Co-Dependency Workbook

This page is a work in progress. 

RECOVERING FROM CODEPENDENCE - Alcoholism embraces not only the afflicted individual, but indirectly it also involves the people around the alcoholic. Ironically, concerned family and friends may actually support the very disease that they are fighting against through their codependency and enabling.

THE ENABLER - You do not have to be a family member to enable an addicted person.  An enabler is defined as any person who "reacts to an addict in such a way as to shield the addict from experiencing the full impact of the harmful consequences of addiction."  The enabler may be a well-meaning friend, a trusted advisor, a supervisor at work, or even a substance abuse counselor.  Any person who knowingly acts in such a way as to protect the addicted person from the natural consequences of his or her behavior may be said to be an enabler. To enable someone means to knowingly engage in certain behaviors.  The enabler, by protecting the addicted person, prevents the individual from taking advantage of the many opportunities to discover first hand the cost of his or her addiction.  One father of a narcotic addict admitted, in a mixed group of family members and other addicts, that he had taken out personal loans more than once to pay off his daughter's drug debts.  Another addict, who had been in recovery for some time, asked the father why. The father responded that, if he did not, his daughter "might leave us!"  Several group members then suggested that the daughter might need to suffer some consequences on her own in order to "hit bottom" and come to terms with her addiction.  The father was silent for a moment, then said "Oh, I couldn't do that!  She's not ready to assume responsibility for herself, yet!" It is difficult to understand the multitude of ways in which one person might enable an addict to continue his or her compulsive use of chemicals.  A secretary may enable an alcoholic superior's continued drinking by providing an excuse as to why she or he missed an important staff meeting.  Rather than say "She was drinking all morning, and I don't know where she is now," the secretary might explain that "There was an emergency at the downtown office, and she had to leave."  In so doing, the secretary has prevented the superior from suffering the consequences of addiction.  The secretary, in this hypothetical example, has enabled another person's continued use of chemicals.

Not uncommonly, the addicted person will treat the enablers as if they are being granted a favor for the privilege of living with, and taking responsibility for, the addicted person.  When confronted by his or her supervisor for being late again, the addict might respond, "you are lucky that I work here in the first place!"  Yet the supervisor, perhaps fearing legal or union action, takes no action other than to warn the addict not to let it happen again.  The supervisor might be said to have enabled the addicted employee, though not a codependent of that person. The issues of codependency and enabling are often intertwined within the same individual. One does not have to be codependent in order to enable an addict.  Enabling involves knowingly protecting the addicted person from the consequences of his or her behavior.  It does not require an ongoing relationship.  A tourist who gives a street beggar a gift of money, knowing that the beggar is likely addicted and in need of drugs, might be said to have enabled the beggar.  But the tourist is hardly in a meaningful relationship with the addicted person. This is often a confusing point to the student of addiction.  Codependency and enabling may be, and often are, found in the same person.  However, one may also enable an addicted person without being codependent on that person.  Enabling refers to specific behaviors, while codependency refers to a relationship pattern.  Thus, one may enable addiction without being codependent.

The issues of codependency and enabling may be thought of as overlapping issues, which may or may not be found in the same individual. Often, codependent and enabling behaviors are found in the same person.  The wife who calls in to work to say that her husband is sick when he is actually hung over from the night before is both codependent and an enabler.  Another example might be found in the husband who calls to tell the probation/parole officer that his wife cannot keep today's appointment because of illness, knowing full well that if the probation/parole officer were to ask for a urine sample for a drug screen, that his spouse would test positive and be sent to prison. 

Like chemical dependency, enabling is progressive.  The chemically dependent person was once a user, then an abuser, finally becoming chemically dependent.  Once chemically dependent the disease is not arrested but continues to progress ultimately resulting in death. Like chemical dependency enabling is progressive. 

The Three Stages of Enabling are:

Denial -  The enabler may see the addict's behavior as fun and shares in the drinking/drugging episodes.  This is the "It can not happen to me" stage.  Numerous reasons/rationalizations are found for the chemical abuse and why "the abuser" can not have a problem.

Loss of Self-Respect - Due to the inability to effect change, constant blame and taking responsibility, verbal and/or physical abuse, the family members become increasingly dependent and suffer fear and shame.

Collusion - Family excuses protect the addict from their using and subsequent consequences.  At this point if you can not beat them you just might join them! 

As enabling progresses to the point of collusion, it becomes generalized and crosses the line from isolated specific behaviors to a relationship pattern known as codependency.  Codependency is much more severe than enabling, but if the enabler does not stop enabling, it will progress to the point where they lose control and become codependent. Generally speaking a codependent is someone whose life has been significantly affected by another person's use of chemicals.  A part of healing codependency can include professional counseling  and A-anon

The following list defines codependence more explicitly. exaggerated dependent pattern of learned behaviors, beliefs and feelings that make life painful.  It is a dependence on people and things outside the self, along with neglect of the self to the point of having little self identify. 

....preoccupation and extreme dependence (emotionally, socially, and sometimes physically) on a person or object.  Eventually, this dependence on another person becomes a pathological condition that affects the codependent in all other relationships.  This may include ...all persons who (1) are in a love or marriage relationship with an addict; (2) have one or more addicted parents or grandparents; or (3) grew up in an emotionally repressive family....It is a primary disease and a disease within every member of an alcoholic family. emotional, psychological, and behavioral pattern of coping that develops as a result of an individual's prolonged exposure to, and practice of, a set of oppressive rules - rules which prevent the open expression of feeling, as well as the direct discussion of personal and interpersonal problems. 

....a disorder based on: a need to control in the face of serious adverse consequences; neglecting one's own needs; boundary distortions around intimacy and separation; enmeshment with certain dysfunctional people; and other manifestations such as denial, constricted feelings, depression, and stress-related medical illness. 

....a stress-induced preoccupation with another's life, leading to maladaptive behavior. 

....a disease that has many forms of expression and that grows out of a disease process that....I call the addictive process.  The addictive process is an unhealthy and abnormal disease process whose assumptions, beliefs, and lack of spiritual awareness lead to a process of nonliving which is progressive.

A codependent is an individual who has been significantly affected in specific ways by current or past involvement in a chemically dependent or other long-term, highly stressful family environment. 


A. Continued investment of self-esteem in the ability to control both oneself and others in the face of serious adverse consequences. 

B. Assumption of responsibility for meeting others' needs to the exclusion of acknowledging one's own. 

C. Anxiety and boundary distortions around intimacy and separation. 

D. Enmeshment in relationships with personality disordered, chemically dependent, other codependent, and/or impulse disordered individuals. 


1. Excessive reliance on denial 

2. Constriction of emotions (with or without dramatic outbursts)

3. Depression 

4. Hypervigilance 

5. Compulsions 

6. Anxiety 

7. Substance abuse

8. Has been (or is) the victim of recurrent physical or sexual abuse 

9. Stress-related medical illnesses 

10. Has remained in a primary relationship with an active substance abuser for at least two years without seeking outside help.  Continued investment of self-esteem in the ability to control oneself and others in the face of serious adverse consequences. Codependency has a distorted relationship to willpower, a confusion of identities, denial, and low self-esteem.

Distorted relationship to willpower - Like chemical dependents, codependents believe that it is possible to control their lives by sheer force of will.  Chemical dependents show this by repeated efforts to control their drinking or drug use ("I know I can stop after one drink." Or, "I swear, I'll never take another drink again"). Codependents show it by repeated efforts to control the feelings and behavior of the chemical dependent, as well as their own feelings and behavior ("If only we all try hard enough and pull together, we can get your father to stop drinking").

In both cases, the end result is isolation - from others, from their own authentic selves, and from their spiritual and unconscious resources.  It becomes an either/or situation: either they continue to rely totally on willpower, or they succumb to utter hopelessness.  There is nothing in between.

It is important to understand the distinction between willfulness and willingness. he willful person believes that all manner of things can be controlled if one's willpower is strong enough and focused enough.  Failure (even failure to control events beyond anyone's ability to control) leads to a sense of inadequacy.  The willing person, on the other hand, recognizes the value of determination in those areas where it is possible to exercise influence or control while accepting the fact that there are some things he or she simply can not do anything about.  The willing person knows that there are situations beyond any mortal's control, and that everyone has limitations.

Confusion of identities - When one person becomes dependent upon another, he or she gives that person power over one or more aspects of his or her life.  What usually results is a sort of inter-dependence.  The two strike implied "bargains":  "I'll take care of the kids, and you'll put food on the table and pay the rent."  If either partner fails to uphold his or her end of a bargain, the other person suffers.  But his or her sense of self remains relatively unaffected. 

When the line is crossed into codependence, the sense of self is compromised and even lost.  A confusion of identities occurs.  The codependent's self-worth rises or falls with his or her partner's success or failure.  It is as if the partner has become a "barometer" signaling how the codependent should feel and behave. 

Now picture what happens when this confusion of identities is combined with the belief that one can control almost anything with willpower.  In order for the codependent to feel good, his or her partner must be happy and behave in appropriate ways.  If the partner is not happy, the codependent feels responsible for making him or her happy.  If the partner is drinking or using drugs (in other words, behaving inappropriately), the codependent feels responsible for making him or her stop.  All of this becomes a matter of intense personal importance.  And all of it is perceived as achievable, if only one puts enough effort into it. 

Denial - To continue using alcohol and/or drugs in the face of obviously negative physical, social, and emotional consequences, the chemical dependent must construct a pervasive system of denial. So, too, must the codependent.  And both go about it in the same way: by suppression, repression, rationalization, and projection.   Uncomfortable facts and feelings ("This marriage is not working," "Her drinking is clearly not normal") are resisted.  They are consciously pushed out of one's awareness (suppression).  Or they are filtered out of awareness before they even have a chance to rise into the light of consciousness (repression).  Or reasonable causes for their existence are substituted for actual causes (rationalization - for example, believing that one got drunk because of being tired, rather than because of how much one drank). Or the cause of one's problems can be seen as lying outside oneself, rather than in one's own behavior (projection). 

At the core of the chemical dependent's world is the prideful insistence that he or she can use and keep using without incurring lasting harm.  As long as this belief remains unchallenged (in fact, it is unchallengeable), then every misfortune and discomfort must be assigned the next most logical explanation.  The mutual consistencies among these explanations become part of the fabric of denial, an opaque curtain that conceals reality.  

The codependent also maintains an unchallenged (and unchallengeable) core belief: that he or she ought to be able to change his or her partner's behavior.  When the partner behaves appropriately, this is seen as proof of success.  When the partner behaves inappropriately, this is seen as proof of failure due to inadequacy.

The perception of the self in this role, like the perception of the self as being able to use drugs or alcohol with impunity, requires a fabric of denial.  The codependent either chooses not to see the chemical dependent's inappropriate behavior or rationalizes his or her own failure to keep the person from using.  In the latter case, the failure is attributed to not having tried long enough or hard enough, or to having tried the wrong way.  Personalizing the failure offers hope that increasing one's efforts can keep things from getting further out of control. 

Thus the denial of the chemical dependent and the denial of the codependent are the same.  Both work to preserve the status quo, since denial is inconsistent with recovery.  And each legitimizes and reinforces the other.  Until the pain of continued denial outweighs anxieties about recovery (if it ever does), the chemical dependent will continue to use and the codependent will continue to feel responsible. 

Low self-esteem - Most healthy people avoid entering into a relationship with an active codependent.  As a result, codependents are often left with some very poor choices as far as partners are concerned.   

If one is going to tie one's self-worth to another person's behavior, it would be best to find a high-functioning, successful partner.  But high-functioning, successful people are not likely to want to carry the burden a codependent expects them to carry.  This burden may be disguised as sincere caring, loyalty, or martyrdom, but the healthy person will not be fooled for long.  What the codependent is really saying is, "Tell me how to feel and act.  When you're sad, I'll be sad.  When you're happy, I'll be happy.  My self-esteem is in your hands."  What healthy person would accept such power?

With their options severely limited, codependents usually end up with people with strong narcissistic needs to feel special - such as active chemical dependents. Unfortunately, chemical dependents are bad bets when it comes to taking care of someone else's self-esteem. There is no one more apt to disappoint the codependent than the unrecovering chemical dependent.  The distorted relationship to willpower leads the codependent to try to keep his or her partner happy and sober.  Denial conceals the futility of such a strategy and prevents the codependent from seeing the negative consequences of persisting in it.  Self-esteem plummets, the sense of inadequacy skyrockets, and the exercise of still more willpower seems like the only recourse.  Ufortunately, as codependents urge themselves to try even harder, their efforts to control the situation are often supported by neighbors, relatives, doctors, spiritual advisors, therapists, and society at large.  

But making a choice within the context of a relationship means taking a concrete stand, and that implies risk.  To the codependent, it is preferable to attend a movie one has no interest in than to risk having one's partner not enjoy himself or herself. 

Assuming responsibility for meeting others' needs to the exclusion of acknowledging one's own is a classic symptom of Codependency.  At its root is the fear of being alone or abandoned, which is so great that violence against one's own needs is tolerated.  Gradually the codependent loses the ability to distinguish his or her needs from those of the other person.  He or she takes on the wants and desires of the other in a series of desperate compromises, and the denial system becomes more opaque.  Denial of the self for the sake of feeling connected to others in a hallmark of codependence. It creates a profound void within the self.

Counterphobic behavior is the other side of the coin.  (To understand counterphobic behavior, think of a baseball game.  It does not matter whether one is at bat or out in the field; the same set of rules still applies.)  The codependent who avoids relationships with others is suffering essentially the same disorder as the codependent who ignores his or her needs in favor of a partner's.  Rather than take the chance of being abandoned, he or she goes one step further and refuses to get involved at all.  In a similar vein, there are teatotalers who remain as tightly focused on alcohol as active alcoholics. 

The rules of codependence seem to dictate that relating to another person is incompatible with relating to one's own needs and feelings.  As a result, codependents tend to choose one extreme or another: denial of themselves to keep someone else happy, or compulsive avoidance of others to keep themselves safe. 

Codependents also have anxiety and boundary distortions around intimacy and separation. 

The codependent equates closeness with compliance and intimacy with fusion.  As he or she becomes more involved with another person, the tendency is to take on many of that person's values, wishes, dreams, and characteristics, and eventually much of his or her denial system. The codependent becomes a mirror.   

Picking up on others' feelings is rationalized as being "sensitive."  The codependent involved with a chemical dependent actually feels that person's pain, rather than feeling empathy for the pain.  This helps to fill the void which results from not honoring one's own needs and feelings. 

Anxiety and boundary distortions are experienced most intensely in the absence of an external structure that defines interpersonal relationships.  An example of such a structure is the work environment, in which relationships and roles are clearly defined.  Without this structure the members of any relationship must continually participate in a mutual negotiation of the interpersonal distance between themselves.  When the interpersonal distance decreases, the codependent's grasp on his or her true self becomes even more tenuous.  When it increases, the codependent fears total abandonment, and consequently the loss of the false self he or she has created for the relationship.  Any shift in the status quo will be seen as a threat to the codependent's identity.

When the interpersonal distance between the codependent and others changes, there may be rapid swings between seeing one's partner as all good or all bad as the codependent lurches back and forth between feeling totally inadequate and feeling in control of matters.  As black-and-white thinking increases, the world is split into friends and enemies.  Friends are often those who support the codependent's denial and commiserate with their pain; such friends often are idealized.  Enemies are often those who insist on speaking the truth, and they may become the target of intense rage.  Impulsive and desperate efforts to regain control of one's world frequently occur.  The codependent further neglects his or her own needs and can become overtly self-destructive.  The anxiety created by changing interpersonal distance can spiral into fear of abandonment or of being overwhelmed by intimacy. The codependent does possess the necessary ego strength but voluntarily dismantles his or her ego boundaries in an effort to strengthen connections with others.  All of these factors contribute to relationships being particularly problematic for codependents.

The defense mechanisms we all use to lessen the distress felt in relationships are constantly maturing.  The failure of these defense mechanisms to develop beyond the adolescent stage is frequently seen in chemical dependents and persons with character or impulse disorders. 

It is an almost human characteristic to overpersonalize the behavior of someone with the immature defenses of projection, rationalization, and denial.  That helps explain the hurt and anger most people feel when trying to relate to the chemical dependent or sociopath. Maintaining direct human contact with such a person eventually becomes intolerable, unless one is codependent, in which case one accepts the projections, contributes to the rationalizations, and supports the denial.  In other words, when the codependent is confronted with immature defenses in others, he or she responds by mirroring them. 

There are other reasons for this mutual attraction.  Codependents give others power over his or her self-esteem.  But not everyone wants that sort of power over another person, and those who do usually possess a narcissistic need to be considered special.  Chemical dependents in the active phase of their disease, and persons with personality or impulse disorders, have this need.  Thus a complementary situation exists, one in which the codependent and the chemically dependent, personality disordered, or impulse disordered person can find mutual gratification without ever having to express their needs overtly.  They call it "chemistry." They fall in love!

Unfortunately, the chemically dependent, personality disordered, or impulse disordered person is not the ideal caretaker for one's self-esteem.  When the inevitable happens and the codependent's self-esteem is dashed, the codependent responds with a pledge to redouble his or her willpower and make it work next time.

Codependence is similar to chemical dependence in a number of ways.  Both are diseases of denial, and both exhibit a wide range of symptoms. 

Any chemical dependent can point to certain symptoms of that disease which he or she does not display; the unrecovering chemical dependent may then use such "evidence" to shore up his or her faulty denial system.  Codependents can display a wide enough range of symptoms that no single individual could have them all; some of the symptoms even seem contradictory.  In addition, codependents who are still in denial frequently ignore symptoms which are obviously present while focusing on those symptoms they do not display.  Such "negative" evidence is cited as proof that they are not codependent.  To the CD professional, this whole process is seen as further evidence of denial, which is a prime symptom of active codependence.

Excessive reliance on denial - The denial of codependence and the denial of chemical dependence are virtually indistinguishable.  Each represents a selective inattention to internal and external realities. 

Denial lies largely outside the direct control of a person's conscious awareness.  It results from a deep unwillingness to experience feelings that would ensue if those forbidden realities were acknowledged - an unwillingness so deep that the mind blocks any awareness that would lead to these dangerous emotions.  It is a very active, if unconscious, process, requiring the constant input of psychic energy to scan the environment so "blinders" can quickly be activated.

Denial may be seen as an impaired strategy for achieving security.  In the face of a threat, narrowing one's awareness can create the appearance of safety.  A global constriction of awareness of threatening realities while admitting others. 

If a threat can be ignored, then one does not have to take any action to ameliorate or avoid it.  But one must be constantly vigilant.  As a result, the need to deny compounds over time and may eventually reach a point where the psyche can not maintain.   

Codependents frequently see the breakdown of their denial system as a sign of their own personal inadequacy, much as chemical dependents view their growing lack of control over their using as a sign of personal weakness.  Each typically attempts to regain control through renewed applications of willpower. 

Paradoxically, the recovering person reacts to a threat in quite the opposite way - by expanding his or her awareness.  This allows him or her to more accurately assess the level of danger and, if possible, take effective action.

For active chemical and codependents, however, denial continues to give the false impression of security.  It is rarely acknowledged and relinquished until the pain and emptiness of their ever narrower and more isolated life becomes too much to bear. 

Constriction of emotions - Codependents frequently view emotions as enemies (or as weapons).  Many families in the early stages of treatment mistakenly believe that they must curb their emotions and not allow them to affect their behavior or relationships.  This becomes a test of willpower, a way to prove that they are able to maintain at least a semblance of control over their lives. 

Typically, the emotions they work hardest to restrict are those normally considered to be immature, dangerous, uncomfortable, or just plan bad: anger, fear, sadness, rage, embarrassment, bitterness, loneliness, etc.  Unfortunately, it is impossible to put a lid on such "negative" feelings without also impeding the expression of more positive ones, such as happiness.  Codependents tend to use perhaps 30 percent of their emotional energy to cage another 30 percent they have deemed undesirable. That leaves only 40 percent of their emotional energy free and available to them -not much with which to enjoy a full, rich, and gratifying life.  

This effort to control one's feelings is precisely the behavior targeted by the second half of Alcoholics Ananymous's First Step:  "We admitted...that our lives had become unmanageable." Codependents are deeply dedicated to "managing" their lives.   

When one part attempts to "manage" the whole, our general emotional makeup suffers.  We cannot improve our lives by stifling undesirable emotions.  A typical phenomenon in codependence is the tendency to resort to the more extreme mechanisms of dissociation or depersonalization.  In a desperate attempt to survive (in other words, not to feel), they will "close down," "shut down," "phase out," or go into a spontaneous trance.  This results in a quality of being more present in body than in mind. Clients in therapy can actually be seen to separate themselves from the intensity of the moment. Their facial expressions become fixed, they seem to gaze off into the distance, their breathing grows shallow.  These are signs that they have clicked into their "survival mode" and are allowing the world to wash past them. Numbness gives the illusion of safety and control.

Codependents may also exhibit symptoms which appear to directly contradict the constriction of feelings:  the dramatic outburst, and the compulsive exposure of feelings. When unexperienced feelings have built up over time, the most minor incident can trigger an explosion.  An unpleasant feeling will resonate with a backlog of similar feelings, and the effect will be inappropriately intense.  For example, a codependent who is reluctant to express his or her feelings about a spouse's drinking might blow up at a friend who forgets to send a birthday card.  Or a torrent or rage might follow a relatively insignificant act of thoughtlessness on the part of the spouse.  In any event, the codependent is left feeling "crazy" and "bad." 

Note that the outburst is directed at a "safe" - or at least safer - target.  It is not the forgetful friend who is the real problem, it is the spouse's drinking.  Ironically, the very intensity of the outburst will be used as an excuse for discounting it. 

The compulsive exposure of feelings is an effective disguise for constricted feelings.  Some codependents go to great lengths to verbalize every feeling as soon as it enters their awareness.  They also pressure those around them to continuously expose their feelings.  While such behavior might appear to be the opposite of the emotional constipation so often seen, its purpose is essentially the same: to avoid having to deal with feelings or experience them any longer than necessary. 

The essence of codependence is to minimize the anxiety and ambiguity of allowing feelings to run their natural course, whether by damming them up or by expelling them as quickly as possible.

Hypervigilance - The codependent's environment is unpredictable, basically incomprehensible, and highly stressful.  Active chemical dependents bring chaos into the very fabric of their personalities and family interactions, and those around them can never predict what they will do next.  Decisions that are 95 percent made can be randomly reversed or ignored.  The only way for the codependent to survive is by being ultra-sensitive to subtle shifts in the chemical dependent's behavior and mood. Such hypervigilance is a recognized symptom of Post Traumatic Stress Disorder (PTSD), which is most typically seen in combat veterans.  By putting his vigilance on automatic pilot, a solider is always prepared to react.  Unfortunately, there is seldom an "off" switch.  Once a codependent starts scanning the environment for signs of impending disaster, a state of free-floating anxiety can be established.

Hypervigilance is also a natural byproduct of investing one's self-esteem in another person's behavior.  To feel good about himself or herself, the codependent must first attend to everyone else's happiness.  The merest hint of dissatisfaction in another signals that one's own behavior needs to be modified.  In order to control how others feel and behave - the codependent's goal in life - it is essential to stay on one's toes and catch inappropriate behavior in its earliest stages. Of course, hypervigilance requires great expenditures of energy.  When the strain becomes too much to bear, the codependent may suddenly feel overwhelmed and demoralized.  Episodes of apathy can alternate with frenetic efforts to monitor everything and maintain control. 

Compulsions - Compulsivity is a primary defense process.  The object of a compulsion is of secondary importance and often changes over time.  A recovering chemical dependent may pass through periods of compulsive eating, compulsive spending, compulsive working, and compulsive relationships after achieving abstinence.  The internal dynamic is always the same: a struggle between two poles, one "inside" and one "outside."  The person's identity is connected to resisting the impulse, while the impulse itself is experienced as an alien force.  The resulting high drama distracts the person from unwanted feelings, which usually have little or nothing to do with whatever compulsion is currently occupying center stage.

Like chemical dependents, codependents can only remain active in their disease by disregarding the pain that it brings. 

Unlike chemical dependents, however, codependents have no biochemical "booster" for their denial system.  For them, compulsions serve the same purpose, whether the compulsion is to eat, to work, to rescue others, to watch television, to read, to seek sex, to gamble, whatever.  Many codependents can describe in detail the subjective experience of sliding gradually into the whirlpool of their compulsivity.  There is a surge of adrenaline.  An intense buildup of emotions specific to the compulsion occurs ("I've got to stop eating"), while more threatening emotions are eclipsed ("I feel empty in this marriage").  A feeling of inevitability takes over.  Eventually they stop resisting the compulsion, and this is followed by a temporary sense of relief.

In most cases, the emotions that are being avoided are unavailable for the duration of the compulsion.  In order for the emotions to surface, be identified, and be experienced, one must abstain from the compulsion.  This is another way in which the codependent and the chemical dependent are similar:  to recover, both must choose abstinence.

Substance abuse - Codependence is a setup for the development of chemical dependence.  When one habitually responds to threats by denying that they exist (in other words, by narrowing one's awareness), the use of mood-altering chemicals is a logical next step.  Denial is necessary to avoid being overwhelmed by feelings, and substance abuse serves as a biochemical "booster" for one's crumbling denial.  In short, substance abuse is consistent with the personality structure of the codependent.

As noted earlier, codependents exhibit a wide range of compulsions, and the use of alcohol or drugs falls into this category.  Traditionally, however, the codependent who compulsively uses chemicals in the service of denial is diagnosed as being chemically dependent.  This is as it should be; when chemical dependence is present, it must always be treated as the primary issue.  But it cannot be seen as the only issue.  Once the chemical dependence has been broken, the codependence remains; left untreated, it acts as a barrier to a long-term sobriety. 

Helping professionals tend to view chemical dependence and codependence as two distinct problems and apply different labels to their symptoms.  The denial of the chemical dependent is termed "alcoholic thinking," "drug mentality," or "stinking thinking," while the denial of the codependent is called "codependent thinking."  In fact, these divisions are largely artificial. The denial of the chemical dependent and the denial of the codependent are cut from the same cloth.  The disease of chemical dependence and the disease of codependence largely overlap.  And often the person who has one will have the other as well.  While it is probably rash to say that all chemical dependents are also codependent, we can safely assume that active codependence is at least as common among chemical dependents as it is among their family members.  (This may be true in part because fully half of all chemical dependents have at least one chemically dependent parent they have had to relate to.)   

When a codependent is also chemically dependent, the latter must be treated first. But the underlying codependence must not be ignored. 

Has been (or is) the victim of recurrent physical or sexual abuse - In many chemically dependent families, the threat of physical and/or sexual abuse is always present.  Whether it stems from abusive incidents or merely from feeling like a hostage to the angry rantings or depressed ruminations of an out-of-control spouse or parent, it lodges in the heart like a thorn. 

All too often these incidents, rantings, or ruminations occur during a blackout. When the next morning comes, the chemical dependent has no memory of them and, accordingly, feels no guilt.  Meanwhile the rest of the family stays caught up on the fear from the night before. They hide their emotions, but for the rest of the day - and often for weeks and months to come - they work anxiously to keep the threat from coming true. 

Codependents tend to minimize both the amount of violence in their relationships and the level of stress they live under.  They do not see themselves as victims of physical or sexual abuse except in the most extreme cases, and even then they frequently take the blame; either they "caused" the abuse or they "deserve" to be treated abusively. Especially if few or no overtly abusive acts have occurred, the codependent's denial system prevents him or her from viewing the situation realistically.  As one codependent said (in all earnestness), "My husband is good to me.  Whenever he hits me, he only uses his hand.  He never uses a board or anything that could do any real damage."

In extreme cases, codependents remain in relationships in which they are chronically abused. While it may be difficult to understand how anyone could live this way for any amount of time, it is important to realize that codependents perceive their experience from a distorted and self reinforcing point of view.  When others are unhappy, they see it as a result of their own inadequacy, and being abused further lowers their self-esteem.  As often happens in hostage situations, they begin to identify with their aggressors and empathize with their aggressors' frustration and disappointments.  Their own needs take second place or are not considered at all.  In the end, they stop believing that they should be treated with respect.  They simply can not conceive of living any differently than they are. 

The victims of physical and sexual abuse are usually too embarrassed to speak freely about it.  In such cases the therapist must become a gentle but persistent advocate for the client - a delicate balancing act requiring considerable skill and sensitivity.  For codependents to speak honestly about being abused, they must develop a level of trust in the therapeutic alliance which exceeds what they think they are capable of.  Telling the truth requires them to "betray" their family, and the resulting sense of guilt may activate the tendency to minimize what they have just said.  Or it may release a flood of dammed-up feelings.  For a time, they may be overwhelmed by grief and rage -feelings which must be fully experienced for the codependent to have any change of seeing how and why the abusive relationship has developed, and how it can be changed. 

Physical and sexual abuse take on more ominous dimensions when they are perpetrated upon children, who are frequently unaware that what is happening to them is wrong and not their fault.  These buried feelings and ancient betrayals accompany them into adulthood.  We now know that abuse is cyclical, and that many of its victims grow up to become abusive themselves.    But even those who do not are still damaged.  Many codependents who become the victims of recurrent abuse are caught up in a forgotten pattern which was established long ago.  They never verbalized their feelings then and are reluctant (or unable) to do so as adults, which is why the therapist's role is potentially so important.  By taking seriously the client's buried feelings, the CD professional can create the first safe environment the client has ever known in which to explore and deal with them.   

Chemical dependence is such a common contributor to physical and sexual abuse that its presence should always be considered.  One of the most reliable symptoms of codependence is the inability to leave a chronically abusive relationship behind, whether that relationship is ongoing or past. 

Stress-related medical illnesses - Family members of chemical dependents require greater than average amounts of medical care - not for the somatic equivalents of emotional distress, but for what are generally considered to be stress-related medical illnesses.

A codependent's home life is highly stressful.  Compounding this constant exposure to stress is the codependent's way of dealing with it:  by denying that it exists, and/or by denying that one is affected by it.  In the short run, this strategy seems to work.  The codependent is capable of getting through times that might slow down or stop people with less determination or willpower.  This in itself becomes a source of pride, which serves to offset the codependent's chronically low self-esteem. 

Unfortunately, the body is not so easily fooled.  Although the codependent may remain unaware of the toll that the stress is taking on him or her, this does not change the fact that the body is under attack.  After a decade (or two, or three), parts start breaking down in ways that can no longer be denied.  Conditions that are either created or exacerbated by stress include headaches (tension and migraine), asthma, hypertension, stroke, gastritis, peptic ulcer, spastic colon, rheumatoid arthritis, and sexual dysfunction.  The role of stress in a host of other physical conditions is a subject of legitimate debate.  While the jury is till out on these, it is a fact that stress-related illnesses do exist and are found more frequently in people with dysfunctional reactions to stress, such as codependents.

In treating stress-related illnesses, it is common medical practice to prescribe increasingly more powerful medications, or to add tranquilizers.  But in many cases codependent patients do not respond. In such cases, the most powerful prescription might be a direct referral to Al-Anon.  Joining Al-Anon can be the first step toward learning how to respond differently to the stress one is experiencing. By modifying their awareness of when stress is or is not present, codependents can often begin responding to treatments which work for other medical patients.

Although codependence is not as dramatically or directly life-threatening as chemical dependence, it is potentially just as fatal.  The progression into chemical dependence, suicide, violent or accidental death, and death due to untreated stress-related illnesses can all be tied to codependence.  Since the minimization of one's codependence (or the minimization of oneself) is a symptom of the disease, it is difficult to get the codependent to look honestly at his or her situation.  One way to break through this denial is to confront codependents with the life-threatening medical consequences of living with stress. 

Has remained in a primary relationship with an active substance abuser for at least two years without seeking outside help - Codependents come up with endless reasons for not seeking outside support, and many sound more than reasonable. No one likes to admit that their family is incapable of solving its own problems.  No one wants to expose their family to the scrutiny of others.  

But there is a point at which these reasons become excuses, and the desire to stand on one's own two feet becomes martyrdom.  When one refuses to seek outside support to avoid having one's denial system confronted, silence has become self-serving.  When one is motivated by fear of the chemical dependent, the situation is no longer healthy.  When one is blocked by pride, passivity has become dangerously self-destructive.  

How can we tell when this point has been reached?  How can we be sure that failure to seek help is a manifestation of active codependence, and not simply a normal urge to handle one's problems in one's own way?  When should we stop giving codependents the benefit of the doubt?  I propose an arbitrary time period of two years, after which the codependent's motives automatically become suspect.  Whether this is an appropriate length of time is open to debate.  But there must come a day when the burden is placed on the codependent to prove that his or her actions are not contributing significantly to the problems he or she is trying to hide.  

In other words, if a codependent has lived for two years with an active chemical dependent without initiating his or her own recovery program or doing an intervention, the presumption of active codependence should be made.  

Two years seems long enough for family members to acknowledge the presence of chemical dependence, if they are at all open to facing the truth.  It is also long enough to realize the impossibility of trying to live a normal life in the abnormal environment of a chemically dependent family.  

In the end, whether codependence is seen as a disease or not depends to a considerable degree on how one defines a disease.  Nonpsychotic Psychological Disorders are generally patterns of maladaptive behavior which lie outside an individual's conscious ability to control (e.g., phobias, depression, personality disorders).  In this broad sense, codependence can be seen as a true disease, as outlined by the criteria described above.

The Stages of Recovery  

The recovery from codependence and the recovery from chemical dependence are remarkably similar and can be seen to pass through the same four general stages: the Survival Stage (Stage I), the Re-identification Stage (Stage II), the Core Issues Stage (Stage III), and the Re-integration Stage (Stage IV).  It is not surprising that the two should parallel each other so closely, given that the "ism" of alcoholism is shared equally by both the drinking and the nondrinking family members.  If the diseases are essentially the same, so, too should be the recovery process.   

The Survival State (Stage I) For the chemical dependent, the Survival Stage is marked by blanket denial that an addiction exists.  Every effort is made to maintain the illusion that the chemical use is still voluntary.  Even abstinence is attempted as proof that one is not addicted. 

Denying the existence of addiction requires a lot of fancy mental footwork.  All of the negative consequences of drinking or using must be explained away by enormous amounts of rationalization and projection.  It is important to acknowledge that the chemical dependent is often more rational than he or she is given credit for going.  Many of the rationalizations and projections are actually quite logical, if one accepts that there is no chemical dependence present - which the chemical dependent does. 

Any attempts to attack this logic are doomed to failure.  The only path to recovery lies in confronting the core denial - the belief that one can control behavior and limit one's intake while under the influence of alcohol or drugs.  The most effective tool with which to confront this denial is an awareness of the pain that stems from addiction - the pain one feels, and the pain one causes. Helping the chemical dependent to arrive at this awareness is one of the goals of intervention.

It is important to acknowledge that the chemical dependent's belief that continued use of a chemical is necessary to feel normal is probably not far from the truth. Many chemical dependents experience extreme discomfort during withdrawal. Some have grand mal seizures; others experience high levels of anxiety or profound depression.  In the most severe cases, the individual may be convinced that the chemical is necessary for his or her survival, both emotional and physical. 

Codependents also undergo a Survival Stage characterized by a blanket denial that a problem exists.  They deny that chemical dependence is present within their family; they deny that they might be codependent; they deny that they feel anything one way or another.  They are dedicated to hanging on to their denial and continuing it at any cost.  To relinquish it means to jeopardize their identity.  They fear this on a primitive, existential level, which explains the ferocity with which codependents can fight back when their denial is threatened.  The sourceless sense of pain they feel is tolerated as their lot in life. 

Like chemical dependents, codependents place a premium on maintaining that their behavior is voluntary.  While this appears to be in direct contradiction to the compulsivity which runs their lives, it makes sense if it is perceived a denial of limitations.  Codependents take pride in believing that they can always draw on their willpower to tolerate one more disappointment.  This belief creates the illusion that they are in control while everything around them is out of control.

What happens when codependents start abstaining from their blanket denial?  Although this is not likely to cause the physical symptoms that chemical dependents feel upon withdrawing from alcohol or drugs, it may well exact equally high emotional costs.  Valued relationships may be lost, and if one's identity is tied to those relationships the risks involved in recovery are very great indeed. 

For both chemical dependents and codependents, the initial stages of abstinence would be a lot easier to bear if one could somehow start recovering first!  Unfortunately it does not work that way.  The only avenue toward recovery requires a leap of faith long before anyone feels ready for it. 

The Re-Identification Stage (Stage II) 

At some point, often born of desperation, the core of the chemical dependent's (or codependent's) denial system can be shaken.  We know very little about this watershed moment, except that one is more likely to reach it if he or she can somehow become (or be made) aware of the increasing amount of pain in his or her life. 

One way this happens is through fortuitous groupings of crises, when many things go wrong (and cause pain) at the same time.  Another way it happens is if the person finally "hits bottom" and loses everything (marriage, job, friends, financial position) or tragedy strikes (a car accident, injury to a loved one).  Still another is intervention, a process designed to precipitate a crisis at a time when a person still possesses enough physical and emotional resources for recovery to be possible and before everything is lost. 

Regardless of the means, the result is a crack in the denial system through which the person glimpses his or her true self - a re-identification. 

For some individuals, however, the fortuitous grouping of crises never comes.  For some, the "bottom" is so far down that it is only reached in death.  And for some, the intervention never takes place.  The denial system remains intact until the bitter end.

There are two critically important facets to the Re-identification Stage.  The first is the acceptance of a label; the second is the acceptance of limitations. 

Accepting a label. 

Prior to entering this stage, the chemical dependent is committed to being "normal."  Upon re-identification, he or she becomes willing to accept being labeled an alcoholic or a drug addict. These are harsh words, but they are less harsh than the reality with which he or she is faced. 

Acknowledging one's chemical dependence yields three positive returns.  First, it is a relief to be able to take a more objective view of one's life.  Second, a new framework for reinterpreting one's past become available.  And third, one can actually start looking forward to the future because there is a realistic basis for hope. 

Accepting a label isn't easy.  Chemical dependents have trouble with this, and so do codependents.  For the latter, it means forsaking the role of noble martyr or righteous persecutor.  It becomes much harder to see oneself as a victim when the label of codependent (or adult child of an alcoholic/drug addict) requires that you take responsibility for your own dysfunctional behavior.  Like chemical dependents, codependents tend to enter re-identification only after being convinced that it is more painful not to.  Once they do, however, the rewards are similar.  For the first time, the codependent can more realistically assess what has happened in the past; for the first time, he or she can anticipate the future with optimism rather than fear. There is a critical willingness to have the future be different. 

Accepting one's limitations. 

The second important facet of re-identification ties into the second half of the First Step of the Twelve Step Program pioneered by A.A. and Al-Anon:  recognizing that one's life has become unmanageable.  When one accepts limitations, one can stop attributing this unmanageability to personal inadequacy or insufficient willpower. That, too, is a relief; that, too, absolves one of the past and give one hope for the future. 

Every therapist and CD professional has seen alcoholics or drug addicts whose recovery has never advanced beyond the acceptance of the label.  We call this staying "dry." Because they never deal wit the "ism" of alcoholism - the way of thinking and feeling that was built around their chemical dependence - they are prime candidates for relapse.

Before they move on to recovery, they must acknowledge the distorted relationship to willpower which has heretofore guided their lives.  Only then can they begin investigating the realistic role willpower can play and acknowledging where it can have no effect whatsoever.  Like any tool, willpower is useful only for certain things.  Trying not to be chemically dependent (or to make someone else happy) by sheet force of will is analogous to trying to pound a nail in with a saw. Saws are just right for some jobs, but they were not built for others - including nail pounding.  Similarly, willpower is handy for influencing such things as one's own behavior, but it is totally ineffectual when it comes to influencing another person's emotional world, or one's genetic susceptibility to addiction. 

Codependents are also capable of accepting the label without going any further - in other words, of staying "dry."  As long as they remain in the active phase of their disease, they continue to behave as if all manner of things can be controlled through the exercise of will. When reality proves resistant, they automatically redouble their efforts. 

Recovery, in contrast, is heralded by the willingness to explore what is really under human control and to accept that much of the universe lies forever outside our ability to influence it by force of will.   

The Core Issues Stage (Stage III) 

There is usually one critical aspect of a person's life where it becomes clear that any attempt to control what happens is doomed.  For the chemical dependent, it is his or her drinking or drug use.  For the codependent, it is usually his or her efforts to stop the chemical dependent's drinking or drug use. 

In either case, recovery begins during the Re-Identification Stage through the process of coming to terms with the limitations of willpower.  During the Core Issues Stage, the lessons learned about one's powerlessness are broadened and incorporated into the fabric of one's life, with far-reaching implications.

What we are describing here is the paradox of winning through losing - which is just another way of saying that chemical dependents and codependents can only move ahead by stepping back.  They must abstain from those strategies of willpower which have compounded the problems they were supposed to solve. 

The Core Issue Stage is characterized by an increasing willingness to apply this winning-through-losing approach to wider and wider areas of one's life.  In particular, recovering persons must eventually face the fact that relationships in general cannot be managed by force of will.  Instead, successful relationships require that each partner be independent and autonomous.  For codependents, this idea goes against the grain.  It takes a real leap of faith to stay separate from people with whom you are trying to be intimate!

Carried even further, this also compels the eventual realization that most human emotions fall outside the range of one's influence.  Not only is it impossible to control other people's emotions; it is downright difficult to control your own.  You cannot predict how you will feel about a particular event on a particular day, and neither can you direct yourself to feel a certain way when it happens.  The most you can do is to respond honestly to your feelings from one moment to the next, and choose to respond with healthy and appropriate behaviors. 

The Core Issues Stage, then, is one of detaching oneself from the struggles of one's life - struggles which exist because of prideful and willful efforts to control those things which are beyond one's power to control.

The Re-Integration Stage (Stage IV)

By the time a person passes through the Core Issues Stage and reached the Re-Integration Stage, there is essentially no difference between the recovery process of the chemical dependent and that of the codependent.  Each has turned defeat into surrender and converted blind willpower into open willingness and acceptance.

Many recovering people avoid the Re-Integration Stage because it, too, involves paradox.  After achieving a stage of freedom and health that once seemed unattainable - and recall that they achieved it only after accepting their limitations and relinquishing the power that was not rightfully theirs - they must now reclaim the personal power they do posses!  This is necessary work, but it is also very risky.

During this stage, chemical dependents and codependents weave a belief system which legitimizes self-acceptance.  Self-worth stops being something that must be earned, moment by moment, through one's accomplishments or through relationship with others.

Instead, it becomes a byproduct of maintaining integrity in most areas of one's life. And how does one achieve integrity?  With awareness, not denial; honesty, not secrecy; and a conscious connection with one's spiritual impulses, not arrogance. All of which can be progressively cultivated.

Entering re-integration signals that one has come full circle.  One has returned to being in control - but what a difference recovery makes!  Control now stems from discipline rather than license.

Treatment for the Survival Stage

Treatment for the Survival State has three primary goals: 

1. helping clients to begin dismantling their denial system; 

2. helping clients to focus attention back on themselves; and  

3. helping clients to begin recognizing how they are perpetuating their own problems.

A large percentage of codependent clients come into contact with therapists while still deeply ensconced in denial.  They may have been referred by a physician.  They may have sought therapy themselves for treatment of their depression, anxiety, or phobias.  Or they may be cooperating with a chemical dependence treatment program, thinking that they are going to be taught how to keep their addicted family member sober.  In any event, they are firmly convinced that the source of their problems lies outside themselves.  In some cases they may not even be willing to admit that a problem exists. 

Education is an important cornerstone of therapy at this point.  Clients need to be exposed to information about the disease of addiction, its effects on family dynamics, the concept of codependence, and the process of recovery.  Although this can be accomplished inside the therapy sessions or through the provision of appropriate literature, it is probably best if a series of public lectures is available to which you can make referrals.  This latter approach accomplishes four goals:

It gives clients the message that the business of recovery is not something that can be attended to only within the confines of your office or treatment center,

It thrusts them into a setting where they will begin to receive validation for their emotions and perceptions.  ("If other people feel this way, then maybe I'm not crazy.") 

It sets the stage for speaking openly about their problems.

And, finally, it offers them the opportunity to start developing a social network of recovering friends.

Giving codependents simple information about themselves and about chemical dependence in general can work wonders.  But what about those who become impervious to it because their denial is so strong?  This is precisely the same situation that arises with chemical dependents who stay stuck in denial.  And you must respond in precisely the same ways.

First, you must continually comment on the existence of denial.  It must be labeled as such whenever it prevents therapeutic progress.

As soon as you begin allowing bits of denial to pass without comment, you run the risk of being considered "arbitrary" if you point it out at a later time. 

How can one avoid entering into a battle over denial with a client while still maintain one's integrity as a therapist?  Needless to say, this can be a delicate balancing act.  It is easier to keep one's balance if it is struck from the first moment of contact with the client.  The temptation to "seduce" people into therapy by failing to comment on their denial is just as problematic as "blasting" them from the outset for every iota of denial they display.  For this reason, you must set the terms of the therapeutic contract from the beginning, and one of the terms must be that denial will be commented on whenever you, the treatment professional, deem it necessary in order to keep the therapy on track.

Second, you must form empathic connections with your clients.  Otherwise they will have no reason to tolerate having their denial commented on.

Particularly in the early stages of recovery, a client's denial will be unconscious, and anything you say about it will not make much sense to him or her.  The client will perceive such comments either as personal attacks or dismiss them as the irrelevant stuff that therapists tend to go on about.  He or she may listen simply because having your attention is such a novel experience.

You should approach the creation of an empathic connection with a codependent client in the same way you approach an unrecovering chemical dependent.  Do not expect it to "take" immediately; instead, realize that your best efforts can never be anything more than invitations.  An invitation can be as plain, as eloquent, as direct, or as nonthreatening as possible, but from the start you must be prepared for the fact that the client may not be interested, period.  And you must also acknowledge that you have no power to change this.  Any other attitude incorporates a codependent point of view that is counterproductive for all concerned. 

The easiest way to form an empathic connection is by assuming that the client is in pain.  The client may not be aware of his or her pain but will usually respond on some level to your communication that pain is present and that you are open to hearing about it.

Be alert to clients who claim that they do not know what they are feeling, or that they are feeling "numb."  In the former case, linger on this point until the client begins to sense the frustration of being cut off from his or her emotions.  Frustration is something you can empathize with, and this can be the start of the empathic connection.

When clients report that they are feeling numb, anesthetized, or simply "nothing," it is best to treat these as legitimate feelings rather than as the absence of feeling.  (You might ask the client, "What does it feel like to feeling nothing?")  Codependents will share their feelings only with people they can trust to hear, respect, and validate them.  This level of trust will not come easily, since everything they have learned up until now has taught them not to expect it.  You can help by assuming that there are valid reasons behind each feeing the client is experiencing, even if those reasons are not immediately apparent.

Try to avoid being put in the position of judging whether a client's feelings are sufficiently justified by outside circumstance.  Instead, simply listen, knowing that you are hearing the cries of someone who has been under an abnormal amount of stress for quite some time.

Once a client has allowed you to connect with his or her pain, two things become possible: 

You have the opportunity to model a non-codependent way of relating to another's feelings.

But you must be sure to feel empathy and not take on the client's pain as your own. This will not only frighten the client and leave him or her feeling responsible for what you are feeling; it will also lend indirect support to the codependent view of the world.

You can return to that connection whenever the therapy appears to be heading into a blind alley.

Many a codependent client has "proved" to therapists the uselessness of trusting others or of being aware of his or her feelings, only to be taken back to what I call "square one" - the fact that his or her life is filled with pain, and that something must change if that is ever going to be any different.

By continually returning to the feeling connection that has been made around the client's pain, you will be able to bring the focus back to the individual and his or her experience.  Since active codependence involves habitually paying attention to others and their feelings, this process of making the client the primary focus represents a step in the direction of progress and health. 

If there is a guiding motto for therapy at this stage, it is this: "Pain is inevitable, but misery is optional."  In other words, it makes complete sense for codependents to feel pain and distress at what is happening to them and the people they love.  It is how the client responds to that pain which determines whether it escalates into the misery of self-hatred. 

Treatment for the Re-Identification Stage

Treatment for the Re-Identification Stage has four primary goals: 

1. helping clients to solidify their identity as codependents; 

2. helping clients to work through the grieving process that accompanies the loss of the illusion of power. 

3. bringing clients to a new awareness of compulsivity; and 

4. initiating an investigation into the realistic limits and uses of willpower. 

In other words, clients need to understand that when they say they are codependent, they are accepting that they are powerless over areas of their lives they have long tried to control.

Education remains an important cornerstone of therapy, as it was in Stage I.  Once the client's denial system has been broken, he or she is ready for assertiveness training, communication skills, and information about the multiple symptoms seen in codependence.  The best place for such learning is in a small group setting with other codependents where there is ample time for discussion.  

Working with the client's awareness of being actively codependent, you can being guiding him or her through a re-interpretation of the past and the present.  A tremendous amount of internalization will occur as the client stops blaming low self-esteem on outside causes and starts recognizing that it comes from having done violence to his or her own feelings, having lived a life controlled by compulsions, and having sacrificed integrity for the sake of security. 

The client may experience profound depression during this stage, which you should view from its inception as an important grieving process.  The relief that comes from no longer feeling responsible for the chemical dependence within the family will invariably be accompanied by a sense of loss.  The client must relinquish his or her illusion of being (at least potentially) powerful enough to force the chemical dependent to become sober. 

For many active codependents, this illusion of power is the primary source of self-esteem, and it is hard to leave behind.  In fact, giving up such an important illusion is emotionally equivalent to losing a body part.  It is not uncommon for clients to engage in a grieving process similar to what they might go through after the amputation of a limb.

While this is perfectly normal and even healthy, it is often profoundly confusing to clients.  I point out that people only grieve over things which have truly been lost.  If the client were still hanging on to the illusion of power, he or she would have no reason to grieve.

Honor the grieving and respect its intensity as a measure of how far the client has come.  Meanwhile, being helping the client to assess his or her current emotional world and come to grips with the failure of past strategies to keep life under control.  Some things to explore in detail include:

how the client went about trying to keep his or her feelings under control; 

how the client avoided acknowledging his or her personal needs; and

how the client tried to "make" family members love him or her, feel better about themselves, and get sober. 

As the client comes to an understanding of the broad range of codependent symptoms, your office should be a safe place for being honest about those which he or she has personally experienced.  Previously buried feelings will surface; since many of these were effectively "buried alive," they may emerge with their intensity unabated.  This, too, is a sign of emotional health.  Unhealthy people kill their feelings before burying them.  As long as feelings are still alive, they can be healed, and verbalizing them is a first step toward healing.

More than one client has said to me, "I could never let other people see me having such feelings.  "To which I reply, "You need the experience of having others take your feelings seriously if you're ever going to relearn how to do the same."

The Re-Identification Stage is also the time to introduce the concept of compulsivity as a primary mechanism for avoiding feelings.  Start by helping the client to recognize the subjective sensations associated with being in the throes of a compulsion.  Once the client is able to identify these sensations for what they are, he or she can begin working toward recognizing them as they occur.  And once the client has achieved this level of awareness, he or she can begin realizing that the presence of a compulsion indicates the opportunity to make a choice.

Specially, one can choose between experiencing one's feelings - including the feelings one has previously avoided - or giving in to the compulsion.  The only way to get to those previously avoided feelings is by abstaining from the compulsion.

This approach "reframes" compulsivity.  The client must now decide whether to deprive himself of the immediate but temporary gratification of succumbing to the compulsion, or to deprive himself or herself of feelings that will be obscured if the compulsion is allowed to take over.

This "reframing" permits only two responses, either of which has therapeutic value: 

The client may abstain from compulsions, thereby releasing emotions which have been buried for years; or

the client may discover how difficult (and frightening) it is to abstain from something as familiar as his or her compulsions. 

In other words, the client might come face-to-face with his or her own reluctance to experience feelings which have habitually been avoided.  That is not a comfortable position to be in; it is never comfortable to be aware of how one resists the truth. But such awareness is a necessary precursor to change.

From a therapeutic standpoint, this discomfort can serve yet another purpose:  Use it as a touchstone for creating empathy in the client for what the chemical dependent has been going through. 

By focusing attention on the codependent's compulsivity, you are also teaching a valuable lesson about the proper role of willpower.  When my clients ask what they need to do in order to defeat their compulsions, I lead them toward developing the willingness to have the feelings that will be unlocked once they become abstinent. In effect, I "reframe" the inability to abstain from compulsions as a measure of one's unwillingness to feel.  Willingness, by definition, can never be forced or controlled by one's willpower.  It can only be invited in - which is all that can be done with emotions one is trying to reclaim. 

Treatment for the Core Issues Stage

Treatment for the Core Issues Stage has two primary goals:

1. helping clients to become aware of how their codependence has pervaded all aspects of daily life, and 

2. helping clients to generalize what was learned during the Re-identification Stage about how efforts to control the chemical dependent have intensified the problem

Until now, much of the recovery process has dealt with ending preoccupation with the chemical dependent and abstaining from compulsions (including the compulsion to control anything causing anxiety).  During Stage III, codependents become ready for an honest self-appraisal of the ways in which they have distorted their relationships with others (not just the chemical dependent), their own emotions, and even their physical bodies through an unwillingness to accept the natural human limitations on what can and cannot be controlled.  It is time for them to stop strangling life in an effort to say "safe," and to start making friends with some of the unpredictability that real life involves.  

It is during the Core Issues Stage that much of the existing therapy for codependence and chemical dependence becomes destructively simplistic.  Several factors contribute to the deficits in the treatment available for codependents in this stage: 

CD family programs are limited in the number of resources they can devote to advanced recovery.

Aftercare is usually limited to still more classes (with much of the material having already been presented in other forms) and discussion groups from which old-timers gradually drop out as newcomers keep the focus on early recovery issues.  Newcomers are the lifeblood of self-help meetings, but they are not necessarily what Stage III people need.

CD therapists and treatment professionals tend to stick to highly structured counseling techniques.

While these may continue to be appropriate for some clients, they may also hold back those who are ready to deal in depth with characterological issues. 

For example, many codependent groups begin with a meditative exercise designed to diminish anxiety, followed by a formal check-in by group members.  Clients in stages I and II may require such imposed structure in order to tolerate being in groups.  But some may reach the point at which they are ready to start facing the difficulty they have in letting others know their need for attention.  As long as the meditation quiets their anxiety and the check-in satisfies their need for attention, they are never required to experience their usual patterns (e.g., distancing themselves from their personal needs in order to diminish their anxiety). 

To rephrase an old metaphor, structured, supportive groups give people fish to eat, while interactive groups can take them through the process of learning how to catch their own fish.  You give fish to people who are starving; you give the opportunity to learn how to fish to people who have regained sufficient strength and health to being taking full responsibility for themselves. 

Codependents in stages I and II can be indistinguishable from borderline clients. 

Often their response to therapy becomes an indispensable part of the evaluation process.  Obviously some codependents are borderline and will be able to keep improving only as long as they receive treatment within a structured environment. For them, the goal of therapy should be the establishment of a strong connection to a structured setting which can then serve as a long-term resource. 

However, many codependents who initially appear borderline will quickly appear much less so as soon as the most active phase of their disease has passed.  These clients will eventually be capable of benefiting from less structured, insight-oriented therapy.  Unfortunately, many therapist develop unnecessarily pessimistic prognoses for codependents based on the severity of their dysfunction during the active phase of their disease.  A similar mistake is often made with chemical dependents when the insanity present during active alcohol and drug abuse is used to diagnose their underlying personality structure. 

Treatment professionals have failed to recognize an important point:  Once the dysfunction of a personality disorder is no longer present, clients with codependent personality traits can make excellent candidates for insight-oriented therapy.  Motivated by the benefits they have already received from treatment, they can bring into the next level of therapy a concrete understanding of denial, an appreciation for the value of letting feelings emerge, and a realistic view of willpower - all very useful tools.   

For the lessons learned during stages I and II to be used most effectively, however, therapists must have an intimate working knowledge of the process of recovery.  While many chemical dependence therapist possess this knowledge most therapists outside the CD field do not.  At the same time, those outside the CD field tend to be the ones who are practiced in less structured, insight-oriented therapy, but few of them understand the dynamics and language of early recovery from chemical dependence and codependence.  What many recovering clients need is a therapist trained in both the chemical dependent and the psychodynamic traditions. 

The truth is that it is easier to find a competent CD therapist than it is to find a therapist who can do effective codependence treatment.  CD therapists are trained to focus attention away from the past and onto the concrete behaviors required for continued sobriety.  They are skilled at working with adult denial. But their training does not prepare them to deal therapeutically with primitive emotions intruding into an adult's life, nor are they trained in child development issues.  In order to be effective as a therapist with a codependent in Stage III, these latter two skills are required.  However, therapists from the general mental health field who posses them rarely understand the work a codependent client has accomplished during stages I and II.  Recovering codependents are unlikely to form a therapeutic alliance with anyone who is unable to validate the hard-won progress they have already made.

It is during the Core Issues Stage that long-term interactive group therapy becomes valuable.  The essential aspects of such groups are:

! a focus on relationships which develop and are played out among group members (attention to the "here and now");

recognition of the problematic behavioral and emotional patterns which clients "import" into the group from their outside lives;

encouragement of feedback by group members on how they react to each other; and 

restriction of the therapist's role to one of initially setting the group norms, paying attention to group dynamics, and facilitating recognition of behavior patterns. 

The primary purpose of a long-term interactive group is to provide a setting in which the issues of codependence emerge spontaneously, rather than in response to the therapist's provocations.  The relative lack of structure, combined with the presence of more people than can be monitored and controlled, will go a long way toward activating codependent behavior. 

For the group to be truly effective, however, the therapist must permit such behavior to emerge at its own pace.  The therapist who impatiently provokes codependent issues is setting himself or herself up to exercise more power than interactive group therapy can tolerate.  Group members will begin interacting primarily with the therapist or with one another through the therapist.  They will feel that whatever happens within the group is artificial - the result of a clever therapist's techniques. 

Interactive group therapy works best when members discover themselves behaving inside the group much as they do in "real" life - being distrustful, controlling their feelings, sacrificing their own needs to ensure that others are taken care of, revealing only carefully chosen parts of themselves, covering their feelings with politeness, etc.  When they finally understand that these behaviors reflect habitual and unconscious patterns, the group can become a laboratory for experimenting with alternative behaviors.  The therapist's role during much of this process should be limited to promoting the feeling of safety and uncovering the reasons for any unsafe feelings group members are experiencing. 

Long-term interactive, insight-oriented group therapy is extremely sophisticated work, and it is not easy to do it well.  For this reason it is best for therapists to work in pairs so they can be objective for each other.  They must also be alert to the activation of codependent tendencies in themselves.  (Activating those tendencies is precisely what the group is supposed to do for the clients, and being a therapist does not automatically make one immune.)  Even the most subtle unresolved codependence issues among therapists will quickly and profoundly limit the potential value of the group.  Signs that these are present include:

! talking too much;

! encouraging specific feelings, such as anger;

! aborting feelings by intellectualizing or problem-solving;

! feeling clients' feelings, as opposed to feeling empathy;

! being defensive;

! being controlling;

! not tolerating silence; and

! taking action to make the group "work" (for example, be interesting and sufficiently emotional) rather than exploring why it is stuck. 

Finally, it is important to recognize that interactive group therapy is a very delicate flower that must be painstakingly cultivated.  Whenever therapists mix experiential work, individual work, education, and supportive techniques into an interactive group, the essence of interactional therapy is quickly diluted and lost.  It does little good to "trust the process" only halfway, since half-hearted efforts give mixed messages about how much responsibility the therapists is willing to place on the clients.  Codependents in Stage III are ready to accept full responsibility for their own therapy. 

Treatment for the Re-Integration Stage 

Therapy during the Re-Integration Stage has one primary goal: preparing clients for termination. 

The line between states III and IV is both fine and ephemeral.  Clients may spend considerable time moving back and forth across it.  On occasion they may even work with one foot planted firmly on each side.  It is during the process of termination that most clients first experiment with  planting both feet in the new territory of Stage IV. If they are truly ready to terminate, their autonomy will be firmly established, self-esteem will be legitimized by an integrated belief system, and serenity will be experienced on occasion. 

Much of the therapy suggested for stages I through III is geared toward helping clients reach this stage.  All too often, overly simplistic treatment for codependents tries to teach self-esteem, relaxation, and serenity through didactic classes, role-playing, and endless repetition of the Serenity Prayer.  Lectures on assertiveness and building positive self-worth are offered during the first four weeks of most family treatment programs.  For codependents in early recovery, these classes can be refreshing and useful for instilling hope and a blush of self-confidence. 

However, an active codependent's character structure is impervious to fully internalizing lessons about self-esteem. Being good "co's," clients are capable of learning such lessons rapidly, understanding them intellectually, and giving the appearance of  

having incorporated them into their lives.  Once we accept that codependence is a recognizable Mixed Personality Disorder, it becomes clear that short-term methods can effect only superficial changes. 

The characterological changes necessary for codependents to internalize a new belief system legitimizing self-acceptance usually begin during the Core Issues Stage.  At this point many clients have the urge to terminate therapy - a sign that codependence is still active.  This urge stems from an old strategy of grasping tightly to any feelings of relief and self-worth.  Continued treatment is seen as a threat rather than a support for any progress which has already been made. 

Many therapists feel tempted to validate too quickly the client's newfound sense of independence by refraining from a full exploration of what termination means. Clients who are pushed to explore their feelings about termination may well exhibit normal defensive reactions, such as accusing the therapist of trying to foster dependence or not having enough faith in their ability to stay healthy.  Use this as rule of thumb:  When clients are really ready to terminate, they will recognize these defenses as a way of resisting experiencing the emotions associated with termination -and they will be willing to become conscious of these feelings. 

When clients do choose to terminate abruptly out of fear that further work in therapy will challenge their newfound sense of independence and power, or because they are not willing to explore their feelings during the act of separation, do not dwell on this choice as a failure.  Instead, review the progress the client has made so far and end with an open invitation to reenter therapy at any time.  If appropriate, you may predict the probability that specific events in the client's future life may well activate additional issues.  Note that the client has learned to understand the meaning of his or her feelings and to discover alternative ways of dealing with these events. 

For some clients, termination represents the first time in their lives that they will voluntarily leave a relationship.  They may feel a sense of guilt for abandoning someone (the therapist) who respected them even before they respected themselves.  They may feel anxious about being on their own.  They may frighten themselves by the degree to which they regress once termination becomes a realistic prospect.  Working through the process of termination gives ancient issues of abandonment and separation enough time to surface.  On occasion, these issues can be so significant that the therapy enters a deeper level of work. 

Successful termination can be an event of rare beauty.  Being with a client who keeps his or her eyes open while saying "good-bye" is quite moving.  To experience the act of separating as opposed to one's fears of separation is to stay in relationship during one of the most difficult moments any relationship can encompass.  The decision to stay aware of one's feelings no matter what is happening is the essence of recovery.  If you are met with such behavior in a client, take it as cause for joy.

Codependents and enables have rescued the chemically dependent persons in their lives so often that being codependent and an enabler has become their second nature.  Thinking of codependence and enabling as second nature is appropriate because it is not normal to be so.  Both are reactions to being exposed to a chemically dependent person.  This reaction, an adaptation, or transformation, of their normal personality, is a defense complex  to help them to survive with the chemically dependent person.  Unfortunately this mechanism which allows the codependent and enabler to survive, only serves to encourage the chemically dependent person to continue in his disease.  Tough love can begin to correct the tangled web - the damage - woven by the chemical dependent, codependent, enabler interactions.

Contact Us Today


Appointment Times


9:00 am-6:00 pm


9:00 am-6:00 pm


9:00 am-6:00 pm


9:00 am-6:00 pm


9:00 am-6:00 pm