Codependency Therapy

Codependency is a condition that affects thinking, feelings, and behavior. It’s trans-generational and stems from learned behavior in a dysfunctional family environment.
Codependency Therapy
Codependency is an addiction in which effective treatment may require individual therapy and attendance at 12-Step meetings.

What is Codependency?

Codependency has been studied for nearly fifty years. It grew out of research on alcoholism. The term “co-alcoholic” referred to people close to someone with substance abuse issues. But the traits of codependents were described decades earlier by psychoanalyst Karen Horney (1950), a humanist in the self-actualization movement. She wrote that individuals who were alienated from their real self due to faulty parenting lead to neurosis. Researchers ultimately discovered that the dysfunctional behavior of co-alcoholics both pre-dated and continued after the alcoholic attained sobriety. Later they found that it was also prevalent in adult children of depressed or mentally ill parents and those who grew up in dysfunctional families. Codependency was more widespread in modern society than anyone had initially realized. Codependents Anonymous was founded by two therapists in 1986 who had grown up in abusive families.

Defining Codependency

Multiple definitions of codependency exist, although none has been empirically derived. (Dear, et al., 2004). Lack of agreement has hampered both testing and its inclusion in the DSM diagnostic manual. Some definitions focus on interpersonal behavior, some on their childhood, and others on the individual. In 1989, experts at a National Conference on Codependency arrived at a consensual definition:

“A pattern of painful dependency on compulsive behaviors and on approval from others in an attempt to find safety, self-worth and identity.”

Wegscheider-Cruse (1990) saw codependency as a brain disorder that leads codependents to seek the relief of soothing brain chemicals, which are released through substance abuse and compulsive behaviors, including addiction to work, gambling, food, sex, and/or relationships. For relief, “we get into self-defeating behaviors that keep the rush coming. . . The living problems are “results of having the disease of co-dependency, not the cause.”

Codependents have been described as having a “lost self.” John Bradshaw (2010) defined codependency as “a loss of one’s inner reality and an addiction to outer reality.” Darlene Lancer (2015) refers to a codependent “as a person who can’t function from his or her innate self and instead organizes thinking and behavior around a substance, process, or other person(s).” The disorder exists in the person whether or not he or she is in a relationship.

Codependents become dependent on other people in unhealthy ways, even though they might do fine on their own. The degree of codependency varies on a spectrum. Some experts consider codependency a disease and addiction because, like alcoholism, the behavior is compulsive and worsens over time if untreated. It progresses through stages of degeneration and regeneration during its decline and recovery.

Signs and Symptoms of Codependency

Core symptoms of codependency include:

  • Denial
  • Shame, which leads to low self-esteem, anxiety, fear, and irrational guilt
  • Intimacy problems
  • Dependency
  • Dysfunctional communication
  • Dysfunctional boundaries
  • Control of oneself and/or others

These core symptoms interact to create other dysfunctional behavior, such as people-pleasing, indecisiveness, enabling, or obsessing about, helping, or managing someone else. Fear of being alone or abandoned causes codependents to stay in abusive or one-sided relationships. They often put their relationships and other people’s needs and feelings before their own. They sacrifice their individuality and become dependent upon another person. Keeping those around them happy appeases their anxiety about rejection and abandonment, even when they’re unhappy themselves. Over time, their self-esteem declines due to prolonged abuse or from sacrificing oneself for others.

While having some of these traits is normal, when they become extreme or compulsive, codependents often find themselves struggling throughout their adult life to find happiness that’s not tied to another person (often in intimate relationships). Examples include spouses who stay in abusive relationships because they believe they’re the cause of the problem, those that never seem happy without a spouse or romantic partner to please, and parents who “live” through the lives of their children and only experience happiness through them. Addicts are also codependent. Once they’re sober or abstinent, their relationship issues are more apparent. Some codependents avoid commitment due to shame or fear of losing themselves in a relationship. While these examples fit the definition of codependency, the actual condition can present itself in a myriad of ways and no two cases are exactly alike.

Deleterious patterns from childhood usually get repeated in unhealthy adult relationships. Researchers have also found that codependency can lead to elevated levels of stress and anxiety as well as higher instances of depression and physical symptoms, including stress-related illnesses. The good news is that codependency is treatable, and often reversible with the right therapist and a willing patient.

Treatment for Codependency

Codependency has been proven to get worse if left untreated. In addition, it often leads to severe anxiety, depression, or even suicidal thoughts or tendencies. However, codependency is a treatable condition that often has a very high success rate with individual therapy and attendance at 12-Step meetings. Commonly, therapists rely on combination therapy in order to treat codependency. Some recommend prescription medication to treat any underlying mental health issues as well as to relieve depression, stress, and anxiety. Cognitive-behavioral therapy is effective as well as other person-centered types of therapy. Twelve-Step groups, such as Al-Anon Family Groups and Codependents Anonymous, are beneficial in the treatment of codependency. Therapy to address trauma may also be indicated in cases where the patient has experienced abuse or abandonment. It’s important that a therapist is knowledgeable about codependency and treating issues of shame and self-esteem, as well as teaching healthier behavioral and communication skills.

Post-Pandemic Boundaries

We all have needs for independence and closeness. But when we’re close with our partner and family all the time, tensions rise. The pandemic quarantining for some couples increased their codependency. One person joked she felt guilty leaving the dog to pee. Venturing out afterwards can be difficult because we stopped doing our routines that included driving to work, socializing, dining out, going church, to the gym, classes, clubs. Some activities are still restricted, and it can be hard to create new ones. Codependents have difficulty initiating, but that’s what is necessary.

For some people in the pandemic, instead of getting more entangled and enmeshed, quarantining has created artificially rigid boundaries when they were alone. They may have enjoyed their solitude, but isolating is a risk for codependents who need to connect with others and learn to verbalize boundaries, rather than rely on government rules or the pandemic to feel safe. This is especially true with dating. Some people stopped dating and now have to create their own rules to keep themselves safe.

How to Find Help?

Due to denial, most codependents aren’t consciously aware of their low self-esteem and dysfunctional behavior. It often takes a third party to recognize these patterns as well as to offer alternatives that could lead to improved interactions with a spouse, loved ones, friends, or co-workers. This is why therapy is important. Additionally, making the changes required to recover increases anxiety. Hence, it’s necessary to have a good support system to reinforce the new behavior. Therapy and twelve-Step programs provide this support. You can search TherapyTribe directory for a licensed psychotherapist near you specializing in Codependency therapy and treatment.


  1. John Bradshaw, Healing the Shame that Binds You, Health Communications, Inc., 2010.
  2. Greg E. Dear, et al. (2004). “Defining codependency: a thematic analysis of published definitions.”
  3. In S. Shohov (Ed.), Advances in Psychology (Vol. 34, pp. 189–205). New York, NY: NovaScience Publishers
  4. Karen Horney, Neurosis and Human Growth: The struggle toward self-realization, Norton, 1950.
  5. Darlene Lancer, Codependency for Dummies, 2d. ed. John Wiley & Sons, 2015.
  6. Sharon Wegscheider-Cruse, Joseph Cruse, Understanding Codependency, Health Communications, Incorporated, 1990.