For full emotional communication, one person needs to allow his mind to be influenced by that of the other.1
—Daniel Siegel, The Developing Mind
If my beloved wife of twelve years received a cancer diagnosis and we had two kids under the age of seven, would anyone label or judge me for doing everything possible—even to the point of giving up important parts of my life—to keep my family stable and relatively happy? If I took on two jobs, quit my exercise program, resigned from the company softball team, and stopped seeing friends to address this unexpected family crisis, would anyone in my life call me out as enmeshed or enabling? And if I went to a therapist for support, would my therapist ask me to explore the ways in which my dysfunctional childhood might be pushing me into an “unhealthy obsession” with my wife’s cancer diagnosis?
Of course not.
To push this example a bit further, what if my wife refused to accept the traditional medical route to healing, deciding instead to rely on unproven herbal treatments? In that situation, should I support my wife’s attempts to heal “her own way” even if I disagree? Should I spend every waking moment trying to convince her to trust Western medicine? Should I try to slip prescribed but unwanted medications into her tea when she’s not looking? And if I did any or all those things, would the people in my life think of me as overreactive? Would they think that my family commitment was a negative manifestation of my traumatic past? Or would they have empathy and compassion for my grief, my fear, and my unshakable commitment to someone I love?
To be honest, I have no idea how I would act under those circumstances. I might make the right decisions. I might make the wrong decisions. Either way, I know that I would be doing the very best I could to help my spouse heal and to care for my children. And I wouldn’t let anyone—friends, family, my employer, a member of the clergy, my therapist, or anyone else—tell me that my attempts to help were borne out of anything but healthy love and attachment.
Of course, nobody in my world would try to tell me otherwise. Instead, friends and family would show up on my doorstep with flowers, home-cooked meals, and sincere offers to help with childcare, shopping, yard work, and housecleaning. Meanwhile, my therapist, clergy, and employer would understand and accept that my family is in crisis, that I love them, and that I must give of myself in an extraordinary way, even if that looks a little obsessed or makes me seem a bit nutty at times. And if any of these supportive individuals felt that I was overdoing my attempts at caregiving, possibly to my own or my family’s detriment, they would not chastise me. Instead, they would nudge me toward caring for myself as well as my family while offering gentle advice about how I might care for my loved ones more effectively. They wouldn’t stand back and judge me; they would lean in to help.
In my world, people who take time out of their own lives to help an ailing or physically disabled loved one are called saints. They are amazing, wonderful, and special.
Unfortunately, things are different when it comes to addiction.
In contrast to the story above, let’s say my spouse of twelve years became addicted to alcohol and prescription painkillers. Let’s say she lost her job because she was drunk and high at work. Let’s say that because of her addiction, I can no longer trust her to adequately care for our kids. What happens now when I take that second job, stop going to the gym, stop hanging out with friends, eliminate my recreational activities, and start to obsess about her drinking and using, all while paying the family bills and caring for our children? Will my friends and family, my employer, my clergy, and my therapist support this degree of caregiving and caretaking while empathizing with my frustration and exhaustion?
Most likely they will not.
In the addiction world, support and therapy for the loving spouse or parent of an addict typically involves judgmental head-shaking, tut-tuts, and expressions of concern about the caretaker’s problem, with that problem being identified as dysfunctional attempts to love, save, rescue, and heal the addict and the family.
Move over empathy; make way for judgment.
Addiction is a universe where caregiving is often viewed as enmeshed, enabling, and controlling, and choosing to stick with an addicted loved one is seen more as a reflection of the caregiver’s troubled past—meaning unresolved early-life trauma and abandonment issues—than an indication of love and healthy bonding.
This does not make sense to me, and it troubles me deeply. If I love someone with a physical illness or a disability by helping that person and the rest of my family, even to my detriment, I’m a saint. But if I love and care for an addict in the same way, I am called out as enmeshed, enabling, controlling, and codependent, and I’m likely to be told that my efforts to love and care for the addict and others in my family are keeping us stuck in the problem. I may also be told that I need to “get out of my disease” and to “pull back from all my unhealthy rescuing.”
Perhaps the difference in how we view caring for a loved one with a cancer diagnosis versus caring for an addicted loved one stems from the fact that addiction remains deeply stigmatized in our culture, viewed as a moral failing or a sign of inherent weakness. Our 1930s picture of the addict as a bum living in a shanty down by the river with no job, no family, and no future persists, even though only a very small percentage of addicts fit this stereotype.
Moreover, our perception of “addiction as a family disease” implies that everyone in an addict’s family is pathologically unwell. Thus, the entire family is stigmatized by addiction, especially the person closest to the addict (most often the addict’s spouse or a parent).
Despite everything we now know about addiction—what causes it, why some people are more susceptible than others, and how to treat it—addiction is viewed in nearly every culture (and in most families) as shameful, and silence is encouraged. Because of this, spouses, parents, and others who care for addicted loved ones tend to suffer in silence, providing care as best they can but with little or no useful guidance. There’s too little information, there’s too much shame, there’s what the neighbors will say, etc. So families desperately work to “look good” on the outside while they collapse internally. When the problem is finally brought to light, the advice that loved ones often receive is to intervene and then detach and distance themselves from the problem. And woe to those who choose otherwise, as they will surely be blamed, shamed, and pathologized.
When these loving individuals do make their way to therapy, either on their own or in conjunction with the addict’s treatment, do we honor and celebrate their devoted efforts at caregiving to the best of their ability and then offer them support and guidance? Hardly. Instead, we almost instantly assume they are enmeshed, enabling, controlling, and thus contributing to the problem. Then we give them a label—codependent—that sounds a lot like a diagnosis. Once labeled, these wounded, scared people are asked (at the height of a profound interpersonal crisis) to look at themselves and “their part” in the problem. They are told that they are ill, just like the addict, and they need to work on themselves so they can fix whatever it is they’ve been doing wrong.
How is this helpful? Why do we pin the stigma of addiction on the addict’s family as well as the addict? Why do we negatively label hard-working, deeply loving, intensely loyal, profoundly afraid, nearly exhausted loved ones of addicts as codependent or worse? Is this the kindest and most effective way to invite them into the healing process? Does this represent the empathetic, nonjudgmental embrace that such people clearly need and deserve?
No wonder it’s tough to keep family members of addicts involved in treatment. These are individuals who’ve spent months or even years trying to keep the family afloat, with hardly any thanks for their efforts, and now we’re talking to them (or maybe at them) in ways that cause them to feel blamed, shamed, and at fault.
For years, I have listened to therapists and counselors talking about how difficult it is to work with the wives, husbands, and parents of addicts. I consistently hear statements like:
• They don’t want to own up to their part in the problem.
• They view the addict as the sole source of the problem, and that makes it hard to help them.
• They don’t see how their attempts to be caretakers are making things worse.
• They may be sober, but they’re every bit as sick as the addicts, and sometimes sicker.
• They just can’t stop rescuing, and that causes more problems than it solves.
Ouch!
What if loved ones of addicts aren’t so difficult to treat? What if “the problem” lies more in how we conceptualize them? What if our primary model for treating them has misunderstood and marginalized them in ways that simultaneously confuse them and cause them to feel unnecessarily blamed and shamed? What if we prejudge loved ones of addicts as codependent, and therefore driving a dysfunctional family system? What if that “diagnosis” pushes them into a reactionary state where they feel they must defend their actions and tell us where the real problem lies, which, in their mind, is with the addict and we then go round and round with them, playing pin the tail on the pathology?
I find it hard to understand why we choose to initiate therapeutic relationships with painfully overwhelmed and undersupported loved ones of addicts by thrusting a negative, pathological view of caregiving on them. Then we expect them to not only embrace this concept but to start working on it immediately. And when they act out against this model, we call them difficult, which reinforces our belief that they are as innately troubled as the addicts they love.
What about their grief for how their lives have turned out? What about their years of feeling confused, anxious, overwhelmed, and fearful about the future of their addicted loved one, themselves, and other members of their family? What about the fact that they have been victimized in their own homes, sometimes for years on end, by an addict who is more willing to lie, manipulate, and keep secrets than to face the truth?
Even when caregiving loved ones have been “doing it all wrong,” experience has taught me that it’s usually not a good idea to tell them that or to blame them in any way for facilitating and perpetuating someone else’s dysfunction. And why would we expect otherwise? If you were exhausting yourself working part-time in three different places while taking care of multiple people, including an active addict, would you feel engaged by a message that asks you to start looking at your problem? Most likely you would not. Instead, this message would feel both hurtful and counterintuitive.
If our approach to loved ones of addicts alienates them before they can take advantage of the care and insight we can offer, then maybe we need to change our methodology. Maybe it’s time to find a better, more empathetic and compassionate way to approach caregiving loved ones of addicts. Instead of blaming caregivers for resisting a path that feels innately wrong to them, maybe we should find a less intrusive, less shaming way of supporting them.
The simple concept of an empathetic connection is well summed up by the oft-used social work phrase “be where the client is.” This phrase means that, as therapists, we should closely track what clients are saying/doing/expressing/feeling and then reflect what we’ve heard. When we do this, our clients tend to feel safer and better understood. The simple act of being empathetic and curious about a client’s experience, while simultaneously setting our own opinions and judgments aside, demonstrates in real time that we care about and want to understand the client’s world.
So, no matter how distracted or out of touch we might get when working with someone in therapy—and hey, even good therapists have bad days—we can always refocus on the work at hand by directing ourselves back to what the person in front of us is expressing. This emphasis on understanding and continually reviewing the client’s point of view and experience, no matter our own beliefs and feelings, is what keeps us in sync with and attentive to the work at hand.
In my experience, quick judgments (with a few important exceptions) are counterproductive to building a therapeutic alliance. This means my clients need to know me more as “the guy who leaves them feeling understood, safe, motivated, and hopeful” than as “the guy who points out what’s wrong with them and pushes them to change.” By demonstrating empathy and reflective compassion rather than assuming I understand the client as soon as he or she walks in the door and offering quick solutions based on that judgment, I earn the client’s trust, and eventually the right to offer useful advice and direction. But I need to build that precious therapeutic alliance first. I need to be where the client is.
This means I don’t verbalize my assumptions or ideas about how to help someone before that person has fully shown me, from his or her perspective, exactly what is needed. Until then, unless there is an emergency, I keep my ideas, suggestions, directions, beliefs, and assumptions to myself as I go about assessing, understanding, and relating to them. So, again, and I cannot state this any more clearly: The foundation of all useful therapeutic work is an empathetic, nonjudgmental relationship where the client feels both understood and supported by the therapist.
Do I always agree with everything that every client says? No, I don’t. And depending on the circumstances, I may, when the time is right, disclose what I think. If the timing is not right, I keep my thoughts to myself. Either way, if therapy and counseling are rooted in care and empathy for that person—demonstrated over and over by continually working to understand what that individual feels and believes—he or she will ultimately get what he or she came for. Without this respectful alliance, however, even the best therapeutic models and targeted advice are likely to fail. Unless and until someone seeking help feels my understanding and empathy for his or her lived experience, therapy doesn’t work.
Like everyone who seeks therapy, addicts need to be seen, heard, and responded to based on what they say, think, and feel. However, as therapists, we must also see, hear, and respond to an addict’s behavior because, with active addicts, behavior is usually a much more accurate and honest indicator of where they really are and what they really need. We need to recognize that by the time addicts are troubled enough to seek help, their thoughts, feelings, and words are considerably less honest than the truths revealed by their actions.
Simply stated, active addicts are steeped in denial. They will insist, despite their addictive behavior patterns and the many consequences with which they are currently dealing, that they are doing just fine. They will say that they deeply love their spouse, kids, job, home, friends, etc., and would never do anything to jeopardize that. Yet when offered a chance to get high or act out with an addictive behavior, they will nearly always choose that path over a path that would protect the people, places, and things they profess to love and care about. Still, it’s all under control as far as they are concerned.
What addicts tell a therapist (and everyone else in their lives) about what they feel, want, and need does not always align with their choices and behavior. Active addicts will say their goals are love and success, but they spend their time engaging in behaviors that are clearly out of sync with that. As therapists, we must recognize this and see through it. That is how we meet addicted clients where they are.
To reiterate, untreated addicts are out of control. By the time they get to therapy or treatment, their obsession with their drug or behavior of choice has pushed the arc of their lives askew. They are wobbling, out of balance, or worse. Therefore, meeting an addicted client where he or she is means we must trust what that person does more than what he or she says. Then we must help the addict see and accept the truth of the situation, while providing structure, containment, and accountability. Without this type of intervention, the addict will continue to live in harm’s way. So, we must confront the addict’s denial, challenge the addict’s misguided thinking, and push the addict (sometimes kicking and screaming) toward sobriety and mental health.
As stated above, helping an active addict get and stay clean involves breaking through his or her denial while introducing containment, structure, guidance, support, and accountability (whether the addict wants it or not). But what about the needs of those who love the addict? How can we best support the spouse or family member of an addict? Do such people also need containment, structure, and accountability, or do their emotional needs differ from those of the addict? How do we meet such supportive loved ones where they are? And what do these often fearful, hurting, betrayed individuals need from therapy?
Nearly all the current books and treatments intended to help loved ones of addicts have been created by individuals focused on the ways in which childhood trauma can (and often does) affect adult relationships and life. The general thinking is that people who end up loving, partnering with, and staying with addicts are generally people who experienced similar trauma in childhood, usually by growing up with an alcoholic, addicted, or mentally ill parent or caregiver. Codependence in particular is focused on the belief that those who survive early-life dysfunction tend to carry that forward into their adult lives, often by bonding with and becoming dependent on people who, over time, neglect, abuse, and let them down in similar ways—thereby mirroring to some degree their past relationships, losses, and trauma.
This dynamic of re-creating childhood trauma by partnering with an addict likely makes perfect sense to those who’ve written about it as codependence because this is almost universally their lived experience. In fact, nearly all the major codependence literature, especially the earliest material, was written by women who say they experienced profound trauma in childhood, often related to an alcoholic father, only to grow up and re-create similar situations by marrying alcoholic men or becoming alcoholic and/or codependent themselves.2
Prodependence takes a vastly different approach, looking at addiction not from a trauma perspective but from an attachment perspective. Instead of viewing loved ones of addicts as inevitable victims of a traumatic past that has caught up with them and is now repeating itself in their adult lives—mostly in their relationship with the addict they’re paired with—prodependence views them as valiant individuals struggling to love another person even in the face of addiction. With prodependence, there is no shame or blame, no sense of being wrong, no language that pathologizes the caregiving loved one. Instead, there is recognition for effort given, plus hope and useful instruction for healing.
Why, I ask, would we ever want to pathologize a person whose “problem” is typically defined as loving too much? Is loving too much even possible? If so, count me in. As a healthy friend, husband, and family member, my primary goal is to love all that I can love, to give all that I can give, and, if I am lucky enough, to be loved and cared for with the full heart and soul of the people who matter most in my life. Without a doubt, my love may at times be delivered in unskillful or ineffective ways. My love may get in the way of my own or others’ healing without my seeing or knowing it. But please don’t tell me that there is ever a time when I can love too much. Love poorly, yes. Love inadequately, yes. Love imperfectly, yes. Love in overly needful ways, yes. Love selfishly, yes. But love too much? No way.