By Matthew D. Federici, MA, LMHC
15 Minute Read
Do you exist without the presence of your family, loved one, or significant other? What can you say about your identity that has no relation to them whatsoever? Are you truly your own person? Non-codependent relationships involve healthy people who exist and have value without predetermined notions from the relationship attributing to such value. Learn how to combat this unhealthy type of relationship through establishing love, value, and ultimately, identity for the self. Our family therapy program can help.
Codependency is understood as a dysfunctional relationship dynamic within social aspects of humans (Cullen & Carr, 1999). According to Wright and Wright (1991) codependency is commonly found in dysfunctional romantic, intimate, platonic, and familial relationships, and can have negative implications on the overall success of the relationship, and overall mental health of the individuals involved. Codependency involves inappropriate emotional and physical need on others, or to provide such needs for an individual (Burn, 2015). In regards to the total spectrum of psychologically dysfunctional, and otherwise maladaptive behaviors in relationships and elsewhere, the nature of enabling and codependent behaviors are paramount in perpetuating aspects of overall inappropriate relationships, and negative implications of such. This is important to consider in counseling applications due to inherent social nature of individuals, and possible prevailing symptomology due to such.
According to DSM-5 (2013), dependent personality traits are found across several clusters of personality disorders. Research conducted found that 0.49% of individuals may demonstrate dependent personality traits, and according to the study, were consistent with individuals diagnosed with dependent personality disorder (DPD), however inadequate data exists for those demonstrating symptoms with borderline, histrionic, and other attachment related personality disorders (DSM-5, 2013). Further research calls for identifying a previously thought to be subclinical dependent traits that may be called codependent traits, or codependency. Mental health professionals, and those interested in this topic may be surprised that the word “codependency” is not in the DSM (DSM-5, 2013).
According to Burns (2015) codependency “involves relationship patterns characterized by imbalanced giving and receiving where relationship intimacy and closeness are built on one’s person’s ongoing crisis and the other’s rescuing and enabling.” Codependency, according to Morgan (1991) and Cermak and Timmen (1986), is described as a behavioral disorder, specifically pervasive patterns of enabling dysfunctional behaviors interpersonally, usually at a detriment to the individual engaging in enabling. Many psychology-based professionals disagree on the symptomatic nature of codependency, as well as negative implications on overall functioning as a result of such, and possibly are considered as exclusively situational, and episodic, and therefore, typically classified as subclinical (Lillenfield, 2001; Cromak & Timmen, 1986). Additional research has suggested that codependency can be particularly characteristic of dysfunctional romantic, and intimate relationships, with associated implications of such negatively affecting such relationships (Wright & Wright, 1991).
There are less than ideal amounts of empirically researched knowledge base regarding this topic in the last several decades (1977, 1986, 1989, 2001). However, many psychology-based professionals also agree that enabling another individual’s dysfunction is interpersonally unhealthy, and therefore tantamount with inadequate mental health (Burns, 2015; Bandura; 1977, 2001). Codependency in counseling implications usually involves two individuals, the enabling individual, and the codependent individual on the receiving end of the enabling, however this can also include persistent symptomology that may remain with an individual through various relationships and interactions, not necessarily limited to long term or monogamous relationships.
Forerunner studies attempting to identify codependency began in the field of substance use and relationships (Gomberg, 1989). Original studies in codependency were routed in studies of intimate relationships including one or more alcoholic participants. Specific studies aimed to identify relationship traits perpetuating desire to remain in a relationship that was destructive, problematic, or otherwise inappropriate due to unhealthy amounts of alcohol consumption via one or more individuals. Research in this manner found that spouses of alcoholics were more apt to stay in the relationship if they felt that their role was protective of, or helping the individual to some extent attain greater functioning despite their deficits due to alcohol consumption. These studies were later able to be replicated using a variety of substances in the substance use field, and suggested implications requiring exploration and additional research in other areas of dysfunction in terms of enabling behaviors in relationships (1989).
Some research since initial studies have developed since, including initial clinical implication, however remains under-researched, particularly in regards to clinical application in individual and family settings (1986, 1989, 1991, 1998, 2008, 2010). Codependency is not collaborative, nor complementary relationships. In terms of boundaries studies, appropriate boundaries are defined as those which are not collapsed, or rigid (1986). Codependency can be understood in a similar fashion. Relationships that consist of individuals who collaborate in the relationship are not to be understood as codependent – sharing of responsibilities, designation of roles, designation of skills, and assisting with problematic areas of life are not to be considered as codependent. For example, an individual relying on a spouse or another individual to assist in household tasks in which the individual has no knowledge or skill in is not considered codependency, and is more appropriate diagnostically elsewhere. Akin to boundaries, indicators of poor or collapsed boundaries share traits similar to codependency, however also includes the characteristic over-reliance emotionally, behaviorally, and socially, on part of the enabler, and the codependent individual (1986).
Dependent Personality Disorder (DPD) should also not be incorrectly diagnosed as codependent behaviors. According to DSM-5 (2013) DPD, characterized as a cluster C disorder, is characterized by “A pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation, beginning by early adulthood and present in a variety of contexts. Criteria include difficulty with decision without excessive amount of advice and reassurance, need for others to resume responsibility for personal parts of life, difficulty expressing disagreement due to fear of loss of support or approval, difficulty initiating life endeavors, going to excessive lengths to obtain nurturance and support, the point of agreeing to tasks or initiatives that are not pleasant, discomfort being alone, seeking other relationships when one relationship ends, and unrealistic preoccupying with fears to being left to take care of one’s self (DSM-5). According to DSM-5, differential diagnoses of DPD can include other mental health related disorders including depression, panic disorders, and agoraphobia, as the result of other medical conditions, substance use disorders, and other personality disorders, due, or not due to another medical condition (2013). It worth noting again that not only DPD can demonstrate codependent traits, including borderline, histrionic, and insecure attachment, however these disorders and cluster A diagnostic criterion have not been established to show relation to general statistics of dependent traits (DSM-5, 2013).
One can see similarities between what is described as codependency and diagnostic criteria for DPD, however the paramount difference between codependency and DPD can be considered can be considered in terms of both “enabler role,” and “codependent role, is degree of functionality. When codependency has been identified and ruled out from differential criteria, it is important to consider the relative factors of codependency as attributed by reported problematic relationships.
Origins of symptomology later clarified as codependency, as previously stated, were originally researched when attempting to understand problematic romantic and intimate relationships where alcohol was abused (1989, 1991, 2008). Additional research found that maladaptive symptoms and behaviors attributing to codependency could be routed in various dysfunction in other intimate and/or sexual, and/or otherwise close relationships, as well as platonic relationships, and other relationships such as family, and developing in various societal constructs (1991, 2008, 2015).
Given the social nature in which codependency is typically demonstrated, it is beneficial to examine family systems model in terms of isolation of origin of symptomology (Titleman, 1998). Cullen and Carr (1999) conducted an analysis that found that individuals demonstrating high codependent traits were more like to have parents with history of mental health problems or family dysfunction. The authors further found that alcoholism and physical/sexual abuse were not found to be correlating factors for those demonstrating high codependent traits, which was noted by the authors as being contrary to popular understanding at the time (1999). According to Fischer and Crawford (1992), parenting styles of paternal figures were found to correlate with individuals endorsing codependent traits on self-assessment. The authors found that parenting style (uninvolved, permissive, authoritarian, and democratic) were related to offspring codependency in that daughters of authoritarian fathers were found to have higher codependency scores than did daughters of permissive fathers, and sons of authoritarian fathers reported higher levels of codependency than did sons of uninvolved fathers. The authors concluded that further research is required to understand parenting and gender components associated with this (1992). Other research has also found connections between family stressors and development of codependency in offspring (Gierymski & Williams, 1986; Morgan, 1991; Fuller & Warner, 1999). According to Burns (2015), over empathetic interpersonal styles, associated impulsivity, and low self-esteem are also predictors of codependent behaviors, which reportedly can be routed in parenting styles, or absence of parenting styles/indifference, neglect, and experience of trauma. Attachment theory also seeks to examine personal understanding of interpersonal relations as routed in family upbringing (Titelman, 1998). According to DSM-5 (2013) cultural considerations are also crucial for diagnostic accuracy and appropriate therapeutic direction, especially when assessing degrees of enmeshment.
Identification of codependency is crucial in personal and counseling applications. Consider the scenario of a middle aged man presenting with alcoholism. He reported recently experiencing an affair, with his estranged wife as perpetrator with a man from another state, and is reporting large distress. The woman is an alcoholic and cocaine user, and endorses hypersexuality. This individual may enable this behavior due to own experience with mother, who was identified as alcoholic and mentally dysfunctional and an authoritarian father. Consider the scenario of the young woman whom husband recently perished in a motorcycle accident after an argument with the individual. In addition to demonstrating symptoms of PTSD, this individual reported inappropriate relationships and enabling behaviors in that she typically dates unemployed, addicted men, and endorses intent to engage in “fixing behaviors,” towards these individuals. The individual reports that her father is a vagabond musician and has a strictly platonic relationship with her mother. Consider the scenario of the man currently subject to an affair, however remains enabling of such due to own guilt for extra-marital affairs.
In regards to dysfunctional romantic, intimate, platonic, and/or familial relationships, codependency is perhaps common due to nature of overemotional involvement in the relationship, and dysfunctional and inappropriate endorsements benefits associated with relationships as such (Cullen & Carr, 1999; Wright & Wright, 1999). Individuals are perhaps biased due to intimate and emotional nature associated with romantic and intimate relationships, and due to such, other prevailing factors may attribute to negative symptomology.
According to Burn (2015), individuals who identify with codependency, both enabler role and/or codependent role, appear to perpetuate such through continued failed relationships, negative self-fulfilling prophecies regarding self-esteem, self-efficacy, and self-advocacy, and impulsive, and inappropriate use of empathy. According to Beattie (1986), and Titelman (1998), counseling implications consist of several separate and crucial functions, all revolving around development of independence, and development of mindset and coping strategies yielding to comfort and skill with such. Essentially, it does not simply require establishing behaviors, it requires cognitive-based contentedness with such. Some effective methods of counseling individuals endorsing codependency are cognitive behavioral therapy (CBT) and rational emotive behavioral therapy (REBT), and both are subsets of the cognitive model initially developed by Aaron T. Beck are paramount in overall cognitive-based therapeutic approaches (Beck, 2014). Several models of this theory, and in this specific counseling application, will include, cognitive challenging, cognitive reframing, and cognitive restructuring (2014). Therapeutic orientation could also include family systems approach (Titelman, 1998)
Ideal therapeutic approaches should explore benefits of establishment of autonomy in decisions, and feelings about decisions, and forming healthier relationships that don’t share previous maladaptive significance. Clients will be encouraged to describe the personal endorsement, style and pattern of emotional dependence in relationships, and this will be done via exploring the client’s history of emotional dependence through parenting styles, history of family mental illness, history of family conflict, and any trauma relating such. Clients will then be encouraged to verbalize increased awareness of own dependency, through activities such as family exploration i.e. genogram and other narrative and interpersonal based approaches to exploration of such. Clients will then be encouraged and assisted, where necessary, in developing understanding of automatic and/or distorted thoughts regarding assertiveness, being alone, or acting independently via cognitive restructuring processes, i.e. teaching connections between thoughts, beliefs, and actions as a result of such, identifying automatic thoughts and associated biases, developing alternative more positive perspectives and testing such, utilizing of behavioral experiments to test such, all to assist client in replacing automatic negative thoughts with thoughts and associated actions pertaining to assertiveness, being alone, and overall independent acting and decision making processes (1986; 1991; 2014; 2015). Therapeutic direction will then call for identification of own emotional and social needs, and ways to fulfill such, and identification, as well as development and implementation of increases self-responsibility and decreased sense of responsibility on others. All of these clinical implications are relevant to the enabler and codependent role. The paramount direction is to develop and implement sufficient skills, coping, life, and interpersonal in nature, to establish contentedness with sincere autonomy in decision making, emotional regulation, and overall life independence (1986, 1991, 2002, 2015, 2018).
Other beneficial therapeutic work, depending on originations and associated implications of development of codependent traits, could include grief working, most specifically tasks of grief including filling voids (Beattie, 2018). Appropriate therapeutic work could include inner-child work (2018). Appropriate therapeutic work could also include other CBT-based concepts including undoing maladaptive thought processes such as undoing unhelpful thinking styles and associated rationale, as well as development, implementation, and appropriate understanding of uses of appropriate boundaries. Specific methods could include cognitive challenging, cognitive reframing, cognitive restructuring, role-play, interpersonal therapy, and motivational aspects (2014).
It is important to consider these concerns in therapeutic/counseling, and other helping relationships due to inherent prevalence interpersonally in regards to individuals endorsing dysfunctional relationships, and associated maladaptive behaviors associated with such. Addressing such will not only improve individual accountability, self-efficacy, self-advocacy, and independent and sincere decision making in terms of all life endeavors, but overall attribute to a larger life satisfaction, and inherent overall quality of life, interpersonally, and elsewhere.
References
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Health Disorders. American Psychiatric Association.
Bandura, A. (1977). Social Learning Theory. Englewood Cliffs, NJ: Prentice Hall.
Bandura, A. (2001). Social Cognitive Theory: An Agentic Perspective. Annual Review of Psychology. 52, 1-26.
Beatie, M. (2018). Codependent No More. Createspace Independent Publishing. North Charleston, SC.
Beck, A.T. (2014). Advances in cognitive theory and therap. Annual Review of Clinical Psychology. 10, 1-24. PMID 24387236.
Burn, S.M. (2015). Unhealthy Helping: A Psychological Guide to Overcoming Codependence, Enabling, and Dysfunctional Helping. Createspace Independent Publishing. North Charleston, SC.
Cermak M.D., Timmen L. (1986). Diagnostic criteria for codependency. Journal of Psychoactive Drugs. 18 (1): 15–20. doi:10.1080/02791072.1986.10524475.PMID 3701499.
Cullen, J. & Carr, A. (1999) Codependency: An empirical study from a systemic perspective. Contemporary Family Therapy, 21(4), p. 505-526.
Fischer, J.L., & Crawford, D.W. (1992). Codependency and Parenting Styles. Journal of Adolescent Psychology. 7(3). doi.org/10.1177/074355489273005
Fischer, J.L. & Spann, L. (2008). Measuring codependency. Alcohol Treatment Quarterly.
Fuller, J. & Warner, R. (1999). Family stressors and development of codependency. Genetic, Social, and General Psychology.
Gierymski T. & Williams T. (1986) Codependency. Journal of Psychoactive Drugs. 18 (1) 7-13, DOI: 10.1080/02791072.1986.10524474
Gomberg, E.L. (1986). Current Issues in Alcohol/Drug Studies.
Lilienfeld, S. (2001). The teaching of courses in the science and pseudoscience of psychology. Teaching of Psychology. 28 (3): 182-191.
Rushton, P.J. (1982) Social Learning Theory and the Development of Prosocial Behavior Academic Press.
Titelman, P. (1998). Clinical Applications of Bowen’s Family Systems Theory. Routledge. New York.
Wright, P.H., & Wright, K.D. (1991). Codependency: Addicted love, adjustive relating, or both? Contemporary Family Therapy. 13 (5). 435-454.
