Codependency Awareness Month 2023 Advocacy Guide
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“Codependency is a big enough problem that people need training on it, and people need education about it. But we have to take a culturally humble approach.”
Dr. Frederick Dombrowski, President of the American Mental Health Counselors Association (AMHCA)
Codependency can be a tricky topic in the world of mental health. Broadly speaking, codependency means relying upon someone else to a detrimental extent, where the desire to help causes further harm. People can be in codependent familial, personal, professional, or friendly relationships, and perhaps this universality is part of the reason for the term’s occasional misuse: the concept of codependency long ago entered the mainstream vocabulary, where it’s been subverted from its original clinical usage. The truth around codependency is more complicated—and more controversial—than it first appears.
January is Codependency Awareness Month. For the general public, it’s a time to revisit the concept of codependency with compassion and curiosity. For mental health professionals, it’s an opportunity to raise awareness about what codependency is and isn’t. Read on to learn more about the truth and the myths around codependency and how today’s mental health professionals approach it.
Meet the Expert: Fredrick Dombrowski, PhD, LMHC
Dr. Frederick Dombrowski is the president of the American Mental Health Counselors Association (AMHCA). He earned his master’s in mental health counseling from Medaille College and his PhD in counselor education and supervision from Capella University. Dr. Dombrowski is also an associate professor at the University of Bridgeport.
Dr. Dombrowski specializes in transgender clinical mental health counseling and has directed several clinics for LGBTQIA+ populations. He also served as an educator for various clinical mental health counseling programs and substance use programs. Dr. Dombrowski won the Connecticut Counseling Association’s Human Services Award in 2020.
The Origins of Codependency
In 1952, Lois Wilson—wife of Bill Wilson, the founder of Alcoholics Anonymous (AA)—co-founded Al-Anon, a support group for those who experience the side effects of their partners’ substance use disorders. This was the origin of the modern concept of codependency: a relationship with toxic elements, such as a person enabling a partner’s addiction, while still suffering the abuse of a partner because of that addiction. In this view, codependency is a type of relationship addiction, one that hurts both members of that relationship. Those suffering from codependency still attend groups like Al-Anon and have their own dedicated group, Co-Dependents Anonymous (CoDA), formed in 1986.
“We often think about codependency in romantic relationships, but it can happen in all types of relationships,” Dr. Dombrowski says. “We’ve also moved towards seeing substance use as one of many different types of behavioral addictions, which can also include video game addiction, internet addiction, and sex addiction.”
Codependency often masquerades as helping a loved one, when it’s really contributing to further problems for everyone involved. Codependent behavior may include enabling, avoiding, hiding, or excusing someone’s addiction. It can also manifest in low self-esteem, a fear of being alone, and an inflated sense of responsibility. CoDA offers a list of patterns and characteristics for codependence, but Dr. Dombrowski cautions against over-applying blanket assessments.
“There’s sometimes the perspective that if you meet criteria for codependency, then you are a codependent person,” Dr. Dombrowski says. “But this could just be the dynamics of a single relationship, and there could be instances in people’s lives where they may show more traits with codependency than at other times.”
Controversies Surrounding Codependency
Clinicians began using the term codependency in the early 1980s when it was used exclusively concerning substance use disorder. But it’s important to note that codependency is still not an official diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). While that doesn’t mean codependency isn’t real, it does make it slightly controversial. One of the reasons it isn’t listed is because its symptoms and characteristics overlap significantly with other mental health disorders. But its lack of a formal diagnosis hinders formal discussions about codependency and its treatment, and fosters the myths that surround both.
“Having a diagnosis means having an agreed-upon way that we identify a problem,” Dr. Dombrowski says. “Without that frame of reference, especially around how certain behaviors can be viewed as detrimental to an individual, it makes sense that there would be a lot of differing perspectives on codependency.”
A 1986 book by Melody Beattie, Codependent No More: How to Stop Controlling Others and Start Caring for Yourself, has sold over seven million copies, leading to many in the general public diagnosing themselves with codependency. Some mental health experts have worried that some elements of the codependency discourse can reinforce the myth of needing ‘tough love’ to treat people with substance use disorders.
But addiction needs to be treated, not penalized, and being overly concerned about codependency can stifle more compassionate policies around harm reduction. Some mental health professionals have even pushed for a reframing of codependency to pro-dependency.
“We all have our own opinions and beliefs in regard to relationships and in regard to substance use,” Dr. Dombrowski says. “It can be tricky for the clinician to navigate.”
How Mental Health Professionals Treat Codependency
Treatment plans for codependency can vary from individual to individual, and from counselor to counselor. Options may include cognitive behavioral therapy (CBT), motivational interviewing (MI), and group or family therapy. Counselors can also help their clients in creating healthy boundaries, asserting themselves, and growing comfortable with asking for help. But codependency is a complex and nuanced condition that requires individualized attention.
“Codependency is a big enough problem that people need training on it and people need education about it,” Dr. Dombrowski says. “But we have to take a culturally humble approach, because how people show love and support to the people in their lives is unique. When we don’t have a culturally humble approach that uses an individual’s strengths and validates what’s important to them, we could actually be making things worse.”
A 2018 study in the International Journal of Mental Health and Addiction suggested mental health professionals should be sensitive to the importance and impact of the codependent label. While the label itself doesn’t necessarily have negative connotations—it can actually be helpful by offering a socially-recognized explanation—therapists and counselors also need to be aware of issues related to fragile self-conceptualization. The study’s authors suggest that people with codependency issues benefit strongly from empathic listening, which can validate their experiences and help restore a sense of self. Through listening, therapists and counselors can help in a process of self-reconstruction. A strong therapeutic relationship is key to build the trust and communication needed to address the contextualized nature of a potentially codependent relationship.
“Codependency is a unique and individualized problem, but at the same time, a very broad one,” Dr. Dobrowski says. “I encourage counselors to take a culturally humble approach to the individuals they’re working with to help them make sense of what’s happening.”
Resources for Codependency Awareness Month
To learn more about codependency, and how mental health professionals are treating it, check out some of the resources below.
- American Mental Health Counselors Association (AMHCA): Formed in 1976, AMHCA is an organization of licensed mental health counselors. Their mission is to advance the profession of clinical mental health counseling by setting the standard for collaboration, advocacy, research, and ethical practice, offering education, training, and professional development.
- Codependents Anonymous (CoDA): A 12-step program in the mold of Alcoholics Anonymous, CoDA is a fellowship of men and women whose common purpose is to develop healthy relationships.
- National Association for Alcoholism and Drug Abuse Counselors (NAADAC): The Association for Addiction Professionals, NAADAC brings together counselors, administrators, social workers, and others who are active in counseling, prevention, intervention, treatment, education, and research. You can find a recording of their 2016 webinar on codependency here.