Leaving Codependent Relationships In Psychosomatic Families

2024 Author: Harry Day | [email protected]. Last modified: 2023-12-17 15:43

Beginning Codependency in a family with psychosomatic disorders

Working with psychosomatic clients is one of the most difficult in psychotherapy. However, it is even more difficult to work with codependency in psychosomatic families, since often the patient himself receives a secondary benefit from the disease, and is unlikely to want to part with it. At the same time, the codependent partner ceases to live his own life and cannot change anything, because it is not his illness - it is not for him to recover. Of course, in a family where this state of affairs suits more and more parties, there are often no problems or requests, especially if the children are closely intertwined with the codependent family system and consider such a device to be the norm. Problems begin when one of the participants becomes dissatisfied with their "fate", but under the pressure and resistance of the system, they cannot get out of it. The most difficult cases for therapy are when the parent is sick, and even more difficult when the disorder has the character of a "sort of" psychopathology (the very case when mental disorders are nothing more than a chosen way of interacting with the surrounding reality).

It is not by chance that I use the term "system" here, since in this case it is not just about two people, where one is the victim, and the other is the rescuer. There are many components here, including: family histories and traditions of other relatives of observers, advisers and keepers of rituals; social connections, which in one way or another became possible and were able to build precisely thanks to the disease or the role of a "helper"; medical services, where it is simply beneficial to preserve a psychogenic pathology that is, as it were, harmless to health, and at the same time, always in need of treatment, and the moral, ethical and spiritual frameworks that help put your life on the altar of obligations and condemn the choice to be independent, mature and happy. Only a few, having objectively assessed the depth of the issue, all the "windmills" with which it is worth ending the relationship and putting an end to it, choose the way out of the codependent dysfunctional system. The majority, after weighing all the pros and cons, prefer to keep the system. At first glance, everything is normalizing, in fact, unfortunately, it often happens that without accepting a way out of the situation and not being able to come to terms with it, experiences are looking for a way out and resolution through the body of the codependent itself, as if to say: "Now I am sick and now I need attention, help and care. " This is a kind of way to finally declare to the system "I am", "I mean", "I have my own needs and desires", etc. However, in order to "interrupt" the illness of a loved one, a codependent needs a more significant, complex or completely incurable one. And often the roles in the system do change, but codependent behavior and a destructive atmosphere persist.

Speaking about the exit from the codependent psychosomatic family system, first of all I would like to draw your attention to the fact that not all diseases have a psychological "root cause". The very principle of the mutual influence of the mental on the physical and vice versa does not place the superiority of the mental over the physical, but considers a person as an integral system. And then it matters whether the psychosomatic connection is healthy or pathological, whether the psychological problem is a resolving factor for the disease, or whether the disease itself provokes changes in the psyche, is the disease "spontaneous" or chronic, hereditary, etc. Depending on this, the tactics of influence will be completely different. So, for example, when in this article we discuss psychosomatic illness as a symptom that helps a person achieve what he wants, some of the recommendations will not be applicable at all in the case of a family where one of the members is disabled or has genetic pathologies. And vice versa, when it comes to hereditary diseases, family members often ignore individual symptoms, up to anosognosia (denial of the disease), which in turn gives them the opportunity not to build their lives depending on the disease, sometimes even aggravating their condition, however at the same time, conflicts and codependency of the partner only intensify. In each of these cases, there is a problem of codependency, but it is solved in different ways.

The topic I touched upon probably has no boundaries, and it can be discussed endlessly and from different angles. That is why here I will still restrict myself to precisely the situation in which the psychosomatic problem has the character of a secondary benefit, conscious or unconscious.

The first step in such matters is precisely a medical examination and treatment, which not only establishes a diagnosis, but also gives us information about how a person relates to his state of health, to procedures and, in fact, how his body reacts to certain methods of treatment. If there is aggravation (we notice that the patient tends to exaggerate the complexity of his condition), non-compliance with the treatment regimen, diet and other procedures (omissions and unauthorized cancellation), neglect of preventive recommendations, a weak reaction of the body to various methods and quick relapses, we are more confident we can talk about the psychosomatic basis of the problem, including secondary benefits. Awareness of the problem - the first step towards its solution.

In the second step, we can select directly acknowledgment of the problem … A disease that is "not cured" (or a person who is constantly being treated) very quickly becomes overgrown with rituals and involves the family in a "prevention and rescue" regimen. It is important to discuss this with the patient himself. I usually tell my clients that no one likes to be reprimanded, threatened or manipulated, so there is no need to invent, bypass and tweak anything. It is important to say directly: "We spoke with the doctor, he believes that your behavior indicates that you are not ready to get rid of the disease. For what reason, it is not known, but if you cannot trust the specialists and carry out all the appointments as they are prescribed, our life will not change for the better. You are recommended to contact a psychologist-psychotherapist, we may have to work with him, or each with his own specialist. Most likely our relationship will change, but since they will change in any case, I suggest trying to do so, so that these changes are for the better and for the benefit of both of us. " I want to note right away that the percentage of those patients who decide to work on themselves is minimal, but this is not a reason to fold their hands. In this case, a lot of psychological defenses come to the surface, and sometimes a person just needs time to observe himself and it is possible to return to this conversation later.

After we talked about the existence of the co-dependence problem, various questions begin to arise in the head of each of the partners, which one way or another boil down to one thing - "Why". Indeed, it is the search for the reasons that can give the answer to the question "What to do". So in the third step we determine the reason the current situation. Theories of the emergence of codependent relationships are numerous. Some researchers generally see a genetic predisposition in the propensity for codependency, while others insist on environmental factors. For me personally, these positions do not contradict each other, tk. it is environmental factors that can influence the disclosure of certain genes. By changing environmental factors, we can at least try to prevent the development of other patterns, and elements of behavioral therapy will help to correct destructive patterns of interaction. Supporters of TA (transactional analysis) show a scheme in which the problem of codependency grows out of a violation of role interaction, where the patient is infantile and irresponsible as a Child, and the codependent partner is a hyperresponsible controlling Parent. And the way out of this bundle is that each of them, through personal changes, translates the level of relations and interaction into the Adult-Adult mode. The authors of EOT (Emotional Image Therapy) consider the option of codependency as a desire to recoup the investment and, with the help of verbalization and visualization, the client can regain a sense of balance, compensate for the loss of mental energy (figuratively). Analytical theory proposes to return to that difficult childhood, in which the "rescuer" had to grow up early, and change his attitude to the situation. Many options for solving the issue of codependency exist in psychotherapeutic practice. The choice and tactics of psychotherapy, as usual, will depend on the individual case and on the personality of the client himself … However, changes are only possible if the client is ready for them.

So, decision to withdraw from a codependent system is the next step in getting rid of destructive behavior. As mentioned above, such changes may concern not just 2 people, they are tightly connected with society, various institutions and state services, professional environment, intrageneric relations, etc. You cannot say "from today on I will not indulge your whims, but I will live a full life, satisfying my interests." It won't work. Not in a pair, not in a system, not in a specific person. It should be remembered that almost everything that has been built in life in recent years has been built on the basis of the disease itself.

Imagine that there is a skein of tangled threads in front of you, and your task is to unravel it. If you just cut the pieces before and after the "knot", the thread will be unusable. First you need to find the ends, and by threading them into specific places, you will be able to free some of the threads. Over time, these ends will become too long and you will no longer be able to pull them through the main knot. Then you will pull along the thread and see which one is where and what is pulling. Pull up, release, make the hole large, draw a ball, change the thread and pull up and down again, etc. Only in this way will you slowly but surely reach your goal while maintaining the thread. Needless to say, how many times during this work you will want to throw out the skein itself and cut it with scissors;)?

So it is in psychotherapy. Before changing the system, it is important to consider every causal relationship that in one way or another relates to the illness of your loved one. Then the changes occur step by step, starting with discussion, search, ending with direct actions - not to tear everything at once, but to take a small step, step back, look at the changes and adjust the plan for a further exit. Otherwise, the system will simply swallow you: those around you will increase the feeling of guilt, perhaps even make you believe that you are completely out of your mind; health services will increase your fears about prognosis and outcomes; somewhere the question will arise about the deprivation of material compensation, etc. It is difficult to describe everything that can happen, just believe that changing such a system "once and done" is almost impossible.

It is also important to note that the problem of codependent behavior is a reciprocal change. It often happens that the patient himself is actively working on the problem, while the codependent close, losing their usual role and function, begins to unconsciously oppose the partner's changes. Therefore, each of the participants must remember about the "insidiousness" of psychological defenses, and if the family does not have the opportunity to visit a specialist together, then it makes sense for a partner who is outside of therapy to go through at least periodic scheduled meetings to identify and correct defenses. In addition to the widespread guilt, shame, resentment, anger, etc., fear is one of the strongest feelings accompanying the client at almost any stage of interaction with codependency. Sometimes we get the impression that we are keeping the client in therapy by force, because the closer the changes, the more fear, resistance and temptation to leave everything as it is, in extreme cases to take a break. It is important to talk about all this with a specialist as many times as the thought appears that "everything does not work, everything is in vain, everyone is against it", etc.

Only after a time of analysis and unraveling of our "tangle", we can talk about the final stage - growing up in TA, closing gestalt, reimbursement of investments, etc. qualitative changes … If you do not break the system in the heat of the moment, and approach the work thoughtfully, it is very likely that the partner will gradually pull up to these changes himself. The essence of getting rid of emotional dependence lies in knowing yourself, your desires, interests, self-love (in the good sense of the word), growth, improvement, independence and self-sufficiency, and most importantly, to make your life interesting. So, the main criteria for getting out of emotional dependence are:

- distribution of responsibility … What we call "helping, not saving." Gradually, through discussion, we come to the fact that a person himself monitors appointments and preventive measures, organizes his own meetings with specialists, himself strives to understand his psychological state, etc. These are signs of an adult, mature personality - to be responsible for your life and health on your own. We can provide any kind of help, but by helping, we do not do anything for the patient himself.

- setting the boundaries of your self … No matter how close and close a partner is for us, it is always important to remember that we are two different people. Each of us has our own joys and sorrows, our own personal feelings and fears that are incomprehensible to anyone, needs and pleasures, etc. In codependent families, their feelings are replaced by those of a partner and vice versa, so it is important to learn how to share the experiences of each of us separately. The partner who "decides" for the other what and how should be, coming to the reception answers all the questions himself, even when they do not concern him). It looks nothing more than a symbiosis of a mother and a newborn baby, which says: "we ate, we slept, our teeth are crawling", etc. Accepting that we are not one whole, that we are different, that the partner's experiences can and should be different from ours is an important stage in learning to recognize our emotional experiences and accordingly manage them. It is so important not only to learn to define your boundaries, your needs, desires and interests, but also to respect the boundaries, needs and interests of your partner.

- distribution of roles and adequate communication … Speaking about the equality of two adults, we very often want to object: "How is it, because one of the partners is healthy, and the other is sick and simply cannot perform a number of functions on its own." Psychosomatic realities differ precisely in what they can. But either he gets used to the fact that everything is done for him and is in no hurry to leave his comfort zone himself, or he unconsciously uses the disease as a communication tool, or both and something else. In fact, it is important that every psychosomatic patient has the opportunity to get rid of his disorder or disease with the real desire and help of a specialist. As we already said, step by step, through dialogue and awareness, through trial and feedback, but over time everything is solved. The behavior of a mature person differs in that he takes responsibility for his health on himself, and, if necessary, uses the help of others, but help, and not shifting his worries onto other people's shoulders. In this case, it is also important for the other partner to note whether there is excessive pride and self-confidence in the relationship, that no one except him can take better care of a loved one. Equal distribution of rights also implies that everyone equally has the potential to be the smartest, the most dexterous, the most powerful, etc.;)

- integration … In working with codependency in psychosomatic families, the question often comes to the surface that family relationships have been built around a disease or disorder for so long that family members have practically nothing left that would really unite them. Subconsciously, partners understand this, in part because so often there can be resistance to exit from codependent relationships. From the point of view of psychotherapy, it is important to find out how these fears are justified, to look at the current situation without embellishment and to figure out whether partners need this union or not. If a couple decides to keep the family, then it is important to find something that would unite them in addition to illness (common interests, goals) and possibly turn life in a new direction. The same applies to other social ties, institutions, etc., where the patient is used to functioning through his illness.

When writing this note, many questions remained unsolved or partially covered, since the versatility of the topic does not make it possible to write about everything once and at once. The only thing that can be said unequivocally is that each family case is still individual, and almost everything ultimately affects the solution of the issue, from the composition of the family and attitudes regarding health / illness, to the psychological atmosphere itself, which allows psychosomatics to be put into action.