Codependence: Is It Time for a New Model?

Source: Shutterstock

In nearly 30 years as an active master’s level psychotherapy provider, educator, and creator of addiction treatment programs throughout the US and abroad, I have never felt entirely comfortable initiating family treatment by using the codependency model. Sourced in the trauma and systems theories of the 1970s and early 80s, codependency’s early-treatment emphasis on looking for pathology in an addict’s spouse, partner, or family (arising from situations that pre-date the current crisis) rather than looking at the current trauma of living with an active addict has always felt misplaced and misguided to me.

The codependency paradigm’s enduring emphasis on finding “something wrong” with the non-addicted family member, to me, ignores the power of our deep and enduring human experiences of attachment and connection. Thus, I cannot imagine telling a deeply hurting wife (for example) in deep crisis and fear over losing her most meaningful connection (spouse/father of her children) to a problem with alcohol that anything she has tried to keep him from falling into the abyss should be thought of as anything except loving. I mean, who taught any of us how to properly and usefully stop a loved one from drinking or using? I don’t remember learning that in high school, do you?

Thus, I have worked hard over the last few years to create a useful model for supporting spouses, partners, and family members of addicts — a model that approaches them from an attachment (and not an early-life trauma) perspective, and validates them for doing everything they can to save their failing loved one and family, regardless of the quality of their attempts. To this end, I researched codependence while hoping to find or develop a more loving and useful paradigm.

After reading pretty much everything ever written about codependency (before, during, and after the term was coined) and conversing with countless colleagues at every level of clinical addiction treatment, I have reached the following conclusions:

• There have been so many adaptations of codependency that the original intent and clinical stance of the movement’s progenitors (Black, Beattie, Cermak, Norwood, and others) bears little resemblance to the work that many clinicians provide to spouses, partners, and family members of addicts.
• For the most part, clinicians still call spouses, partners, and family members of addicts codependent, even though the original meaning of the word and subsequent treatment has nearly been lost.
• Despite many, many adaptations and renewed versions of the term and the treatment, codependency asks spouses, partners, and loved ones of addicts to question their motivations and their history of caregiving in ways that often feel alienating and dismissive of their experience. It asks them to look back at their past for solutions to a problem that is happening here and now.
• As explained in the original texts on codependence, codependence tends to feel more blaming, shaming, and pathologizing than welcoming. And because of this, exhausted clients in crisis over a loved one’s addiction will often walk away from treatment (feeling blamed and made partially responsible for the addiction) before we can even start to help them.
• Codependency has never been a formalized DSM diagnosis. (So what is it exactly?)

In my experience, and in the experience of many of the clinicians I have spoken with, caregiving loved ones respond to the suggestions of codependence with comments like:

• My spouse/child/sibling is addicted, and you’re telling me that I’m the one with the problem?
• What do you mean I’m enabling the addiction and making it worse? All I do is work to keep this family going.
• How can I possibly walk away from a person I love, especially when that person is so very broken?
• I work three jobs, give away all my free time, and forgo self-care to help this family survive, and now you’re telling me that I’m part of the problem?

Because of the challenges to the codependency model that I hear from both my peers and this treatment population, I have created a new paradigm to support the spouses, partners, and family members of addicts, one based and sourced in attachment theory. I call this new model "prodependence."

With prodependence, clinicians need not find that something is wrong with caregiving loved ones of an addict in the early stages of treatment. Even when a spouse’s caregiving is less than productive or outright problematic, we can reframe the behavior in a positive light as having initiated from love and attachment. We can acknowledge the trauma and inherent dysfunction that occurs when living in close relationship with an addict, and the pain and confusion that causes, without having to ask the client to look back at his or her past (for quite some time). We can then help the client find more productive and effective ways to support an addicted loved one — without making prior attempts wrong or sourcing those attempts in the client’s early-life trauma.

With prodependence we can say things like:

• I am so impressed with the ways you kept your husband from drinking and driving. How clever of you to bring liquor home for him to drink so he wouldn’t go out and get yet another DUI. And you did it! Once you started bringing home bottles at night for him to drink, he stopped driving drunk. Good job. And while that solved one of your problems, I wonder if we can work toward some new methods together that might help end his drinking altogether.

Now let’s compare this to a codependence-oriented statement such as:

• I’m troubled by the fact that you have been bringing home bottles and thus enabling your husband’s drinking. I think you’re making things worse rather than better. When you enable in this way, it’s like you unconsciously support the problem (even though you consciously want it to go away). So, I think your best next move is for you to detach from his problem and focus on yours. I wonder what has happened to you in your past that would leave you enabling a loved one to stay in this way, rather than trying to help him find a way out.

Which of the above statements do you think is more likely to build a solid therapeutic alliance? Which statement do you think will leave the client feeling understood and hopeful? And which statement do you think will leave the client feeling personally responsible for her husband’s alcoholism and thus more hopeless/helpless?

Codependency Essential Reads

How to Become Someone Who "Matters"

Collective or Codependent?

Interestingly, prodependence recommends and implements the same basic therapeutic actions as codependence: a fresh or renewed focus on self-care, implementation of healthier boundaries, and an ever-improving response to the addict and the addiction. But prodependence views this work through a different lens. Prodependence does not ever ask loved ones to doubt themselves, to doubt their love for the addict, or to consider some of their loving as pathological. Nor does it give them any reason to feel as if they are “part of the problem.” I believe that we can create change in such partners by validating their efforts as being nothing but love — no matter how ineffective — and then shifting their efforts toward becoming more useful. We do not need to discuss enabling, past trauma, or the spouse having contributed to the problem.

Regarding the end-goals of treatment for family members and for the addict, the prodependence and codependence models are mirror images, but with one profound difference. The models vary significantly in how the therapist/counselor/clergy frames “the problem.” Consider the following chart delineating the “typical traits” that are often seen and called out by clinicians when working with loved ones of addicts. In the left-hand column, I’ve listed the words that we see in discussions that utilize the model of codependence. In the right-hand column, I’ve listed similar traits but reframed from a prodependent perspective.

Codependent Versus Prodependent Traits

CODEPENDENT TRAITS PRODEPENDENT TRAITS

Enmeshed Deeply involved

Externally focused Concerned about others

Enabling Supporting

Fearful Concerned

Lacking healthy boundaries Eager to care for a loved one

Can’t say no Chooses to say yes

Obsessed with the addiction Determined to protect the addict

Living in denial Unwilling to give up

Angry Fearful of further loss

Controlling Trying to be heard

Hypervigilant Anticipating problems

As stated above, the primary difference between these two models lies in how we frame the problem to our clients and to ourselves. Prodependence, as an attachment-based model, applies a positive and supportive lens toward the client (and his or her behaviors), essentially meeting that loving caregiver where he or she is (trying to solve an ongoing crisis being evoked by an addicted loved one, a problem not of his or her making). Codependence, as a trauma-based model, closely examines the spouse’s past/present activities, looking for connections and calling out the client as having some kind of pseudo-pathology that often makes that person feel more self-doubt and fear than hope.

To be fair, many spouses of addicts do have trauma and emotional baggage. And once the crisis stage of healing is passed (their spouse is now sober or they have separated), that client may want to explore deeper forms of inner-work (addressing unresolved trauma, for instance). If so, that’s great. And that is often what occurs. When the dust has finally settled and the addiction is being adequately addressed, such clients will say, “I’m beginning to wonder if anything about the way I grew up might relate to me choosing this person and tolerating the dysfunction he/she creates.” At that point, the door is open for deeper work. However, in the early stages of treatment, that’s just not where the loved one of a troubled individual is likely to be. And attempting this deeper internal work too soon often leads a client not toward crisis resolution, better boundaries, and improved self-care, but to increased anxiety, self-doubt, and overall shame that he or she is part of an escalating (if not causing) the problem (the addiction).

This type of “codependent shaming” is counterproductive. And yet these partners and spouses clearly do need all the support, validation, hope, and direction we can offer — as does anyone who comes into our offices in the midst of a crisis. Thus, prodependence very clearly states that loving and caring for an addicted or otherwise troubled person is not a pathological behavior, even if that love and care occasionally runs off the rails and turns into enabling, enmeshment, and control. Instead, (because it is sourced in attachment theory), this person’s help is viewed and validated for the beautiful, wonderful, natural, and life-affirming thing that it is — period. Prodependence states that instead of labeling and pathologizing loved ones of addicts when they refuse to abandon their caregiving roles, we should thank them for their efforts and encourage them to continue their pursuit of love and emotional intimacy — but with help and by using healthier, more productive actions.

This simple reframe can make the difference between such caregivers joining the family treatment process vs. their feeling alienated by it. First and foremost, it moves therapists away from thinking about caregiving loved ones of addicts as being difficult clients when they rebel against being asked to take early responsibility for being a part of the addiction. Instead, we can view them as ideal clients because they’re willing to expend tremendous time and energy to invest in the world of those they love to make things better. All we need to do as clinicians is provide a bit of guidance on how they might better achieve this. At the same time, it gives our caregiving clients a supportive, empathetic framework they can accept in the early stages of treatment.

To me, prodependence is a win-win. The model is designed to validate all the helping/rescuing efforts of the loved one — however those actions may have worked out — while offering these loving people new ways to grow and heal their situation. And all this without these loving spouses being negatively labeled as having their own problem (codependence) and without asking them to explore their past while they are in an immediate crisis — a path that is never recommended and rarely productive.

Am I going to take heat from my peers for attempting to move the needle of family addiction treatment for the first time in 35 years? You bet. Am I eager for the challenge? Bring it on! If it helps keep people in treatment longer, if it helps families heal faster, if it leads to better outcomes, I’m all in.