific terms which afford the sufferer some practical tools, without having to incorporate the disease idea, or “purging the unconscious.” Earlier I mentioned specific treatments, mostly in the cognitive-behavioral realm for addressing such problems as anxiety, depression, anger control, relationship problems. Before tossing your whole system of values and making the plunge into the recovery lifestyle, consider less invasive measures. If they prove insufficient, up the ante.

The treatment tiering approach is very appropriate here. In the realm of medicine, least invasive treatments are usually tried first, and when proven insufficient or inadequate treatment intensity is increased. Arthritis is an analogy I usually use. A competent MD would not prescribe joint replacement as an initial treatment for painful joints. She would first attempt less potentially dangerous treatments, such as non-steroid anti-inflammatories. If these prove insufficient, she might try steroids, then up to more intense drugs with potential side effects and so on. I believe the treatment tiering model is relevant to all psychological problems. Consider the least invasive and potentially most effective intervention first, not the most drastic.

There are so many potential problems with over-diagnosing and over-treating. When people begin to believe that their problems are bigger than life they begin to question the effectiveness of their coping in realms previously not questioned. This doubt and insecurity, which can be perpetuated by “long-term therapy” and nebulous diagnoses like codependency, dissolve the mind set that one is robust or resilient, and replace it with one in which one is weak and vulnerable in a cruel world. Our ever broadening “self awareness” results in our becoming chronically ill-equipped.

1. Avoid victim making. Victim making is crazy making. The hydraulic model of psychodynamic theory has not been supported by research. The nasty “events” in our past do not stockpile in a cauldron called the unconscious festering like an infection until the host re-experiences them in their full horror, unleashing the past so that serenity can at last be found. This exorcism mentality, though popular in the field of clinical psychology, and good fodder for Hitchcock films, does not fit with current information processing literature, which has demonstrated that the chronic activation of negative information perpetuates negative mood states. Furthermore, the exaggeration of negative information and the belief of “helplessness” is strongly associated with depression.

The bottom line is that it is quite unlikely that you must do “grief work” in order to become more assertive or less depressed. Adult functioning is not linked to events in our past, but how those events have been assigned meaning. Instead of separating the “precious child” from the harsh cruel world, assign new meaning to events from the perspective of a coping adult who has survived. Do an inventory of the events which you overcame. Consider adult qualities which were related to surpassing and having insight into difficult times in the past. Victimhood, though stylish these days, creates a historical distraction for incoming information that is not healthy.

1. Acceptance is often the greatest change one can make. In working with couples, partners often come in pointing fingers at each other. She points, “He needs to stop being so controlling.” He points back, “She is so damn emotional and irrational!” I find that lasting change occurs, not when couples make marked changes in their behavior (like he becomes less controlling or she less emotional), but when partners_both partners_gain clarity with regard to the other’s uniqueness and of their relationship as completely singular in terms of what will help it survive or not; in short, come to understand and accept each other.

The codependency authors who believe that relationships should be fair, and that there is some standard to which all relationships should be compared, are living on a fantasy island. A good thorough read of one of Camilia Paglia’s books might illuminate the reality that there is noting tidy about intimacy, that love is driven by irrational, uncontrollable, often self defeating urges and very different agendas depending on one’s gender. Codependency authors, like some feminists, want sexual equality, blame males for all the unhappiness which befalls women and believe that “equality” once achieved will pan out in complete ease in relationships. Impossible, says Paglia. Men and women are vastly different and their differences, though creating an often chaotic world for one another, are what passion is all about. Modern feminist attitudes “have a childlike faith in the perfectibility of the universe, which they see as blighted solely by nasty men.” (Paglia, Vamps and Tramps)

Relationships are never completely balanced. There is always some degree of hierarchy. In fact, relationships function often on many hierarchies simultaneously, and balances shift during the course of relationships, often many times. The “raw material” which makes up one relationship is completely different from any other, and gauging balance against other relationships, or the ideal of complete equity in all regards is futile, impossible. Paglia says, “(Feminism) sees every hierarchy as repressive, a social fiction… Feminism has exceeded its proper mission of seeking political equality for women and has ended by rejecting contingency, that is, human limitation by nature or fate.”

Caring is good. Some people care more than others, and caring often endures despite inequity. Thankfully, we live in a world in which caring can shower itself on the good, bad and ugly. Sometimes this results in imbalance. Imbalance is not necessarily bad, and to deem it so would require us to reckon the most altruistic individuals in history as flawed.

So what is the alternative to the idea that caring contributes to the problem or directly perpetuates it? How about the exact opposite? “I’m in no way responsible for the endurance of your addictive habit. You are making a decision to drink, use drugs, squander, overeat or whatever. Period. Now that we have that settled, let’s examine my behavior. Well, I do a lot to make his life comfortable. I’ve been that way for as long as I’ve known him. And now our lifestyle has changed and we have this awful substance abuse problem and I’m feeling spent and frustrated most of the day because he won’t change. I wonder if there are certain behaviors that, in and of themselves are okay, but which make his quitting this habit more difficult now, at this juncture of our lives.” This mind set results in an examination of many caring behaviors and the possibility that some many need modification while others may not.

I once worked with a young man who was in his 40s and living at home with his mother. He had moved in with her secondary to a nasty divorce and a bout of depression which was proving particularly tenacious. This fellow was drinking heavily every night and the mother finally had it and mandated that he get some help. She went to an outpatient clinic and was told that she was the majority of the problem with regard to her son’s addiction, that she was enabling. She took the bait and evicted her son, and told him that she could not be responsible for his problems any more. She wouldn’t take his calls and had her locks changed.

This would have been fine and dandy, but the woman felt miserable. She went to Al-anon meetings and left feeling depressed. She constantly worried about her son, about his well-being, his health, his depression. Ultimately she made the decision to let him come back home. She was quickly back to where she started. He was depressed and drinking heavily in the evening. To boot, she felt even more helpless than before, because she now felt that she was causing his problems, though she simply could not abandon her son as the counselor had suggested.

When the family came to me they had been told that I had a different clinical concep-tualization of addictive behavior and family involvement. Initially I met with the son and thoroughly assessed his alcohol abuse problem which was clearly triggered by his tenacious depression. After a medically supervised detoxification and thorough evaluation by a psychiatrist it was agreed to afford him a pharmacological regime as well as cognitive therapy, emphasizing the acquisition of skills to counter urges and craving, prevent and cope with relapse, modify lifestyle and manage negative mood states. Upon meeting with the mother and the son together the idea of enabling, which had been so indoctrinated by the previous counselor, was discussed. She was told that her son’s depression was not 75% her fault, as she had been told. I also encouraged her to entertain the possibility that the patent’s behavior was being driven by the need to feel better, not by her actions. I told her that her housing of her son, providing meals and so forth were manifestations of a caring mother, and in and of themselves were not pathological. She agreed that these qualities had been utilized in the rearing of her other three children and in her friendships, none of whom had addiction problems. I encouraged her to consider the present situation with her son as a special situation, evaluate all behaviors involving her son, and make a determination whether they are making it less easy or more easy to change.

She came to the conclusion that providing shelter for her son in intoxicated states and while recuperating was probably making it less easy for him to change. She felt that “kicking him out” while he was attempting to recover from such a long-standing depression was counter to her convictions regarding family and probably wouldn’t help him either. She was able to give herself permission not to do this. The son was able to articulate that he would very much like to be independent and have his own place again, and didn’t feel he was in a position to take on independent living at that time. He also saw how a comfortable bed to drink in and nurse his withdrawal was not going to help him change. The mother was receptive to my “recruiting” her in the effort of helping her son stay on course with regard to his rehabilitation and agreed to make her house available to her son as long as he avoided alcohol. If she suspected he was drinking, he was to find another place to stay for the next 72 hours or until he was not intoxicated or withdrawing.

The mother did not have to follow through with this condition, as the threat alone served to help the patient stay on course. She felt that it was okay to provide the caring she had always provided and did not feel as though this condition conflicted with her values.So you’ve tried to “stop caring” and found that it makes life dreadful? Maybe you don’t have to relinquish core standards to be happier. Perhaps you’re trying to eliminate the foundation and expect the building to continue standing. Maybe it’s okay to “care too much.” Can you “care too much” and be happier than you are now? That would take a lot of re-evaluation…of yourself, of your spouse, of your family, maybe even your past. Now that’s a challenge!

 

REFERENCES

Affleck, G., Tennen, H. & Rowe, J. (1991) Infants in crisis: How parents cope with newborn intensive care and its aftermath. New York: Springer-Verlag.

Affleck, G., Tennan, H., Croog, S., & Levine, S. (1987) Causal Attribution, perceived benefits, and morbidity following a heart attack. Journal of Consulting and Clinical Psychology, 55, 29-35.

Moos, R.H., Finney, J.W., & Cronkite, R.C. (1990) Alcoholism treatment: Process and outcome. New York: Oxford University Press.

Beattie, M. (1987) Codependent No More: How to Stop Controlling Others and Start Caring for Yourself. San Francisco: Harper.

Gomberg, E.L. (1989). On terms used and abused: The concept of codependecy. Drugs and Society, 3, 113-132.

Gordon, J.R., Barrett, K.(1993) The Codependency Movement: Issues of Context and Differentiation. In Baer, J.S, Marlatt, A. & McMahon, R.J. (eds.) Addictive Behaviors Across the Life Span. Newburry Park: Sage.

Kaminer, W. (1992). I’m Dysfunctional, You’re Dysfunctional: The Recovery Movement and Other Self- Help Fashions. New York: Vintage.

Melody, P. Wells-Miller, A., Miller, K.J. (1989). Facing Codependence: What it is, Where it Comes From, How it Sabotages our Lives. New York: HarperCollins.

McMillen, C., Zuravin, S. & Rideout G. (1995). Perceived Benefit from Child Sexual Abuse. Journal of Consulting and Clinical Psychology 63(4) 1037-1043.

Paglia, C. (1992) Sex, Art and American Culture. New York: Vintage.

Paglia, C. (1990) Sexual Personae: Art and Decadence from Nefertiti to Emily Dickinson. New York: Vintage.

Schaef, A.W. (1986) Codependence: Misunderstood, Mistreated. San Francisco: Harper.

Paglia C. (1991). Sexual Personae: Art and Decadence from Nefertiti to Emily Dickinson. New York: Vintage

Copyright Robert Westermeyer.

Reprinted with permission.