In Consultation

Rethinking Codependence

An Attachment-Based Framework for Caregivers

Magazine Issue
November/December 2023
Photo by lalesh aldarwish/pexels

Q: I run groups for people supporting loved ones in recovery, and I’m wondering how to distinguish between “bad” codependence and “good” care and love?

A: I understand your uneasiness. As a clinical social worker and addiction specialist with 30 years of experience, I’ve thought deeply about the underlying assumptions and judgments that have shaped our ideas about codependency. Given how frequently we pathologize caretaking behavior, I’ve often seen clients withhold support for loved ones struggling with addiction as a reaction to the blaming and shaming they’ve experienced within the codependency model.

For four decades, this model has told us that caregivers of people struggling with addiction must have something wrong with them that makes them give away so much of themselves to support another’s survival. Codependency suggests that such people’s unconscious, unexplored pathologies motivate their supposedly desperate, boundaryless caretaking. I believe this approach has pathologized our natural willingness to set aside our own needs to help, save, or even rescue those we love.

Sourced in analytic concepts of the 1950s, humanistic psychotherapy of the 1960s, and feminist theory of the 1970s, codependency today reflects a worldview that’s more anti-dependent than pro-dependent. It was originally the brainchild of women like Melody Beattie and Robin Norwood, who’d been raised in alcoholic homes and found themselves married to alcoholic men. By sharing their own stories to help explain why women raised by abusive or alcoholic parents might end up in similarly troubled adult relationships, they wanted to create a system of support for themselves and others in similar situations.

Though intended to empower clients, codependence reinforces Western- and male-centered values like individuation and self-sufficiency, while ignoring more culturally inclusive and feminine values like compassion and community building. By insisting that early-life trauma repetition is the primary motivator behind emotional attachment to, and loving support of, people with addictions, the codependency model misconstrues counterdependence as strength and frames attachment as a liability and a weakness.

To undo these and other misleading assumptions, it helps to remember that no one—regardless of their actions, behaviors, or words—can make an addicted individual use or act out. If someone else’s codependency leads an alcohol-abusing person to feel miserable, the alcohol abuser can go for a walk, talk to a friend, call a therapist, or even end the relationship. To imply—as codependency does—that someone’s addictive behaviors are the result of another person’s words or actions is incorrect.

A Prodependence Framework

In Practicing Prodependence: The Clinical Alternative to Codependency Treatment, clinician Kim Buck and I explore the value of caring for troubled loved ones, even to the point of sacrificing one’s own needs and desires at times. Far from being negative traits, love and care are prosocial tendencies with individual, relational, and societal benefits. Not only that, but there’s a vitally important reason why caregivers give so much of themselves to loved ones in crisis—something that often goes overlooked: they do it because they love them. Most of us will naturally give of ourselves fully and wholeheartedly, even to our own detriment, when someone to whom we’re deeply attached is in medical or emotional crisis. Our framework of prodependence views the codependency approach of holding caregivers accountable for an addicted individual’s choices as woefully misguided—a sophisticated form of victim blaming. This is evident in the ways these frameworks talk about similar problems.

Codependence might frame someone who’s attempting to limit an addicted loved one’s exposure to alcohol as “enmeshed, externally focused, and enabling.” Prodependence, in contrast, might frame them as “involved, concerned about their loved one’s welfare, and supportive.” When they attempt to inform others in the addict’s life of the need to set boundaries around drinking and using drugs, codependence might frame that as “angry and controlling” behavior, while prodependence might frame it as “being in crisis and trying to keep their family safe.” These alternative conceptualizations reframe and honor caregivers’ positive intentions and strengths.

Imagine you’re treating the wife of a man who’s been drinking excessively for years. Lately, he’s missed work and his boss has threatened to fire him. Sometimes, he’s verbally abusive. Your client’s husband knows he has a drinking problem but refuses to go to AA. His addiction has negatively affected your client’s health, and she’s been having panic attacks and trouble parenting their two kids.

Consider the different approaches of codependence and prodependence.

Codependence-focused therapist: “I’m glad you came to see me before you sink any further into the rabbit hole of your husband’s drinking. It’s clear that your devotion to him is dragging you into desperation. Your continued focus on his healing and needs, which we call enabling, is actually making his addiction worse, not better. This is codependency. You want him to be well, but if you don’t stop engaging in enmeshed, controlling behaviors, you’re contributing to the problem, and you’re part of what’s keeping him unwell. Stepping away from this dysfunction by understanding your own unmet childhood needs and working through them may help end these generational patterns.”

Prodependence-focused therapist: “I’m impressed with the strength you’ve shown in trying to help your alcoholic husband while working day and night to keep your family afloat. What a powerful and compassionate person you are! You’ve put your own needs and desires aside to try to help him. I’m glad we’re here together so you don’t have to face this challenge alone. Let’s try something new. With my support, let’s create an action plan and put together a support team of safe people. On some days, you’ll need assistance getting the kids to school. On others, you’ll need support when your husband comes home drunk. With a plan and some concrete help, we can find ways to support you and work toward helping your husband get sober. Many families survive this and move on to thrive. Let’s start making your life a bit easier and more predictable, so you don’t have to feel hopeless, overwhelmed, and disempowered.”

If you were this client, which approach would feel more helpful and hopeful? More focused on the here-and-now issues that led to therapy? More likely to help manage the painful life crisis in which you found yourself through no fault of your own? More honoring of your deep attachments?

The prodependence framework shifts the focus away from an individual’s past onto their present. It’s concerned with helping an individual survive now by leaning into the assistance and clarity offered by safe and supportive others. The goal is to help clients get through the rest of the day or week. Therapists viewing their clients as prodependent use crisis intervention methods to educate, support, guide, and normalize feelings. They keep interventions simple and brief, providing pragmatic, achievable actions to help them regain a sense of control and efficacy.

Working within a prodependence framework, clinicians don’t need to learn new models or even engage in challenging motivational questioning. Most importantly, even if the method a client is using to help a struggling loved one isn’t effective or healthy, clinicians still view it as natural for a person to give of themselves when a loved one is in crisis.

An Attachment-Based Framework

With its trauma-repetition framework, codependence negatively labels the client as wounded and broken, thereby leading to feelings of self-doubt, shame, and fear, while encouraging a self-referential, individually focused path. As an attachment-based framework, prodependence validates their feelings of loss and being in crisis while guiding them toward healthier and more effective behaviors. Both models share goals of improving self-care, setting better boundaries, and seeking out supportive others to help the addicted person get sober. They move toward these goals using different means.

Unsurprisingly, many loved ones of people struggling with addiction do have trauma that may drive responses and actions. Once a crisis has passed and the addicted person is actively working on sobriety—or the relationship with the addicted person has ended—clients may want to explore deeper forms of inner work. These clients might say, “I wonder if the way I grew up relates to my choosing this person as my partner and tolerating all the dysfunction of their addiction.” That can be the start of meaningful, introspective work. In my experience, however, attempting this kind of work too soon can lead to increased anxiety, self-doubt, and shame, making it harder for clients to reach the practical goals that’ll help them get through their crisis. In therapy, as in life, timing is everything.

Earlier in my career, I myself once viewed the partners of addicted people who ended up in my office as difficult. I saw them as operating in ways that were counterproductive, and I’d point them to codependency work to help them set better boundaries. Time and again, when a codependency lens was used to make sense of their experiences, they’d drop out of treatment. Finally, when I got curious about this trend—and about my own experiences loving and caring for a mentally ill family member—I realized that a prodependence approach has far more to offer than a framework that casts attachment as a form of pathology.

 

Photo by lalesh aldarwish/Pexels

Robert Weiss

Robert Weiss, PhD, LCSW, CSAT, is an educator, a licensed clinician, and the chief clinical officer of Seeking Integrity LLC, which provides residential and online treatment, education, and support for male sex and porn addicts, some with co-occurring substance-abuse disorders, and their families. He’s created six residential intimacy and addiction treatment programs and is the author of 11 books, including ProdependenceSex Addiction 101, and Out of the Doghouse.