Michelle is the 48-year-old wife of an active alcoholic. She and her husband, Alex, have three children, ages 11, 14, and 21. For years, Michelle has covered up and attempted to manage Alex’s drinking with varying degrees of success. Now her eldest child, Jonathan, is abusing drugs and has dropped out of college. Michelle is perpetually worried that Alex will get fired for missing too much work (he often skips work while binge drinking and recovering from his hangovers) or for showing up at his job while drunk. Meanwhile, Jonathan is living in a crowded two-bedroom apartment with four other dropouts, supporting himself with a part-time, minimum wage job and a steady stream of ‘loans’ from his parents. For now, the younger children seem to be doing OK in school and socially, but Michelle worries they will follow in their older brother’s footsteps or worse.
Unsure about how she should handle everything that she and her loved ones are going through, and terrified about her family’s future, Michelle finally seeks therapy and asks for advice for both herself and Alex. After listening to Michelle’s gut-wrenching, occasionally teeth-gnashing version of what is happening in her life, her highly recommended therapist offers a bit of emotional support, and then does what she’s been taught to do, which is to turn to a disease model for treating loved ones of addicts (codependence) that mirrors the disease model used to treat addicts.
Over the next several weeks, the therapist focuses treatment on Michelle’s underlying trauma issues, trying to help her understand that her childhood was less than ideal, and because of this she learned to relate to others in less than ideal ways, which in turn led her into a ‘codependent’ relationship with an addict, and that together she and the addict have created less than ideal childhoods for their kids, who are likely to repeat their parents’ dysfunctional patterns—as is already occurring with Jonathan—if she doesn’t learn to relate to her loved ones differently.
This is frustrating for Michelle, who wants validation for her fears, appreciation for all the giving and caretaking she has done, direction on what to do next, and, most of all, some hope. The seemingly endless talk about her unresolved early-life trauma and the damage that has wrought leaves her feeling alienated, shamed, and blamed. And that does not make sense to her. She is not the addict. She is not the problem.
Because Michelle does not feel heard or understood by her therapist, she often has angry outbursts during her sessions. Unfortunately, as her frustration mounts, her therapist leans more heavily into the codependence model. And why not? After all, the therapist is trained to understand that Michelle’s anger and pain are derived from trauma and codependence.
And let’s face it, no therapist likes an angry client who screams, yells, cries, blames others, and won’t take responsibility. For therapists, it’s just plain easier to tolerate all that pain, loss, anger, regret, and fear when we can put a nice, neat label on it, wrap it in a bow, and give it back to the client. So, we turn to codependence as a go-to, even when that model doesn’t fit the client’s immediate needs.
Admittedly, some clients do embrace the codependence model and make great strides in a short amount of time. However, plenty of other caregivers will just plain walk away from treatment because they don’t feel heard or understood. At best, they feel that what they are being offered does not apply to them. At worst, they feel insulted and judged. As a result, they and their families don’t get the care and guidance they desperately need. That is what happened with Michelle. She stuck it out for a little under two months, felt like she was getting nowhere, and decided to exit therapy. In the end, there was no useful help for Michelle, no useful help for Alex or Jonathan, and no useful help for the younger children. All Michelle got from this experience was a sense of being labeled, blamed, and shamed.
How is This Helpful?
Sadly, I hear stories like Michelle’s far too often. The caregiving loved one of an addict (or multiple addicts) feels hurt, overwhelmed, and fearful, and seeks therapeutic validation and guidance on how to make things better. But instead of receiving warm, empathetic support, the tables are turned. In one way or another, the caregiver is told that he or she is a part of the problem, that he or she has unresolved (possibly unacknowledged) trauma that has led to the ‘disease’ of codependence, and that he or she is the person who must change.
I ask you, how is this message meeting the client’s current emotional needs? In the example above, Michelle is hurt, fearful, and needs validation for what she is feeling. She needs guidance about how she can take better care of herself, and how she can love and care for her addicted loved ones and the rest of her family in healthier ways. She needs her therapist to understand that she has exhausted herself trying to ‘keep it all together’ for the sake of her family. She needs her therapist to understand and affirm that she has done this out of love, not because her unresolved early-life trauma has driven her into pathological relationships.
In my experience, telling a client like Michelle that she is codependent and needs to detach from a troubled loved one is not sound advice. And I continually hear from other therapists who struggle, as I do, with pinning a pejorative, pathological sounding label on the spouse or parent or sibling of an addict—mostly because these therapists understand that such a client is in crisis and is struggling in the same ways that just about anyone in crisis tends to struggle. So, instead of treating these clients as individuals with a pathology, maybe we should treat them with a model that views them as loving, caring, connection-oriented individuals in crisis. That model is prodependence.
Dr Robert Weiss
Chief Clinical Officer of Seeking Integrity LLC
Robert Weiss PhD, LCSW is Chief Clinical Officer of Seeking Integrity LLC, a unified group of online and real-world communities helping people to heal from intimacy disorders...