CHAPTER 35 – CODEPENDANCY
Gail Notes
Codependency is a progressive yet treatable illness characterized by self-defeating behaviors, distorted thinking, problems expressing feelings, and difficulty with relationships.
It begins in a person’s family of origin. In a codependent family system, there may be an individual addicted to a substance or to a behavior (gambling, sex, food, work or spending). There may be a chronically mentally ill person, physically ill person, or a person with strongly moralistic orientation. The family may have rigid family unwritten rules that encourage dishonesty, manipulation within the family system, and prevents normal development. They have many secrets, discourage autonomy, and there may be role reversal (child caring for parent)
Chief enabler- rescuing and controlling behaviors. Rescue from jail, give money or support them financially, lie for them.
Hero- the child who is the straight A student, involved in sports, he/she is "perfect"
Scapegoat- is blamed for the problems in the family
Mascot- the pet, he/she tries to lighten things up by telling jokes or doing something funny.
HIGH RISK GROUPS FOR CODEPENDENCY:
Spouses of addicts
Practicing and recovering addicts
Adult children and grandchildren of addicts
Professionals in a caretaker role
Families with a secret or unresolved trauma
Families that do not foster autonomy
Families that reward helplessness
Families with a chronically ill person
Families with a fundamentalist and moralistic emphasis
Children with workaholic parents, grandparents or siblings
Adult survivors of abuse (physical, sexual, emotional, spiritual, intellectual)
CONTRIBUTING FACTORS:
The child submerges his/her feelings and emotional development is arrested
Children have a difficult time progressing through the normal stages of growth and development. They have distrust and fear of abandonment. Shame, a sense of being flawed as a person, develops, as a result of these messages given by the caretaker and the idea that autonomy is unacceptable.
A core of codependency underlies all addictions. The person may use drugs, food, etc to feel more comfortable with him or her self.
They don’t know where self ends and others begin. They may have a too-diffuse boundary from growing up in an enmeshed family. They have problems saying no even if it is harmful to their well being. On the other, hand a too-rigid boundary where they don’t let anyone to enter. May have grown up feeling abandoned or needs not met.
Bowen- "togetherness force" is where the persons’ thoughts, needs, and feelings are determined by other people.
Undifferentiated self- spends time and energy getting approval from others.
Transactional analysis theory- codependency is understood from the standpoint of three internal ego states (parent, adult, and child). Within a person the child ego is the free, creative spirit, and rebellious (the inner child). The inner parent has trouble nurturing the inner child and instead is a shaming parent. The adult is the seat of logic and problem solving and wrongfully expects the inner child to have all the answers.
The boyfriend is caught cheating and the woman who he cheated on sends cards, flowers, calls q night, and waits for him to return to her. She reacted this way when her father abandoned her at age 4. She is repeating the past because she is unaware of the options and support available through her inner parent and inner adult.
NURSES AT HIGH RISK FOR CODEPENDENCY:
Many people who become nurses had a "fixer" role in their family of origin. "If I can’t change my family at least I can fix my clients"
Control and perfectionism dominate. The nurse’s core identity is sacrificed for the client or the system through false feelings of duty. The nurses self worth comes from the feeling of being needed by others. The client may become over dependent on the nurse instead of maintaining a sense of self-control and confidence. They take on the pain of others and overreact. The nurse becomes frustrated, angry, and resentful if not continually reinforced. The codependent nurse is at risk for burn out, physical and emotional illness, and addiction. All nurses need accepting and nurturing support systems.
ASSESSMENT:
The codependent person will deny codependency. Codependency manifests itself in all aspects of life. The codependent person just wants to make other people happy.
NURSING DIAGNOSIS:
Ineffective individual coping
Ineffective denial
Ineffective family coping
Fear related to unresolved abandonment or abuse issues
Powerlessness
PLANNING:
Long term goals-
Client will express increased feelings of self-esteem
Client will set healthy boundaries for self
Express a sense of internal motivation
Be truthful and honest with self and others
Be able to grieve for the past and live in the present
Sort term goals:
Ensure safety
Admit powerlessness and need for help
Recognizing and decreasing maladaptive behavior
Set limits with others
Recognize anxiety
INTERVENTIONS:
Recovery is a life long process of building intimacy with self and others.
Teach self affirmation- replace negative messages wit positive ones. Written positive messages about the self that are empowering.
Use a journal as a tool of recovery
Sharing personal experiences with the client. The client usually has a sense of uniqueness ("you could never understand me")
Involve the client in a spiritual recovery program- codependency anonymous. Encourage 12 step programs
Help the client grieve over past losses
Help the client create a healthy inner child- encourage play
Teach cognitive methods to deal with shame attacks
Help the client develop healthy boundaries
Encourage healthy communication patterns
Teach relaxation techniques
EVALUATION:
Inform the client that periodic slips are normal and it does not mean failure.
Questions:
Which of the following meets all the criteria for self affirmation?
"I choose healthy relationships for myself"
In a dysfunctional organization, there may be codependent behaviors that prevent the meeting of organizational goals. Rigid role behaviors may be obvious to the observer such as: A boss who plays the family hero role, refusing to delegate tasks and taking all the credit for the success of the business.
What does the phrase, "controlling increases as the person feels out of control" mean? The person tries to control external things, such as other people and organizations; proportionate to how out of control they are feeling on the inside.
SoutheasternNurse
