An overview of the prevalence and challenges of codependency, how it affects our clients, and how codependency in counselors can negatively impact our quality of service.

1. By Laura Kearney & Lauren Varallo

2. • Definitions
• Types
• Characteristics
• Origin/Facts
• Challenges
• Patterns
• Development
• The Codependent Counselor
• Diagnosis/Treatment
• Strengths
• Two Stories
• Q+A

3. Codependency is a condition or state of being, that results
from adapting to dysfunction (possibly addiction) in a
significant other.
Codependency is a learned response to stress which, over
a person’s lifetime, can lead to the development of the
following characteristics:
• External Focus
• Repressed Feelings
• Comfort with Crisis
• Boundary Conflicts
• Isolation
• Stress related illness
• Compulsive Behavior

4. “Codependency is a pattern of thinking,
feeling, and behaving.
If you are codependent, you are unable to
identify and follow your own needs, wants and
feelings.
It’s as if you have grown antennae, and you
wave them as you move through life, straining
to pick up vibes from others.
If you are codependent, you are not powered
from within; your quest for power is through
controlling others.
In fact, you’re so focused on another, you may
not even know how you think or feel.”
(Sowle, 2015)

5. Interdependency
• Mutual dependence between people
• Healthy Intertwining
Codependency
• One sided – mutation of interdependency
• Balance between dependency & autonomy has not been achieved
• Needs reflection of himself in another to know he is okay

6. Family members
Spouse/Partner
Mutual Codependence
Parent to Child
Adult Child to Parent
Work
Friendships
Domestic Violence
Emotional Abuse
Mental Illness
Chronic Illness
Disability

7. http://www.youtube.com/watch?v=1yfvjlE0ztc

8. • Term emerged from AA in 1960s to describe enabling relationships.
Satir & Bowen - psychological problems can be connected to family systems
• 1 in 5 people in U.S. have a parent who suffers from alcoholism/addiction
• 50% of individuals have a close family member who suffers from some form
of addiction
• That means 20-50% of your future clients may be affected
• Putting this In perspective – prevalence of other mental disorders we study:
• OCD 1%
• Bipolar Disorders 2.6%
• PTSD 3.5%
• ADHD 4.1%
• Major Depressive Disorder 6.7%
• Anxiety Disorders 18%
• Codependency 20-50%
(Sowle, 2014; NIMH, 2013)

9. Characteristics and behaviors may develop that can
seriously affect personal relationships & quality of life:
• Increased likelihood of developing an addiction: 50 – 90%
• Damaged worldview, including serious issues with boundaries, trust,
shame, self-esteem, fears and perfectionism (Lancer, 2012)
• Higher rates of mental disorders and depression, marriage to addicted
partners, and divorce (Sonnenberg, 2011)
• May negatively affect critical areas of life including romance, career,
parenthood and financial matters (Sonnenberg, 2011)
• Increased physical illness – ACE score
correlations for trauma & future health

10. 5 Major Patterns & Examples:
• Denial
• Low Self-Esteem
• Compliance
• Control
• Avoidance

11. By young adulthood, failure/negative resolution of stages may lead to –
OUTCOMES
Stage 1 – Infancy TRUST vs. MISTRUST Learns not to trust
Stage 2 – Early Childhood AUTONOMY vs. Shame & doubt over parent’s behavior
SHAME & DOUBT
Stage 3 – Play Age INITIATIVE vs. GUILT Guilt over inability to change parent’s behavior
(+ responsibility for their behavior?)
Stage 4 – School Age INDUSTRY vs. Feels inferior due to diminished self-concept
INFERIORITY
Stage 5 – Adolescence IDENTITY vs. Confused about who they are
IDENTITY CONFUSION
Stage 6 - Young Adulthood INTIMACY vs. Isolation due to lack of trust
ISOLATION Belief that no one would listen/understand
Chooses toxic partners, reinforces inability to trust
Seeks good parent they did not have in partners
(Whitaker & Rivinus, 1988)

12. Attachment Style
20% Anxious attachment (“The Pursuer”)
25% Avoidant attachment (“The Distancer”)
55% Secure Attachment
Narcissistic Partners (“The Dance”)
Parenting Style
Authoritarian parenting style in fathers

13. Areas where unresolved issues may negatively impact our
responses to client and quality of service/care:
SHAME & DENIAL
LOW SELF-ESTEEM
GUILT
FEAR
BOUNDARIES
CARETAKING & CONTROL
What we avoid in ourselves, we avoid in others.

14. DSM Diagnosis –
Not recognized as diagnosable mental health condition in the DSM-5
Type of Disorder –
Referred to as a syndrome, but closest to a personality disorder
Related Diagnoses –
Anxiety, chronic depression (PDD), chronic trauma/PTSD, addictions
Prognosis –
If left untreated, codependent symptoms will worsen (Lancer)
Culture –
Recognized in western/individualistic cultures, may not apply to clients
from collectivistic or other cultures

15. Types of treatment
• Individual therapy – the 4 “A”s – abstinence, awareness, acceptance + action
• Family Therapy
• Healing Shame
• 12 Step Support Groups
• Medication for associated disorders
Treatment Goals
1. Increase understanding of codependency/relationship issues
• Accept that codependency is causing their problems
• Identify underlying issues
• Take steps toward dealing with issues and applying new skills
2. Correct irrational thinking leading to the codependency or relationship issues
• Identify specific areas of cognitive distortion
• Challenge irrational thoughts with reality
3. Address areas of potential concern for future relationships
• High risk people, places, or situations
• Old patterns which may emerge

16. Empathy –
• Exceptional listeners, great friends/teachers/counselors, advocate for the underdog
Independence –
• Like to be in control and work independently, hard workers, entrepreneurial
Creativity –
• Sensitive, heals through creating, uses their art or craft to speak their truth
Resiliency –
• Survivors, positive coping skills too, driven toward healing
• Relationships – married consciously into happy, healthy and/or strong families
Calmness in Chaos –
• Difficult to shock, tough, calm exterior (Eden)
Initiative –
• More likely to take control
• Used to being caretaker/keeping things together

17. • Lauren
• Laura

20. • Dayton., Retrieved from: http://www.huffingtonpost.com/dr-tian-dayton/adult-children-of-
alcoholics_b_1835677.html
• Eden., Retrieved from: http://guesswhatnormalis.com/2007/05/play_to_your_st
• GoodTherapy. Retrieved from: http://www.goodtherapy.org/therapy-for-codependency.html
• Lancer, D., Retrieved from:
http://www.camft.org/AM/Template.cfm?Section=Home&ContentID=14161&template=/CM/Content
Display.cfm
• Lancer, D., Retrieved from: http://psychcentral.com/lib/problems-of-codependents/00011982)
• Lancer, D., GoodTherapy webinar
• Sonnenber, 2011, http://www.beliefnet.com/healthandhealing/getcontent.aspx?cid=14242
• Wilson Schaef, A. (1986). Co-dependence: Misunderstood, mistreated. New York, NY: HarperCollins.
• http://www.nimh.nih.gov/health/publications/the-numbers-count-mental-disorders-in-
america/index.shtml#MajorDepressive
• http://www.coda.org/tools4recovery/patterns-new.htm
• http://www.wellmont.org/Health-And-Wellness/Health-Library/ ?eid=14242& lang=1033
• http://www.goodtherapy.org/therapy-for-codependency.html
• http://en.wikipedia.org/wiki/Codependency
• Treatment Plan Overviews Codependence, http://www.insightandoutlook.com/tp-codependency.php#mg1
• http://www.whatiscodependency.com/what-is-codependency/