Practicing Prodependence

The Clinical Alternative to Codependency Treatment

Robert Weiss, Kim Buck

• Verlag: Routledge
• Jahr: 2022
• ISBN:
  9781000569384
• Auflage: 1
• Thema: Psicología
• Thema: Adicción en psicología

In Practicing Prodependence: The Clinical Alternative to Codependency Treatment, Drs. Weiss and Buck present a new social and psychological model of human interdependence-focused treatment for families and loved ones of addicts.

Unlike Codependence, Prodependence celebrates the human need for and pursuit of intimate connection, viewing this as a positive force for change. This strength and attachment-based model is focused on accepting and celebrating human connection in ways that are healthy and life affirming for each person – even in the face of addiction. In this way, Prodependence presents a new paradigm through which loved ones can learn to love more effectively, without bearing shame or judgment for the valuable help they give.

This book will assist counselors, therapists, and addiction professionals in improving the ways they treat loved ones of addicts and other troubled people, teaching readers how to offer clients more dignity for their suffering than blame for the problem.

Section 1 Understanding Codependence

1 The "Diagnosis" of Codependency

DOI: 10.4324/9781003058359-2

Understanding Diagnoses

As longtime licensed mental health and addiction specialists, we need not question the need for universally agreed-upon diagnostic criteria and related treatment methods that are supported by valid research. Lacking such succinct guides, we could not provide effective, relevant clinical care. Like them or not, diagnostic guides like the Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Diseases (ICD) provide clinicians with the common language required to define, share, and clearly understand various mental health diagnoses. Such guides also help us understand how and when such diagnoses can be effectively applied – the same as any medical health procedure.

Moreover, mental health and addiction professionals must have shared accurate language toward understanding a client’s mental status. Within this diagnostic structure are guidelines toward how to best evaluate clients as they present. Well-organized psychological, psychiatric, and addiction counseling should always begin with the search for a working diagnosis while understanding that such diagnoses are forever evolving in sync with our understanding of the client. Accurate diagnoses offer clinicians a shared language informing us how to best proceed with directive, useful treatment. To this end, the DSM and ICD provide commonly accepted criteria and terminology, which in turn provides clinicians with a shared foundation for accurate treatment planning, documentation, and clinical work.

As stated, addiction and mental health providers cannot be fully effective without a common language regarding the issues our clients present. For example, if a therapist is temporarily treating a person who is in Baltimore for a few months, to do their best therapy, that clinician needs to receive accurate information from the client’s home therapist in, say, Mississippi. For these therapists to accurately communicate about the client’s needs, there must be a shared understanding of terms like bipolar disorder, depression, OCD, and all the rest. As our therapeutic goal is the provision of accurate, useful care to our mentally ill, psychologically challenged, and addicted clients, we must share a universal understanding of these diagnoses, along with common names for problems we treat.

Problems with Diagnoses

Despite all that is stated earlier, many therapists don’t fully agree with the rhetoric surrounding some diagnoses. In one example, the criteria given us to assess for personality disorders (borderline, narcissistic, and the like), which are described as lifelong and chronic by the DSM, often appear to arise more often from early-life complex attachment trauma and related emotional survival than any fixed personality problem. As such, our addiction and mental health diagnoses often reveal only a fraction of the larger issues being treated. Thus, they can miss the mark.

In fact, manuals like the DSM and ICD are written to describe what we see in front of us (what we see in the here and now), with little if any focus on where, how, or why these problems might have evolved. For example, the DSM provides no reason why someone has ended up with depression, OCD, narcissism, or addiction because the sole function of that text is to offer succinct, universally recognizable diagnostic criteria and labels that we can apply to define the problems most commonly addressed in psychotherapy and counseling.

We are not fans of labeling people, as all humans are complex and unique individuals who can never truly fit into any single category. Still, despite our personal beliefs and occasional frustrations regarding diagnostic tools like the DSM and ICD, we have never questioned the need for them.

Diagnoses Change Over Time

Can diagnoses change? Yes, absolutely. In fact, therapists are ethically required to consistently review our working diagnoses and related treatment plans, altering and changing them as our experience of the client grows over time. That said, some diagnoses tend to be fixed and unchanging (often those that require psychiatric medication). Such diagnoses are likely to follow someone throughout their life span. Examples of fixed mental health diagnoses include bipolar disorder, schizophrenia, depression, and ADHD, to name but a few.

At the same time, we realize that many psychological concerns will shift and even disappear altogether as our work progresses and evolves. Our clients grow (or they do not), they get better (or worse), so our labels for their presenting problems will change accordingly.

Interestingly, it’s not just personal diagnoses that can change. Diagnoses themselves can evolve.

Without question, evolve is the right word, as nearly all of us have witnessed many deeply held mental health beliefs deservedly tossed into the dustbin of history as more accurate truths were proven valid. In one obvious example, homosexuality, transgenderism, and fetishes were viewed as primary mental health disorders in the United States for over a century. It was only as validated research and societal norms advanced that we were able to gain new insights and beliefs, thus vastly improving the ways we evaluate and support human sexual health.

The very fact that we are asked to universally shift from prior belief systems to new ones based on ever-changing views of mental health is frustrating to some and downright upsetting to others. Understandably so. After all, change is never easy. But when seen in the larger picture, this ongoing process of clinical reevaluation and evolution on all levels provides the kind of insight and clarity that allows mental health and addiction care to be even more useful, safe, and effective. Every person treated brings us new truths. The fact that such new truths can be examined and explored leads to the growth of psychotherapy and addiction treatment.

New Treatments Abound

There are constantly changing dynamics in the worlds of psychotherapy and addiction beyond the irregular diagnostic revisions offered up in the DSM and ICD. Every few years or so, some new therapy technique or concept, useful or not, lands with a splash in the clinical world, offering new ways to think about and implement various therapies. These new ideas often lead eager acolytes, aflame with enthusiasm, to boldly declare that they have found the latest and most effective way to provide therapy, counseling, trauma work, addiction treatment, etc.

In the early stages of such clinical trends, it’s not unusual for some professionals to incorporate these new ideas into their practices (whether proven valid or not) and then enthusiastically tell all their peers about this great new therapy thing. And, in truth, as long as we practice ethically (have the patient’s best interests in mind, do no harm, etc.), we are free to adopt any form of therapy that we think might be useful – proven or not. Thus, mental health and addiction treatment professionals and programs will often embrace new treatment trends, especially when they reflect meaningful changes in our societal and cultural beliefs.

Understandably, informed caregivers are always on the lookout for more productive ways to help. Thus, when presented with a therapy process purported to be faster, less painful, and more productive (especially one with deep cultural resonance), who wouldn’t want to be first to jump on that bandwagon? We have made this leap ourselves at various points – including with Prodependence, the subject matter of this book.

Over the past half-century, clinicians have had to consider many new and evolving concepts, including dialectical behavioral therapy (DBT), eye movement desensitization and reprocessing (EMDR), somatic therapy, mindfulness, rebirthing, equine therapy, narrative therapy, Buddhist recovery, and on and on and on. Many of these methodologies have proven to be effective and have found their place in professional practice. Many others, including a few that seemed incredibly exciting and potentially useful in the moment, did not live up to expectations and faded away from practical application. Those not meeting validated standards of clinical work were discarded. Primal scream and Bataka bats leap to mind. Meanwhile, some of the more outré-sounding techniques – EMDR, for example – seemed a bit (or a lot) odd when introduced but now are well-validated and extremely useful.

At one time or another, all sorts of theories and practices have been embraced as viable, usually with well-defined methods (proven or not) for use. But sadly, as popular as many such clinical concepts and practices were at the time, a lot of these ideas have failed and been discarded. Exciting, new, and popular at the time? Yes. Effective? No.

A brief analysis of the evolution of trauma therapy reinforces these notions. Starting in the late 1960s, abreaction (emotional venting) was viewed as a primary therapeutic method for the treatment of trauma. Thus, any therapy that got clients crying, screaming, yelling, or (safely) expressing physical anger seemed like the way to go. Many therapists fully believed that these methods were essential ways to help people express and work through trauma, although many clients left our offices (and programs) more debilitated than when they arrived.

In this way, the passage of time, combined with useful research and experience, has taught us that many of these once new and exciting techniques are at best ineffective and, at worst, may create more trauma than they heal.

Today, we understand that meaningful trauma work is not primarily defined by abreaction but by a nurturing clinical relationship, internal and external boundaries, somatic work, DBT, and the like. The process of working with trauma survivors is far more articulated today than in the past as we now closely track our clients in their moment-by-moment experiences, rather than beginning with preconceived notions of what might help them. Trauma therapies now balance our clients’ need for reflective insight into their experience with therapies that encourage emotional containment and stability.

In part, many past therapy methods seemed so right, even unassailable, because they deeply mirrored strongly held cultural beliefs and trends of the time. In the 1960s through the 1990s, for example, pop psychology trends strongly mirrored the Eurocentric beliefs and goals of the “Me Generation,” which were strongly focused on self-actualization – the implicit goals being self-awareness, individuation, and personal growth.

The Me Generation was generally thought of as self-involved and narcissistic, particularly as commented upon by writers Tom Wolfe.¹ Younger people of the era (baby boomers) were generally thought to ascribe more importance to self-fulfillment than social responsibility. This attitude carried over into almost every aspect of American culture, including the world of psychotherapy.

Codependence, like many of the other concepts and techniques previously mentioned, evolved more from popular culture than from recognized clinical experience or research. As such, Codependency is a prime example of a hugely popular new idea that entered the therapy space while lacking the validated research to back it up (then or now). As trendy, well-timed concepts like Codependency become culturally dominant, they can also become entrenched in clinical practice before we’ve had time to fully evaluate their worth. Fortunately, such techniques are usually relatively quickly and easily discarded. But others, such as Codependence, can resonate so strongly with popular culture that they take on a life of their own. In one small example, at the time of this writing one can find more than 400 pop-culture, self-help, and clinical books on Codependency. And yet, many decades since its inception, we lack valid proof of the concept as well as any universally understood diagnostic criteria by which we can determine whether someone is Codependent. Thus, the obvious question arises: Which of the 400+ books on the topic is required reading for those who wish to accurately learn how to treat it? Even more importantly, what version of these should we be teaching the next generation of treatment professionals?

When Compelling Trends Enter Clinical Work

Culture always profoundly influences how we view our work – sometimes in useful ways, sometimes not. In one small example, the Victorian period of the 19th century viewed women as soft, vulnerable creatures who needed protection (by men). To this point, women who got angry or expressed any other strong and therefore culturally inappropriate emotions were referred to as hysterical. Fainting was considered a sign of being overly emotional, even though corsets of the era left women little room to breathe, much less express strong emotions. No wonder they sometimes passed out. These misguided beliefs had far more to do with the rigid gender roles and views of sexuality of that period than with any validated facts.

In the psychotherapy world, it is only when cultural/clinical trends are validated by research-based facts that the rubber hits the road. Again, we will use the example of EMDR. When we first heard about EMDR, we were skeptical. How could eye movement lead to a reduction in trauma reactivity? But over time the science outweighed our skepticism; the facts became clear in the research. These days, EMDR is a proven, effective, and clinically validated form of trauma treatment. People wh...

Inhaltsverzeichnis

• Cover
• Half Title
• Title
• Copyright
• Dedication
• Table of Contents
• Foreword
• Preface
• Acknowledgments
• SECTION 1 Understanding Codependence
• SECTION 2 Understanding Prodependence
• SECTION 3 Conceptualizing Prodependence Treatment
• SECTION 4 The Workbook
• SECTION 5 Prodependence FAQs
• Prodependence Clinical Guide List of References
• Index