Prodependence: A New Paradigm for Relational Counseling

In my practice and my writing, I use the term “prodependence” to describe healthy interdependence and intimacy in the modern world. For me, prodependence is the logical, expected, adult-life outcome of healthy childhood attachment and development. With prodependence, we care for, watch out for, and support our loved ones—at times to our own detriment—and they do the same for us. Prodependent relationships are (ultimately) mutually beneficial, with one person’s strengths filling in the weak points of the other, and vice versa—mutual support occurring automatically and without question. Over time, prodependence creates a healthy balance that keeps families and communities connected, safe, and healthy.

This idea is especially useful when working with loved ones of addicts, as these clients often struggle with enmeshed, controlling, and enabling behaviors that tend to preserve rather than change the problematic status quo. That said, the concept of prodependence relates to all relationships, not just relationships damaged by addiction and other serious issues such as profound mental or physical illness. For purposes of this article, however, I will limit the discussion to relationships hampered by addiction.

Codependence: A Brief History

Prodependence is, rather obviously, a play on an older term with which readers are almost certainly familiar: “codependence.” Codependence, as originally conceived and defined, occurs when people try to control the actions of others in the guise of helping, so that they can feel better about themselves and their relationship with those other people.

The seeds of the codependency movement were sown in 1937, with Karen Horney’s theory of the “moving toward” personality style, where people subconsciously try to control others through seemingly unselfish, virtuous, faithful, and martyr-like behaviors (Horney, 1937; Cottrell & Gallagher, 1941). A few years later in 1951, Al-Anon, a support group for loved ones of alcoholics, was founded. Al-Anon recognized, among other things, the role of “moving toward” behaviors in perpetuating the family disease of addiction.

It was not until the mid-1980s, however, that the term “codependence” came into vogue, mostly through the publication of three books: Adult Children of Alcoholics (Woititz, 1983), Women Who Love Too Much (Norwood, 1986), and Codependent No More (Beattie, 1986). Based on these works, the Twelve Step fellowship Codependents Anonymous (CoDA) was born, with its first meeting taking place on October 22, 1986 (Irvine, 1999).

For the most part, the early codependency movement focused on loved ones of addicts. One of the best explanations of this appears in the foreword of Pia Mellody’s book, Facing Codependence (2003). There, Pia Mellody, Andrea Wells Miller, and J. Keith Miller state,

It was actually the families of alcoholics and other chemically dependent people who brought [codependence] to the attention of therapists in treatment centers. These family members all seemed to be plagued with intensified feelings of shame, fear, anger, and pain in their relationships with the alcoholic or addict who was the focal point of their family. . . . One irrational aspect was that most of the family members had a deluded hope that if they could only be perfect in their “relating to” and “helping” the alcoholic, he or she would become sober—and they, the family members, would be free of their awful shame, pain, fear, and anger (2003).

This statement recognizes and summarizes the feelings that many loved ones of addicts experience. They think, “If I can just control my loved one’s addiction in some way, everything will turn out the way I would like.” That single misguided thought is the crux of addiction-related codependence in its truest and purest form.

Unfortunately, over the years the concept of codependence has morphed—in the minds of the public, a large segment of the therapeutic community, and many of the people who self-label as codependent—into a pathology rather than a relatively normal response to an abnormal situation.
The initial definition of codependence encouraged individuals to care for themselves as well as their addicted loved ones. The idea was to meet their own needs and the needs of others. Now, however, many people interpret healing from codependence as caring for themselves instead of their addicted loved ones. As a result, people seem to think that caring for and trying to help others, especially if those others are addicted, is a psychological disorder requiring diagnosis and treatment—even when the caring behaviors do not attempt to control other people or the addiction as a way of feeling better about themselves.

This is not what the progenitors of the codependence movement intended, but it is what we have.
In today’s world, spouses, parents, siblings, and friends of addicts are generally coached to step away from them, to stop rescuing, to stop enabling, to detach with love, and to “stop being so codependent.” Family, friends, clergy, and even therapists can and often do work very hard to convince loved ones of addicts that caring for and supporting addicts is irrational and counterproductive for both loved ones and addicts.

Of course, loved ones of addicts often respond to these efforts with a statement like, “How can I abandon the people I love in their time of need?” And who can really blame them for refusing to walk away from spouses, children, siblings, or any other loved ones—especially when they know the potential consequences of unchecked addiction. Consider the following:

Mark is a forty-five-year-old father whose oldest son started using heroin at the age of fifteen. From the moment he found out about his son’s drug use, he did everything he could possibly to do help. He sent the boy to rehabs, paid his rent, and paid for college even though he never went to class. When his son was twenty, Mark finally took his therapist’s, his CoDA sponsor’s, and his friends’ and family members’ advice and walked away. Within a year, his son was homeless, arrested for theft, and sent to prison for eighteen months. When the boy was released, Mark wanted to get him into a drug rehab instead of the depressing halfway house he was placed in, but again he was advised to detach with love. So that is what he did. Unfortunately, his son was unable to find work, became depressed, and started using again. He died with a needle in his arm one week before his twenty-third birthday.

As a therapist who has worked with addicts and their families for more than twenty-five years, I admit that in the past I have espoused similar (and sometimes harmful) “detach with love” advice. In my defense, this is the stance I was taught to take, both in school and in my continuing professional education. In trainings I was told, “If loved ones cannot emotionally detach from active addicts, they will be dragged into the murky depths of despair alongside the addicts.” So, when I saw spouses, family members, and friends refuse to distance themselves from active addicts, I suggested they were enmeshed and codependent, and I encouraged them to detach.

Unfortunately, this tactic ignores both potential consequences and the ways in which human beings are wired for survival and healing.

Prodependence: The New Paradigm

Human beings are meant to work together, not to go it alone. For evidence, think back to prehistoric times when people lived in tribes. If we went hunting, we went in a group; otherwise, we were as likely to be eaten as to eat. Additionally, hunting trips could take a very long time, so other members of the tribe stayed behind in the cave and tanned hides to keep the group warm; gathered nuts and berries to eat; collected sticks for the fire; and maybe even did some rudimentary farming.

For thousands of years, this type of communal living was the standard for survival. Because of this, our brains evolved in ways that encourage interpersonal bonding, and now we are evolutionarily wired to be dependent upon others. Basically, we enter the world completely reliant on others for shelter, nutrition, and emotional support—core requirements that do not change as we grow older. What keeps us healthy as children also keeps us healthy as adults. Yet somehow, as we move into adulthood, the intrinsic need for emotional connection (i.e., love) gets discounted. This is despite the fact that people who spend their lives “apart from” rather than “a part of” do not function as well as those who feel emotionally connected.

An immense amount of mental and physical health research tells us that isolated/separated individuals suffer both emotionally and physically (House, Landis, & Umberson, 1988; Hawkley, Masi, Berry, & Cacioppo, 2006; Hawkley, Thisted, Masi, & Cacioppo, 2010; Caspi, Harrington, Moffitt, Milne, & Poulton, 2006). Conversely, people who place a high value on developing and maintaining meaningful connections tend to be happier, more resilient, and more successful (Vaillant, 2003; Johnson, 2008). They even tend to live longer (Holt-Lunstad, Smith, & Layton, 2010; Patterson & Veenstra, 2010; Luo, Hawkley, Waite, & Cacioppo, 2012; Perissinotto, Cenzer, & Covinsky, 2012). So, we clearly see that emotionally intimate connections are nearly as essential to life and well-being as more obvious needs like food, water, clean air, and shelter.

In recent years, I have come to recognize and strongly believe in the importance of healthy interdependence—the need for prodependent connections no matter what. I now believe, based on both clinical experience and quite a lot of research, that there is a big difference between enabling and/or trying to control loved ones’ behaviors versus continuing to love and care for them despite their life challenges. One set of behaviors (e.g., enabling and/or controlling) is something that needs to change, while the other (e.g., loving and caring in prodependent ways) can be extremely helpful for all parties.

I think about the situation this way: If my spouse or child or sibling or best friend was diagnosed with cancer and needed my help with doctor’s appointments, household chores, and maybe even finances, would I walk away from that person? No, I would not. Furthermore, nobody in my life would blame me or pathologize me for temporarily pushing my own needs to the side. If I tried to care for an addict in similar fashion, however, the story would be very different. I would be pushed to detach with love. That is the wrong approach.

Rather than preaching detachment and distancing over continued bonding and assistance, as so many therapists, self-help books, and Twelve Step groups currently do, I believe we should celebrate the human desire and need for healthy intimate connection, even in the face of addiction.

With the introduction and definition of this new psychological term (i.e., “prodependence”), I am hoping to create an updated, research-based, less culturally influenced, and much more accurate social and psychological understanding of healthy interaction and interdependence. It is an understanding that celebrates the fact that human beings are innately wired for emotional intimacy and connection, an understanding that says we should not abandon this imperative just because it is made more difficult by loved ones’ addictions.

Let me state this very clearly: loving and caring for addicts is not a pathological or even a problematic behavior, per se. Enabling or trying to control other people’s behaviors is quite another story, of course. The trick to healthy interdependence and connection is finding the line between the two extremes—a line that understandably varies from person to person and situation to situation—and staying on the proper side of that boundary.

Prodependence in Therapeutic Practice

When Monica and her husband met and married, she knew that he drank, but not how much, because he kept much of his drinking hidden. As their marriage progressed, she became more aware of the issue, and she started to find empty pill bottles in the trash—prescription opioids that belonged to neither her nor her husband. Because she loved her husband and had no interest in leaving him, she tried to hide and manage the problem by controlling his drinking and pill popping and preventing him from driving while intoxicated.

Sadly, despite Monica’s best efforts, her husband got arrested for driving while impaired. After the arrest, his attorney encouraged him to get treatment. At the same time, Monica decided to see a therapist for advice on how to help him. Her therapist heard her story and immediately said, “Wow, you’re a classic coaddict. You’re an enabler and a caretaker, and you need to go to CoDA and Al-Anon to deal with your problem.”

Monica never went back to therapy, and she never went to a CoDA or an Al-Anon meeting. Instead she felt hurt, angry, ashamed, and confused about why the therapist blamed her for her husband’s addiction. So, instead of seeking support that could help her walk through a difficult time, she retreated into her marriage, and she now speaks only to her husband about her feelings. Of course, as an addict who is (understandably) keen to maintain the status quo, he is little help.

The treatment tactic previously described is dated and counterproductive, yet all too common. From my perspective, treating the loved ones of addicts in this way is a bit like treating the parents of a child who was hit by a car as psychologically disordered because they are deeply emotional, psychologically fragile, and struggling to make it through the day without coming apart at the seams.

Of course, decent therapists would not do that to the parents of a badly injured child. Instead, we would help clients see that their reactions are normal and expected given the traumatic situation with which they are confronted. Then we would focus on helping clients find concrete ways of making it through the day as productively as possible while still feeling and acknowledging the powerful emotions that inevitably arise. Trying to force such clients to look at the underlying psychological concerns that might be causing them to behave erratically pushes blame onto the clients. It shames them for a situation that was out of their control.

The same is true with loved ones of addicts when they first enter treatment. When these clients seek therapy, they are nearly always in serious crisis, so an emotional and behavioral rollercoaster ought to be expected. As therapists, we should recognize this and refrain from treating clients’ lability, indecision, enmeshment, enabling, and other nonproductive behaviors as pathological. Instead, we should view and address these behaviors as typical responses to abnormal, deeply traumatic situations.

Whether the presenting issue is loved ones’ addiction or some other equally painful issue, for the first year or so of treatment (the crisis stage) clients’ clinical needs are as follows:

• Validation of intuition and feelings, including feelings about being helpless and/or victimized by other people’s behavior
• Structure for day-to-day life, geared toward simple survival and moving forward
• Education about addiction and the family dynamics of recovery and healing
• Insight into the effects that lies, manipulation, and secrets have on clients and other members of the family
• Concrete direction regarding in-the-moment and longer-term self-care
• Guidance toward social support (e.g., group therapy, support groups)
• Guidance for setting healthy, prodependent boundaries
• Hope

As therapists, we need to understand that loved ones of addicts and other troubled individuals have every right to feel angry, hurt, confused, and mistrustful. As such, they may understandably rage, split, decompensate, enmesh, control, and more. This is a perfectly normal reaction to the traumatic situation in which they find themselves.

Unfortunately, as discussed earlier, the standard approach to treating these individuals, especially when the underlying issue is their loved ones’ addiction, is to pathologize them by telling them they are codependent. Admittedly, if we are using the original, nonpathological definition of codependence, such an assessment might be accurate. However, as previously discussed, in today’s world the concept of codependence has morphed into a negative, pathological label that is indiscriminately applied to almost any people who try to help troubled loved ones, no matter how they go about it. Worse still, this label can drive people away from much-needed treatment and support.

Instead of being confrontational with people who love and care for addicts and others who are struggling, we need to be invitational. We need to meet these clients where they are and teach them not to detach, but to support their loved ones in healthy, prodependent ways. Rather than preaching detachment and distance over continued bonding and assistance, we should celebrate clients’ desires for and pursuits of intimate connection, using that as a positive force for change.

So, rather than labeling and pathologizing loved ones when they refuse to abandon caregiving roles, we should encourage them to continue their pursuits of love and intimate connection as best they can. At the same time, we must help them develop and maintain healthy, prodependent boundaries—margins within which they can love addicts without enabling the addiction.

Setting Prodependent Boundaries

There is a fine line between prodependent assistance and unhealthy enmeshment, enabling, and control, and it is very easy to cross that line. There is an equally fine line between prodependent connection and complete (and completely unhelpful) detachment. Neither extreme will help your clients or their troubled loved ones. A happy medium—a healthy middle ground defined and facilitated by prodependent boundaries—is the only tried and true route to healthy connection and useful support. The trick is knowing when and how to set boundaries that are appropriate and prodependent for each specific situation—boundaries that represent the healthy middle ground for your clients and their troubled loved ones.

First and foremost, you must let your clients know that they cannot get sober for other people. Moreover, some addicts have no real interest in sobriety, even if they say they do. So, your clients—those whose loved ones are addicts—must understand that the addicts’ health and sobriety is not dependent on them. There is nothing they can do (or not do) that will (or will not) cause their loved ones to get or stay sober. Recovery is the purview of the struggling individuals and no one else. Period.

Still, loved ones of addicts often feel responsible for the safety, well-being, and recovery of the addicts. Because of this, they sometimes find themselves doing one or more of the following:

• Taking care of things that are the addicts’ responsibility, not theirs
• Doing things they do not want to do because they feel they have no choice
• Forcing their assistance on others, even when that assistance is not wanted or needed
• Giving and giving, but never receiving
• Focusing more on the problems and feelings of others than on their own
• Making excuses for and/or covering up the problematic behavior of others
• Becoming indispensable to others or trying to control others as a way of keeping them close

In these and similar ways, loved ones of addicts can be just as destructive as addicts, though they tell themselves that their behavior is motivated by love. And they are not even lying with this justification. Their desire for love and connection (i.e., their desire for prodependent intimacy) does drive them, but it does so in conjunction with its flip side: their intense fear of not feeling loved and connected. So they turn themselves into the adult-life equivalent of schoolyard bullies, projecting fear and bad feelings about themselves and their current situation onto other people in ways that attempt to control those other people and their behaviors.

Recognizing this, loved ones of addicts and other troubled individuals must be coached in ways that help them set and maintain prodependent (rather than control-oriented) boundaries. This process is beyond the scope of this article, but basically clients must be guided toward boundaries that help them become responsible to the addicts rather than for the addicts. With that basic tenet in mind, they are often able to stop trying to control their troubled loved ones.

Simply stated, prodependent boundaries recognize that when people enmesh, enable, and try to control other people, they take something important away from those people. They take away their sense of responsibility and other people’s ability to make decisions and solve problems. They take away their opportunities to experience and learn from negative consequences, and their ability to grow as people.

Consider the words of Alissa, the thirty-two-year-old wife of an active alcoholic:

There were plenty of times when I thanked God that I was there to help my husband through a rough patch, to keep him from getting fired from his job, to patch up his wounds so he could live another day. What I didn’t understand was that if I’d been listening for a response from God, God likely would have told me to get out of the way so my husband could grow up and learn to help himself. I wanted to crawl inside my husband’s brain so I could direct his every move because I thought I could do a better job of it than he was doing. The fact that I was preventing him from having a life never occurred to me.

Needing to get out of the way so struggling individuals can learn and grow does not mean there are no roles for your clients. There absolutely are roles, and they are important roles, too. For example, when addicts are too impaired—either in the moment or in a general way, courtesy of the addiction—to make informed and rational decisions, your clients will have to step in. Otherwise, addiction wins. However, this is a balancing act; your clients’ healthy, prodependent jobs are not to control addicts, but to guide them into a process of recovery and to continue doing so until the addicts are ready to take the rudder and steer the ship without assistance. This is the crux of prodependence in the face of addiction or any other serious issue. 

Summation

Let me be perfectly clear here: wanting to care for loved ones, in and of itself, is not a mental health disorder, even if those loved ones are addicted. Rather, it is a perfectly natural and commendable human response to a difficult situation. However, as therapists who have counseled the loved ones of addicts know, this natural and commendable human response can be carried too far, to the detriment of everyone involved. That is what we call “codependence” . . . in its original and unaltered form, anyway.

The good news is that codependence can be redirected into prodependence, which is what most people who call themselves codependent are hoping to be—even if they do not yet have the language or skillset to describe and achieve it.

As therapists, rather than pathologizing individuals who stand by their addicted or otherwise struggling loved ones, we should help them set healthy, prodependent boundaries that protect both themselves and their loved ones. In so doing, we can steer them away from the mutated codependency model of caring for themselves instead of their loved ones, and into the new prodependency model of caring for themselves as well as their troubled loved ones.

References

Beattie, M. (1986). Codependent no more: How to stop controlling others and start caring for yourself. Center City, MN: Hazelden.

Caspi, A., Harrington, H., Moffitt, T. E., Milne, B. J., & Poulton, R. (2006). Socially isolated children twenty years later: Risk of cardiovascular disease. Archives of Pediatrics & Adolescent Medicine, 160(8), 805–11.

Cottrell, L. S., & Gallagher, R. (1941). Important developments in American social psychology during the past decade. Sociometry, 4(2), 107–39.

Hawkley, L. C., Masi, C. M., Berry, J. D., & Cacioppo, J. T. (2006). Loneliness is a unique predictor of age-related differences in systolic blood pressure. Psychology and Aging, 21(1), 152–64.

Hawkley, L. C., Thisted, R. A., Masi, C. M., & Cacioppo, J. T. (2010). Loneliness predicts increased blood pressure: Five-year cross-lagged analyses in middle-aged and older adults. Psychology and Aging, 25(1), 132–41.

Holt-Lunstad, J., Smith, T. B., & Layton, J. B. (2010). Social relationships and mortality risk: A meta-analytic review. PLoS Medicine, 7(7), e1000316.

Horney, K. (1937). The neurotic personality of our time. New York, NY: WW Norton & Company.

House, J. S., Landis, K. R., & Umberson, D. (1988). Social relationships and health. Science, 241(4865), 540–5.

Irvine, L. (1999). Codependent forevermore: The invention of self in a Twelve Step group. Chicago, IL: University of Chicago Press.

Johnson, S. (2008). Hold me tight: Seven conversations for a lifetime of love. New York, NY: Little, Brown, & Company.

Luo, Y., Hawkley, L. C., Waite, L. J., & Cacioppo, J. T. (2012). Loneliness, health, and mortality in old age: A national longitudinal study. Social Science & Medicine, 74(6), 907–14.

Mellody, P., Miller, A. W., & Miller, J. K. (2003). Facing codependence: What it is, where it comes from, how it sabotages our lives. New York, NY: Harper & Row.

Norwood, R. (1986). Women who love too much: When you keep wishing and hoping he’ll change. New York, NY: Simon and Schuster.

Patterson, A. C., & Veenstra, G. (2010). Loneliness and risk of mortality: A longitudinal investigation in Alameda County, California. Social Science & Medicine, 71(1), 181–6.

Perissinotto, C. M., Cenzer, I. S., & Covinsky, K. E. (2012). Loneliness in older persons: A predictor of functional decline and death. Archives of Internal Medicine, 172(14), 1078–83.

Vaillant, G. E. (2003). Aging well: Surprising guideposts to a happier life from the landmark study of adult development. New York, NY: Little, Brown, & Company.

Woititz, J. G. (1983). Adult children of alcoholics. Deerfield Beach, FL: Health Communications.