An overview

Therapists and counselors see people with an array of symptoms, such as depression, anxiety, addiction, or intimacy and relationships issues. Clients are hurting and often believe the cause is something outside of themselves, like their partner, a troubled child, or a job.

On closer examination, however, they (and many readers of the first edition of this book) start to see that, despite whatever else may be going on, their behavior and thinking patterns are adding to their problems — that is to say, their patterns are dysfunctional. These patterns have an addictive, compulsive quality, meaning that they take on a life of their own, despite their destructive consequences. The root problem is usually codependency.

Why relationships hurt

Along with comfort and pleasure, intimate relationships especially evoke all your hopes, fears, and yearnings. You want to feel secure and be loved, appreciated, and taken care of. Dependence upon those closest to you further magnifies your emotional needs and vulnerability to being rejected, judged, and seen at your worst.

Codependency is a particular kind of dependence. It’s insidious and powerful. It robs you of joy, peace of mind, and the ability to have sustained, loving relationships. It affects your relationship with yourself and limits your flexibility and the natural flow of relationships with others, including giving and receiving love and support and the ability to communicate, compromise, and problem-solve.

All the symptoms I outline in Chapter 3 work together to not only deprive codependents of the benefits possible in relationships, but they also create problems that wouldn’t have otherwise existed. For example, shame and low self-esteem make you insecure, anxious, and dependent upon others’ acceptance and validation. You may feel uncomfortable being yourself and be hypersensitive to perceived criticism or abandonment (even where neither exists). You may attempt to control or manipulate people to maintain a relationship and to be liked. Some codependents require repeated reassurances or are afraid to be direct and honest, which is necessary for effective communication and real intimacy.

Childhood shame and trauma conceal their real, core self, which they can’t access. Instead, codependents develop a persona in the world that reacts to others, to their own self-criticism, and to their imagined ideal of who they should be. To be acceptable to others and to themselves, you hide who you are and become who you aren’t. You may not even be aware of how self-critical you are but suffer the “tyranny of the should’s” — a phrase coined by psychoanalyst Karen Horney (pronounced “Horn-eye”). Even though you may not relate to this, it still operates beneath your conscious awareness. You may only be aware of your persona illustrated in Figure 1-1 and nothing on the inner circles.

All relationships require boundaries. Love is not safe without them. Yet many codependents tolerate being treated without respect, because they lack self-worth. They don’t feel entitled to compliments, to be truly loved, or to set limits. They might do more than their share at work or in a relationship to earn acceptance, but they end up feeling unappreciated, used, or resentful. In reading this book, ask yourself whether your relationships feed you or drain you.

Shame can also cause codependents to deny or discount their feelings and needs, both to themselves and in their relationships. To cope, they sometimes disregard what’s actually happening, ruminate with worry or resentment, or finally explode. Their denial and confusion about their boundaries and responsibilities to themselves and to others create problems with intimacy and communication. Instead of bringing couples closer, frequently communication is avoided, is used to manipulate, or is highly reactive, leading to escalating conflict and/or withdrawal. Nothing gets resolved. They end up feeling trapped and unhappy because their symptoms paralyze them with fear of rejection and loneliness.

The symptoms of codependency are all interwoven. They lead to painful emotions and self-sabotaging behaviors that produce negative feedback loops. This book helps you untangle and free yourself from them and create positive, healing feedback loops.

The work of neo-Freudian Karen Horney

In the late 1930s and early 1940s, leading neo-Freudians and humanists began focusing on the development of personality. Karen Horney, referred to as the first feminist psychoanalyst, was one of the leading proponents for self-actualization.

Horney broke with Freud on many issues and believed that children have a fundamentally good “real self,” which thrives in a healthy, empathic, and supportive environment. Natural striving to actualize their true nature can be thwarted due to poor parenting and cultural influences; however, self-awareness can go a long way to unshackle the real self from those negative influences, allowing it to flourish. Horney conceptualized a compliant personality alienated from the real self that today resembles typical traits of codependents. Some of her other personality categories may be codependent, too. Her influence is apparent in the writings of humanist psychologists Abraham Maslow and Carl Rogers in the mid-20th century.

Codependents repress their real Self and authentic feelings and develop deep, shame-based beliefs about who they are and their rights, needs, and lovability. This happens in reaction to dysfunctional parenting in childhood (such as critical, indifferent, rigid, invasive, inconsistent, or rejecting parents). Sometimes their beliefs are due to abuse, and sometimes they’re inferred from the behavior of emotionally unavailable parents. Shame is also the result of the anger they have turned against themselves because they couldn’t direct it toward parents they looked up to and relied upon for survival. (See Chapter 7.)

To get by, many codependents learned to comply and measure up to an imagined ideal (refer to Figure 1-1). Others withdrew or rebelled. As adults, some codependents constantly feel inadequate, whereas others identify with their ideal self and think they have high self-esteem. Many become perfectionists to balance the self-hatred they feel inside. They may strive to be loving, good, beautiful, accomplished, or successful in an effort to prove their worth and/or to be independent and never again need anyone. Yet the more they try, the more depressed they become, because they’re abandoning the real self that wasn’t nurtured by their original caretakers. Some enter therapy because of an addiction or relationship problem, while others go to understand why they’re depressed even though everything in their life is working.

The influence of family systems therapy

Family system theories emerged from the study of cybernetics, systems theory, and systems psychology. In the mental health field, theorists and therapists were increasingly viewing mental illness in a family context. In clinics, counselors noticed that some patients improved, but when they returned to their families, their symptomatic behavior returned. The counselors deduced that the family dynamics were maintaining or even causing the illness and began focusing on family interactions.

Therapists who worked with alcoholics observed repetitive patterns among the spouses and families of the alcoholics that reinforced drinking behavior. They saw husbands and wives who reproached and tried to manage an alcoholic, unaware that they were trying to control an uncontrollable illness. The family members displayed dysfunctional characteristics and were initially referred to as co-alcoholics. From years of disappointments and submergence of their personality, they had become empty shells. Their self-esteem and despair were as low as that of the alcoholics.

Surprisingly, clinicians discovered that many of the problems in the family persisted even after the alcoholics found sobriety. They found that their spouses’ dysfunctional patterns predated the alcoholic marriage and continued into new sober relationships. They realized that the co-alcoholics had to recover independently of the person and relationship that brought them to Al-Anon, the Twelve Step program for families of alcoholics. Still later, it was observed that those patterns appeared in others who weren’t involved with an addict but had grown up in dysfunctional families (see Chapter 7). All of their findings thus validated and converged with psychoanalytic theory.

The term codependency was born in the late 1970s and by the 1980s was being applied to addicts and their relatives, family members of someone with chronic mental or physical illness, and caregiving professionals.

Addiction and Twelve Step programs

Soon after AA was founded, Bill Wilson’s wife, Lois, saw that the spouses, mostly wives at that time, needed support. She started holding meetings in members’ homes. These meetings expanded to include all relatives and friends of alcoholics, and Al-Anon was born. In the 1950s, a main office was established in New York City to coordinate groups that had spread nationwide and today worldwide.

Other Twelve Step anonymous programs began to form based on the model of AA, which had proven so effective. Soon these programs proliferated. After Al-Anon founded its headquarters, Narcotics Anonymous began in 1953, followed by Overeaters Anonymous in l960 and Gamblers Anonymous in 1961. The 1970s saw the arrival of Emotional Health Anonymous, Sex Addicts Anonymous, Sex and Love Addicts Anonymous, Debtors Anonymous, and Adult Children of Alcoholics. The list grew in the 1980s to include, among others, Workaholics Anonymous, Nicotine Anonymous, Clutterers Anonymous, Cocaine Anonymous, Marijuana Anonymous, and Sexual Compulsions Anonymous.

Eventually in 1986, the self-help program Co-Dependents Anonymous (referred to as CoDA) was founded by two therapists, Ken and Mary, who both grew up in dysfunctional, abusive families and had histories of addiction. CoDA was also modeled on the Twelve Steps of AA. Unlike Al-Anon, membership wasn’t linked to having a relationship with an alcoholic. The only requirement, as stated in its preamble, “is a desire for healthy and loving relationships.” The meeting of the First National Conference on Co-dependency was held in 1989.

A codependent society

As the awareness of addiction grew, more habits and compulsions began being characterized as addictions, and increasingly people seemed to have codependent traits that compromised their relationships, both among addicts and those close to them. Family systems author and theorist Virginia Satir commented that of the 10,000 families she’d studied, 96 percent exhibited codependent thoughts and behaviors. By the late 1980s, former psychotherapist Anne Wilson Schaef called America an addictive society in her 1988 book, When Society Becomes an Addict (HarperOne).

It may be that all the focus on relationships is the sign of the times, reflected in the growth of family therapy, and the women’s sexual liberation and human potential movements. In prior generations, intimacy was left to novels, poetry, and fantasy, because the focus was on survival and productivity, but today it’s considered a need. It’s no coincidence that the codependency movement arose in America, the champion of independence and romantic love — with the highest divorce rate. Americans want romance to work! Whatever the reason, just about everyone wants a fulfilling intimate relationship — something that seems to elude codependents.

The codependency debate

The controversy around codependency is divided into two camps — for and against. At one end are mental health professionals who advocate that codependency is a widespread and treatable disease. On the other is an array of critics of codependency, who argue that it’s merely a social or cultural phenomenon, is over-diagnosed, or is an aspect of relationships that doesn’t need to change. Those in the “against” camp state that it’s natural to need and depend upon others. They claim that you only really thrive in an intimate relationship and believe that the codependency movement has hurt people and relationships by encouraging too much independence and a false-sense of self-sufficiency, which can pose health risks associated with isolation.

Other naysayers disparage the construct of codependency as being merely an outgrowth of Western ideals of individualism and independence, which have harmed people by diminishing their need for connection to others. Feminists also criticized the concept of codependency as sexist and pejorative against women, stating that women are traditionally nurturers and historically have been in a nondominant role due to economic, political, and cultural reasons. Investment in their relationships and partner isn’t a disorder, but has been necessary for self-preservation. Still others quarrel with Twelve Step programs in general, saying that they promote dependency on a group and a victim mentality.

Committees have lobbied for codependency to be recognized as a mental disorder by the American Psychiatric Association, which would allow insurance coverage for treatment. A major obstacle is the lack of consensus about the definition of codependency and diagnostic criteria. For insurance purposes, clinicians usually diagnose patients with anxiety or depression, which are symptoms of codependency.

Here are some things to think about, to help put the naysayers’ points in perspective:

• Codependency’s detractors are correct to claim that people are meant to need, love, and care for others. Yet, when you look at codependent relationships up close, you discover that many of the benefits of healthy, intimate relationships elude codependents due to their dysfunctional patterns of interacting. Instead of feeling supported and enhanced by relationships, the symptoms and consequences of codependency provoke anxiety in relationships and cause pain. Codependents complain of feeling lonely and unhappy in their relationships. Similarly, a “false sense of self-sufficiency” is part of codependency. Codependents ignore their needs and depend upon others and frequently self-sacrifice to an unhealthy degree. They care for others in a way that leads to control, resentment, and conflict. The concept of codependency isn’t to blame for the increase in divorce, loneliness, and unhappiness. Codependency itself limits our ability to have satisfactory intimate relationships.
• Some recovering codependents choose to leave an abusive or painful relationship as an act of self-preservation. Remaining in such a relationship may also pose health risks from the chronic stress. Separation doesn’t have to lead to isolation. It’s untreated codependency that can cause people to isolate. In contrast, recovery helps individuals cope with loneliness in healthy ways by reaching out to others. The goal is to create healthy, nurturing, interdependent relationships. Thus, recovery from codependency doesn’t necessitate ending a relationship to become independent. The aim is to be able to function better and to enjoy more intimacy and independence in your relationships. I’ve worked with many codependent individuals and couples whose relationships benefited when they became more autonomous and assertive. Calling codependency what it is doesn’t create the problem.
• Finally, I agree that the term codependency shouldn’t be used to judge people. It arose out of Western socio-political thought and should be considered in a cultural and ethnic context. There may be instances where codependency is adaptive, and change would be disruptive. This poses a problem as American and European ideas spread to Asia, the Middle East, and Africa. I’ve received correspondence from men and women who feel conflicted between their eager desire for independence and the oppressive restraints of their religion and culture. Many don’t have the institutional or cultural support necessary for change that exists in the West.