By Jeff Dwarshuis LMSW ACSW
Eye Movement Desensitization and Reprocessing (EMDR) is a treatment method that dramatically reduces or eliminates the negative impacts of traumatic memory leading to Posttraumatic Stress Disorder (PTSD). Therapists have expanded the use of EMDR to include other presenting concerns besides PTSD such as depression, anxiety and relational hardship by addressing the underlying negative experiences leading to the problem. EMDR, when combined with other treatment suggestions such as cognitive therapy or psychoeducational work, is called Integrated EMDR since it is a combination of approaches to meet the needs of the client. (For a description on EMDR and Integrated EMDR see my articles “What is EMDR?” and “Integrated EMDR”)
Codependency is a psychological and relational problem that causes an individual to feel compelled to focus on the needs of others while ignoring or neglecting their own needs. Often times the person shows an overreliance on the approval of others to develop or hold a sense of identity.
Codependency can be described as a disease of the loss of self and codependent relationships consist of unhealthy communication, poor boundaries, reactivity and problems in intimacy. Relationships are often unbalanced with the codependent person attaching themselves to people who are in need due to the effects of substance abuse, poor health or dependency. These unbalanced relationships serve the need of the codependent person to continue their compulsion to over help. For this reason, codependents often times take the role of being a rescuer, confident and supporter in relationships. Codependent relationships happen mainly in families but they also exist in friendships, romantic relationships and the workplace.
Codependency is not a formal disorder listed in the Diagnostic and Statistical Manuel of Disorders but is a term that has been created through literature having to do with substance abuse and dysfunctional relationships. Because of this it does not have a formal and universally accepted definition or treatment approach. In general, however, people with codependency come to therapy most often with the primary concerns of depression, anxiety and relational hardship. Physical problems and psychosomatic problems are also very common. Often times clients in the midst of chaotic codependent patterns do not realize the existence of the disorder or know they have it. They generally see their emotional and relational patterns as normal.
Codependency and Causes
The development of codependency has a variety of possible causes. Each cause might exist in a single person. The most common understanding of the development of codependency is that it occurs as the result of emotional abuse. This may have happened in childhood, a close adult relationship or both. Because of abuse the individual‘s self esteem is challenged and the person develops patterns of pleasing others to increase their own sense of worth and esteem. Since the effort is based on external acceptance and not self acceptance the person continues to feel empty. The individual will easily solidify a pattern of this behavior since they receive reward for what they are doing. Helping behavior is generally self rewarding and feels good. Also, society highly rewards individuals who are helpful. This relational and social cycle combined with the person’s challenged esteem and identity perpetuates a negative cycle of need and overworking.
Codependency also can develop through longstanding family expectations that a child take on inappropriate family roles. Specifically a child might have the expectation that he or she take the role of the fixer, emotional support or pseudo parent. This family cycle occurs in homes where there is substance abuse with a parent. In this case, the child may have to pick up the pieces for the overwhelmed enabling parent and take on family tasks beyond his or her age. Also the child could develop emotionally reactive behavior to the substance abusing parent’s core defenses of denial and blame projection which often times causes the child to develop patterns of self blame, low self esteem, undue personal responsibility and personal denial of self needs. This codependent pattern can also occur in families that are overwhelmed with physical illness, financial hardship or parental limitations and incapacities. In these families the development of codependency is possible but not likely. In families with substance abuse however, the development of codependency is both predictable and expected.
Codependency is also developed by an addictive pattern that serves to help the person avoid their emotional pain, emptiness and hopelessness of their social life. Behaviorally the individual uses the excessive behavior of helping others as a method of distraction from their own problems. Due to this need to distract the codependent can grow irritated when others do not accept their offers of help and then maintains a controlling nature that can lead to perfectionism. Generally the person is completely unaware they are doing these things.
EMDR and Brain Functioning
Eye Movement Desensitization and Reprocessing (EMDR) is a treatment method used to quickly and effectively eliminate the negative impacts of traumatic memory. EMDR is a neurobiological intervention that makes use of eye movements to facilitate a physiological impact on brain functioning which creates permanent emotional and cognitive change in an individual when thinking about or visualizing traumatic memory.
Recent studies on brain scans of individuals indicate that traumatic experience and traumatic recall negatively impact brain functioning and that EMDR corrects it. Specifically, during trauma a part of the brain called the amygdala, which controls many of our emotions and is responsible for autonomic responses associated with fear and fear conditioning, becomes over activated and this creates an impasse between itself and the hippocampus. The hippocampus plays an important role in the consolidation of information from short term memory to long term memory and spatial memory which is responsible for recording information about one’s environment and spatial orientation.
It is recognized that this impasse between the hippocampus and the amygdala creates symptoms found in generalized anxiety, panic attacks and posttraumatic stress disorder. During EMDR, this impasse is corrected as eye movements will both enlarge and activate the hippocampus so it can receive the overwhelming amount of information coming from the amygdala and then sort it. The hippocampus then completes the proper brain processing by sending information to the anterior cingulate cortex which is involved in aspects such as attention, decision making, reward anticipation, ethics, morality, impulse control and emotion. The impact of opening this impasse and restoring proper brain functioning means that a negative memory, once too overwhelming to manage, is put into the proper context of time and space, has affective and cognitive aspects of the memory merged, is viewed with more rational thought, reason and control and exists in a clear distinction between the past and the present.
During the EMDR procedure, which is administered by a psychotherapist, a client experiences two primary reactions to the traumatic memory. First there is a distancing from the memory that includes an elimination of the negative emotional reactions related to the trauma. Second, the client experiences an increased level of rational perception related to the memory. This increased rational thinking is called Adaptive Information Processing (AIP). AIP is the result of successful EMDR reprocessing and allows the client to hold a more rational view of personal safety, personal responsibility and personal choice while visualizing or discussing a trauma memory. AIP also allows the client to hold an accurate positive self perception or cognition while visualizing the trauma. This allows the client to problem solve how he or she would react or prefer to react differently in a similar situation.
EMDR for Codependent Behavior
The EMDR Protocol for the treatment of codependency targets memories of abuse, patterns of addictive behavior and negative cognitions leading to low self esteem. Typically the memories of abuse involve emotional or verbal abuse such as negative talk from an addicted parent or spouse, feelings of loss due to excessive demands for caring for the family or longstanding patterns of self blame in the face of hopelessness to change a bad situation. In some cases codependent behavior is linked to all forms of child abuse including verbal, sexual, physical abuse and neglect and the person additionally has symptoms of posttraumatic stress disorder.
To create a list of traumatic memories in preparation for EMDR it may be important for the therapist to discuss specific aspects of the client’s childhood as well as discuss clear definitions of what qualifies as abuse. It is not uncommon for people with codependency to have been abused in many ways yet have no understanding or consideration that what they endured was abusive in any way. Clients may also have a history of abuse from adult relationships. These memories also must be listed as topics of EMDR reprocessing.
A cognitive ranking can be helpful for targeting EMDR memories. Due to patterns of emotional avoidance, clients with codependency have difficulty creating associations between life events and the development of low self esteem. Evaluating cognitive thought patterns can assist. The therapist verbally states a list of negative cognitions and the client responds by indicating how much they believe the negative cognition by applying a number ranking. Referring to the most challenged cognitions reviewed the therapist then asks when the person started believing the negative cognition and how they learned it. This process then begins to illustrate to the client and therapist which life events have impacted self esteem. The event then is a target for EMDR processing.
Once the memories are listed the client follows the EMDR Protocol. As stated previously, successful EMDR will create a distance from the memory as well as create a more rational perspective of self and others. The distance from the memory allows the individual with codependency to be less emotionally reactive to recalls of the memory as well as to situations that are like the memory such as repeated relational patterns. Also, a decrease in emotional reactivity allows the person to remain more thoughtfully present when using learned skills of management.
The increase in rational perception resulting from successful EMDR creates a more realistic perspective of one’s self and abilities. In general this creates an increase in self esteem. As self esteem increases the need to please others to aid one’s self esteem decreases. Additionally the client is more able to rationally distance themselves from unfair self blame and begin to create a broader narrative applied to personal choice and management of personal safety. The distance from emotional reactivity combined with increased rational thinking will cause the client’s symptoms of anxiety and depression and posttraumatic stress to decease or end.
As stated, people will use codependent behavior as a method to avoid what they are feeling. As this cycle of need and partial reward intensify the behavior becomes additive. The EMDR protocol can be used to break this cycle. For more information on this see my article “EMDR for Addictions” to see how it can be used for codependency.
As the client continues to experience success with these topics there are typical times of crisis when an old pattern might occur. These instances are treated as a trauma memory and reprocessed with EMDR.
Integrated EMDR and Codependency
Typically clients with codependency will need additional objectives to the EMDR for proper treatment since many skills commonly developed in childhood have not been provided. For example, clients generally need communication exercises to formulate and manage their increasing assertion. Parenting material is also commonly needed as well as tools for relational management. Following EMDR processing treatment should consist of problem solving therapy as the client will be faced with the many challenges of restructuring their family and social life to parallel their increased need of self care and deceased focus on others. Eventually the client ends codependent behavior, the anxiety and depression disappear and the times of relational stress grow both less frequent and less intense. The client then is able to manage.