Emotional Addiction Therapy

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

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Codependent Personality Therapy is a growing up therapy

The article will focus not on people dependent on various substances, but on clients with a dependent personality structure, on those people who are pathologically attached to another person.

In the classifiers of mental disorders, when describing people with a dependent personality structure, the terms "dependent personality disorder" (heading "Mature personality disorders and behavioral disorders in adults in ICD-10) and" personality disorder in the form of addiction "(heading" Personality disorders "in DSM -IV).

The characteristic signs of this personality disorder include: active or passive shifting to others of making most of the important decisions in one's life, lack of self-control, lack of self-confidence, "adhesion" to the object of addiction, lack of psychological boundaries, etc. These psychological characteristics are often accompanied by various symptoms … Among them are often: psychosomatic diseases, alcoholism, drug addiction, deviant behavior, codependent and counterdependent manifestations.

Most often, the dependent personality structure manifests itself in the form of dependent and codependent behavior. Consequently, dependence and codependency are different forms of manifestation of the dependent personality structure.

They have in common a number of personal properties: mental infantilism, pathological attachment to the object of dependence, with the only difference that in case of dependence, such an object will be a substance, and in case of codependency, another person.

The focus of the professional activity of a psychologist / psychotherapist is more often a codependent client.

Typical characteristics of a codependent personality are involvement in the life of the Other, complete absorption in his problems and affairs. The codependent personality is pathologically attached to the Other: spouse, child, parent. In addition to the highlighted qualities, codependent people are also characterized by:

• low self-esteem;
• the need for constant approval and support from others;
• uncertainty of psychological boundaries;
• feeling of powerlessness to change anything in destructive relationships, etc.

Codependent people make the members of their system dependent on them for their entire lives. At the same time, codependents actively intervene in the life of the addict, control him, know how best to act and what to do, disguising their control and intervention under love and care. The other member of the couple - the addict - has, accordingly, opposite qualities: he is lacking initiative, irresponsible, and incapable of self-control.

It is traditional to view addicts as a kind of social evil, and codependents as their victims. The behavior of codependents is generally socially approved and accepted. However, from a psychological point of view, the contributions of the codependent to such pathological relationships are no less than the dependent. The codependent himself is no less in need of the dependent - he is dependent on the addict. This is a variant of the so-called "human" addiction.

Codependents themselves maintain dependency relationships, and when they escalate to a symptom, then they turn to a specialist to “cure” the addict, that is, in fact, to return him to his former dependent relationship.

Any attempts by the addict to get out of the control of the codependent cause a lot of aggression in the latter.

The partner of the codependent - dependent - is perceived as an object and its function in a couple of codependent-dependent is comparable to the function of the dependent's object (alcohol, drug …). This function is to "plug the hole" in the identity of the codependent by means of an object (in our case, a partner) in order to be able to feel oneself as a whole, to find the meaning of life. It is not surprising that for the codependent, the dependent, despite all its shortcomings (from the point of view of the codependent), turns out to be so important, because it provides for him the most important function - meaning-making. Without it, the life of a codependent loses all meaning. The addict has his own object for this. Hence the strong attachment of the codependent to the addict.

It is not surprising that the Other occupies such an important place in the picture of the World of the codependent. But for all the importance and fixation on the Other, the attitude towards him is purely instrumental - as a function. In fact, the Other for the codependent, due to his egocentric position, as an individual with his experiences, aspirations, desires simply does not exist. Yes, the Other is present in the picture of the Codependent World, even exaggerated, but only functionally.

The reason for the formation of both dependent and codependent personality structures is the incompleteness of one of the most important stages of development in early childhood - the stage of establishing psychological autonomy necessary for the development of one's own “I”, separate from the parents. In fact, we are talking about the second birth - psychological, the birth of the I as an autonomous entity with its own boundaries. According to G. Ammon, “… the formation of the I border in symbiosis is a decisive phase in the development of I and identity. This emergence of the I border, contributing to the distinction between I and not-I in terms of the formation of identity, becomes possible due to the primary inherent functions of the child's I. In the formation of the boundaries of the Self, the child also depends on the constant support of the environment, his primary group, especially the mother."

In the research of M. Mahler it was found that people who successfully complete this stage at the age of two or three years have a holistic inner feeling of their uniqueness, a clear idea of their “I” and who they are. Feeling your Self allows you to declare yourself, rely on your inner strength, take responsibility for your behavior, and not expect someone to control you. Such people are able to be in close relationships without losing themselves. M. Mahler believed that for the successful development of a child's psychological autonomy it is necessary that both his parents have psychological autonomy. The leading condition for such a birth of a child's self is his acceptance by parental figures. In the same case, when parents, for various reasons, are not able to accept (unconditionally love) their child, he remains in a state of chronic dissatisfaction in accepting his self and is forced all his life to unsuccessfully try to find this feeling or obsessively "clinging" to another (codependent), or compensating for this feeling with chemical surrogates (dependent).

In terms of psychological development, the dependent and the codependent are approximately on the same level. Undoubtedly, this is the level of the borderline organization of the personality structure with characteristic egocentrism, impulsivity as an inability to retain affect, and low self-esteem. The dependent-codependent pair is formed according to the principle of complementarity. It is difficult to imagine a couple of a person with an autonomous self and a codependent.

They also have in common a pathological attachment to the object of addiction. In the case of a codependent personality structure, such an object, as mentioned earlier, is the partner. In the case of a dependent, a "non-human" object. The mechanism of the "choice" of an object is unclear, but in both cases we are dealing with a dependent personality structure.

How do people with this personality structure get to psychotherapy? Most often, a psychologist / psychotherapist deals with two types of requests:

one. The request is made by the codependent, and the addict becomes the client of the psychologist / psychotherapist (the codependent leads or sends the addict to therapy). In this case, we are faced with a non-standard situation for psychotherapy: the customer is the codependent, and the dependent becomes the client. This situation seems to be prognostically unfavorable for therapy, since here we are not really dealing with the client - one of the necessary conditions of therapy is not observed - the client's recognition of his own "contribution" to the current problem situation, as well as denial of the existence of the problem itself. As an example of the situation under consideration, we can cite cases when parents address a request to “correct” the problematic behavior of a child, or one of the spouses who wants to rid a partner of a pathological habit.

2. The codependent seeks therapy himself. This is a more promising prognostic option for therapy. Here we deal with both the client and the customer in one person. For example, parents seek professional help with a desire to understand a problematic relationship with a child, or one of the spouses, with the help of a psychotherapist, wants to understand the reason for a relationship with a partner that does not suit him.

If in the first case, psychotherapy is, in principle, impossible, then in the second, the codependent client has a chance. Despite this, such clients usually do not respond well to psychotherapy, since the spectrum of their problems is due to an underlying defect in their psyche. Lack of self-control, infantilism, a limited sphere of interests, "adhesion" to the object of addiction are a serious challenge for a psychologist / psychotherapist.

Dependent clients are easily recognized at the first contact. Most often, the initiator of the meeting is a codependent close relative of the addict - mother, wife … Often the client's first feeling is surprise. And it is no coincidence. After talking with the calling mother about the problems of her boy, you naturally wonder how old is he? To your surprise, you learn that the boy is 25, 30, or even more … So you come across one of the central qualities of the addict's personality - his infantilism. The essence of mental infantilism is in the mismatch between the psychological age and the age of the passport. Adult men and women in their behavior demonstrate childish traits atypical for their age - resentment, impulsiveness, irresponsibility. Such clients themselves are not aware of their problems and are not able to ask for help from the environment - usually their relatives turn for help or someone brings them to therapy literally "by the hand." The psychotherapist will have to work with a “little child” who is not aware of his desires, needs, his own separation from the environment. The addicts always remain children for the codependents.

Working with both addicted and codependent clients is not limited to the therapist-client relationship, but inevitably draws the therapist into the field relationship. The psychologist / therapist does not have to work with one person, but with the system. He is constantly drawn into these systemic relationships. It is very important for the psychologist / therapist to be aware of this. If he is drawn into systemic relations, he loses his professional position and becomes professionally ineffective, since it is impossible to change the system while being in the system itself.

One of the forms of "pulling" the therapist into the system is the so-called triangles. Triangles are a necessary attribute in the life of addicts-codependents. S. Karpman, developing the ideas of E. Berne, showed that all the variety of roles underlying the “games that people play” can be reduced to three main ones - the Rescuer, the Persecutor and the Victim. The triangle that unites these roles symbolizes both their connection and constant change. This triangle can be seen both interpersonal and intrapersonal. Each role position can be described using a set of feelings, thoughts and characteristic behaviors.

Victim - this is the one whose life is spoiled by the tyrant. The victim is unhappy, does not achieve what she could if she were released. She is forced to control the tyrant all the time, but she does not succeed well. Usually the victim suppresses his aggression, but it can manifest itself in the form of outbursts of rage or auto-aggression. To maintain the pathological relationship, the victim needs external resources in the form of help from a rescuer.

Tyrant - this is the one who persecutes the victim, while often believing that the latter is to blame and provokes him to "bad" behavior. He is unpredictable, not responsible for his life and needs the sacrificial behavior of another person to survive. Only the departure of the victim or a lasting change in his behavior can lead to a change in the tyrant.

Rescuer - this is an important part of the triangle, which gives "bonuses" to the victim in the form of support, participation, various types of assistance. Without a lifeguard, this triangle would have disintegrated, since the victim would not have enough of his own resources to live with a partner. The rescuer also benefits from being involved in this project in the form of the victim's gratitude and a sense of his own omnipotence from being in the "top" position. At first, the psychologist / therapist is assigned the role of a rescuer, but in the future he can be included in other roles - a tyrant and even a victim.

Analyzing the therapeutic relationship in the work with the described clients, it should be noted that they (the relationship) are rather unstable due to resistance in the work from both the client (addicted-codependent) and the therapist.

Codependent (most often the customer of therapy) is dissatisfied with the results of the work, since the psychologist / psychotherapist does not do what he would like. He most often deliberately resists therapy, hinders it in every possible way, using an arsenal from the most harmless methods - excuses of the addict to the therapy, to quite serious - threats to both the client of therapy and the therapist himself.

Dependent (client) - on the one hand, he consciously wants changes, on the other hand, he unconsciously resists her in every possible way, since he is pathologically attached to the codependent. He is childish, lacking in initiative, he is held back by guilt, fear. He often unconsciously connects the objects of the system to the resistance.

The psychologist / therapist may also unconsciously turn on the mechanisms of resistance to work. The feelings that he has for the client can hardly be classified as positive: fear, anger, despair …

Fear arises as a result of the fact that the position of a psychologist / therapist is quite vulnerable, it can easily be harmed, since the content of psychological help is not clearly understood by ordinary people. In the work of a psychologist / therapist, there are no clear objective criteria for the success of therapy. The position of a psychologist / therapist is also vulnerable in legal terms - often he does not have a license for this kind of activity due to legislative peculiarities. The position of a specialist is also unstable in terms of competition with medical colleagues - “psychotherapists in law”. Any complaint from a dissatisfied client can create many difficulties for the psychologist / psychotherapist.

Despair stems from the fact that working with such clients is long and slow, and changes are minor and erratic.

Anger is due to the fact that the client is a manipulator, a borderline personality, he is a great specialist in breaking psychological boundaries, including the boundaries of therapy and therapist.

Therapy

When working with clients with a dependent personality structure, it is important to keep a number of important points in mind.

In the case when the client is an addict, the therapist does not work with the client, but with a systemic phenomenon, the client is a symptom of a dysfunctional system. This makes it impossible to work with the client as a symptom in individual therapy. In this case, the best that a psychologist / psychotherapist can do is to try to attract a codependent to therapy. In working with a codependent, it will be strategically important not to be involved in systemic relations (the system is stronger), but to maintain his psychological autonomy in the client. The general strategy in working with both addicts and codependents is to focus on their psychological maturation.

Codependent Personality Therapy is a growing up therapy. The origins of codependency, as we noted earlier, lie in early childhood. The therapist must remember that he is working with a client who, in terms of his psychological age, corresponds to a child of 2-3 years. Consequently, the goals of therapy will be determined by the developmental objectives characteristic of this age period. Therapy with clients with a dependent personality structure can be seen as a client “nurturing” project; such therapy can be metaphorically represented as a mother-child relationship. This idea is not new. Even D. Winnicott wrote that in “therapy we try to imitate a natural process that characterizes the behavior of a particular mother and her child. … it is the “mother - baby” pair that can teach us the basic principles of working with children whose early communication with the mother was “not good enough” or was interrupted”[3, p.31].

The main goal of therapy with clients with a dependent personality structure is to create conditions for "psychological birth" and the development of his own "I", which is the basis for his psychological autonomy. To do this, it is necessary to solve a number of tasks in psychotherapy: restoring boundaries, gaining the client's sensitivity, first of all to aggression, contact with their needs and desires, teaching new models of free behavior.

The use of the parent-child metaphor in the psychotherapy of codependent clients allows us to define a strategy for working with them. The psychologist / therapist should be non-judgmental and accepting of the various manifestations of the client's self. This makes special demands on the therapist's awareness and acceptance of the rejected aspects of his own I, his ability to withstand the manifestations of various feelings, emotions and states of the client, especially his aggression. Working out destructive aggression makes it possible to get out of the pathogenic symbiosis and delimit one's own identity.

The psychologist / therapist will have to put in a lot of effort to create a trusting relationship before the client allows himself more freedom to express his own feelings and experiences. The emergence at the next stage of work of the client's counterdependent tendencies with aggressive reactions towards the therapist - negativism, aggression, depreciation - should be welcomed in every possible way. The client has a real opportunity to receive in therapy the experience of manifesting his "bad" part, while maintaining the relationship and not receiving rejection. This new experience of accepting oneself as a significant Other can become the basis for self-acceptance, which will serve as a condition for building healthy relationships with clear boundaries. At this stage of therapy, the therapist needs to stock up on a capacious "container" to "store" the client's negative feelings.

A separate important part of the therapeutic work should be devoted to the client's acquisition of self-sensitivity and integration. For clients with a dependent personality structure, selective alexithymia is characteristic, which consists in the inability to recognize and accept the rejected aspects of their I - feelings, desires, thoughts. As a result, the codependent, as defined by G. Ammon, has a "structural narcissistic defect", which manifests itself in the existence of a "defect of the boundaries of the I" or "holes of the I". The task of therapy at this stage of work is to be aware of and accept the rejected aspects of the self, which contributes to "filling holes" in the client's self. The discovery of the positive potential of "negative" feelings is the client's invaluable insights in this work, and their acceptance is a condition for the integration of his identity.

The criterion for successful therapeutic work is the emergence of the client's own desires, the discovery of new feelings in himself, the experience of new qualities of his I, on which he can rely, as well as the ability to remain alone.

An important point in the therapy of clients with a dependent personality structure is the orientation in work not towards the symptoms of addictive behavior, but towards the development of the client's identity. It must be remembered that the Other, as described above, performs a structure-forming function that gives the codependent a sense of the integrity of his I, and in general - the meaning of life. F. Alexander spoke about the "emotional gap" that remains in the patient after the elimination of the symptom. He also stressed the dangers of psychotic disintegration that may follow. This "emotional gap" just denotes a "hole in the I", a structural deficit in the patient's I border. Therefore, the goal of therapy should be to assist the patient in the formation of a functionally effective border of the I, which leads to the unnecessary use of dependent behavior that replaces or defends this border.

An important criterion for the success of working with this kind of clients is overcoming their egocentric position. This is manifested in the fact that the client begins to notice in the therapist and in other people their humanity - vulnerability, sensitivity. One of the markers of such a neoplasm is the client's feeling of gratitude.

Psychotherapy for a client with a dependent personality structure is a long-term project. It is believed that its duration is calculated at the rate of one month of therapy for each client's year. Why is this therapy taking so long? The answer is obvious - this is not a therapy for a specific problem of a person, but a change in his picture of the World and such structural components as the concept of I, the concept of the Other and the concept of Life.

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