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Old 03-06-2008, 12:14 AM   #1
clean42day
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Lightbulb codependence, contradependence, and interpersonal dependence........

Very long professional article but worth the read....................

Title: TOWARD AN INTERPERSONAL MODEL OF CODEPENDENCE AND CONTRADEPENDENCE , By: Hogg, J.A., Frank, M.L., Journal of Counseling & Development, 07489633, Jan/Feb92, Vol. 70, Issue 3
Database: MasterFILE Premier


Contents
CODEPENDENCE
CONTRADEPENDENCE
EMOTIONAL NEEDS AND GENDER ROLES
AN INTERPERSONAL MODEL
DIAGNOSTIC CONSIDERATIONS
RAMIFICATIONS OF THE INTERPERSONAL MODEL
REFERENCES

Codependence is used increasingly to describe various dysfunctional relationships. This article differentiates codependent from contradependent behavior and defines both in an interpersonal context. A model is proposed to address gender issues, diagnosis, and treatment from an emotional health perspective.

The theoretical construct of codependence has its foundations in the disease model of alcoholism Johnson, 1980) and family systems concepts (Wegscheider-Cruse, 1989). The concept of codependence is derived from the "co-alcoholic" behavior of spouses and children in chemically dependent family systems (Friel & Friel, 1988). Counselors observed that family members often took on the psychological defenses and survival behaviors of the alcoholic, thereby extending the disease from the individual to the entire family system.

The construct of codependency has been expanded in recent years to include addictive behaviors in sexual disorders (Carnes, 1983), intimate relationships (Norwood, 1985), and organizational systems (Wilson-Schaef, 1987). Kaufman (1985) has postulated that the emotion of shame may be the common affective experience underlying all addictive behaviors. Families or peer groups that use humiliation, labeling, abuse, or other shaming behaviors may pass the predisposition for addictive disorders from generation to generation (Bradshaw, 1988; Friel & Friel, 1988). In the popular self-help literature, almost any problem of identity development or impulse control has been associated with codependency (Beattie, 1987; Woititz, 1985).The difficulty with the broadened application of the codependency construct is that it has lost much of its diagnostic and clinical utility.

When almost all relationships are defined as codependent (Wilson-Schaef, 1987), the construct becomes a sociological statement instead of a clinical assessment. Ironically, the construct of codependence has lost its own identity.

The concept of contradependence may be helpful in differentiating the wide range of interpersonal behaviors that are often identified with codependency. By isolating the concept of contradependence from the codependency framework, it may be possible to increase the specificity of codependency without diminishing its educational and clinical value. In discussing the aspects of gender, diagnosis, and treatment for codependent and contradependent individuals, a context is developed for proposing an interpersonal model of emotional needs.

CODEPENDENCE
The first National Conference on Codependency defined codependence as "a pattern of painful dependence on compulsive behaviors and on approval from others in an attempt to find safety, self-worth, and identity" (Laign, 1989, p. 2). The breadth of that kind of definition decreases its meaning and utility. There are, however, common behavioral patterns that typify codependence in the literature (Cermak, 1986b). Some of those behaviors include the following: (a) martyrdom--sacrifice of one's own needs to meet the perceived needs of others; (b) fusion--loss of one's own identity in intimate relationships; (c) intrusion--control of others' behaviors through caretaking, guilt, and manipulation; (d) perfection--unrealistically high expectations of oneself and others, often resulting in overachievement or inadequacy; and (e) addiction--use of compulsive behaviors for emotional self-management.

At the heart of this behavioral matrix is the lack of clearly defined ego boundaries in intimate relationships. Codependent clients often do not know where they end and others begin. Consequently, they live for others, feel responsible for others, and attempt to regulate the world around them. Lerner (1986) told the story of the codependent man who was drowning and someone else's life passed before him. The covert message of codependence is "Your needs are more important than mine so I'll be whatever you need." Thus, the construct of codependence accurately describes the loss of personhood that is intrinsic within many dysfunctional family systems.

The behavioral matrix of codependence encompasses the Enabler and Family Hero roles in alcoholic family systems (Black, 1981). The Enabler functions to protect the alcoholic from the consequences of his or her behavior. Although the primary Enabler is usually the spouse, any member of the family may assume the major responsibility for the alcoholic's life. The Enabler attempts to deny the problem in the outside world and control the behavior within the family, blurring individual responsibilities and identities (Miller & Ripper, 1988). The Family Hero is usually the oldest child in the family. The Family Hero steps in to fulfill the neglected needs of the family, often functioning in a quasi-parental role for the other children. The Family Hero is often a super-achiever in the outside world and the designated peacemaker within the family (Miller & Ripper, 1988). Many Family Heroes choose occupations in the human services because they are accustomed to rescuing people from their emotional pain. It would make sense that many of those individuals would seek counselling later in their lives when their caretaker roles are no longer adaptive. Those clients fit the codependence model of self-sacrifice, high achievement, guilt, inadequacy, and denial of personal needs. They need to learn to set healthy ego boundaries for themselves.

CONTRADEPENDENCE
Contradependence can be defined as a behavioral tendency to separate oneself from others to prevent being emotionally hurt. Contradependence serves to keep others at a distance to avoid pain. Cermak (1986b) used the term "counter phobic behavior" to describe the behavior of the "codependent who avoids relationships with others . . . to keep themselves safe" (p. 18). Many untreated alcoholics present contradependent behaviors as part of their chemically dependent symptomatology, which they in turn model for their children.

The behaviors that typify contradependence include the following: (a) defensiveness--use of psychological defenses to deny ownership of emotions or behaviors; (b) self-sufficiency-denial of emotional needs in relationships with others; (c) isolation--withdrawal from intimate relationships; and (d) acting out--use of blaming, rage, or defiant behaviors to hurt or control others.

Whereas codependent clients may have very loose and permeable ego boundaries, contradependent clients tend to deal with their pain by creating rigid and impenetrable boundaries. Contradependent clients "put up a wall" around themselves, creating an aura of unapproachability. The covert message of interpersonal contradependence is "I don't need anyone else." There is the illusion of emotional safety when a person is an island.

Not surprisingly, clients who use emotional distancing as their primary defense against vulnerability are reluctant to seek counseling services. They are more frequently identified in educational, correctional, and chemical dependency treatment settings because their acting-out behaviors have precipitated institutional interventions. Yet, their issues are also a product of shame-based family systems. Whereas the classically codependent person suffers from loss of personhood, the contradependent person suffers the pain of aloneness.

The definition of codependence that applies so well to Enablers and Family Heroes does not fit as well for contradependent clients, who were probably more often Scapegoats, Lost Children, or Mascots in their family systems (Wegscheider-Cruse, 1989). The most common contradependent role, the Scapegoat, represents the defiant, rebellious, or antisocial aspects of the family system. The Scapegoat confronts the illusion of emotional health through anger and acting out, which serves to shift the focus of attention away from the alcoholic and onto the troublemaking child. The Scapegoat is usually blamed for all of the family's problems, which creates a reservoir of guilt and shame within the child. In contrast, the Lost Child copes with the pain in the family through emotional withdrawal. The implicit strategy is to become a noncombatant in family conflicts by being invisible. Whereas the Family Hero is usually a super-achiever, the Scapegoat and the Lost Child are usually underachievers. Within the family, the Lost Child is generally ignored and lonely. The final role, the Mascot, is someone who uses humor as a defense against emotional pain. The Mascot uses cuteness and joking to distract the family from the inner conflict. Each of the roles serves to maintain the stability of the dysfunctional family system (Wegscheider-Cruse, 1989). Yet, these roles do not fit comfortably within the current definitions of codependence. Perhaps some of the vagueness of the codependence construct is attributable to trying to describe divergent parts of the family puzzle.

Contradependence is a new term to describe the matrix of behaviors that characterize other dysfunctional family roles. Like codependence, contradependence is assumed to develop through the shaming behaviors of families and peer groups (Kaufman, 1985), and thus shares an emotional commonality with codependence. But the behavioral manifestations of those core shame dynamics are distinctly different in interpersonal relationships. Contradependence is the other side of the same psychological coin.

EMOTIONAL NEEDS AND GENDER ROLES
Codependence and contradependence are both strategies that people learn in intimate relationships to meet their emotional needs. Everyone possesses the healthy need for affiliation, which connects one to others, and differentiation, which creates individuality. Erikson's (1968) stage of "intimacy versus isolation" in young adulthood reflected the importance of balancing these developmental needs. In families where nurturance is limited, people learn to adopt potent tactics to fulfill those basic human needs. Viewing those needs on a continuum, affiliation in its extreme form becomes codependence. Likewise, differentiation can become counterproductive when it develops into contradependence. Emotional neediness and shame-based dynamics seem to be mediating factors precipitating movement away from healthy manifestations of differentiation and affiliation, toward the less productive forms of those needs. Codependence and contradependence become the adaptive exaggerations of the otherwise healthy motivations for love and autonomy.

Gender roles, as defined by Baslow (cited in Mintz & O'Neil, 1990) are "the behaviors, expectations, and roles defined by society as masculine or feminine, which are embodied in the behavior of the individual" (p. 381). Gender-based research illustrates the differences found in the interpersonal and activity styles of men and women (Cook, 1990). Cook (1985) described femininity as embodying emotionality, sensitivity, nurturance, and interdependence, whereas masculinity was seen as encompassing assertiveness, independence, dominance, and goal directedness. Of course, gender roles are not necessarily the same as biological sex (Mintz & O'Neil, 1990) because people may adopt gender roles that are usually associated with the opposite sex. Gender roles are a critical factor to consider when viewing the emotional needs of people in relationships.

In our society, the strategy of giving up one's personhood to achieve love and security is associated with stereotypically feminine gender roles. Women have historically been given responsibility for the nurturance and caretaking of men and children. Miller (1976) noted that women believe that their lives should be synchronized with the needs and wants of others. Lerner (1985) described how difficult it is for women to assert their own emotional needs in our male-oriented society. Many women who come into counseling continue the pattern by assuming a passive role and, through compliance, meet the needs of their counselor (Kaplan, 1979). In the process of expressing the affective needs of the human experience, which Gilligan (1982) called "the voice of relatedness," many women were unable to develop autonomous ego boundaries. Thus, codependence is deeply rooted in the undervaluation and powerlessness of women in a patriarchal social structure (Wilson-Schaef, 1987).

Conversely, contradependent behavior seems to be the counterpart for stereotypically masculine gender roles. Men in our society are socialized to deny their emotional needs and problems, hold in their feelings, and never show their vulnerabilities (Goldberg, 1976; Good, Gilbert, & Scher; 1990). For centuries men have been trained for economic competition and military combat, which taught men to deny their feelings of inadequacy, fear, and sorrow. Thus, many men lead lives of emotional isolation even from their own wives and children in an attempt to project strength and decisiveness (Osherson, 1986): In the process of expressing the autonomous side of the human experience, which Gilligan (1982) called "the voice of separateness," many men have never learned how to create intimate bonds with others. Contradependence is when the outer appearance of being "the strong and silent type" masks the inner reality of being alone and afraid.

AN INTERPERSONAL MODEL
Interpersonal theorists (Leery, 1957; Sullivan, 1953) have attempted to describe personality types in terms of how people characteristically engage or disengage others. Homey (1945), for example, categorized people as either "moving toward" or "moving away from others." Interpersonal theories tend to deemphasize individual psychopathology and focus on the transactional styles that individuals use to meet basic human needs (Kiesler, 1982).

With the emphasis on healthy motivations, the concepts of codependence and contradependence may be seen in an interpersonal framework (see Figure 1). A circle is used to capture the continuum from emotional health to emotional neediness. The processes of affiliation and differentiation involve seeking a healthy balance between interpersonal connection and separation; this balance is defined as interdependence. Through establishing functional boundaries between oneself and others, people meet their own emotional needs.

In the upper half of the model, people meet their emotional needs in productive, healthy ways. They may move between being closer to or more autonomous from others, or may find themselves in a state of interdependence, having optimal levels of both affiliation and differentiation. The model is not static; it assumes that one may move either incrementally or in major shifts to alternative transactional strategies for meeting love and safety needs. Familial and cultural values may prescribe the preference for more affiliative versus differentiating behavior., Fairbairn (1952) recognized that a "relationship" implies a "mature dependence." Emotionally healthy individuals meet their own needs without guilt and can connect with others without sacrificing their own integrity.

The lower half of the model represents emotional neediness. The experiences of emotional deprivation or victimization may lead people to the use of transactional styles on the extreme ends of the behavioral continuum. Healthy ways to meet the needs for affiliation and differentiation are not used because of either the persistent patterns of relating or the systemic pressures. Gender role socialization, family birth order, and cultural values may strongly influence which transactional style is used to meet the emotional survival needs of the individual and the family. Generalizing that transactional style to other relationships may perpetuate codependence and contradependence from generation to generation and across social systems.

DIAGNOSTIC CONSIDERATIONS
Although Cermak (1986a) and others have argued that codependence meets the basic DSM-III-R criteria for classification as a personality disorder, this interpersonal model assumes that codependent and contradependent behaviors exist along a continuum of emotional neediness with many relevant diagnostic classifications. Just as codependence and contradependence are theoretically caused by varied experiences of shame and victimization, the DSM-III-R diagnoses may be just as heterogeneous. Classifying codependent and contradependent behaviors as personality disorders implies a chronic mental illness, which may overpathologize many people with codependent and contradependent behavioral traits. In the absence of actual chemical dependencies, the disease model of addictions (Johnson, 1980) should be used as a helpful metaphor of psychological change processes and not a literal description of mental illness. Labeling codependence and contradependence as personality disorders tends to reify the medical model of psychiatric illness and negate the healthy motivations toward affiliation and differentiation.

Viewing codependence and contradependence as behavioral matrices rather than discrete DSM-III-R diagnoses reflects the heterogeneity of causes, severities, and treatment modalities. Codependence and contradependence may be diagnosed as V-codes, adjustment disorders, post-traumatic stress disorders, personality disorders, or addictions (See Figure 2). In mild cases, the V-codes of interpersonal problem or specified family circumstances may best reflect an enmeshed romantic relationship or a dysfunctional family system. Many clients present adjustment disorders when an environmental stressor has activated their transactional style and produced an overreaction to a difficult life event. Post-traumatic stress disorder seems to be the most valid diagnosis for codependent or contradependent behaviors caused by physical or sexual abuse. Allowing the behavior to be seen as an adaptation to a psychosocial, familial, or developmental stressor acknowledges the stressor instead of blaming the victim. Finally, codependent clients may meet the diagnostic criteria for dependent, borderline, or histrionic personality disorders; and contradependent clients may exhibit avoidant, antisocial, or narcissistic personality disorders. At the bottom of the circle, where the codependent and contradependent patterns converge, many clients use chemical and behavioral addictions to try to manage their emotions. At that level of emotional neediness, many addicts have chosen things rather than people to try to meet their needs. They have abandoned the difficult processes of emotional relatedness and become truly dependent on external sources of selfhood.

The value of construing codependence and contradependence as consistent and identifiable behavioral matrices, rather than just as heterogeneous groups of diagnoses, is that conceptual maps may aid counselors in the treatment process. Codependence is already being used as an operational diagnosis by many chemical dependency and mental health professionals, with specific treatment planning for that constellation of behaviors. In much the same way that grief has many causes and levels of severity but may be treated by common counseling techniques, codependence and contradependence may assist counselors in the development of differential treatment strategies.

When using treatment approaches, one should recognize the different emotional needs of codependent and contradependent clients. Implicit in most systems therapies, and more explicit in the wellness model (Travis, 1981), is the notion of balance. Balance needs to exist between connecting with and being autonomous from others. Once the client understands his or her relationship patterns, counseling needs to focus on restoring balance to relatedness. Clients with the contradependent pattern need to learn and experience safe and controlled ways of connecting. Clients with more codependent behavior need to experience and learn ways to care for themselves. Sullivan (1953) noted the two-stage nature of this work: (a) mapping the patterns that block interpersonal relationships and (b) expanding client awareness to abate and prevent future blocks. This model offers a conceptual map of the behaviors to stimulate awareness and begin change.

RAMIFICATIONS OF THE INTERPERSONAL MODEL
At the 1990 National Association of Women in Psychology Conference, Loulan (1990) called the codependency field a "woman hating big business." In many cases women have been inadvertently blamed for their affiliative emotional needs. Unfortunately, the healthy need for men and women to affiliate and care for others has been undervalued and pathologized (Miller, 1976). The press for men to be strong and silent is also not without cost. Perhaps the interpersonal model may help reframe the codependency and contradependency constructs by emphasizing healthy dynamics instead of disease processes. Jung (1971) asserted that psychological health is developed by accepting, affirming, and expressing the masculine and feminine aspects of the psyche in every person. Everyone has the emotional needs to differentiate and connect.

Individuals with transactional styles that are counter to the stereotypical gender norms need support and validation. Their struggles for relatedness are amplified because they are going against social norms. The interpersonal model respects people who meet their emotional needs in nonstereotypical ways and acknowledges their struggle.

The interpersonal model of codependence may help bridge the chasm between the new addictions concepts and more established psychotherapeutic approaches. By placing codependency in a familiar interpersonal context, it may enhance the construct validity and acceptability of the codependence concept for many mental health professionals.

Placing the construct of codependency within an interpersonal framework emphasizes that people who never learned how to meet their needs for love and safety can acquire new interpersonal skills. Codependence and contradependence are seen as relationship skill deficits. Those skills can be developed through individual and family counseling, men's and women's groups, and self-help groups like the Alanon and Codependents Anonymous programs. Group therapies are especially helpful in teaching healthy ego boundaries.

The continuum of interpersonal transactional styles may be useful to describe the transitions in client behavior throughout the stages of treatment. The model can provide a language to discuss changes in ego boundaries. For example, many codependent clients swing to the contradependent end of the continuum in the early stages of counseling. They do not yet know how to give of themselves without giving their personhood away, so they discontinue reaching out to others entirely. It can be helpful to clients to give them a conceptual map of interpersonal emotional health. The model may serve as a guide in learning the art of giving and receiving in adult relationships.

Assuming that codependence and contradependence are actually caused by experiences of shame and victimization, then the treatment of those issues may have political consequences. Confronting and preventing intergenerational victimization may produce long-term effects on entire communities. Improved treatments may be a step toward greater social justice and personal freedom.

Lerner (1985) asserted that we develop our own sense of ourselves best in relationship with others. From an interpersonal perspective, emotional health involves balancing our needs for connectedness and autonomy through each stage of the life cycle. Improving our abilities to relate is not done in isolation. Healing emotional wounds occurs by reconnecting both with ourselves and with others.

DIAGRAM: FIGURE 1; Interpersonal Model of Codependence and Contradependence

DIAGRAM: FIGURE 2; Diagnoses in Codependence and Contradependence

REFERENCES
Beattie, M. (1987). Codependent no more. New York: Harper & Row.

Black, C. (1981). It will never happen to me. Denver: MAC Publishing.

Bradshaw, J. (1988). Healing the shame that binds you. Deerfield Beach, FL: Health Communications.

Carnes, P. (1983). Out of the shadows: Understanding sexual addiction. Irvine, CA: Compcare.

Cermak, T. (1986a). Children of alcoholics and the case for a new diagnostic category of codependency. In R. J. Ackerman (Ed.), Growing in the shadow: Child of alcoholics (pp. 23-31). Deerfield Beach, FL: Health Communications.

Cermak, T. (1986b). Diagnosing and treating codependence. Minneapolis: Johnson Institute.

Cook, E. P. (1985). Psychological androgyny. New York: Pergamon.

Cook, E. P. (1990). Gender and psychological distress. Journal of Counseling & Development, 68, 371-375.

Erikson, E. H. (1968). Identity: Youth and crisis. New York: Norton.

Fairbairn, W. (1952). Psychoanalytic studies of the personality. London: Tavistock Publications Ltd.

Friel, J., & Friel, L. (1988). Adult children: The secrets of dysfunctional families. Deerfield Beach, FL: Health Communications.

Gilligan, C. (1982). In a different voice. Cambridge, MA: Harvard University Press.

Goldberg, H. (1976). The hazards of being male. New York: New American Library.

Good, G. E., Gilbert, L. A., & Scher, M. (1990). Gender aware therapy: A synthesis of feminist therapy and knowledge about gender. Journal of Counseling &Development, 68, 376-379.

Horney, K. (1945). Our inner conflicts. New York: Norton.

Johnson, V. (1980).I'll quit tomorrow (rev. ed.). New York: Harper & Row.

Jung, C. G. (1971). Aion: The phenomenology of the self. In J. Campbell (Ed.), The portable lung (pp. 139-162). New York: Viking Press.

Kaplan, A. G. (1979). Toward an analysis of sex role related issues in the therapeutic relationship. Psychiatry, 43, 112-120.

Kaufman, G. (1985). Shame: The power of caring. Cambridge, MA: Schenkman.

Kiesler, D. J. (1982). Interpersonal theory of personality and psychotherapy. In J. C. Anchin & D. J. Kiesler (Eds.) Handbook of interpersonal psychotherapy (pp. 3-24). New York: Pergamman Press.

Laign, J. (1989). A consensus on codependency. Contact, 2, 2.

Lerner, H. (1985). The dance of anger. New York: Harper & Row.

Lerner, R. (1986). Codependency: The swirl of energy surrounded by confusion. In R. J. Ackerman (Ed.), Growing in the shadow: Children of alcoholics (pp. 113-121.)Deerfield Beach, FL: Health Communications.

Leary, T. (1957). Interpersonal diagnosis of personality. New York: Ronald.

Loulan, J. (1990,March). Women in recovery: Implications for self esteem and sexuality. Paper presented at the National Association for Women in Psychology, Tempe, AZ.

Miller, J. B. (1976). Toward a new psychology of women. Boston: Beacon Press.

Miller, J., & Ripper, M. (1988). Following the yellow brick road: The adult child's personal journey through Oz. Pompano Beach, FL: Health Communications.

Mintz, L. B., & O'Neil, J. M. (1990). Gender roles, sex, and the process of psychotherapy: Many questions and few answers. Journal of Counseling & Development, 68, 381-387.

Norwood, R. (1985). Women who love too much. New York: St. Martin's Press.

Osherson, S. (1986). Finding our fathers. New York: Ballantine Books.

Sullivan, H. S. (1953). The interpersonal theory of psychiatry. New York: Norton.

Travis, J. W. (1981). Wellness workbook (2nd ed.). Berkeley, CA: Ten Speed Press.

Wegscheider-Cruse, S. (1989). Another chance: Hope and health for the alcoholic family (2nd ed.). Palo Alto, CA: Science and Behavior Books.

Wilson-Schaef, A. (1987). When society becomes an addict. San Francisco: Harper & Row.

Woititz, J. (1985). Struggle for intimacy. Pompano Beach, FL: Health Communications.

~~~~~~~~

By JAMES ANDREW HOGG and MARY LOU FRANK


James Andrew Hogg is a psychologist in private practice in Tempe, Arizona. Mary Lou Frank is a psychologist at Counseling and Consultation at Arizona State University, Tempe. Correspondence regarding this article should be sent to James Andrew Hogg, 6625 South Rural Road, Suite 111, Tempe, AZ 85283


Source: Journal of Counseling & Development, Jan/Feb92, Vol. 70 Issue 3, p371, 5p
Item: 9202172245

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Old 12-07-2011, 12:25 AM   #2
lovingmate
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Look up Codependence in the Dictionary and there is a picture of ME

When my doctor, who has been treating me for stress related issues in connection with living with an alcoholic husband who is disabled by PTSD, suggested that I look into Codependents Annon. I didn't understand what that meant - what Codependent meant. That was months ago. I just continued going to my Alanon meetings - afterall...wasn't that good enough?! Apparently - No! I just kept getting worse. So I did a little research tonight and decided that I needed help.

After reading your post - I almost fell off the couch. I couldn't be more Codependent if I tried! The following clip from your post is so me that it is scary. Thank you for taking the time to post it

The first National Conference on Codependency defined codependence as "a pattern of painful dependence on compulsive behaviors and on approval from others in an attempt to find safety, self-worth, and identity" (Laign, 1989, p. 2). The breadth of that kind of definition decreases its meaning and utility. There are, however, common behavioral patterns that typify codependence in the literature (Cermak, 1986b). Some of those behaviors include the following: (a) martyrdom--sacrifice of one's own needs to meet the perceived needs of others; (b) fusion--loss of one's own identity in intimate relationships; (c) intrusion--control of others' behaviors through caretaking, guilt, and manipulation; (d) perfection--unrealistically high expectations of oneself and others, often resulting in overachievement or inadequacy; and (e) addiction--use of compulsive behaviors for emotional self-management.

At the heart of this behavioral matrix is the lack of clearly defined ego boundaries in intimate relationships. Codependent clients often do not know where they end and others begin. Consequently, they live for others, feel responsible for others, and attempt to regulate the world around them.
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