"For Prof. Goodman only"

The labeling controversy aside, millions of adults do identify with the term and relate this to present dissatisfaction in life. Regardless of the extent to which one subscribes to the concepts of adult children, this area is a focal point of current research.

Research on ACOAs has focused on three areas. One branch of research, referred to as risk factors for later substance abuse, includes both qualitative and quantitative studies that examine the variables believed to influence ACOAs’ own drug or nondrug use in adulthood. The quantitative research is aimed at identifying the characteristics that predispose ACOAs to alcoholism, other drug dependence, or other substance-related problems. The qualitative writings in this area focus upon identifying the personality characteristics and problematic behaviors that increase an ACOA’s risk for choosing a partner with an identifiable substance abuse problem. A second branch of research focuses on identifying the clinical characteristics of ACOAs. This area of research is probably the most well-known among the general population of adults. The third branch of research centers on attempts to empirically validate the clinical characteristics. As you will see, the current state of these three research venues generally reveals mixed results.

It is important to remember that many siblings do share a common family environment while growing up, and some parenting will be the same across siblings throughout the family life cycle. Yet, because other aspects of parenting might vary, this could well be the case with alcohol. Just as in the case example of Charlene, a parent might quit drinking between sibling births. This means that an older sibling might be directly affected by a parent’s drinking, while the younger sibling is impacted indirectly. So, when discussing Adult Child of an Alcoholic, it is important to remember that the dynamics can vary between siblings and other family members.

Several researchers have identified some of the characteristics distinctive to an adult child of an alcoholic (see Ackerman, 1983, 1987;Beattie, 1987; Black, 1981; Brown, 1988; Cermak, 1986; Goodman, 1987). These characteristics are fundamentally based upon the assumption that children see parental behavior as a reflection of the child’s own sense of self-worth (Ackerman, 1983). In general, characteristics of ACOAs are seen as emanating from dysfunctional family systems and include excessive use of denial, all-or-nothing thinking, exaggerated need for control, avoidance of anger and other feelings, avoidance of self-disclosure, lack of trust, and difficulty with intimate relationships and/or emotional regulation (Brown, 1988; McCarty, Zimmerman, DiGuiseppe, & Christakis, 2005; Sher, 1991).

Other research suggests that a central issue for ACOAs relates to boundaries. Recall in the last chapter we discussed boundaries and likened them to a fence between people. Kelley et al., (2007 studied female college students who self-identified as ACOAs. Results reflected a group of participants who reported more parentification (a child treated like an adult), instrumental and emotional caregiving, and feelings of past unfairness in their families of origin. It is interesting to note that ACOAs who thought that their mothers had the problem with alcohol reported more parentification and caretaking than did both ACOAs and non-ACOAs who identified their fathers as having the problem. Given the results of this study, ACOAs raised in homes with maternal drinking problems predictably report less positive relationships with their mothers as well as with their peers. At the same time, paternal substance abuse did not predict the quality of parental or peer relationships. In another study, Kelley et al. (2008) also found that those ACOAs who suspected their mothers having alcohol problems reported less support and attachment from their mothers.

In general, empirical studies suggest that ACOAs do often show an increased vulnerability to life stressors and report more symptoms of adjustment difficulties (Hall & Webster, 2002; Hall, Webster, & Powell, 2003). The adjustment difficulties can play out in relationships, where they may regulate their attachments to others by being defensive, self-protective, and mistrusting (e. g. Harter, 2000; Kearns-Bodkin & Leonard, 2008; Kelley, Cash, Grant, Miles, & Santos, 2004).

Perhaps the most controversial assertion made about the clinical characteristics of ACOAs is that their relational difficulties can be described as “codependent.” Because of the overwhelming popularity of this observation, we will discuss the notion of codependency in detail later in this chapter. It needs to be noted here that codependency is variously described as boundary problems that often result in enmeshed relationships (see Chapter 11) and codependents engage in dysfunctional relationships in a variety of forms. While it may be somewhat true that ACOAs have boundary issues in their adult relationships, it cannot be seen as being caused by their families of origin. Family therapists see many couples’ boundary problems that may be associated with other variables mitigated by a more generalized anxiety in contemporary couples that translates into power and control issues.

When considering risk factors for children of alcoholics, it is critical to understand that alcoholism is a family disease. As such, alcoholism affects everyone in the family system in some way or another. Alcoholism in families carries a fundamental risk. Adult children are seen as having been raised in families where a parent’s drinking is the central factor in the life of a child and has the greatest influence over the child during that time as well as having persisting influence over the child’s growth into adulthood. From a family systems perspective, an obvious conclusion would be that ACOAs would experience more risks for the development of problems than would non-ACOAs, and early research confirmed just that (e.g., Ackerman, 1983; Brown, 1988).

More recent research is not as clear. Research is still inconclusive about whether ACOAs are more different than alike when compared to others who have experienced childhood trauma. At the same time, evidence points to the association between substance abuse in one’s childhood home and the risk of developing problems later in life. (Braitman et al., 2009; Fischer, Pidcock, Munsch, & Forthun, 2005; Hall & Webster, 2007). Watt (2002) found that ACOAs are less likely to marry, more likely to be in unhappy marriages, and more likely to divorce. These same researchers report that both males and females whose parents were alcoholic are more likely to marry moderate-to-severe alcoholics. Finally, Olmsted, Crowell, and Waters (2003) report that sons of alcoholics have increased risk for alcoholism. Yet, neither alcoholism nor marriage to an alcoholic is an inevitable outcome for ACOAs.

As illustrated in our case example of Charlene and our previous discussion, some studies suggest that ACOAs do not differ significantly from other adult children who experienced a dysfunctional family home life (Fineran, Laux, Seymour, & Thomas, 2010). Researchers are finding that a number of ACOAs appear stable in spite of their upbringing in alcoholic homes. Moreover, numerous studies on ACOAs and risk factors have been conducted on college students, and research has shown that this population drinks more than the general population. The elevated drinking among the college-age population can confound studies using college students to study ACOAs’ risk factors. This leads Fineran et al. (2010) to suggest that ACOAs may not be as homogenous a group as it once was perceived to be. Thus, it is imperative that helpers do not assume that because an individual is raised in a family where alcohol was abused that he or she will categorically have problems. To obtain a clearer picture of college student ACOAs, West and Graham (2006) suggest that this population should be examined for risk over time, and measures of risk should be conducted before, during, and after college.

Few studies have concentrated on ACOAs from diverse backgrounds and their risk factors. However, De La Rosa, Dillon, Ganapati, Rojas, Pinto, and Prado (2010) reviewed the clinical literature for adult Latino ACOA substance use and found that Latina adults who had reported low levels of attachment to their substance-abusing mothers were at heightened risk for substance abuse. Hall (2007a) found that African Americans raised in alcoholic homes had more depression and lower self-esteem, which was similar to the findings for Caucasian samples.

Berkowitz and Perkins (1988) reviewed the means by which ACOAs have been identified in the professional literature and found both broad and strict definitions of ACOAs. Clinical diagnosis of parental alcoholism reflects the more strict definition whereas the children’s perceptions of parental drinking problems mirror a broader definition. An example of a broad definition is that used in the Russell, Henderson, and Blume (1985) study in which an ACOA is “any person, adult, or child who has a parent identified in any way as having a significant problem related to alcohol use” (p. 1). According to Berkowitz and Perkins, the more strict definition is likely to exclude many individuals whose parents are alcoholic but who have not been formally diagnosed. The more broad definition, based upon the child’s perceptions, may also reflect an inaccurate number of ACOAs because the child may see his or her parents only infrequently or may see his or her parent drink only occasionally.

A detailed instrument is the CAST (Jones, A. C., 1985), which stands for Children of Alcoholics Screening Test. It is a simple, 30-item, yes/no instrument, and it takes less than 10 minutes to administer. It takes no special training to administer, which makes it both good and bad. The CAST is designed to measure the chaotic and inconsistent behaviors and experiences of the alcoholic home such as emotional instability, inconsistent child care, family conflict, and lack of close, intimate, and trusting relationships between parents and children (Williams & Collins, 1986). The CAST6 is a 6-item instrument that is used to assess adult children of alcoholics (over 18 years old) as well as children of alcoholics. The items measure experiences, attitudes, and perceptions about parental drinking in the same yes/no format as the CAST. Two cutoff scores have been used to identify ACOAs. Three or more “yes” responses are used to determine status from conservative perspective, and scores of 2 are more liberal. Thus, if you were to use a cutoff of 2, you would have more people identified as having problems.

Others have used simple, single-item questions as well. For example, DiCicco, Davis, and Orenstein (1984) asked whether one had ever wished that either or both of his or her parents would drink less and found that this single item identified ACOAs reliably over time. In another study, Biek (1981) asked subjects whether their parents’ drinking caused problems for them and found this single question accurately selected ACOAs.

Empirical studies on the treatment of ACOAs are significantly lacking (Williams, 1990). Nevertheless, Williams describes two essential goals in intervening with ACOAs. The first goal is to identify and address early symptoms of problem drinking, and the second goal is to identify dysfunctional behaviors and coping skills that may be predisposing risk factors for drinking or other adult problems.

The mixed results of empirical studies do not suggest that specific interventions should be identified for ACOAs, because it is unclear whether such a group exists whose individual members are significantly different from other adults with dysfunctional family backgrounds. Nevertheless, being associated with alcohol or other drug abuse either directly, as in the case of the alcoholic, or indirectly, as in the case of many ACOAs, has been shown to be problematic. In terms of helping clients, mental health professionals may want to provide information regarding AOD use as well as help clients clarify their values about use so that they may make decisions regarding abstention or moderation. Many clients who were raised in homes with alcohol abuse may not identify themselves as ACOAs. So, counselors need to be careful about using jargon that may create client resistance. Mental health professionals who use the label ACOA may leave their clients with the impression that this is a widely accepted clinical syndrome, but such a posture would be misrepresenting the empirical findings about ACOAs.

Adults who were raised in families with substance abuse, physical or sexual abuse, and/or parental death or divorce do seem different from adults with no such history. Moreover, recall from Chapter 11 that a characteristic of families with alcohol or other drug abuse is unresolved grief. This grief, coupled with poor communication skills and a lack of role-modeling on how to express feelings, may leave these clients predisposed to difficulty in trusting the counselor. Because ACOAs may control their emotions and attempt to control others as well, it is advisable that mental health professionals focus on developing a strong and deep rapport with the ACOA client.

The development of strong rapport with ACOA clients is critical in that they seem to have some difficulty in trusting. Given this, you can see how critical it would be for those who are helping diverse ACOAs and their families. Hall (2007a) maintains that the clinical intervention with ACOAs need not necessarily emerge as a special intervention. Although we discuss some concerns with diversity and twelve-step programs below, it seems that ACOAs may benefit from the same support groups that are identified and discussed inChapter 10, which include Codependents Anonymous (CODA) and Al-Anon. Other self-help groups, such as Sex Addicts Anonymous and Emotions Anonymous, could be used as well, depending upon the identified problem.

The term codependency was introduced in the early 1980s. Originally referring to the co-alcoholic (Whitfield, 1984), this notion was broadened through the writings of Black (1981), Friel (1984), and others who described a variety of compulsive behaviors. With the possible exception of transactional analysis and the famous phrase, “I’m okay–you’re okay” (Harris, 1969), few movements in the mental health field have generated so much popular interest and so much professional controversy as has the codependency movement.

The fields of chemical dependency and mental health were beginning to enjoy a healthy, although somewhat acrid at times, relationship once the notion of the dually diagnosed patient came into vogue in professional circles and more routine. However, it was the phenomenon of the patient with a coexisting disorder that sent shudders down the spine of the community mental health system—administrators and clinicians alike, because this dually diagnosed patient suggested the chicken-or-the-egg idea: What caused what? Which was the primary diagnosis? Did the alcohol or other drug problem create the mental disorder or was it the other way around? If patients were active in their addictive behaviors during the time of their entry into the mental health system, what was the proper treatment plan? The very real complications resulting from having a co-existing disorder caused the fear that the financial backbone of community mental health centers would be broken. That a professional could be treating the wrong problem was a good possibility.

One direct result of the numbers of such dual diagnoses was a bringing together of chemical treatment providers and mental health providers under one roof. Although it was not an easy operation in terms of administrative logistics, mental health centers made great strides to do exactly that. Staff meetings, which were once held to discuss mental health cases, now included addictions counselors whose training was quite different from that of their mental health colleagues. The friction that resulted was to be expected, because often mental health professionals had to move their offices or generate other concessions in order to make room for their new colleagues. As each group became more familiar with and received direct benefits from the work of the others, issues of turf and prestige gradually gave way to more amiable working relationships. Patients began to receive improved care, and with this came shared respect for each professional group. It appeared that all was well.

Then the chemical dependency field introduced the concept of codependency, and whatever strides had been made in the salubrious relationship between the mental health field and the addiction field turned sour once again. The definition and characteristics of codependency were seen by many mental health professionals as a new name for an old mental health disorder, which once again brought problems of professional boundaries into sharp focus. However, the problem was not only that the chemical dependency field was seen as trespassing onto the field of mental health nor was it only that those in the addictions field were being trained to treat codependency: The problem was more the issue of whether codependency actually existed. And if it did exist, questions about what constituted codependency would become the next cause of battle.

Some of the fiery debate was fueled by differences over the disease concept inherent in various views of codependency. Recall that, in Chapter 3, one’s view of alcoholism as being a disease or nondisease was seen to have profound implications for identification and treatment. Moreover, remember how the discriminating variable casting one into a disease or nondisease orientation essentially revolved around one’s view of “loss of control” (with the disease model claiming the centrality of a loss of control). Well, the voracity with which mental health professionals have debated the disease concept has been duplicated in the debate over codependency: Are people responsible for the root of their codependency? In other words, are individuals seen as more responsible for how they manage their impulses rather than being responsible for the impulse itself? Another source of debate centered on the traits of a codependent person. Hoenigmann-Lion and Whitehead (2006) studied whether codependency really exists. For these researchers, codependency is another name for a diagnosis already identified in the DSM-IV-TR under Borderline Personality Disorder, Dependent Personality Disorder, Posttraumatic Stress Disorder. Is codependency essentially a thematic variation on one of these disorders? Does it simply extend the boundaries of an already established diagnosis so that codependent characteristics lie more along one pole of a continuum in a given disorder?

Furthermore, some feminists argue that the perennial influence of the codependency hypothesis suggests that it is a social construct and is heavily influenced by traditional assumptions of gender. For instance, Dear and Roberts (2002) report that many feminists maintain the view of a society that demands that women be nurturing, caring, and sensitive to others’ needs. Yet these are the very characteristics deemed dysfunctional when viewed through a codependency paradigm. Perhaps this contentious issue surrounds the notion of whether codependency is a progressive disease.

Definitions of the term codependency are influenced by the degree to which one subscribes to the concept. That is, staunch proponents of the concept may see everyone and almost all of our institutions as codependent. For example, Giermyski and Williams (1986) state that enthusiastic proponents of the concept see codependency

as a primary disease present in every member of an alcoholic family, which is often worse than alcoholism itself, has its own physical manifestations and is a treatable diagnostic category. Its presence is recognized in individuals, among institutions, in hospitals as well as judicial and legal systems, in schools and even in the Federal Communications Commission (FCC). The last two are viewed as afflicted with codependency because schools expel students for drug-related offenses, and the FCC has not yet banned wine and beer commercials. (p. 7)

Cermak (1986) noted that efforts to define codependency have included metaphoric and interpersonal approaches as well as those approaches based upon ego psychology, behaviorism, and combinations of behaviorism and intrapsychic dynamics. For example, Anderson (1987) uses a metaphor to state that “being codependent is like being a life guard on a crowded beach, knowing that you cannot swim, and not telling anyone for fear of starting a panic” (p. 16). More formalized definitions of codependency are found in the interpersonal approaches of Black (1981) and Wegscheider (1989). Black talks about rules operating in the family structure that prohibit the honest expression of feelings regarding alcoholism and the alcohol-dependent family member. Wegscheider discusses codependency in terms of it being a preoccupation and dependence upon another person or object. Examples of codependency include individuals who are in a significant relationship with an alcoholic, those having one or more alcoholic parents or grandparents, and those who grew up in a family where there was systematic repression of feelings. Schaef (1987) presents a definition that depicts the belief in the progressive nature of codependency. She sees codependency as a disease emanating from an “addictive process” similar to that of alcoholism. This addictive process, unless confronted in much the same manner as alcoholism, can lead to a type of spiritual death—a life aimed at existing rather than thriving—or physical death (Schaef, 1987).

Friel (1984) extended the interpersonal approaches to include codependency and emphasized the impact of such behaviors upon the ego functioning of individuals. These authors maintain that codependency is an emotional and behavioral pattern of interactive coping resulting from one’s protracted exposure to a restrictive environment that does not allow the open or direct expression of feelings about oneself or other family members. For example, children who are consistently told that the mother’s or father’s drinking binges are not problematic, even in the face of drunken rages and subsequent physical abuse, will grow up confused about their reality. Any attempt to talk about the problem when the parents were sober would likely be met with cognitive resistance: “There is no problem.” Any attempt to talk about the problem when the parent(s) were drinking is likewise met with physical abuse. Hence, these children often learn to keep their feelings and thoughts about the parents’ drinking to themselves. This fear of talking would be introjected and thus carried into one’s adult life and relationships.

Whitfield (1984) believes that codependency is a disease of lost selfhood, and that it is the most common type of addiction that people develop. Whitfield states that codependence develops whenever there is “suffering and/or dysfunction that is associated with or results from focusing on the needs and behavior of others” (p. 19). An intrapsychic approach is reflected in Cermak’s (1986) definition in which he sees a codependent person as having a personality disorder based upon an excessive need to control self and others. Other symptoms include neglecting one’s own needs, boundary distortions centered on approach and avoidance in intimate relationships, attraction to other individuals demonstrating codependent characteristics, denial, a constricted or restricted emotional expression, low-level and persistent depression, and stress-related physical ailments.

As Irvine (1999, p. 29) and others point out (e.g., Krestan & Bepko, 1990), codependency’s “definitional ambiguity should not be taken to be ‘so vague as to be meaningless.’” Nonetheless, Irvine maintains that one cannot simply ascribe any and all meanings to it. She goes on to say that the constitution of one person’s codependency is really defined by what the person sees as troublesome in his or her own history. According to the same researcher, codependency can stand for different issues in an individual’s life. For instance, it might mean a series of loveless and oppressive relationships. In another case, codependency might mean distant, aloof, and isolating interpersonal response patterns to others. In yet another instance, codependency might reflect a sense of chronic low self-esteem and boundary problems in relationships (Watt, 2002).

Due to the lack of clear definitions of codependency, it is somewhat difficult to determine characteristics. As a result, several authors have advanced codependent characteristics, and, like the definitions, these characteristics range from less formal to more pedantic (see Kitchens, 1991; Schaef, 1987; Whitfield, 1984).

Dear and Roberts (2002) identified themes of codependency. These include a tendency to put other people’s needs before one’s own, the tendency to engage in taking responsibility for another person’s actions (“caretaking”), and the fixing of the damage cause by another person (“rescuing”). Potter-Efron and Potter-Efron (1989) identified eight characteristics of codependence: (1) Fear is indicated by a preoccupation with the problems of others, an avoidance of interpersonal risk, a general mistrust of others, persistent anxiety, and manipulative attempts to change another’s behavior, especially drinking behavior; (2) Shame and guilt are characterized by a persistence of shame and guilt about another’s behavior, self-loathing, isolation, and an appearance of superiority that masks low self-worth; (3) Prolonged despair relates to a generalized pessimism toward the world and feelings of hopelessness about changing one’s current situation. One may also demonstrate a low sense of self-worth that stands in direct opposition to one’s actual accomplishments; (4) Anger is often present but may be expressed in a passive-aggressive manner. One may also fear that becoming angry will mean a loss of control. Another characteristic of anger is that it is persistent; (5) Denial is usually rather consistent, especially when it involves family pain such as drinking behavior. Denial is also demonstrated by a consistent minimization of problems and the use of justifications or rationalizations aimed at protecting the person from perceived or real consequences; (6) Rigidity is identified by cognitive, behavioral, and moral, spiritual, and emotional inflexibility; (7) Identity development is also impaired. This is usually seen as an inability to take care of one’s own emotional needs and as having an excessive need for others to validate one’s self-worth. Along with this need is an obsessive concern about how one is perceived by others; (8) Confusion about what is normal and what is real is another behavioral pattern. Confusion is also indicated by one’s gullibility and indecisiveness.

In examining the definitions and characteristics, Doweiko (2011) states that the core aspect of codependency includes four elements: overinvolvement, obsessive attempts to control, the extreme tendency to use external sources for self-worth, and the tendency to make personal sacrifices. In codependency, overinvolvement with the abusing family member is coupled with an obsessive attempt to control the abusing member’s behaviors. Using external sources for self-worth is similar to Whitaker’s (1991) notion of “looking elsewhere.” The issue of personal sacrifices comprises those behaviors aimed at “curing” the abusing family member, in which the helper is seen as “saintly.”

According to Kitchens (1991), eight indicators can help to determine the severity of code-pendence: (1) the extent to which the client equates performance with self-value; (2) the extent to which the client equates self-worth with taking care of others’ needs; (3) the extent to which the client believes he or she is helpless to control what happens in life; (4) the extent to which the client attempts to feel more powerful or more in control of life than is actually the case; (5) the extent to which the client ruminates about dysfunctional family of origin behavior; (6) the extent to which the client continues to protect or defend against any criticism of his or her parents in the face of contradictory information; (7) the extent to which the client experiences unexplained or overwhelming anger; and (8) the extent to which the client feels stuck in his or her relationships.

In its heyday in the 1980s and early 1990s, codependency was not formally recognized in the DSM-IV. The fact that codependency does not appear in the DSM-IV-TR (American Psychiatric Association, 2000) continues to reflect the lack of formal professional acknowledgment. Nevertheless, mental health professionals should not categorically dismiss the concept. While the lack of formal acknowledgment in the early years hindered the development of sophisticated assessments of codependency, the same cannot be said today. The lack of appearance in the DSM-IV-TR has not deterred more recent efforts to legitimize the concept and assessment of codependency.

During the period from the mid-1980s to the mid-1990s, assessing codependency in clients was relatively informal, and professionals and nonprofessionals alike used a few notable nonstandardized instruments. However, the subjectivity and informality in the early years of the codependency movement were not categorical and should not be mistaken for a complete lack of validity. In the early years, the differences in the assessment of codependency were probably attributed to variations in the general assessment skills of practitioners, rather than being attributed to differences over the meaning and definition of codependency. While it is true that clinicians often assessed codependency simply through their subjective clinical impressions of the client, these impressions were partly guided by the professional works of Kitchens (1991), who also cautioned mental health professionals to combine subjective and objective assessment procedures. Interestingly, Harkness and Cotrell (1997) show that the pioneers may have been accurate in their assessments of codependency. These researchers studied more than 2,000 practitioners worldwide and found a remarkable agreement and consistency in the meaning and definition of codependency across practitioner subjects.

Fuller and Warner (2000) reviewed scales that are used to assess codependency. They found the Codependency Assessment Inventory (CAI) (Friel, 1985), the Acquaintance Description Form-C3 (ADF-C3) (Wright & Wright, 1991), Beck Codependence Assessment Scale (Beck, 1991), A Codependence Test (Kitchens, 1991), Co-Dependent Relationship Questionnaire (Kritsberg, 1985), Recovery Potential Survey (Whitfield, 1991), the Spann–Fischer Codependency Scale (Fischer, Spann & Crawford, 1991), and the Potter–Efron Codependency Assessment (Potter–Efron & Potter–Efron, 1989). According to Fuller and Warner, the CAI is lengthy (60 items), and the validity and reliability have not been thoroughly evaluated. Wright and Wright’s Acquaintance Description Form-C3 does not have published statistical information.

Fuller and Warner (2000) used the Spann–Fischer and the Potter–Efron Codependency Assessment (Potter-Efron & Potter-Efron, 1989) to study the relationship of these instruments with self-reported chronic family stress. Results of their study showed that women had higher codependency scores on the Spann–Fischer than did the sample of male subjects. This study raises questions about potential gender bias in the instrument, and this issue will be addressed later in the chapter.

Aside from these efforts to update assessments published in the early years of the codependency movement, a review of the current professional literature reveals continued interest in the introduction of new empirically tested psychometric assessments for codependency. For instance, Harkness, Swenson, Madsen-Hampton, and Hale (2001) studied the reliability and validity of a clinical rating scale for codependency. The researchers developed an example-anchored rating scale, based on how clinicians generally construe the term codependency in practice. The researchers administered the instrument to a group of practicing counselors. The design controlled for gender and called for counselors to be randomly assigned to one of four groups. The findings suggest that the rating scale yields reliable and valid clinical evaluations of codependency without appreciable gender bias. The Holyoake Codependency Index (HIC) (Dear & Roberts, 2000) is a 13-item scale that measures the extent to which a person endorses or rejects codependent sentiments. It comprises three scales: external focus, self-sacrifice, and reactivity. External focus is defined as the tendency to rely on other people in order to obtain approval and a sense of self. Self-sacrifice is the tendency to regard others’ needs as more important than one’s own needs. Reactivity is the degree to which one feels overwhelmed by a partner’s problematic behavior. According to the authors of the index, these subscales were derived from factor analysis of key themes using a clinical sample of mostly females. Dear (2004) conducted a reliability study for the test and found that over a three-week interval, test-retest reliability was 0.88 and for the full scale test and 0.76–0.82 for the subscales.

As you can see, arguments can be made about the consistency in the validity and reliability of assessment instruments throughout the history of the codependency movement. One current trend in research in assessment is to conduct concurrent validity and reliability studies as ancillary, yet important components, of other research questions. Lindley, Giordano, and Hammer’s (1999) study is an example. In this study, the researchers validate the Spann–Fischer scale while primarily looking at the relationship between codependency and age, gender, self-confidence, autonomy, and succorance. These studies, and others like them, provide opportunities for enhancing the clinical assessment of codependency.

Should you, as a mental health professional, choose to administer an instrument, you are advised to use these instruments with extreme caution. Probably the best use of these assessment devices is for the mutual identification of problematic areas occurring in the client’s life. Asking the client to share his or her impressions of the assessment results can help focus on areas that might need attention.

As far as the controversy is concerned, the mental health profession has the last word for now: The DSM-IV-TR does not include codependency in its nomenclature on personality disorders. This may or may not dissuade others from adhering to the concept of codependency, but this omission does make a clear statement that may intensify the chasm that exists over the use of the term between mental health practitioners and those practitioners in the chemical dependency field.

A close examination of the concept of codependency and the criticism surrounding the term and its corollaries will likely indicate that much of the argument involves degrees of acceptance. Even though little empirically based research has been conducted on the subject per se, Giermyski and Williams (1986) maintain that

It would be a mistake to deny that living or even working side by side with a drug dependent person causes stresses and problems or that wives and children as well as other members of families of drug dependent individuals undergo deprivations and stresses, that they suffer indignities, that such problems deserve help, and that help should be offered. However, the authors wonder if the term “codependency” has not been given connotations far exceeding justification, whether or not the implications (systematic, theoretical, and practical) at the level of the delivery of needed services have been sufficiently examined and the consequences considered. (p. 7)

In this sense, the very least that can be said about the concept of codependency is that it has helped to describe a variety of interpersonal and intrapersonal dynamics in a language that many can understand. In that alcohol and other drugs are rampant in our society across every economic and social line, the concept of codependency may currently be best operating as a paradigm attempting to make sense out of the confusing, paradoxical, and often deleterious effects of one’s extended drug involvement and its impact on others. Whether intuitively understood or empirically proved, it is safe to say that the characteristics identified as codependent operate in almost all of us at one time or another. Differences between individuals exist in incidence, degree, and persistence. Our society is based upon competition and achievement. You, as a reader of this book, might be termed an overachiever, but it is often overachievers who are in positions to help others. The need for belonging to powerful groups, identified as indicative of an antisocial and narcissistic personality disorder (Kitchens, 1991), can be functional, and decisions that affect us all are made by groups of powerful people. We all need humor in our lives, so the histrionic personality identified as maladaptive is necessary for us to have perspective on our lives. Compulsivity is almost a given in undergraduate and graduate school, isn’t it? Does that mean you are maladaptive for choosing to go to college or graduate school? The point we are making here is that codependent characteristics, per se, are not inherently good or bad. Sometimes behaving codependently is appropriate, very adaptive, and can lead to satisfaction with oneself and others. Sometimes these same characteristics can lead to problems. An inflexible adherence to codependency as well as an inflexible avoidance of it may become problematic. The advice given here is for you to remain open to the client and to employ an understanding of codependency as it relates to the well-being of that client. Categorically disregarding the presence of codependent behaviors may limit the amount and kind of information being presented by clients and can lead to less than efficacious results in counseling. Moreover, since thousands upon thousands attend CODA meetings and adhere to the principles of codependency as outlined in The Coda Book, a limited or myopic understanding of the larger social, political, and economic implications of codependency for women and racioethnic minorities is questionable practice.

In a recent study, Martsolf (2002) sampled 149 males and females whose ages ranged from 23 to 73. The sample included nurses, family physicians, psychologists, and social workers. The results of the study indicate a relatively low incidence of codependency in this sample. This stands in contrast to a preliminary study conducted by Fisher and Harrison (1993b), which assessed codependent characteristics of graduate students in a master’s degree counseling program. We found that these prospective mental health professionals reported more codependent characteristics than did students in other graduate programs. Moreover, the graduate students in the mental health profession were more likely to have come from an alcoholic home. This preliminary study suggests that mental health professionals’ codependency may be a potential problem in a counseling relationship.

Even though these are only two studies (and both are limited in their own ways), some interesting implications are apparent. Given that the pathological discourse of codependency in this culture has been around long enough to be seen and experienced as oppressive by many in the helping professions, one wonders whether clients now show a tendency to be hesitant in identifying themselves as codependent. Fisher and Harrison’s earlier study of graduate students occurred when there was widespread interest in the concept, and helping professionals were thought to be potential codependents because of the nature of the work they performed. During the time in which Fisher and Harrison (1993b) conducted their preliminary study, the stigma of codependency was not as harsh as feminists accused it of being in the 1990s. Thus, in the past, a questionnaire measuring codependency in a population that reflected low incidence may well have been due to a lack of subjects’ identification with codependent characteristics. Currently, the stigma of being codependent has many pathological connotations. This has created a situation in which both male and female subjects (mental health practitioners included) who are being assessed for codependency may not want to see themselves or be seen by others as codependent.

The dynamics that transpire between client and mental health professional in sessions may also reflect transference and counter-transference. Wegscheider (1981) sees attempts to keep an alcoholic from experiencing logical or natural consequences as enabling (see Chapter 11). Thus, your attempts to keep clients from experiencing the natural consequences of their actions can be framed as professional enabling or countertransference and can reinforce maladaptive client behaviors. You might perceive a client’s desire to return to a dysfunctional relationship as reflecting your failure to effect client change. By personalizing the client’s progress, you might strongly advise the client to avoid returning to the dysfunctional relationship and become angry with the client if the advice is not heeded. You might also overidentify with the experience of the client, resulting in an enmeshed relationship with the client. The loss of these interpersonal boundaries can diminish the effectiveness of the helping process, or at least confound the process. For example, you might identify with the client’s feelings of helplessness in changing an alcoholic partner’s behaviors. Rather than recognizing and working with the enabling aspects of the client’s behaviors, you might prematurely attempt to steer the client into solutions rather than helping him or her gain insight into how his or her behaviors actually enable or reinforce the partner’s alcoholism. In this manner, the client is kept from experiencing the consequences of his or her own behaviors.

We could continue with protracted examples of mental health professionals’ potential codependent behaviors. Suffice it to say that codependency in the profession can be problematic. Training programs go a long way in helping mental health professionals understand the parameters of interactions with clients. Yet, if you come from a home where there was alcoholism or other family dysfunction, you may be more prone at times to behaving codependently with clients. Personal work can increase awareness of your codependent behaviors and can help you arrive at some strategies and solutions. It may well be that our profession attracts those who have experienced much of the same pain that clients will have experienced. Your experiences with your own pain and codependency can significantly increase the potential for accurate empathy with your clients and, therefore, can be of potential benefit. The extent of the benefit to clients will likely be related directly to the amount of your own work on codependency issues.

In her book Codependent Forevermore, Irvine (1999) discusses ACOAs and codependency. She states that “codependency and the support group Codependents Anonymous exist today because of the trail blazed by Adult Children of Alcoholics” (p. 19). Thus, for Irvine, the two movements are related. For her, the debate is essentially focused on the extent that the relationship is complementary and/or supplementary.

However, the relationship between ACOA/codependency and AA/Al-Anon is more acrimonious. It goes beyond the fact that AA and Al-Anon were in existence first. According to Irvine, the Adult Child does not belong to AA. This is because AA exists for the alcoholic who wishes to become clean and sober and remain so. Second, the ACOA–codependency movement poses a cultural narrative that is in direct opposition to the discourse and tenets of AA and Al-Anon. The ACOA–codependency movement takes the focus off the alcoholic and places the focus on outside factors, specifically on genetic and/or interpersonal factors leading to addictions. In other words, adults who abuse alcohol are seen in the ACOA–codependency movement as doing so because of their childhoods and/or because of some genetic predisposition or proclivity. By locating some, if not all, of the control outside the abuser, a dramatic and deep chasm between ACOA and AA/Al-Anon is drawn.

Another structural difference is even more pronounced at the macro-level, and Irvine (1999) again provides insight. She says that the AA discourse is a conservative narrative. This means that it conforms more closely to the larger social narrative. If “blame” is to be had at all (remember that in AA, blame is seen as a process to be worked through in order to take responsibility), one could feasibly “blame” it on the bottle—not society. From this perspective, the narrative of ACOA–codependency is anti-AA. This is so because, if “blame” is to be had in codependency, the “blame” is placed on the family. It is imperative for you to understand that we are not saying that “blame” is condoned in any of these venues. We are using “blame” as a means of underscoring a difference between these approaches. While people may enter into these recovery programs blaming, they hopefully learn early-on that blaming is a way of avoiding responsibility. In any case, the difference in worldviews, concomitant with the obvious ensuing implications for treatment and recovery, is hard to understate.

On yet another front, the relationship between ACOA and codependency is an interesting one. According to research results (e.g.,Dube, Anda, Felitti, Edwards, & Croft, 2002), it is imperative that mental health therapists not categorically confuse codependency with alcohol use or being an ACOA. As mentioned previously, studies are now showing that the characteristics of ACOAs are not that unique and that these characteristics may also be found in adults who came from homes where there was neglect, abuse, and/or violence.

For instance, Cullen and Carr (1999) studied the differences between young adults on a measure of codependency. Results indicated that those high on codependency scores reported significantly more family-of-origin problems. Yet, the problems were not necessarily alcohol related. The family-of-origin problems included such things as relationships with chemically dependent partners, parental mental health problems, problematic intimate relationships, and personal psychological problems (for example, compulsivity). Moreover, there was no significant difference among those scoring high on codependency levels and the reporting of physical or sexual abuse.

The results of these studies suggest that codependency is one component of a wider multigenerational family systems issue. Thus, it is quite possible that ACOAs may be codependent, yet not all codependents are ACOAs.

The ACOA–codependency movement’s narrative was seen (and still is seen by many) as pitting children of any age against parents. The movement is seen as attacking the core structure of family. More significantly, the ACOA–codependency movement has been criticized as blaming all families and all parents of all children. Ironically, and to their credit, proponents of the movement adroitly point to the rigidity of the critics’ “all or nothing” perspective as demonstrating the very dysfunction of dualistic thinking firsthand. Thus, the separation between AA and Al-Anon is reiterated with the larger social narrative.

Clearly and from a social perspective, any new discourse that runs counter to the larger, prevailing discourse is enough to spawn criticism. It is to be expected, because societies remain stable through the dialectical processes of homeostasis and change. However, at the outset, the ACOA–codependency movement was seen as significantly altering the traditional Euro-Caucasian discourse on families regarding one’s position in the family structure. The antifamily nature of the new narrative also had significant structural implications for families themselves.

The movement had its emphasis on confrontation. Rightly or wrongly, it was seen as a movement of “parent bashing.” At that time in history, blaming one’s (somewhat elderly) parents ran diametrically opposite to the discourse calling for being grateful to one’s parents (usually fathers) for fighting World War II and bringing peace and prosperity to the world. The movement was seen by some women and mothers as a movement that discredited their choices, their sacrifices for their family, and, in some cases, their livelihoods. (As you will see, the feminist researchers had critics of their own.) As such, a core basic orientation of the ACOA–codependency movement was seen as crossing the decades-old narrative of “healthy and loving families” (of the 1940s through the 1980s).

As the ACOA–codependency movement grew, professional researchers became interested in studying the concept. After all, from a strict research perspective, the ability to identify, isolate, and profile a (albeit reputed) significantly large segment of society (ACOAs) for study was quite appealing. Yet the enthusiasm in being able to identify and isolate this population waned significantly as researchers designed studies and published results. Enormous methodological challenges in studying ACOA–codependency needed to be overcome. Many of the same problems remain today (Jacobs, Windle, Seilhamer, & Bost, 1999).

In the early 1980s, the definitions of COA and ACOA were precise and clear: COA meant a child of a parent who abuses alcohol, and ACOA meant an adult child of a parent who drank alcohol excessively. However, such a precise definition would eventually narrow the subject pool and create a diminished ability to generalize results. The problems were numerous. For instance, there would be difficulties attributing length of exposure to alcohol and the subsequent effects that it had. Second, since many alcoholics also used other drugs, this condition limited the population of alcohol-only users. Third was the issue of the validity of self-reports. Were the subjects reporting their patterns accurately? Fourth, even if one could argue in favor of self-reports, self-reports were (and are always) about events in the past. The validity of recollection was significant at the time, and debate continues in the courts. Today, the validity of self-reports is challenged under the rubric recovered memories. Fifth, assuming that one could validly recall an event and reliably self-report it, Goodman (1987) and then Williams (1990) argue that such things as parental inconsistencies, double-bind messages, the covert expression of feelings, shame, mistrust, and the existence of childhood roles occur in everyone’s life. Therefore, since these experiences are ubiquitous, one should not attribute these characteristics solely to COAs and ACOAs.

From the outset of the movement, researchers were not interested in undertaking studies demonstrating the clinical characteristics of COAs, ACOAs, and codependency (Giermyski & Williams, 1986). Thus, if one were to examine the professional journals in the early 1980s, one would find a dearth of systematic and empirically based studies. Today, this has changed. There is moderate professional research interest in the topic of ACOA–codependency per se.

At the same time, it is important to understand the sequence of the growth and development of the ACOA–codependency movement. Alcoholics Anonymous came first, followed in order by Al-Anon, ACOA, CODA, and Gamblers Anonymous (GA) and other twelve-step recovery programs. This chronology is interesting because it reflects the importance of the ACOA and CODA recovery programs. CODA is the bridge connecting the earlier and more conservative programs of AA and Al-Anon with the other addictions that will be discussed in Chapter 14. As such, the ACOA–codependency narrative has had a significant background effect on the upstream research studies of alcohol, alcoholism, children of alcoholics, fetal alcohol syndrome, and other substance abuse. The downstream effects on research affect studies of gambling and other addictions.

As you would expect, codependency has been thoroughly critiqued from researchers in the fields of sociology and women’s studies. Criticism is wide-ranging, and most of it relates to white women. The feminist criticisms of codependency can fall into three broad categories: gender bias, the codependency discourse, and victimization and victimhood.

Most of the vociferous objections have come from those who see codependency as perpetuating a state of victimhood. From the manner in which many of these researchers write, it is easy to generalize many of their findings to racial/ethnic women. However, it is critical to note that, while feminists would readily agree about the presence of the oppression of women on an international scale, they would also agree that the West has tended to dominate both the theoretical and practical aspects of the feminist movement. Hence, the grand narrative of feminism is the story of Western endeavor and relegates the experience of non-Western women to the margins of feminist discourse (Kurian, 1999, p. 66).

In the United States culture, traditional feminism is not necessarily an appropriate voice for some or many racial/ethnic women. This does not mean that the criticisms advanced by feminists about codependency are irrelevant for the minority populations. It means that some of the criticisms discussed by feminists will be relevant and can be loosely generalized to minority populations. Some criticisms will not be able to be appropriately generalized. Perhaps equally important to note is that the codependent discourse affects both males and females. It just affects them differently. To our way of thinking, the impact of the codependent discourse in general is potentially more harmful to the population of women in general than it is to men. This is due to the social, political, and economic barriers that women face in today’s culture.

Researchers are in agreement that, given the multiple meanings of codependency, it is largely a social construct, as much perceiver as perceived (Harkness & Cotrell, 1997). Harkness and Cotrell (p. 473) and Rice (1992) believe that the concepts of codependency and enabling reflect a twelve-step culture perspective of the world. With this perspective as a backdrop, feminist critiques of gender bias in codependency argue against its many forms. The crux of their argument is that the concept of codependency is prejudicial toward women on social, political, and economic fronts. It also claims that the issue of gender bias and codependency is critical because the consequences for all women are serious (Hurcom, Copello, & Orford, 2000).

A review of the literature on gender bias and codependency reveals that the very notion of gender is a questionable construct and narrative. For instance, Butler (1990) believes that gender is not represented as “real,” but as a boundary that is politically regulated. In agreeing with the principles of Butler’s work, Phoca (1999) goes on to say that, since there is no essential masculine or feminine subject, both genders can take up masculine and feminine subject positioning. In essence, this perspective blurs the boundaries surrounding gender in the traditional sense.

Although you may not agree with these researchers, the implications of this blurring of boundaries for the AOD field are important to understand. The blurring of gender boundaries directly affects the definitions of codependency, as well as favorably affecting the ability of codependency research results to be generalized to larger populations. For instance, the AOD field has adopted a gender-neutral definition of codependency, such as the use of “adult,” “person,” “individual,” and “family member.” In other words, the definitions of codependency do not include or use the gender-driven terms “women” or “men” or any of their derivatives. Thus, the gender lines do not exist and, theoretically, anyone could be codependent.

Yet, in spite of these gender-neutral definitions, earlier studies conducted by Krestan and Bepko (1990) and Parker (1980) showed that the traditional views of addiction and codependency were rather traditional in that they usually reflected male substance abusers connected with helpful females. These helpful females, who were seen as also depending on addicted men, were labeled as codependent. In more current research, Babcock (1995), Babcock and McKay (1995), and Dear and Roberts (2002) reviewed the definitions and various meanings of codependency and enabling and assert that these concepts continue to be framed by traditional views of male and female. These researchers, along with others (e.g., Hurcom et al., 2000; Krestan & Bepko, 1990), argue that the existing structures of codependency nurture the development of caretaking and self-sacrifice in women while, at the same time, keeping men from developing those same qualities. In reality, men (as illustrated in our case example with Tim), can and do develop these traits. In addition, numerous men attend Codependents Anonymous groups (although figures are kept confidential because of the twelve-step traditions).

Unfortunately, little empirical research on males and codependency exists. One of the main consequences of this misidentification and gender bias is the fact that the use of such words as “(codependent) person” and/or “(codependent) adult” has failed to successfully assign codependency or codependent traits evenly across males and females. For instance, it is a fact that males receive treatment for alcoholism far more often than do women. It is a tragic irony that this treatment differential occurs in spite of the fact that women, who are significantly underrepresented in studies of AOD abuse, may have higher rates of alcoholism or other substance abuse problems than are reported in the professional literature and databases. Hence, from this gender-bias perspective, not only does the concept of codependency propel women into stereotypic roles, but it also is seen as helping to mask their AOD abuse. At the same time, gender bias is hindering the development of nurturing qualities in the male population.

Several researchers (e.g., Babcock, 1995; Babcock & McKay, 1995; Krestan, 2000; Krestan & Bepko, 1990; Taleff & Babcock, 1998) write about the nature of discourse in our culture as it relates to codependency. Taleff and Babcock (1998) review the literature in the AOD field and identify five dominant discourses that guided the early AOD treatment culture. Two of these dominant narratives relate directly to the concept of codependency. According to Taleff and Babcock (pp. 34–39), the dominant discourses “in AOD work” are these:

· Blame the client for treatment failure

· Blame the victim

· Closeness equals pathology

· Too much knowledge is bad (don’t think, it will get you in trouble)

· Never trust the client (all addicts are cons and manipulators)

Blaming the victim and closeness equals pathology related directly to the codependency issue. In examining family systems theory and treatment approaches, Babcock and McKay (1995) believe that the notion of codependency has been the most blatant example of blaming the victim. Hurcom et al. (2000) believe that role-specific behaviors that result from a partner being addicted do more than blame. They pathologize the behavior. This followed the research of Taleff and Babcock (1998), who concluded that the AOD field tends to blame family members for the ongoing addiction (p. 37).

This research stream strongly characterizes an essential concern regarding the codependency discourse and feminism. Through this pathological narrative, helping is not perceived as a well-meaning, misguided, and yet unsuccessful attempt to thwart off the addict’s self-destruction. Rather, codependency is an insidious strategy used by the addict’s significant other(s) aimed at perpetuating the addiction. The discourse of blame and pathology results in the fact that cultural closeness, love, anxiety, and feminine nurturing are ignored. On a core assumptive level, the argument is that the paradigm reflects that people who are engaging in codependent behaviors are insidious and are not to be trusted. Women engaging in these behaviors are posited as untrustworthy as well as anti-feminine, because their natural tendency to nurture is now seen as unhealthy and is to blame for the addiction.

These researchers, as well as Krestan and Bepko (1990), see the need to understand the phenomenon of closeness as a way of overcoming the problems with this perspective. Clinicians need to be able to distinguish between normal, healthy closeness and pathological closeness or dependency. Moreover, clinicians need to assess families with AOD problems in terms of the amount of healthy interdependence that exists. If clinicians have a simplistic understanding of the gender-bias issue and codependency, they will miss what is clearly a complex phenomenon.

A related issue is the social discourse of victimization and victimhood. This broad, social narrative is different from the AOD discourses identified by Taleff and Babcock (1998). Nevertheless, the social discourse of victimization clearly has significant implications for the meanings of codependency.

For example, Irvine (1999) presents a subtle and powerful argument regarding the dominant social discourse and victimization as a response. She maintains that the individuals “left or abandoned” are the ones most often claiming the status of victimhood. Moreover, these “victims” are more likely to be unemployed, have fewer commitments to family, and be less committed to service in CODA (p. 148). Through this perspective, victimization and victimhood are structurally tied to the person’s position with regard to who “left the relationship first” (p. 148). This same researcher maintains that victims usually have fewer social–structural resources available to them. As a result, the narrative of victimization initially responds to and then, ironically, augments these very social–structural losses. Irvine (1999) sees this as a failure of our larger social structure to protect individuals from these social losses and resulting isolation. Given these insightful assertions, it is appropriate for counselors to assess the extent to which victimization is stated and the extent to which it might be more of a trait in individuals with AOD abuse issues (Irvine, 1999, pp. 156–157).

At the core assumptive level, victimization and victimhood place individuals, mostly women and racial/ethnic minorities, underneath the dominant discourse. This is because this discourse, in which these groups are portrayed as always seeking, presupposes an absence of something. Among other things, this seeking behavior is a “less than” position. The result is a vicious cycle that continues to isolate individuals from the mainstream and into a constant search to balance the scale.

Harkness and Cotrell (1997) also advance a thoughtful critique of codependency from feminist perspectives. These researchers agree with the views of Irvine (1999) and Krestan and Bepko (1990) regarding the issues of pathologizing and blame. Citing the works of Asher (1992), Collins (1993), and others, Harkness and Cotrell discuss the notion that codependency is re-oppressing women through the recapitulation of patriarchal politics of power in recovery. These same researchers also maintain that, from a certain feminist perspective, the cure for codependency is equally as toxic as the disease itself. They agree with Collins in asserting that the recovery is toxic because it is based on the core basic assumption of subordination.

The argument is similar to the argument about powerlessness and recovery for racial/ethnic minorities discussed in Chapter 11. The argument is based on the idea that recovery is toxic because codependent persons must assume a stance of powerlessness in order to become free from addiction. This powerlessness is layered by the experience of powerlessness in the sociopolitical realm. Thus, feminist concerns about codependency and recovery reflect the subtle and powerful social realm impacting the identification and treatment of women in need.

According to many researchers, studies are also needed that examine codependency in women of other cultures. In terms of assessing codependency in women of diverse cultures, Gayol and Lira (2002) conducted a study aimed at validating an instrument for assessing codependency in Mexican women. Gayol and Lira used a sample of 230 Mexican women (aged 18 to 65 years). The Codependency Instrument (ICOD) was designed to assess codependency in this female population. The authors used a sample of 41 women to determine the ability of the instrument to discriminate between codependency and non-codependency. The results demonstrate that the instrument is a valid and reliable method for screening probable cases of codependency in couple relationships in Mexican women. The research results also indicate a higher proportion of codependency women whose relationships included either an alcoholic partner or one who was abusive.

Central to codependency is the concept of self and the subsequent issue of boundaries (Kelley et al., 2007; Watt, 2002). When codependency first appeared in Western culture and was embraced as a popular movement, it was criticized as being anti-marriage, anti-religion, and antisocial. These same criticisms exist today, although not necessarily in the same vociferous form. Essentially, these arguments center on codependency’s overemphasis on the self. Codependency is seen as a relational problem in which a person’s self is not complete, not satisfied, and not fulfilled until entering into relation with something or someone. As Whitaker (1991) says, this leads these individuals to constantly be “looking somewhere else” for fulfillment.

Once in relationships, codependent individuals were encouraged to set boundaries and, if the need arose, were encouraged to disassociate from marital partners and organized religion and, instead, focus on one’s own needs. The concept of selfishness was reframed into the idea that it is better to be selfish than to be selfless. Codependents were selfless and needed to become more independent. However, Kim (1996) maintains that Americans [sic] have created the fantasy that they can live independent lives. For this researcher, Americans believe that being independent is equivalent to being free. In this manner, dependency becomes a negative characteristic and is viewed as a “failure to be autonomous.”

Because of the collective nature of many non-Western peoples, it is imperative that mental health professionals understand that the notions of boundaries, such as independence and dependence, are culturally defined. To punctuate the point, Kwon (2001, p. 49) states that codependency theorists have failed to describe the cultural matrix of relationality, since their Western views of selfhood conflict with those of Korean and other Asian philosophies at a core assumptive level. For instance, the self in Asian culture is configured entirely differently from Western notions. In general, Asian peoples have strikingly different construals of such constructs as the self, others, and of the interdependence of the two. In turn, these construals can influence and sometimes determine the nature of individual experience, including motivation and emotion (Kwon, p. 43). The significant impact of these different construals is reflected in the quote by Kim (1996), also cited in Kwon (p. 46). Kim says that if one used the Western notions of codependency to examine Korean or Asian family enmeshment, the resulting blurred ego boundaries and diminished ego strength should be reflected in higher rates of psychopathology in Asia and Korea than in the United States. Kim states that this view is not supported by data. In another illustration, Kwon says that many Americans say to their children who refuse to eat their supper, “Think of all the starving children in Africa and how blessed you are to be different from them.” In Asia, Kwon says that the same story would go, “Think about the farmerwho worked so hard to grow this rice for you. Think about how bad the farmer will feel if you do not eat your supper. The farmer’s efforts will have been in vain!” Kwon says that both statements seem to involve others (starving kids and farmers). However, the starving kids are only compared to American children; they are not related.

The notion of relatedness is central in Asian societies. According to Kim, Americans have been cultured into setting boundaries in relation to others. Moreover, this awareness of boundaries has been deeply and inextricably woven into a cultural imperative ofautonomy and self-control. Relationality becomes odious in that it would force some Americans to surrender this cultural ideal. A final example illustrates Kwon’s (2001) views follows:

When I first came to the United States and was becoming acquainted with American culture, I was bewildered when told by an American friend of mine, “Hey, leave me alone!” At the time, I asked myself a question, “Have I ever told anyone, ‘please leave me alone’?” In my memory, I had never insisted on setting my boundary by saying, “Leave me alone.” (p. 42)

In many collective cultures, the fundamental relatedness of the person is emphasized. In other words, the selfhood of the individual is sought more from a relational than from the internal attributes of rugged individualism. This difference clearly requires a reworking of the notion of blurred boundaries when working with some Korean or Asian individuals and families. Ego boundaries are established to separate or differentiate ourselves from others, and relational boundaries are created when we form our own sense of self in relation to others (Kwon, 2001). Kwon says that Koreans are not used to expressing themselves. They are accustomed to engaging in appropriate action that has their self-evaluations focused on normative information such as, “Is it appropriate or does it please others?” Many Asians are taught to feel more comfortable fitting in, rather than being separate or unique.

Therefore, it is not surprising to hear Carr (1997) state that it is more problematic for Koreans to work with self-identity and relatedness than it would be for them to work with identity and autonomy from others. In other words, the problems encountered in that culture move in a different direction than those occurring in America. With respect to mental health, codependent Americans have problems with others and need to be separating from them. Koreans and other Asians have problems because they are alone with the self. (In actuality, it would be more accurate to say that “they are alone and have no self” and need to be joining with others.) For Americans, the difficulty is in the separation. For Koreans, the difficulty is in the joining.

Borovoy (2000, 2005, 2009) and Kwon (2001) are both interested in the impact of the larger social narratives on the meanings of codependency for women in Asian cultures. Borovoy states that since alcoholism in Japan has become more of a social concern the notion of codependency is becoming a more significant issue. Borovoy agrees with many feminist researchers in believing that the codependency narrative pathologized women in the 1980s. Moreover, Borovoy agrees with Kwon in maintaining that the Western meanings of codependency do not transfer well to the Japanese (Asian) culture.

In Japan, the American version of codependency is seen as normal and not viewed as a compromise of the self. Borovoy goes on to state that the codependency discourse in Japan is reminiscent of its postwar national ideologies. These ideologies reflect the value of a familylike (codependent?) intimacy holding together Japanese society. This dominant discourse also implores its social members to develop a highly cultivated sensitivity to social demands.

Kim (2002) is also interested in the impact of a codependent discourse on women of Korea and other Asian cultures. Kim took an accepted feminist perspective in noting the significant influence that social oppression has on codependency. Kim develops a concept of codependency that is derived from the Korean notion of jong-sok-euee-jon, known as “subjugated dependency” (p. 2569). In this context, codependency in Korean women is seen as resulting from the oppressive Confucian patriarchy in marriage and family systems. The hypothesis of this qualitative study was that there would be a strong relationship between the persistence of Confucian patriarchal values and practices in the Korean family structure and females’ disposition to codependency in their marriages. Results confirmed the hypothesis for this sample: A positive relationship exists between codependency and the practices of Confucian patriarchal values.

The studies underscore the significance of being sensitive to cultural differences when applying the essential concepts of Western codependency to collective cultures, specifically for women in Korea and Japan. Borovoy (2000, 2005) believes that Japanese women who define themselves as codependent need to distinguish between socially valued interdependence and unhealthy or systematically exploitive forms of asymmetrical ties. Borovoy believes that, in this way, these codependent women can reject the exploitive demands of society while continuing to function in familial and neighboring communities (p. 94).

MyCounselingLab™

· The 1980s witnessed a spate of interest in the concept of Adult Children of Alcoholics (ACOAs) and codependency, concepts that, although different, many associate together.

· The clinical characteristics exhibited by ACOAs include low self-esteem, being overly responsible, having depressive symptoms, exhibiting antisocial behavior, anxiety disorders, parentification, and blurred and enmeshed boundaries in relationships.

· Other traits include difficulty with intimacy, discomfort with emotions, indecisiveness, and excessively giving into the needs of others.

· Some evidence exists that ACOAs are at risk for substance abuse.

· Intervening with ACOAs includes the identification and addressing of early symptoms of problematic drinking and dysfunctional behavior and should also include the development of appropriate coping skills to replace those that may predispose clients to relational issues.

· There are many definitions of codependency, and these definitions are influenced by the degree to which one subscribes to the concept; many who do not subscribe believe the characteristics have already been identified in various DSM-IV-TR diagnostic classifications.

· Many see codependency as an addiction that is chronic, progressive, and fatal.

· Feminists criticize the concept of codepen-dency asserting that the discourse blames the client for failure, blames the victim, equates closeness with pathology, and advocates for therapists to not totally trust their clients.

· Codependency does not translate well into collective culture narratives because of the emphasis upon “We”; in Asian cultures many see a positive and unhealthy relationship between codependency and Confucian patriarchal values.

· Regarding treatment concerns, the client’s use of the label ACOA and/or the term “codepen-dent” can be helpful in that the terms are easy to understand, and many individuals are familiar with the concepts.

· Mental health professionals should remain aware of their own proclivities toward behaving codependently with their clientele.

Adult Children of Alcoholics

1. What are your views of Adult Children of Alcoholics? Is there such a concept?

2. Why is there so much controversy about ACOAs?

3. What is beneficial about labeling oneself as an ACOA and/or codependent?

4. Codependency has been criticized for gender bias. To what extent do you agree or disagree with those claims?

5. In what ways does mental health professionals’ codependency help or not help this population?

Substance Abuse. Information for School Counselors, Social Workers, Therapists, and Counselors, Fifth Edition

Chapter 12: Adult Children and Codependency

ISBN: 9780132613248 Authors: Gary L. Fisher, Thomas C. Harrison

Copyright © Pearson Education (2013)