 This episode was prerecorded as part of a live continuing education webinar. On-demand CEUs are still available for this presentation through all CEUs. Register at allceus.com slash counselor toolbox. I'd like to welcome everybody to today's presentation on codependency. So what we're going to start out with today is kind of defining codependency and then comparing and contrasting codependency with traits of substance use disorder or what we would think of as addiction. And then we're going to move into more specific issues for screening for codependency and some different interventions we might be able to use. So codependency can serve as an alternate addiction or a distraction from recovery for people. So you may have somebody who has a substance use disorder who also is codependent. So they're not necessarily mutually exclusive. Codependence must use relationships to try and deal with depression or anxiety. They derive most of their purpose and we're going to talk about this a lot from caretaking. Ultimately codependency is a self-defeating because one of the few things that cannot be controlled is the will of another person. So no matter how much somebody tries to rescue and tries to help, if that person is not willing to engage in treatment behaviors or is not able to do what the codependent wants, then the codependent ends up feeling depressed, anxious, angry, all kinds of dysphoric stuff. Codependency describes a type of relationship in which one partner defines his or her worth or goodness based on someone else. The codependent person often chooses relationships in which the other person needs to be rescued thereby making himself or herself indispensable. So when we start thinking about it, I mean really thinking about what's going on, what's the purpose when somebody chooses relationships and really looks for relationships where somebody needs to be rescued or tends to go to those sorts of relationships, what function is the relationship serving? Is it serving a mutually compatible, self-affirming, building, inspiring function? Or is it one because if I don't feel indispensable then I'm afraid you're going to abandon me. So warning signs that we want to look for. If people have an excessive and unhealthy tendency to rescue and take responsibility for other people. Some of our clients and codependency isn't a DSM diagnosis. So this isn't something we're going to be seeing a list of criteria for. But when we start talking with some of our clients who have anxiety or depression, a lot of times we may hear signs or we may hear tips that they do tend to get in relationships where they're rescuing and taking responsibility for other people. We want to help them see what the function of that is. And when they're looking at in the big scheme of things what creates a rich and meaningful life for them and how to achieve that, is it that person that they're in a relationship with or is it being able to nurture and care give or is it being in some sort of relationship because they're afraid of being alone. We want to look at who and what is important in this person's life and how does this relationship where somebody needs to be rescued fit in. They derive a sense of purpose and boost their self-esteem through extreme self-sacrifice to satisfy the needs of others. And if you look at your stereotypical codependent enabler in an addictive family, that person is going to do a lot of covering up for the addict and sacrificing themselves doing whatever they need to do to keep that perfect facade to the outside and to rescue buffer or enable the person who is struggling with the addiction or whatever else. They choose to enter and stay in lengthy high-cost caretaking and rescuing relationships despite the costs to themselves or others. So again, looking at what's the cost of this? Yes, you feel something, true. But is this something you can only get from this person? And again, what is the function of this behavior? What would happen if you woke up tomorrow and this relationship weren't there anymore? Let's talk about what that would look like, what would it feel like and how would you manage if this relationship didn't exist anymore? They regularly try to engineer the change of troubled, addicted or under-functioning people whose problems are far bigger than their abilities to fix them. So they come in going, I will rescue you, I am super person and you like my little thing there? Okay, anyhow. But they try to fix it and they try to manipulate everything and we know whether you're a parent or you're a supervisor or somebody's tried to control your behavior, we can't control everybody. We are not working with Marionette's here. So they're trying to engineer and change things but there maybe and likely is stuff way out of their realm of training like mental health stuff that needs to be addressed and interpersonal things, trauma from the past, social skills, job skills. There's only so much that any one person can do. Even a therapist, we have our limits of confidence and then we refer out for other things and the codependent really wants to do everything. They don't want to let anybody else in because that might risk the person leaving. They seem to attract low functioning people looking for someone to take care of them so they can avoid adult responsibility or consequences or they attract people in perpetual crisis unwilling to change their lives. I've even seen this in some colleagues who regularly end up with friends because they're good listeners. They've been trained to be therapists or peer supporters or whatever and so people who need help or who are in perpetual crisis often flock to them. The question is how that person handles it and whether they start self-sacrificing and it starts draining them or they're able to set healthy boundaries and refer the person out, help them that way. They have a pattern of engaging and well-intention but ultimately unproductive, unhealthy helping behaviors such as enabling. If your spouse gets a DUI and you happen to be a prominent attorney and so you make sure that DUI goes away so your spouse doesn't have to get the DUI on their record. Well, that's well-intentioned. However, now you've potentially called in some favors, you've risked your reputation and there is no motivation for your spouse to get help necessarily. So looking at what the behaviors were, what the intentions were and validating, your heart was in the right place. However, is it going to have the outcome you hope? And one of the things that I do with some of my clients is I encourage them to play it out. Okay, your wife got a DUI. You don't want her to suffer the consequences because it's going to suck. No doubt about it having to go to a substance abuse assessment and pre-empt probation and anything else that you got to do. It's just like a coops to jump through. So I can understand this and she won't have a driver's license which is going to cause some problems. So let's play it through. If you make this charge go away, what's going to happen? Is she going to do it again? Is she going to learn her lesson and spontaneously change? Usually the first time people think that the other person is just going to learn their lesson and never ever do it again. And that's what we want. We want them to if they feel like they need to reach out the first time and they feel like in their head, heart and gut it's the right thing to do. That's your choice. But if you keep doing it time after time after time, I had a family member who kept bailing her daughter out of jail time after time after time and the daughter wouldn't change. She was just back out doing the same thing. So it's important to be aware of, you know, is the person learning from it. So playing it out. If you make this charge go away again, is she going to change this time? Or is she going to go back and do the same thing again and possibly kill herself this time? Okay, so let's play out the other scenario. You let her experience the natural consequences. Having to go to court, losing her license, jump through all those hoops. Is that going to change anything? And if the answer is no to both accounts, then treatment's probably an important referral here anyway. However, a lot of times once the legal system gets involved, you know, in terms of if we're talking about a person with an addiction, then there's a little bit of motivation to do the next right thing. There's some bite to not following through with what you're supposed to do. So let's look at codependencies and addiction. Tolerance. The need for more of the same substance or activity to get the same feeling. In a codependent relationship, as time passes, the codependence identity becomes increasingly defined by the relationship with the other person. So if that person goes away, and we'll talk about this down in withdrawal too, they need to be around that person more often. And they need, because they're kind of becoming, they're morphing into one person, they're losing themselves. So in order to feel okay, they need to make sure that they're still joined at the hip, so to speak. Withdrawal means not getting the substance, being around the person results in physical, not being around the substance results in physical or psychological withdrawals. When the codependent is apart from the codependent D or from the addict, they're unable to control that person. Generally, if you're not in the same proximity, it's harder to control. Now they may call them, they may phone stock them, but it's harder to control them. So they may start getting worried that the person's going to abandon them or make another mistake that they're going to have to clean up. So the codependent starts experiencing extreme anxiety and or depression. Because codependents, just as much as people with addictions, tend to need to control everything that they can. They spend more time thinking about engaging in or recovering from the behavior. You know, this is common one in addiction. When people are spending time thinking about their drug or gambling, engaging in gambling or they're using their drug and recovering physically, psychologically, and financially from use. Codependents are always hyper-vigilant to the other people's behavior and obsessing about what they're not doing or what they're doing. So their life revolves around thinking about this other person. What is he doing? What are his motivations? Codependents spend large amounts of time rescuing or covering up for the other person and fixing it. So engaging in this codependent behavior. And the codependent gets exhausted taking care of the other person but cannot stop because they rely on the other person to tell them they're okay. So they're recovering from the behavior and they can't seem to get out of it because if I don't do this, then I'm not okay. If this person is not there to validate me, then I kind of disappear. So real weak ego strength. Forgoing other interests in order to maintain the addiction. So the relationship is the drug of choice in the codependent's lives. Having that person in their life makes them feel okay or whole. And the relationship takes the place of self-love. So we see, you know, a huge glaring sign here of a step that we can take in treatment is helping clients develop self-esteem and the ability to love themselves and not rely on other people to say, you know what, you're okay. You know, we need you in this world. They can look in the mirror and go, the world needs me, thank you very much. Continuing the addiction or the relationship despite negative consequences, emotional consequences. A person who's codependent experiences frequent bouts with depression, anxiety, anger, and resentment, especially when they can't control the other person or when the other person is not doing well. Social consequences can include loss of other friends because sometimes friends will see what's going on and go, you know, Sally, this is really not helpful to you right now. This is not healthy. And this is not helpful to the other person either, potentially. And eventually friends may back away because codependents tend to take sort of a martyr position sometimes. And sometimes friends get tired of that going, well, eventually friends get to the point where they're saying, you stayed in the situation. I don't know what you want me to say. Physical consequences of codependency, stress-related physical issues, and we know that there's a myriad of those. And occupational, the codependent is going to call in sick to take care of the alcoholic who's hungover. The codependent is probably going to have poor job performance because they're focused on the addict who is not in their direct presence. The codependent is going to suffer in their job performance because they're plum exhausted from worrying about the person with the addiction. So you can see, you know, all the prime characteristics of a substance use disorder can be applied to codependency and these relationships. They can be very, very toxic. So what is similar between addicts and codependents? Because you would say, you know, well, what's the function of the addiction? What's it doing for the person? Or, you know, how can we... What sorts of issues might this person be dealing with? And we find that the issues that are similar are similar between addicts and codependents with a few exceptions. So both have low self-esteem. Most people with addictions tend to feel like... feel ashamed, feel like they're not worthy. I don't think I've ever met a person with a full-blown addiction that truly feels all that good about themselves. They may be very successful in certain things, but they may also recognize that they're not living the kind of life they want to. Both tend to struggle with depression and anxiety and a need to control. So we can help people develop distress tolerance... Wow. Distress tolerance skills. We can help them address cognitive distortions. We can help them work with radical acceptance and we can help them use techniques, such as acceptance and commitment therapy to address their need to control everything. They need to start learning what things they can control, what things they can't control, and how to cope with those things that are out of their control. So when Jim Bob goes out and drinks all night long, even though you told him not to, you feel angry and resentful. You couldn't control that behavior. How do you deal with that? Because you can't control another person. How do you deal with it so it doesn't destroy you? Both struggle with fear of abandonment. It's really a common theme in people with addictions as well as people with codependency issues. Because their self-esteem is low, they tend to need other people to validate them and if they don't have other people validating them, then they kind of feel like they cease to be or they feel unworthy. So they need to be surrounded and when people disagree with them and people leave, that abandonment is almost like ripping apart their heart out. Relationships often comfort and numb in codependency especially, but sometimes in addiction. You know, I see a ton of unhealthy relationships that are based a lot of times on merely physical presence and sexual involvement in order to comfort themselves. I can tell you stories after working on a coeducational unit for 20 years about the lengths people will go to for relationships. The relationship becomes the addict's primary focus. So this is true with codependence, with people with addictions, if they're blocked from their primary addictions such as in treatment, we can quickly see them moving into focusing on a person and or sex. Minimizing, denying and blaming to protect the relationship. I've seen people with addictions use all of these, minimize how bad their problem is, deny they have a problem, blame others. I wouldn't have to drink, I wouldn't have to use. But we also see this in codependency. They minimize the impact that the relationship is having on them. They're like, you know, it's not that big of a deal. They deny that the person with the addiction is or this relationship is not helpful. And they tend to blame others. Well, if you would help me with this person or blame the person, if you would do the next right thing and get better, then I wouldn't have to take care of you. So there's a lot of throwing focus, throwing blame instead of taking responsibility. A lot of stinking thinking in both. And if you're not familiar with this term, that's really cognitive distortions. Global negative internal attributions. The world is against me. What the DSM-5 tends to refer to as neurotic behavior. Addicts and codependence both have difficulty identifying what they're feeling. With a person with an addiction, well, with both of them, but especially with a person with an addiction, my experience has been sometimes they don't have the words to put to it. They just don't have the emotional vocabulary. Sometimes they've been numb for so long that they don't feel anything anymore. Sometimes trauma has made people emotionally solid. So we need to be aware of those things. People with codependency often can't identify what they're feeling because they take on the feelings of everybody around them. They're like the little chameleon. I don't know if you've ever watched the Bugs Bunny cartoon where there was a chameleon in there and he walked in front of a pink screen and he turned pink and a blue screen and he turned blue. And then Bugs Bunny threw up all these polka dots and he walked in front of it and just freaked out because they were multi-colored polka dots and he freaked out because he couldn't be all of those things at once. And that's kind of the way people with codependency may feel sometimes too because they're in a room and there's this person that has this feeling that's angry and resentful and there's this person that's sad and there's this person that's addicted and you're wanting to fix them and you want to rescue them. So there's multiple feelings and you're trying to rescue multiple people. Think about being on a ship and there's 15 passengers overboard and you're trying to figure out how to save all of them and one person can only do so much. Lack of empathy for the feelings and needs of others. Now this is interesting because codependence you tend to think are over-concerned about the feelings and needs of others. However, sometimes they kind of switch and they're like, you know what? I need you to do this. You need to do this for me. I need you to get better. I can't live without you and you know, I don't care what you need right now. I need you to follow directions. Both addicts and codependence may mask pain in various ways such as anger, humor or isolation. They experience and we want to help clients start identifying when they feel hurt, when they feel depressed, when they feel angry or betrayed, how do they react? You know, when they feel those feelings. What is their emotional reaction? What is their behavioral reaction? So we can help them start identifying and becoming more cognizant of when they feel hurt and develop skills to effectively resolve that hurt instead of lashing out in anger, making a joke or just withdrawing completely and going to their room. They both often experience significant aggression, resentment and negativity. Anxiety builds up when you can't control everything in your world, when you feel like everything's spiraling out of control and you're just holding on with this death grip. Yeah, I can see where you would feel threatened periodically because, you know, we know that aggression, anger is a response to fear and threat. They have difficulty making decisions because there's just too much. It's overwhelming. They're trying to make everybody happy and pacify everyone. Judge what they think, say or do harshly and is never good enough. They have this negative internal voice that says you're not good enough, which is another reason they need external validation to say, yes you are, you're good enough. So we need to help them silence that internal critic as well as develop a positive, strong self-esteem. They value others' approval of their thinking, feelings and behavior over their own. So a lot of times with people who are codependent, none of these are all the time. This is just kind of general characteristics we're looking at. If they get rejection, if somebody disagrees with them, it is like pouring salt in a wound. They don't handle other people's dissension very well at all. Even if it's not a big deal, if you disagree on politics or religion or what the best color of car is, it can be something that's not super critical, but anything that, when anybody disagrees with the codependent, it feels like just absolute raw rejection. And they don't perceive themselves as lovable or worthwhile people. They seek recognition and praise to overcome feelings of less than. So you see this theme keep coming up. So a lot of these we can knock off with self-esteem work and helping people learn how to set healthy boundaries and develop an understanding of what a healthy relationship looks like. Healthy relationships, there are arguments. There are discussions. I mean, Ward and June Cleaver are not a good picture of a healthy relationship because I don't think they ever argued in any single, in any single episode. There were a few other shows of the time where occasionally they would argue. I think life, my personal experience and impression is life is more like I love Lucy than leave it to Beaver. And you know what happens? You get into disagreements, you make up, you apologize. Each person occasionally makes a bad decision. It happens. And people who are codependent need to learn how to do that. So they learn that an argument doesn't mean the person's walking away. It doesn't mean they hate you. It means you had an argument over something. And healthy relationships sometimes result in conflict. How you handle the conflict is also important. They need to appear to be right in the eyes of others and may even lie to look good. Again, wanting that approval. I'll say whatever I need to say be that chameleon in order to get your approval. They're unable to identify or ask for what they want and need. Mindfulness activities are really awesome for people who are codependent because we need to start having them check in with themselves and separate not what your kids need right now. Not what does the addict need right now. What do you need? In order to feel happy, healthy, and fulfilled. And they have trouble setting healthy priorities and boundaries. So once we identify what you need in order to feel happy, healthy, and fulfilled, how can we set priorities and boundaries where you can say, you know what, no. This is, for example, today is Saturday and this is my family time so I am not going to come bail you out of jail for the 14th time today. And help them learn how to put themselves and what's important in their lives first. Both use blame and shame to control and adopt an attitude of indifference, helplessness, authority, or rage to manipulate outcomes. And it depends on the person. Some people, if you're like, okay, whatever and you start to walk away, they're like, wait, wait, wait, wait, wait, wait, wait. Come back. Think about a car salesman. They will pursue you aggressively if you're indifferent. If some people react more to helplessness so if the person acts helpless then other people will come to their rescue. Other times, it behooves them to be more authoritarian so they behave that way. People with addictions and codependency issues are amazing at reading other people and pushing their buttons. They are really good at manipulation, which, when harnessed appropriately, can be really helpful in communicating when they're using it to get their own way, not necessarily because it also can keep them sicker. Sometimes they use recovery jargon in an attempt to control the behavior of others. You know, I'm doing my 90s and 90s, so clearly I'm sober. Okay, I don't know what that means, but okay, sure, it sounds like you're doing something. And they may pretend to agree with others to get what they want. Codependence. I said there were a few exceptions. Codependence tend to believe people are incapable of self-care. So the codependent derives their importance, derives their sense of worth on helping other people. Well, to help other people, they need to have help or they need to need help, which kind of translates to everybody around me is incapable of self-care. So I'm going to make myself indispensable and I'm going to make sure they're okay. They may try to convince others what to think or feel, telling them how they should feel. And remember, when there's dissension, when somebody disagrees with the person with codependency, they tend to get their feelings very, very hurt if it's not right. They offer unsolicited advice and direction, you know, you need to do this. They may become resentful if their help is rejected. So maybe you're moving into your new house with your new husband and your mother-in-law wants to help decorate the house. And you say, you know what, no, you know, you say it nicely, but you reject her help. And she just loses her stuff thing and becomes terribly resentful. You know, that's, you know, one example, lavish gifts, favors or sexual attention on those they want to influence. So codependency, since it's sort of a addiction to a relationship, sort of an addiction to interactions, you can see how a person with codependency issues may use a relationship to influence others because they want that love back or attention back. And they often demand that their needs be met by others. And if those needs aren't met, then they go into, they become angry, resentful, depressed or anxious. So interventions, now we're to the fun part. One of the first things we want to do is identify the benefits, well, maybe not first, identify the benefits to the relationship and the benefits and drawbacks to being single. This is going to highlight a bunch of issues for a lot of people. I find that helping them do a decisional balance exercise can really help ferret out some of the reasons that they need to rescue, that they need to be engaged in these kinds of relationships. And it's important, again, to differentiate between helping and codependency. At what point do you cross that line? And it really becomes when it's self-defeating and when it's not helping the person. And like I said, I've seen therapists also and counselors also go down the same road where they start helping too much or establish dependencies because they need to be needed by particular clients. So we want to identify the benefits, let's start with the benefits to the relationship. You're in it, this person will stay with alcoholic for right now because that's your stereotypical codependent image is the enabler and the alcoholic. What's the benefit staying in this relationship? And they may say, well, it's my kid's mom. We've been together since we were in high school. I love her, yadda, yadda, yadda, this whole laundry list of reasons they're staying because they figured out a bunch of reasons they're staying in order to convince themselves and to tell other people. All right, sure. So we've got that list. All valid reasons because they're your reasons, they're valid. Now, let's look at the drawbacks. What are the drawbacks to staying in this relationship? And they generally have a laundry list of these two because they thought about leaving and when things get bad, when they can't control the alcoholic, then they start thinking about all the reasons that this is not working out and they can't do this anymore. Okay, so now we've got those. Those are pre-designed, but then we go over to the other side and this they often haven't thought about. What would be the benefits to being single, to not being in a relationship for a while? I'm not talking about getting in another relationship and rescuing somebody else, but to actually developing a relationship with yourself. What are the benefits to that? And you hear the crickets chirp. A lot of times it takes a little prodding and socratic questioning to help people start figuring out and sometimes I'll leave this quadrant relatively sparse and then we'll add to it as we go through counseling as they realize, you know, okay, yeah, you know, one of the benefits of being single is I might actually start to get to explore some hobbies that I've wanted to. All right, let's put that there. And then the drawbacks to being single and they may have thought about this before. What are the drawbacks to leaving this relationship and list all that? And some of it could be financial. A lot of it's emotional. Let's just start looking at those things and evaluate it. And we help them get objective information such as if they say that they're staying in that relationship because that's the kid's mother and the kids need their mother. Well, yeah, the kids need their mother. That's true. You know, we need our parents. That's kind of why God put them on this earth. However, is this relationship dynamic and this family system the best situation for right now? Not necessarily advocating for divorce or complete separation, but it may be one of those things where the codependent has to step back and say, what's best for my kids at this point? Is this really the best for them? So have them investigate. Have them learn about the effects of codependent relationships and alcoholism on children and have them make their own decisions about how they can improve the situation at least for their kids or improve the situation for themselves so they can do better at work so they're not exhausted all the time. We need to remember that codependency like other addictions is often used to escape, distract or avoid pain. Oftentimes it's emotional pain when we're talking about this because it doesn't do much for physical pain, but codependency, if I am focused on helping the alcoholic, if I am focused on controlling the alcoholic, if I am focused on every breath the alcoholic takes, then I don't have time to think about how disappointed I am or how unfulfilled I am or how lonely I am or how any of that stuff. I can't think about me because I'm thinking about this over here. When I go to the doctor, I'm a big old sissy about getting shots and I just got my flu shot this year and that's unpleasant. But instead of focusing on the needle going into my arm, I distracted myself in order to avoid feeling the pain. When bad things happen, I experience them or whatever, but then at a certain point I need to distract myself from those things if they're not going to get better, like after there's a death. It's like, okay, got to grieve, but I've also got to start moving on. With codependency, they use that relationship to focus outside themselves. The problem is they never check back in. Most of us, when we're dealing with pain of some sort, grief, we distract ourselves for a little bit to give us a break and then we come back, we deal with it and then we distract ourselves. The person with codependency is just always out here. They have no idea what's going on or festering inside. So encourage clients to begin self-esteem work. A lot of their pain often comes from self-esteem, abandonment issues, lack of healthy attachments in childhood. Depending on your therapeutic approach, you can argue different things, but we want them to start developing self-esteem so they're not needing external validation and they start feeling like they deserve to be treated a certain way and they deserve more from life and they deserve to be happy. This will start laying the groundwork and then we start encouraging them again to use that mindfulness to identify how they're feeling. If they're feeling depressed or hurt or lonely, they may not have the words to put to that. We may have to help them find that emotional vocabulary. Art therapy can be really good if clients aren't used to identifying their feelings or their reactions. Art therapy. One of my clients had a really hard time and he was just like, I'm not artistic. I'm like, well, neither am I. I do really good for stick figures. But we took a box of crayons and I poured them into a big bowl and I said, what color do you feel today? He would draw out a color like yellow, for example, and I'm like, okay, yellow, what does that mean? I said to me, yellow represents bright and cheerful and spring and he'd be like, yeah, I feel pretty good today. I feel pretty energetic and then sometimes he would pick out brown or whatever and we would talk about what that color represented to him and it wasn't necessarily all about feeling words and it was a little less warm and fuzzy, if you will, because he wasn't real comfortable talking about feelings but we could talk about what the color represented. Cheerfulness, contentment, sadness, feeling like you're drowning, whatever. There were a lot of different phrases that came out of that and gradually he began to start to be able to identify those feelings, put words to it and then we could start working it, okay, you're feeling abandoned or out of control right now. Instead of trying to distract from it, what can we do to deal with it? So screening questions. And these are things that we can ask clients. You don't have to do them all in one setting unless the client, especially if the client starts indicating that they're either living with or grew up in a family where there was someone with an addiction, then we may want to go through these more in depth. If that stuff doesn't really come up, then you may just listen for these or periodically ask one or two of these, throw them in there to see if codependency may be an issue as you're, you know, getting to know the person. Do you keep quiet to avoid arguments? Sometimes codependence will bite their tongue. They just, they don't want to make waves. I remember my grandmother, a sweet little woman, and I say little, she was, you know, five foot tall and maybe a hundred pounds soaking wet. My grandfather was like six foot three big guy and he got to be kind of cranky when he would drink. And most of the time she would just put her around and she wouldn't get the kids to be quiet and they would kind of walk on eggshells and but she would keep everything together. And I was in third grade, you know, so the kids were, her kids were grown, my parents and there was one day that he came home and he was drunk and he was just in an awful mood and she looked at him and I have to add she is just the epitome of the Catholic woman. I mean, she says her rosary every day and you know, never says a swear word and a little bit of a thing. He comes home, he's in a mood. She looks at him, she's like, you know what? And she flips him the bird and he just kind of stands there in shock for a second as did the rest of us. And she went back to cooking and about 30 seconds later she turned around and said, you know what? On second thought, take a whole handful and walked into the bedroom and we were all just like, grandma just got some attitude. Not saying that that's the way to do it but she had kept quiet for so long and then she finally was like, you know what? I deserve better than this. I'm not going to live like this anymore. She started standing up for herself and was, I mean, she was good about it. We want to ask clients though, do you avoid talking about your feelings? If you get your feelings hurt by a friend, do you just not say anything? Because I don't want to make waves and you know, maybe if I say something they'll get mad at me and they won't want to be my friend anymore. Or you know, when something happens do you address it, get it out in the open and move on. If they keep quiet to avoid arguments then assertiveness, skills can be very helpful and we can help them see how shoving that stuff down, you know, constantly not stating their needs and their wants can lead them to feel resentful and helpless and hopeless. So we can help them see why assertive communication would be good and provide them those skills if they think that's useful. Obviously, we want the client to start taking the role and people who are codependent are not going to make waves. A lot of times they're not going to question what we say. If we said, you know, stand on one leg and cluck like a chicken, I hope you would never do that because that would be a ethical violation in so many different ways. But if we did, they may not argue because they'd be like, well, I was told to do it and I don't want to make arguments, I don't want to make waves. And they also may modify how much they tell us in order to give the best picture because they don't want to be rejected. So we've got to kind of bear that in mind and make sure that we are validating of how they feel and of their reactions, if necessary. Are you always worried about others' opinions of you? Why? What does it matter if Sally that lives three doors down from you can't stand you? And talk about it. You know, try to fair it out why other people's opinions are so important. Could be that's the way they grew up. Their parents always taught them to be concerned about what everybody else thought of them. So we want to start looking at where are these cognitions, these beliefs coming from that are saying that we need to care deeply and desperately about everybody else's opinions. Have you ever lived with someone with an alcohol or drug problem? You know, what was that like? Have you ever lived with someone who hits or belittles you? Obviously, these are screening questions that could lead to a domestic violence screening or something like that, but just asking them because it's not uncommon for people who are domestically violent or people who have an alcohol or drug problem to be in relationships with people who are codependent. Are the opinions of others more important than your own? You know, sometimes people may say certain people's opinions are. You know, I used to put my father's opinion really high, you know, whatever his opinion was. Was usually pretty good. I usually, I did my own thing anyway, but his opinion mattered a lot to me and a lot more than other people's opinions. But ultimately, I was the one living my life. So, you know, my opinion really mattered and it's important to have our clients really figure out whose opinion matters in terms of how I live my life. Do you have difficulty adjusting to changes at work or home? If you're trying to control everything and you're holding on, then when things start to change, it can throw you for a loop. Do you feel rejected when significant others spend time with friends, fear of abandonment? So, we want to start working on those issues and why is it that you don't want to share with your friends or with your person with their friends. And a lot of times it comes down to, number one, they owe me because I've taken care of them through all of this. And number two, I'm afraid if they start spending time with those people that they're going to replace me. Do you doubt your ability to be who you want to be? Are you uncomfortable expressing your true feelings to others? And have you ever felt inadequate? I think most of us have felt inadequate at one time or another. So, none of these are necessarily screen in or screen out questions. It's just giving us a better picture of what may be going on. Do you feel like a bad person when you make a mistake? So, this leans more towards assessing self-esteem and global internal attributions. Do you have difficulty taking compliments or gifts? Self-esteem, feeling worthy? If they do, we want to look at why and help them address that. Do you feel humiliation when your child or spouse makes a mistake? They couldn't control because that shows that they couldn't control absolutely everything in their life. Do you think people in your life would go downhill without your constant efforts? Do you frequently wish someone could help you when something's done? So, they take on this. They're trying to rescue everybody. Then they start getting resentful when people won't do what they want them to do. And they start feeling overwhelmed because they've got too much to do. So, you can see how the martyr aspect can come out. Do you have difficulty talking to people in authority, such as the police or your boss? Are you confused about who you are or where you're going with your life? Do you have trouble saying no because they're taking on the opinions and ideas of everybody else and they're so-and-so's spouse or so-and-so's parent? Do you have trouble saying no when asked for help? Trouble asking for help? This comes straight out of the dialectical behavior therapy manual on helping people ask for things and get yes and say no. So, teaching healthy boundaries. Do you have so many things to do at once that you can't do justice to any of them? And this is a question that I find is really powerful for a lot of clients because it makes them stop back and step back and think and go, you know what, you're right. You know, I want to be everything to everybody and right now I'm no good to anybody because I'm just doing so much and then you see, then we can say, okay, so let's make a list, let's prioritize, let's figure out what direction you want to go. So, the coda promises. I will know a new sense of and coda is codependency anonymous and even if someone is not completely bought into the 12 steps, recovery from codependency does offer some liberation. So, you can, you know, look at how you may want to use these but I will know a new sense of belonging, the feeling of emptiness and loneliness will disappear because they'll become friends with themselves and hopefully they will become friends with their healthy social supports and maybe a higher power. When I work with clients with in 12 step programs or places where we use 12 step programs, not everybody buys into the higher power. So, one way we talk about it is God as good orderly direction. So, if you think of acceptance and commitment therapy looking at those people, places, things and experiences that are important to help you live a rich and meaningful life. That is your destination. Good orderly direction makes sure that everything that you do is moving you toward that rich and meaningful life and not taking detours or worse yet making you turns. I am no longer controlled by my fears. I overcome my fears and act with courage, integrity and dignity. So, learning how to deal with anxiety, learning how to deal with fear, learning how to identify what is worth being afraid of by addressing cognitive distortions and then figuring out what your values are. You can't live with integrity unless you know what your values are. I know a new freedom. I release myself from guilt, worry and regret about my past and present and I am aware enough not to repeat it. So, everybody makes mistakes. Everybody has adversities. Everybody's had life. OK, so there are some things that you don't want to do again. Some things that you look back and you go, oh, yeah. Regretting just locks up energy in the past. If you learn from it and are able to move on then you're freeing up that energy to move towards the future. I know a new love and acceptance of myself and others and I feel genuinely loveable loving and loved. Now, this is way down the road for a lot of our clients, but this is a goal. We want clients to feel like they're generally pretty awesome people. They're not perfect because nobody's perfect, but they are pretty awesome. They're capable of loving others without overwhelming them and they're capable of being loved in a healthy, effective boundary sort of way. I learned to see myself as equal to others. My new and renewed relationships are all with equal partners. So everybody's opinions matter. Everybody's feelings matter. I'm capable of developing and maintaining healthy and loving relationships. I need to control and manipulate others. The need to control and manipulate others will disappear as I learn to trust those who are trustworthy. Not everybody's trustworthy. I wish they were. But because of their stuff they cannot be trustworthy. But the person who is codependent needs to learn how to identify dangerous people. And that's generally those people that they feel a compelling need to rescue. But that's not always the case. So we want them to start figuring out what does a healthy, loving relationship look like? What do boundaries look like? What does give and take look like? I learned that it's possible to mend and to become more loving intimate and supportive. I have the choice of communicating with my family in a way which is safe for me and respectful for them. So that assertive communication comes out now instead of blaming, minimizing you know being angry at, lashing out you know being able to state what I need, what my feelings are if they like it great but if they don't like it being able to say alright I respect your opinion. I acknowledge that I'm a unique and precious creation. I no longer need to rely solely on others to provide my sense of worth. And this is a huge thing. And there are some awesome self-esteem exercises you can do in group as well as individual. I trust the guidance I receive from my higher power. And again if they don't believe in a higher power we look at guidance I receive from my good orderly direction. And we look at what is your Google Maps telling you. Used to say the trip tick. For those of you who are you know old. When we used to go on trips we would get a trip tick from AAA. And it would be the maps and everything that would get us from one place to the other. Some of you may be going oh I've forgotten that. Now we use Google Maps. So on your directions in Google Maps that's your good orderly direction. It's telling you where to go and they even tell you when there's a traffic jam how to get around it and still keep on your best route to your destination. I gradually experience serenity, strength and spiritual growth in my daily life. You can spend an entire session just talking about what these things are. What would it look like if you felt serene? Are there other words? What other words are synonyms for serene? Because serene is not a word we use a lot. We say it in the serenity prayer grant me the serenity to accept the things I cannot change. But if you don't know what serenity is then you're kind of out. So we talk about what serenity means in general and what it looks like for each person. We talk about experiencing strength in their daily life. Focusing on the strengths, focusing on their successes and spiritual growth. Spirituality looks different for every person. But we talk about it in terms of connectedness. What you do impacts everybody else and what everybody else does unfortunately probably impacts you. If you walk past someone who is who looks desperately depressed on the street that may tug at your heart strings. It may not impact your debt for the rest of the day, but it's going to have a little impact on you. I know it does on me. So we talk about what spiritual growth means. What does it mean to create an environment that nurtures love? So co-dependence generally get in relationships with addicts or others who need to be rescued. That's kind of a clue right there talking about every relationship they've had and the hiccups that have been in it and you hear that they're in this rescue dynamic being alert to what's the function of that relationship. Is it really about love among equal partners? Or is it about desperately needing somebody to prove your worth? Co-dependence does not feel worthy or lovable. They need someone else to validate them. Recovery involves developing a sense of self-worth, addressing depression and anxiety, and learning about and creating a network of healthy relationships. If you enjoy this podcast, please like and subscribe either in your podcast player or on YouTube. You can attend and participate in our live webinars with Dr. Snipes by subscribing at allceus.com slash counselor toolbox. This episode has been brought to you in part by allceus.com providing 24-7 multimedia continuing education and pre-certification training to counselors, therapists, and nurses since 2006. Use coupon code counselortoolbox to get a 20% discount off your order this month.