Working with Codependency in Psychotherapy

I am a psychologist in Stockholm, Sweden. I have been working with co-dependency as a specialty for 15 years, and I have developed a way of viewing it that seems promising. In this posting I would like to outline the main tenets of how I think and work with this problem.

My main point is that I see many people who benefit from learning about codependency, usually by doing more of self-care and lowering the over-engagement with other people’s problems. But this does not entirely solve the problem because you need to learn a new way of doing relationships, which is more of a complex skill, that is not so easy to transmit in a book or a 12-step-group. Psychotherapy for codependents should include helping the client to learn these important relationship skills.

I made this video that describes the same things that I talk about here:

Definition of co-dependency

When I talk of codependency, I mean a general pattern in a person’s relationships. This means that virtually all your relationships are oriented towards you being of help. It is common among codependents not to have one single relationship which is balanced in terms of help and support flowing 50 % in both ways.

Origin of the problem

My impression from working a lot with this group of people is that most codependent people grew up in an insecure or chaotic environment where the child finds out that it can somehow help the situation by solving problems. Tending to siblings, doing the dishes, listening to the parents and the like. There is too little of the sound, caring parenting where the parent gives support, affection and validation to the child.
I wont dwell too much on the details of such a childhood, since it is well described elsewhere.

The dysfunctional relationship pattern

So in this environment the child learned to focus much of her energy on being helpful. You leave such childhood with a one-sided focus in relationships, just focusing on the other person, not being able to do relationships in a way where you yourself also can get help and support.

The codependent pattern might be summarized like this

  • An exaggerated, somewhat stressed focus on spotting problems. It might be an organizational problem at work, a project that will not meet its deadline. A colleague that is becoming depressed, or your child having problems in school.
  • Helping to ”solve the problem”. This does not necessarily mean the best long-term help. Often the focus is more short-term, to get the problem out of sight, like cheering up the depressed colleague.
  • The nervous system experiencing a short term reinforcement from this behavior.

When working with this group of people I have been hypothesizing that when you grow up in this sort of insecure, dysfunctional family, it is possible that your brain will start connecting a dopamine-reward to helping behaviors. This way you become “hooked” on helping, just like it is possible to get addicted to drugs or gambling. I don’t think this hypothesis has been researched, but if some reader know more about this, I would be glad if you let me know.

Starting to recover

So what I often see is a client who have heard about the concept of codependency, and then start trying to shift this focus in her life. It makes sense to increase self-care activities. Like resting, exercising, enjoying yourself more. And at the same time to try to do less of helping behaviors. Many people have one or a few friends that they feel the need to get rid of or at least to engage with in a different way, if the relationship is too one-sided.

Here I would like to stress that we humans are social animals. Our well-being is very much tied to the quality of our social relationships. This has been described in several research areas in the latest decades. Please read about interpersonal neurobiology or polyvagal theory if you want more in-depth understanding of this.

Think of it like this: social relationships are just as important as food for the individual. We have a very strong instinct to search for and eat food. If we don’t find the food we would prefer, hunger will make us eat anything that will fill the belly. In starvation situations people eat grass and earth. Humans have a similar instinct to seek social connection. When your social connections don’t work out well, the risk of depression or other mental health problems increases.

The thing here is that is that the codependent person have this strong drive to have social relationships. Just like all human beings. But she can only do it this one-sided way. The person ends up chasing a real feeling of connection, but always fails, and end up feeling more and more empty. One metaphor would be to be hungry for food, but the only food you find is a type of food that just gives temporary relief, that doesn’t give you real nourishment nor make you feel really satisfied.

What is needed

One way of describing a normal helping relationship from the perspective of the person in need of help could be:

  1. Paying attention to inner processes. Like emotions and needs.
  2. Identifying these. Like naming that uncomfortable feeling in your chest as sadness or fear.
  3. Talking about your experience with a trusted other. Saying ”I just lost my job that I really liked. This makes me so very sad”.
  4. Registering that the other person is responding to what you say. This can be both verbal and nonverbal. Normally the face would express a similar feeling. In this example, the listener would look sad, and this way convey a feeling of being understood to the other person. ”Huhu” and hummings are common ways of transmitting a sense that you are really listening. Saying ”Thats really sad” will also communicate understanding and empathy.

The way I understand this is that for the codependent person this doesn’t work. You don’t know how to do this, because life didn’t teach it to you. Your parents were too preoccupied with each other or themselves to give you very much validation and understanding, so you grew up pursuing relationships without being able to get this soothing, understanding quality from your interactions with other people.

My codependent clients usually have problems with several of the points above. For instance, it is common to avoid eye-contact when talking about sensitive issues. This way the empathy radiating from the other person it will not enter your brain. And consequently you will not reap the benefits of a good talk with a friend.

Another common pattern concerns the point number 3, how to express personal, vulnerable things. I often see that in the beginning of the therapy my client will tell me about painful stuff with a smile in the face. The lips are moving upward when they should normally be moving downwards. If your face does not express the same feeling as you are trying to express verbally, it will be confusing to listen, and the listener will not know exactly how to respond. Is it a happy or sad story? Obviously this will also be a great obstacle to experiencing an understanding and soothing interaction with someone. Talking about vulnerable things in a very intellectual or factual way is another way of missing this flow of vulnerability and support between trusted fellow humans.

People with knowledge about different therapy concepts might notice that I approach this from a rather behavioral angle. I have studied and worked with a concept called FAP – Functional Analytic Psychotherapy, which tries to describe relationships with help from the behavioural tradition that stems from BF Skinner. But it does not really matter what therapeutic orientation the therapist comes from, what matters is if you in therapy get help to correct such dysfunctional ways of relating that I just described.

So if I notice that my client smiles a lot when talking about painful, difficult stuff, I will tell him/her to continue talking about the same things, but pay attention to the face and not to smile. More like relaxing the face. This usually help her to get the connection-process to work better. It often feels like a watershed moment when this happens. For decades, a whole life, empathy, love and support have been flowing out from the client to people around her, and now she finally learns how to also receive these things from other people.

From the perspective of what I see and hear in the therapy-room, it really seems that learning to do real vulnerable self-exposure like this leads to substantial improvements. My impression is that the whole outlook on life start to change. I see more smiles and happiness, and hear that ”life can be hard at times, but it is not so chaotic any more” and such things. I would really love to do research to confirm this impression but life hasn’t turned out this way for me yet. The FAP-research done about similar things looks very promising. This is a short video that talks about the FAP-approach in general, not specifically about codependency.

Interestingly, there is research showing that vulnerable relating with other people will make the body produce oxytocin, which is really a health-hormone of sorts. If my description of the relationships of codependents above is true, codependents also lose out on getting this relaxing hormone when they go through difficulties in life. The codependent will go through life with stress-reactions activated a lot of the time. And there will be too little of the destressing functions of the body, like release of oxytocin. I believe this puts the codependent population at risk of burnout, chronic fatigue and similar health issues.

Summary

One might summarize this in concluding that the codependent need to move from a focus on short term “fixing” or helping behaviors towards other people, towards more authentic, vulnerable “closeness behaviors”, that gives both a sense of real belonging and also plenty of oxytocine to regulate the system of recuperation, sleep etc.

My advice if you are a codependent that feel stuck in your recovery: Inquire yourself about the quality of your closest social relationships. To what extent do you talk to them about your innermost thoughts and feelings? Are you able to do this in a way that feels like nurtuting, soothing and relaxing? My experience as a psychotherapist is that it often feels really scary to take the first steps in vulnerable self-talk, so there are good reasons to seek help from a good psychotherapist in this.

The codependents way of helping

I would like to add a thing about the codependent persons interpersonal patterns. Since these helping behaviours were learned rather early in life, they are often focused in an immature way to “get away with the problem”. If the other person is angry, you might rush to apologize, even if you haven’t properly understood what caused the anger. Or trying to talk the person into thinking differently. Maybe smile a lot to appease him. A more constructive long term solution would be to really listen to the misgivings of the angry person and see what is behind it. It could be some feelings or values being hurt. Or maybe you need to have a serious talk to find a long term solution to a tricky problem.

Towards the end of my psychotherapies we often talk about communication from this broader perspective. How can my client be of help to others in a more mature way? How to handle difficult conversations and conflicts without just bowing to the other person’s needs?

Note 1: There is a complex interplay between stress, de-stressing and different systems in the body. Oxytocin is an important hormone here, but my description is simplified. In fact there are many body systems involved. These processes are much more intricate than what I can describe in this post.

Note 2: When I and my client practice ”vulnerable self-disclosure” like I have described above, the subject is often the difficult things that happened during childhood. There is a schism within psychotherapy regarding to which extent it is useful to work with childhood this way. I have chosen not to delve too much on this debate here, since it is quite easy to describe the therapy process in terms of learning new behaviors. I hope that my observations might be of use to clients and therapists of different therapeutic orientations.

Note 3: Please feel welcome to comment and discuss. I sometimes have time to answer questions here, but if you want to get in touch with me, please send me an e-mail at daniel@dkraft.se.

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