This outline is adapted from Chapter 1, Co-Dependency Groups by Ani Amersalv, M.A., M.F,C.C., which appears in the book Focal Group Psychotherapy, Edited by Matthew McKay & Kim Paleg, 1992, New Harbinger Publications, Inc. The material has been modified to address the needs of children and adolescents in educational and clinical settings.
Interdependence Group
Introduction
Dependency affects the lives of many people. Labeled as co-dependence, it can be defined as “a specific condition that is characterized by preoccupation and extreme dependence (emotionally, socially, and sometimes physically) on a person or object. Eventually, this dependence on another person becomes a pathological condition that affects the person in all other relationships.” (Wegscheider-Cruse, 1985) Co-dependency hinders marriages, friendships and healthy family functioning. It erodes trust and the ability to have honest and open communication. It blunts a person’s feelings and impedes his/her judgment about reality. These things happen because people who are co-dependent tend to put their own needs aside, aren’t assertive, often attempt to control others and outcomes of events, and are often unaware of their feelings.
The elements of co-dependence are seen in many relationships, including when parents, teachers and clinicians try to make decisions for or take responsibility for the actions of the children they manage. This belief, that one is responsible for another autonomous human being is prevalent in today’s American society and co-dependence is becoming a national problem.
One of the most effective ways of treating co-dependence is with group intervention (Cermak, 1986). Through the group process, a co-dependent’s interactional problems are triggered; at the same time, peer validation, feedback, modeling of new behaviors, and healing can occur.
Cermak (1986) suggests that co-dependency can be approached in three different ways: 1) as a didactic tool, 2) a psychological concept, and 3) a disease entity. It is the last of these that we reject. While the construct of psychological disorders as biological diseases offers many useful opportunities for easing immediate stress, it is ultimately self defeating in that it hinders the individual in becoming self actualizing and is therefore rejected as a construct in this helping process. In fact, it is a symptom of the co-dependence belief system so prevalent in the culture.
This is a group developed to increase the interdependence of independent or autonomous people. Following the cognitive pattern of positive attributions and expectations, we have chosen to entitle the group by its expectation rather than by the deficits of its participants.
Selection and Screening
Several characteristics create a secure foundation for the group and help ensure success. The following issues are best screened for in an individual pre-group interview:
• Consistent attendance is of utmost importance. Potential absences are best discussed ahead of time, so group cohesion is not affected and the individual has an opportunity to explore the double message “I want to be in group and I can’t come to group”.
• The group is designed for beginners, adolescents who have had little exposure to the clinical issues of co-dependency and have not been in long-term therapy groups focused on co-dependency.
It’s also important to identify clients with the following characteristics:
• Those who are actively chemically dependent. If needed, numerous evaluation instruments are available, including AA’s “Twenty Questions” and the Michigan Alcoholism Screening Test.
• Those who are actively psychotic or on intensive psychotropic medications.
• Those who have little insight into their own motivations and behavior and are unwilling to develop introspective skills.
• Individuals who are related or in a significant relationship with one another.
Keeping in mind the above considerations, meet with each potential group member individually. Explain the scope of the group, its goals, and the outcome expectations. Be clear and concise. Being open to questions and concerns is very important. Make sure that you are able to identify the member’s as well as the organization’s outcome specifications. If not congruent, they must at least be compatible.
During this session, identify adolescents with hostile, borderline characteristics. Careful selection in the beginning saves much aggravation and disruption later. This material, although it sounds simple, is very emotionally charged. Witnessing a group member decompensate or become verbally abusive is an experience other group members don’t need to have, although a worker, if well prepared, can use such emotionally charged situations for growth and development of both the individual and the group. What is vital is that the leadership is not surprised and unprepared.
Time and Duration
The group runs for 12 meetings of one and one-half hours or for eighteen total hours. Traditional counseling procedures tend to be scheduled once per week at maximum, but there is no reason [except for the homework] that these eighteen hours cannot be reconstructed into a more dense involvement. Meeting every day may be possible, although the leadership will need to determine what if any other emotionally tense experiences might weaken the impact.
Structure
This group is designed to be a closed group. Group members develop skills and insights in a cumulative manner from week to week. For this reason, attendance of all sessions is essential. Of course, if a client is ill or an emergency arises, all is not necessarily lost. However, the returning client may feel out of sync with the group and have a feeling of having “missed out.” If the group meetings are densely structured [everyday], the leadership will need to make a decision in regard to how much loss is critical, since a return after missing so much may simply disrupt the group. It may be better in these circumstance to simply reschedule the adolescent in the next group.
The optimal size for the group is eight to ten people. The determination of size should be contingent upon what we call the ‘extant horizon’ of the group facilitator. The extant horizon is the limit of the person’s ability to perceive what is happening to all participants when one or more persons in the group are in crisis. One can determine a worker’s extant horizon by talking about a crisis that occurred and a soliciting information about where each of the other people in the room was and what they were doing during the time the person was directly involved in handling the crisis. If the leader exceeds his/her extant horizon, they will be unable to say much about anyone else but the people who were the focal point of the crisis. [A similar notion can be comprehended by two series of dots. Those placed in an organized fashion will allow a person to state immediately and with some confidence the number. However, the number selected with confidence will drop quickly if the dots are random.] The larger the extant horizon, the larger the number of people who can be perceived in a confused situation. Most people can handle about five. Trained group leaders should be able to do eight to ten people at one time.
Attention should be paid to the room in which the group meets. Chairs should be placed in a circle so that everyone has a clear view of everyone else. Gently invite members to “join us in the group” if they are hiding behind others outside the circle, behind posts, or in doorways. A room with adequate ventilation and satisfactory lighting is also important, since many co-dependents have anxiety symptoms. What is most important, however, is that the room not contain seductive structures which can be disruptive. The most obvious example is to have a ball lying in the room. If this were to happen, you can be assured that someone will pick it up and ultimately throw it. Large spaces can also be seductive [See Fritz Redl’s Children Who Hate for more specifics in this area.]
It’s important to start and stop the meeting on time, and to have a good understanding of the material being covered. Holding a meeting up for late comers not only punishes those who arrive on time, it suggests that you can [and perhaps should] come late. If people know that a meeting will start at a specific time and that they will be chastised [by the group, if not the leader] for being late, they will arrive on time. Starting on time also underlines the importance of the meeting. This is serious business.
Having these things under control, in addition to being relaxed and emotionally present, gives group members a sense of security. Members often enter group feeling anxious, fearful, and full of anticipation, wondering how they will be required to carry conversations, take care of others, or monitor you. A demonstration of good boundaries on your part, aptly modeled from the beginning, is necessary. A thorough discussion of boundaries can be found in Vannicelli (1989).
Goals
The goals are very straightforward:
1. Help clients understand what exactly co-dependency is and how it negatively affects their quality of life.
2. Improve boundaries for clients by helping individuals own their feelings and identify their own goals and desires.
3. Increase self-image as manifested by better assertiveness, more self-nurturing behavior, and a decrease in self-critical thoughts.
4. Help the client identify and begin to appropriately express feelings.
The cognitive skills taught during the group address the above goals. This in turn reduces the discomfort, fear, and depression which co-dependent people present. They will see that they are not alone, their problem is not unique, and that they can develop an ongoing personal support network. This can bring a sense of relief from which healthy control develops allowing clients to make healthier choices in their lives and choose more appropriate outlets for their feelings.
Such group experiences can be the catalyst for existential awakenings, or “spiritual awakenings”. AA literature goes into this phenomenon very adequately, as do the writings of Victor Frankl and many others. If you don’t feel comfortable with this concept, it’s imperative not to invalidate what a client reports, but to refer the person to someone well versed in this area.
Ground Rules
Confidentiality, timeliness, and attendance are mentioned in the first session, in addition to issues of no dating or sex with other group members. People with poor boundaries often confuse frank, open talk with sexual availability. This issue must be brought up. Don’t reserve this information just for mixed-sex groups; it pertains to all-male and all-female groups, too.
These are somber issues. To balance the heaviness, approach the group with an attitude of hopefulness and a sense of “this is the place where healing occurs.” Modeling honesty and openness is imperative. Consistently use positive internal attribution which indicate that individuals in the group are perfectly capable of taking control of their own lives and dealing with problem issues.
Description of Group Process
Except the first session, in which each client makes a brief introduction of themselves and their outcome expectations, each session begins with a brief check-in. Next, there are a series of seven specific interventions. The interventions listed below are not all used in all classes.
1. Didactic Presentation [Language & Concepts]
2. Mini-evaluations
3. Soliciting Examples from Clients
4. Group Process
5. Family Sculpting
6. Problem Solving
7. Role-Playing
The group always starts with the presentation of didactic material which set the tone for the class. The leader must assure that each participant understands the language and concept to be used and uses mini-evaluations and examples for that purpose. The group processes that material and begins incorporating it into the body of knowledge each member is accumulating. Specific skill exercises are suggested for this portion of the group. The participants can begin to test this knowledge in a personal way. Finally, the testing will arouse emotional responses which must be dealt with.
The leader should use the group to address issues and not always do it him/herself. The group is a powerful tool for socialization and creativity. One outcome of the group, although not necessarily a specific intent, is the improved quality of the relationships of the group members. The process of sharing both information about vulnerability and coping strategies provides new roles for members.
Starting the Group
You might begin in the following way:
“Hello everyone! I’d like to welcome you to our group. As you all know, I’m [insert name] and I will facilitate this group. Let me begin by going over some ground rules so we all have the same understanding of what this group’s about and how it’s run.
“As we’ve talked about before, it’s really important that you attend every group meeting. Each week builds on the previous week, and it’s easier if we all go through this process together. Also, please be on time, because I start at 0:00 p.m. sharp. Please be sitting down and ready to go at that time. Anyone have any questions about this? I’ll be making sure that we not only start on time, but that we end promptly at 0:30, too.
“In order for the group to work we must honor everyone’s privacy. In other words, what’s said in this group stays in this group. This is important. Does anyone have any questions about this? Can we all agree to honor this rule? The only exception is if I believe that you or someone in your life is in a potentially life threatening or abusive situation.
“It’s each person’s responsibility to let me know when they’d like to have some group time – so please speak up. I can’t always tell if you need to speak; it’s up to you. Also, only one person talks at a time. Otherwise we can’t clearly follow what’s being said, and we all miss each person’s contribution.
“Then there’s the issue of relationships between people in this group. It probably sounds odd to you, but I must ask that you not date any other member of this group. Of course, after our time together are up, what you do is your own business; but in the meantime, let’s just come together for group discussion and not muddy the waters with socializing or sex.
“Okay, enough about ground rules. Now, what are we here to do? We’re going to look at co-dependency – not only the issue in general, but how it relates to you specifically. We’re going to look at how to change situations or behaviors that don’t benefit you anymore. Oh, I know they probably worked great at one time in your life; but as life progresses, things change – sometimes we’re stuck with old behaviors in new situations and the end result is pain … or fear … or self-defeating behaviors … or problems in relationships.
“This is probably a good time to get started with introductions. You all know me already. [Note: you may briefly self-disclose your interest and history with codependency at this point if you wish. This is optional.] Maybe each of you can take two or three minutes to tell us your name and then say what brings you to a codependency group [Note: this should have been noted as an expectation in the pre-group interviews and each client should understand well the purpose of the group].”
Don’t allow people to go over their time limit. Gently remind them that their time is up and that they will have opportunities later to talk in more depth.
Section I Main Concept and Skills
The didactic materials include eight [08] concepts and eleven [11] skills which are presented here as one section for coherence in reading although they are interspersed throughout the twelve classes. The leader, in preparation for the classes, may want to reorganize the didactic material so that it appears in the class in which it will be used. If this is the case, ask your supervisor to provide you with the disk, and make the changes you prefer.
The skills are the specific competencies that the participants are expected to master in the course of the group. The leader and the organization should prepare an exit interview process which will verify the acquisition of these skills. Some interview materials for consideration are included at the end of this document.
A. Concept: How Co-Dependency Operates
‘Co-dependency’ was first identified in work with alcoholic families. More recently it became clear that people can become co-dependent when no chemical addiction exists in the family.
There is a tendency for children with problems in living to seek help from others rather than to find their own solutions. Dependency seeking children benefit most from child management systems which encourage them to work independently whenever possible and to make some of their own decisions. Giving these children models to follow and assigning them tasks that are within their grasp are essential to success. However, when such a child begins to say to him/herself, ‘I can’t do this’, ‘I need help’, or ‘Other people are more competent’; these mantras often become part of their way of living. We have talked before about how such self-talk influences the way you behave.
The original problems in living, such as a learning disability, now becomes a broader issue in which the individual feels more and more helpless. They then begin to see other people as the problem, to see the problem as outside themselves, to not take responsibility for themselves, and to ‘meddle’ ineffectively with the problems of others. In an attempt to develop a more positive image of self, the person often begins to see the problems as external, connected with some one else, and then they try to correct other people’s behavior.
When such a child grows up and becomes a parent, there is the potential to both rely on, and be critical of the spouse, or sometimes even the child about making decisions. If the child has his/her own problems in living, s/he may also feel less than competent, and start the mantras all over again. This becomes the equivalent of the ‘blind leading the blind’. When the blind lead the blind, they often ‘bump’ into obstacles, and so it is with co-dependents. The obstacles occur – one or the other becomes alcohol dependent and the other doesn’t know what to do. Thus, s/he asks the dependent person for leadership – enabling the dependency to continue. The other person actually facilitates the problem by echoing the mantras.
Let’s just say that the condition of co-dependence develops from living in a cognitively discordant situation. Pia Mellody (1989) says that co-dependents have difficulty
1. Experiencing appropriate levels of self-esteem.
2. Setting functional boundaries.
3. Owning and expressing their own reality.
4. Taking care of their adult needs and wants.
5. Experiencing and expressing their reality moderately.
Dysfunctional parenting can turn the natural characteristics of a child into co-dependent traits. This is not to say that the parents are bad or ‘wrong-headed’ people. In fact, they probably did the best they knew how. Co-dependency can be transmitted from one generation to the next. Parents pass on to their children what they themselves learned. Unless you address these issues and become interdependent [independent thoughts and feelings combined with cooperative behavior], you will potentially have children with dependency issues.
B. Skill: Identifying Your Own Co-Dependency
Co-dependence is passed on as long as there is no consciousness or awareness of it. As soon as you become aware, beginning to examine and question your own thoughts, the cycle is disrupted. So the first step in breaking the cycle is to become aware of your own co-dependent thoughts and behaviors. Since you are in this group, we can surmise that this first step has been at least considered.
C. Concept: Changing the Pattern That Maintains the Turmoil
Constant and exclusive focus on another person or a behavior as the BIG PROBLEM keeps people stuck feeling anxious, worried, and powerless. Tensions rise, health suffers, relationships are hindered, and the BIG PROBLEM doesn’t get better. Moreover, this focus gets in the way of appropriately and responsibly addressing one’s own issues.
Tensions are greatly reduced by taking the focus off the BIG PROBLEM and putting it on yourself. By broadening your perspective, you can begin to see how you and others in your life actually contribute to keeping turmoil going. Of course, you do this unwittingly; but, nonetheless, such behaviors as fighting, arguing, distancing, getting sick, and blaming keep tensions high.
When you begin to focus on yourself as a responsible agent, you automatically shift from a position of blaming others for your situation to one in which you take more responsibility. You can begin to be responsible for your health, mental well-being, and personal growth. You can then allow others to be responsible for themselves and their own issues. It’s a form of detaching compassionately: disengaging from others’ problems without simply cutting off; thinking about your needs and wants rather than reacting to theirs; and being assertive rather than passive or manipulative and aggressive.
As individuals begin taking better care of themselves, tensions in the system reduce and the system’s overall health improves. The lower the levels of anxiety and tension in a system, the fewer living problems the members of the system are likely to experience.
Some achievable, moderate ways of putting the focus back on yourself are regular exercise, meditation, laughter, having meaningful friendships outside the primary relationship, and engaging in good communication.”
D. Concept: Control
When the focus is off the BIG PROBLEM and on you, several things become apparent:
• You really can’t change anyone else.
• Trying to do so makes life difficult or unmanageable.
• Over the years, the need to control people’s behavior, feelings, and thoughts, and the outcomes of situations, has become important – even though it doesn’t work.
The negative effects of attempting to control others are twofold. Attention to your inner reality is lost. When you’re attempting to control others, your focus is on the outside: what others do, say, or think; the effect you’re trying to make; the way events turn out. You lose touch with your inner life. A major symptom of this is not being able to adequately process your feelings. They get denied, sidetracked, stuffed, or over expressed (as in overreacting). The second negative effect is that you’re trying to control something that is not controllable by you. This failure at successful control becomes food for shame and increases the need to control. Your self-esteem begins to depend on your controlling behavior. It’s a vicious cycle with a no-win ending.
No matter how adept at controlling you are, something always goes awry. Someone is late, you burn the eggs, you forget an appointment, an emergency comes up. Life is unpredictable.
Having some control is a good, recommendable thing. You are not being told to lie down and give up. It’s trying to control things that are beyond your control and not your business that’s negative. It’s important to know what is in your range of control and what is not.”
E. Skill: Differentiating Between What You Can and Can’t Control
(Adapted from Hall & Cohn, Self-Esteem: Tools for Recovery)
Problems fall into two categories: those that can be controlled and those that can’t. As a first example, let’s consider an abuse survivor. S/he can’t control this past event. It happened. However, s/he can try to change his/her feelings about it. She has two options: one, s/he can resist, wish it hadn’t happened, and try to forget and ignore the physical and mental side effects of the experience. Of course, this option most likely leaves him/her feeling rotten about him/herself. The second option is to accept the fact that the abuse happened. S/he can take steps to overcome the effects of this devastating event. By exploring more about the events, their impact on his/her life, his/her feelings about the abuser and him/herself, s/he can begin to feel better about him/herself and to heal.
Consider a person with an eating disorder. This is a problem that can be controlled. The person has three options. One, s/he can attempt change and seek help to tackle the eating disorder. Entering recovery helps a person feel good about him/herself. Two, s/he can resist change and simply wish things were different. S/he can find excuses to support not changing. This leads to poor self-esteem. The third option involves accepting that the problem can be changed but realizing that s/he’s not quite ready to do so. The person can understand how his/her eating disorder serves him/her and can accept the consequences. The small steps involved in this acceptance can lead to his/her feeling better about him/herself, and can eventually lead to tackling the problem.
F. Concept: Compassionate Detachment Versus Caretaking
Caretaking is another form of control. It means not only taking care of others but also taking responsibility for them (and from them). Caretaking implies getting so deeply involved in other people’s lives that you prevent them from growing and experiencing the natural consequences of their behaviors. Many times caretaking begins with love and concern. An example of this is an overprotective mother who loves and cares for her child but is blind to his/her need for independence. S/he is always her ‘good boy/girl’ and she gives him/her all the money s/he needs. When s/he incurs drug debts, she rescues him/her by paying the debts, giving him/her a place to stay, and telling lies on the phone for him/her.
Another example is a man who constantly monitors his mate’s feelings. He is constantly worried about her reactions, carefully watches what he says, and ‘walks on eggs.’ He worries about whether she’s happy or not, and carefully controls his own actions in an attempt to ensure her happiness.
Compassionate detachment means detaching from the problem, but not cutting yourself off from the person. Detaching in this way involves not controlling another’s life yet remaining emotionally present to him or her. It means being there as a friend, listening and responding. It does not mean giving solutions, fixing the problem yourself, criticizing, or judging.
All individuals have the right to be free, to have and to solve their own problems. When you don’t allow others their personal freedom of choice, then you are being possessive. Solving their problems or being responsible for their feelings is also a form of possessiveness. Possessiveness is not love. Compassionate detachment allows us to love our friends and ourselves.”
G. Skill: Identifying Emotions
One of the major problems of codependency is not being in touch with your emotions. Many families with problems in living either overtly deny the right to feelings or covertly denigrate them. As the child grows up, s/he teaches him/herself to either override, become numb, or overreact to these feelings. The exact method depends on what you had or have to do to survive in your family.
This may have worked in your family of origin, but it can cause problems in adulthood and stand in the way of healthy relationships.
Emotions are very important. We all have the potential to experience a wide variety of emotions. When they remain unexpressed or are stuffed down, they begin to cause emotional or physical trouble for us. They can show themselves inappropriately, become overwhelming or confusing, or become transformed into physical symptoms like high blood pressure and ulcers.
A good way to start identifying your feelings is by using a very basic list:
Mad Hurt
Sad Ashamed
Glad Afraid
Of course there are many more feelings than this, but the list is a good starting place.
Remember, feelings are just feelings. Accepting them as they are is the key. You are experiencing the feelings you are experiencing. This doesn’t mean you have to act on them. It doesn’t mean you’re good or bad because you have them. Feelings are not concrete facts in the outer world. Once you identify a feeling, then you have the choice to act on it or not.
Emotions can be ‘qualified’ as mild, moderate or intense. It is helpful to assign a numerical value to denote middle [1,2,3,] moderate [4,5,6,7] and intense [8, 9, 10]. This allows for participants to better describe their emotions and monitor changes and fluctuations.
H. Skill: Communicating Feelings
“Learning to talk about your feelings is the next step. It sounds so simple, yet in reality can be quite difficult, especially when you’ve been taught that your feelings are inappropriate. However, expressing feelings can enhance trust, improve your self-esteem, deepen intimacy, and reduce the need to control.
“A good way to start is to use this script:
I feel ___[mildly, moderately, intensely]___________________ (your feeling)
when you ___________________________________________ (an action)
because _______________________________________________ (your reason)
1. Skill: Dealing With Difficult Feelings – Fear, Shame, and Resentment
Fear, shame, and resentment are very powerful emotions. Not dealing with them can keep you trapped.
Fear
It is often said that fear is a lack of faith. Instead of a higher power running the universe, you act as if you’re personally in charge. Therefore, control plays a big part in struggling with fear. You may attempt to control people or outcomes rather than looking at the underlying, or root, causes of your fear.
Root causes of fear may include rejection, abuse, the need for approval, hurt, suppressed anger, or ignorance about taking risks or knowing how to change. These things elicit fear because they seem overwhelming. You haven’t learned how to address these feelings. Possibly you have been punished in some way, at some time, for having these feelings. As a result, you have a feeling, you don’t know how to deal with it, and it turns into fear. It’s easier to project [assign your own feelings to another person or persons] fear outside of yourself than to see that it springs from your not knowing how to deal with a feeling or situation in a healthy way. And how do you deal with fear that is projected onto someone or something else? By controlling that person or thing. This is a vicious cycle that never addresses the underlying cause of fear.
This, of course, doesn’t refer to reality-based fears, such as being afraid of a mugger with a gun; or afraid of abandoned, dark alleys; or riding with a drunk driver. Such reality-based fears are matters of survival and protection. They keep us out of trouble.
Shame
Shame and good self-esteem are never found together. Shame is used in dysfunctional situations to control people and keep secrets. Guilt differs from shame in that whereas guilt implies that your behavior was not okay, shame implies that you are not okay. ‘Shame on you!’ means not only ‘What you did isn’t okay,’ it also says, ‘Who you are isn’t okay, and nothing you do will change that.’ (Beattie, 1989)
Shame implies that what you did is a direct reflection of who you are. We become ashamed of our bodies, sexuality, feelings, mistakes, and even our thoughts.”
Resentment
Resentment is commonly identified with anger. However, the roots of the word mean to ‘re-feel’. Resentment can involve the re-feeling of most feelings: anger, hurt, grief, jealousy, fear, shame, and so on.
As long as you feel resentment, you hold on to a feeling. This feeling grows and changes. It causes physical side effects. Pretty soon the original event or feeling is obscured by out-of-proportion resentment.
The cure for resentment, as for fear and shame, is to look at the underlying cause and address it. In time, talking about the initial event or feeling and the resulting feelings and difficulties can alleviate the resentment. Acceptance starts to creep in and resentment diminishes.”
J. Concept: Boundaries
Boundary problems are common in co-dependency. Boundaries refer roughly to where you end and someone else starts. A boundary is a matter of knowledge, an internal line that marks off me. There is a sense of respect for ‘me’ and ‘my space’. Only selected people are invited in. Boundaries have to do with what you feel comfortable doing and with whom.
Boundaries are first developed in the family. Parents who have poor boundaries can be intrusive and seemingly disrespectful of their children’s boundaries. Sometimes parental boundaries are delineated by cultural differences. Parents from a different culture may find that their children, who are being raised in this culture, feel very different about these boundary violations. While in the old culture they were accepted as correct, they are seen differently in the new culture. Such parents sometimes teach children how to have boundaries that are unacceptable in this culture. This is often done by shaming and controlling. When the parent’s boundaries aren’t clear and in line with the predominant culture, the child may not come to know where his/her responsibilities begin and someone else’s end. The same goes for your feelings and even your life. You feel mixed up with other people.
The use of discipline as a verb – to discipline another person is to control them, instead of as a noun – to teach a person discipline, is an issue of boundaries. Too often child managers [parents, teachers, coaches, and clinicians] attempt to make decisions for children rather than teaching children how to make decisions.
When you have poor boundaries in a relationship, you often end up taking on someone else’s life at the expense of your own. A current joke asks what the co-dependent person sees as she’s drowning. The answer is that someone else’s life flashes before her eyes. Of course, such focus can seem like love or caring. But this obviously leads to controlling and, ultimately, trouble. At the other extreme, if you’ve walled yourself off (a form of poor boundary definition called rigid boundaries), relationships are very difficult to have because you can’t let someone get close enough to be intimate.
The ideal seems to be flexible boundaries. To be able to give support and accept it. To respect your own and others’ feelings, needs and wants, and to be clear about their separateness. To be able to talk and have fun with each other, while allowing each person to be responsible for herself or himself.
As our boundaries become defined, self-esteem usually improves. Melody Beattie (1989) sites the following facts about boundaries:
• Setting boundaries means learning to take care of ourselves.
• Defining what we deserve means developing boundaries.
• Knowing what our needs, wants, and likes are helps boundaries develop.
• Boundaries develop as we define our personal rights, and define who we are.
• Boundaries emerge as we honor and value ourselves.”
K. Skill: Setting Limits
Limit setting builds on what you learned to do with ‘feeling scripts’ ( I feel _________when you____________because___________.) by adding two important additional components:
1. Your limit. This should be stated specifically and behaviorally: ‘I don’t want you to shout at me when you’re upset.’ Or ‘I don’t want to have to do the dishes every night; I’d like us to do them on alternate nights.’
2. Consequences of noncompliance. This is your plan for how you will take care of yourself if the other person doesn’t accept your limit. Don’t make it sound attacking or punishing, just matter-of-fact. ‘If you shout, I’ll leave immediately and we’ll talk about it only after you’ve calmed down! Or ‘If you won’t do the dishes, I’m planning to start eating on paper plates!’
“Here’s how to put it all together:
I feel frightened and hurt when you shout during our conflicts because it reminds me of growing up with my family. I don’t want you to shout at me when you’re upset (limit). If you shout, I’ll leave immediately and we’ll talk about it only after you’ve calmed down (consequence).
I feel frustrated and irritated, when I come to pick you up and you’re not ready. (Because) I get concerned about rushing through traffic and being late to work. Please be ready when I get here (limit). I’m afraid I’ll have to stop carpooling with you if this isn’t possible (consequence).”
L. Concept: Honesty, Openness, and Willingness – “HOW” To Recover
Recovery is about change. Changing starts by becoming aware of and attending to our thoughts. This can lead to changing the way we are inappropriately involved in others’ lives, changing the way we handle our feelings, improving our communication and feeling better about ourselves.
Three things that help keep recovery going are honesty, openness, and willingness.”
Honesty
Honesty is simply a matter of being truthful about your feelings [and the thoughts that evoke them], your goals, or whatever is going on for you. Many co-dependents lie. Honesty is an act of honoring yourself. Because you honor your feelings, you don’t lie about them. They deserve to be valued.
Openness
Openness refers to being emotionally present and available. You are able to put aside preconceived notions and feelings and really listen and hear what another person is saying. Openness means being flexible instead of rigid with demands and expectations. You are able to hear what is being said to you and reflect back. You are open to new options or different ways of approaching things.”
Willingness
Are you willing to do things another way? Hearing and being open is the first step, being willing is the next. Are you willing to actually try different approaches to living? Willingness takes great personal courage. It also opens the doors to change.”
M. Skill: Congruity
Congruity means that the way you look, the message you are giving, and the way you feel, all match up. Incongruity is common in co-dependence. How many times have you asked a glassy-eyed, disheveled, exhausted person how s/he is and received the response, ‘Oh, just fine!’ Or how about the person with fire in the eyes, clenched jaw, and red face exclaiming, ‘I am NOT mad!’
We learn to be incongruent in family environments in which having feelings is not okay Some families cannot tolerate anger, so the children learn to cover up and deny their feelings. Some families cannot tolerate grief, so the children learn never to cry or show sadness. Those feelings are pushed down. Unfortunately, feelings don’t just go away because they’re ignored. Usually they are revealed nonverbally in body language, leading to the kind of incongruity just described.”
N. Concept: Self-Esteem
Mellody (1989) says this about self-esteem:
Positive self-affirmation is the internal experience of one’s own value as a person. It comes from inside a person and is reflected outward into relationships. Sound people know that they are valuable even when they make a mistake, are confronted by an angry person, are cheated or lied to or are rejected by a lover, friend, parent, child, or boss…. Sound individuals may feel other emotions such as guilt, fear, anger, and pain in these circumstances, but the sense of self-affirmation remains intact.
Self-affirmation is about honoring your internal reality. Externally based self-esteem means your worth is dependent on who you are dating, how much money you have, what kind of fancy clothes you wear, the car you drive, where you go to be seen, and the kind of job you have. You value yourself only as you are reflected by external circumstances.
This kind of self-worth is very vulnerable because at any time these things can be taken away. It becomes important to try and control things that maintain your sense of worth and, as mentioned before, the world doesn’t always function by your plans. When you lose something, your self-worth goes down.
Honoring your inner self is achieved by: focusing on yourself, controlling only that which is controllable, being compassionately detached, honoring and talking about your feelings, having healthy and flexible boundaries, being honest and open, and being congruent.
Positive self-affirmation can be manifested by actively working on
accepting yourself as you are rather than constantly criticizing or berating yourself, responsibly taking care of yourself rather than putting your own needs and wants aside in favor of another’s, and honoring your value as a unique individual on this earth, rather than trying to mold yourself to be like someone else.
0. Skill: Examining Your Self Image
How do you feel about yourself? This is an important question. You can’t change until you know where you’re starting from. With a starting point in mind, you can then set goals for yourself.
P. Skill: Assessing Wants and Needs
Co-dependents are notorious for not taking proper care of themselves. One way this is seen is through the tendency to overindulge oneself. The person who does this has poor self-esteem but attempts to mask it with extravagance, little regard for others, and what seems to be a self-serving lifestyle.
Another way of not taking proper care of oneself is more blatant. It’s demonstrated by the person in obviously poor physical condition and shaky mental condition, who eats poorly and doesn’t get proper medical care. S/he has ‘friends’ who all take and don’t give; his/her intimate relationships are in trouble or nonexistent. S/he may dress poorly and doesn’t have time or energy to have fun. This person doesn’t know what s/he needs or wants, and therefore rarely asserts him/herself.
It is nearly impossible to have a healthy relationship with someone like this. Because they’re so out of touch with their goals and desires, they can’t be emotionally present in a relationship.
Pia Mellody (1989) lists four categories of difficulty in meeting wants and needs . They include:
1. Being too dependent: You know your goals and desires, but don’t meet them because you expect others to do so.
2. Being antidependent: You know your goals and desires, but insist on trying to meet them yourself. You’re unable to accept help, and feel too vulnerable to ask.
3. Being needless and wantless: You are unaware of having any goals and desires. This is a desirable state if you are enlightened as you have no attachments, however, if you are simply denying or repressing any needs or wants, you are simply denying yourself.
4. Goals and desires are confused: You know what you want and you get it, but you don’t know what really matters. For example, you buy everything you want and you use this to ‘cure’ needs that aren’t being met (maybe you’re not even aware of them).
Needs as opposed to wants, are necessities. Some examples of human needs are food, shelter, love, affection, nurturance, a sense of belonging, and medical care.
Wants are things we’d like to have or do. They might include such things as: wanting to own a Corvette, wanting to go to Hawaii, wanting to learn to windsurf, wanting to get married, wanting to call a friend.”
Q. Skill: Expressing Wants and Needs
You can express wants or needs by using a very simple assertive script. It has three basic parts:
1. The situation. Just describe the facts – no blaming, no attacking, no pejorative language. Be as careful as you can to be objective and straightforward.
2. Your feelings. Use I-statements. This means you say ‘I feel hurt’ or ‘I feel scared’ or ‘I feel overwhelmed’; not ‘You hurt me’ or ‘You’re scaring me’ or ‘You’re overwhelming me.’ Those are you-statements. They convey blame. They make people feel attacked and defensive, and less likely to respond to your needs.
3. Your wants. Be specific – what, when, and where. People have trouble remembering or responding to general requests. Ask for behavioral rather than attitudinal change. People can alter what they do a lot more effectively than change their beliefs.
Here’s how you can put the three parts together into a coherent assertive statement. Let’s say, for example, that your best friend keeps borrowing money – $5 here, $10 there -but never pays it back.
Two or three times a week you borrow money for lunch or cabfare. But you often forget to pay it back [situation]. I feel irritated and frustrated sometimes when I don’t get the money back [feelings]. I would like you to keep track of the tab and try to pay me back by the end of each week [wants].
Notice that the situation is described without using aggressive language, the feelings are I-statements, and the last part asks for a specific behavior change.
R. Skill: Self-Care
You’re learning to identify your needs and wants. The next step is to put them into practice and live in a self-caring way. To be self-caring means to honor and value yourself, your goals, needs, and your wants. It means to live for you, not for others. You may – and hopefully will – choose to have others in your life; but they’re not the sole reason for your living or dying.
Self-care means moderation, for too much or too little involves denying your needs. For instance, impoverishment is a mask just as much as excess is.
Self-care means self-discipline. You are like a flower garden that needs to be tended, watered, and cared for on an ongoing basis, a little every day. It’s easy to start something and give up in a few days or weeks. However, you are unlike a lower organism which has little ability to strategize and implement the means to get water and care. Loving yourself enough to follow through and commit a bit of time just for you is a mark of good self-affirmation.
Self-care means that the focus is on you. Learning to control the things you can rather than trying to control what you can’t. The focus is off the other person, place, or thing.
Self-care means acceptance, accepting that you need to care for yourself. It means accepting yourself just as you are now and working with this body and soul to keep them running well. The development of goals and implementation strategies for improvement can only occur after an acceptance of where you are.
Self-care also means thoughtfulness. You have to contemplate your goals, needs and wants and then determine how you can best care for yourself.
S. Concept: Tying It All Together
Maybe you’ve noticed that all the issues we’ve covered in this group are somehow interrelated. For example, controllers have boundary problems and they have trouble detaching. People who are confused about their boundaries don’t know how they feel, nor can they communicate well. They don’t take good care of themselves, reflecting their poor self-esteem.
Recovery from co-dependence begins with becoming conscious of what you’re doing. Your focus must be redirected onto yourself.
Learning to live with yourself in mind is the first step toward increasing your self-esteem. You cannot feel high self-esteem and shame at the same time. Honoring and valuing yourself means accepting yourself as you are in reality. You must take responsibility for yourself and work toward positive change. This is what recovery is – one day at a time.
Section II: Classroom Intervention
Class 1
Introduction
See Getting Started.
A. Concept: How Co-Dependency Operates
Intervention 1: Didactic Presentation (See Concepts and Skills section)
Intervention 2: Mini-Evaluation
After the didactic presentation, evaluate quickly how group members are responding to the material. The reason for this is:
1. To determine which issues can be addressed during the group process
2. To quickly assess how individual group members are coping with the material Sometimes the pulse of the group is calm, at other times a few clients might be upset, confused, or angry. Make a mental note of how various individuals are reacting, and weave this into later group process work if at all possible.
The best way to do a mini-evaluation is to briefly entertain questions (no more than 5 to 10 minutes) after the didactic part of the session. Observe each person and note the sorts of questions being asked.
Example
Leader: Okay, are there any questions about the way co-dependency operates?
Chris: (agitated) I don’t know. This sure seems like laying all the blame on my parents. I came from a nice family.
Leader: Yeah, it’s difficult to understand this at first. We’re not blaming your parents. But such dependency is a learned behavior. Co-dependency is multigenerational and it happens to lots of nice families who just aren’t aware of it. [Explain ‘multigenerational’ if necessary.] But you’re aware now, and because of your courage, the pattern won’t have to repeat itself..
B. Skill: Identifying Your Own Co-Dependency
Intervention 1: Didactic Presentation (See Concepts and Skills section)
Intervention 3: Soliciting Examples From Clients
Clients often have trouble in the beginning verbalizing their symptoms. Trust has not yet been established within the group; this is also a new behavior. Gently guide clients along.
Example
Leader: I’d like to take a minute or two and see if you can identify any of your own co-dependent behaviors or thoughts. Let’s go around the room and have everyone give at least one example.
Dale: Well, I know that at times I just can’t say no.
Leader: To whom, Dale? Can you give an example?
Dale: Oh, sure. My girlfriend. I just love her so much that when she’s in trouble and seems to be really sorry, I just give in.
Leader: So that’s an example of a boundary issue. Thanks, Dale. Anyone else?
Sandy: I can’t come up with anything.
Leader: Think about why you came to group.
Sandy: I’m very unhappy at home. My life has been going down the tubes since all my brothers and sisters left home.
Leader: It sounds like your focus – whether you know it or not – has been on your brothers and sisters more than it’s been on you. Maybe your own needs aren’t being met. What do you think?
Sandy: I never thought that I focused too much on my brothers and sisters, but I guess I did.
Intervention 4: Group Process
After everyone has given examples, engage the group members in a discussion concerning their co-dependent behaviors, how they feel about these, and what it’s like hearing others talk about their co-dependency. Begin to use the group to provide support and response to individual concerns. Can group member, for example, begin to pick out the focus of another person. If so, what do they do with that knowledge? Don’t debate with individuals. If Sandy disagreed that she was focusing on her kids, turn to the rest of the group and ask what they think is occurring. Listen closely.
Homework
At the end of group, hand out the “Coping With Turmoil” worksheet located at the end of this lesson plan. Have clients bring these to group next week.
Homework: Coping With Turmoil
1. What situation of unrest can I identify in my life or family
2. How have I reacted to this unrest?
3. How has my way of reacting affected my emotional health? Physical health? Work/school situations?
4. What are some modest, thoughtful options for me to take?
Class 2
Check-in
C. Concept: Changing the Pattern That Maintains the Turmoil
Intervention 1: Didactic Presentation (See Concepts and Skills section)
Share homework.
Intervention 2: Mini-Evaluation
Briefly entertain questions.
Intervention 5: Family Sculpting
The goal of family sculpting is to give clients a transformational experience of what it looks and feels like to be caught in a turbulent situation. Since it’s often difficult for clients to verbalize family turmoil, sculpting allows them to reveal their private views of invisible but meaningful boundaries, alliances, triangles, roles, and so on. Clients do this by translating their thoughts and feelings about family into physical positions in space. You then are able to simply comment on or point out the dynamics in the sculpture.
Instruct individuals in the group to imagine their family as if they were going to pose them for a three-dimensional family portrait. This can show any stage of the family’s life together. The important thing is that this pose be representational of the client’s example of family turmoil from the previous week’s homework assignment. A client chooses other individuals in the group to represent family members. The client positions each person and explains who s/he is playing. The whole sculpture is then observed by the group. The ‘sculptors’ are asked to explain their creations. People representing parts of the sculpture may be called upon to comment on how they feel being in their specific stance.
Once the ice has been broken with the first sculpture, other clients are usually more than enthusiastic about having their turn at sculpting. For complete information regarding family sculpture, refer to Satir (1972) and Duhl, Kantor, and Duhl (1973).
Make sure there’s time to process everyone’s feelings before group ends.
Intervention 4: Group Process
Homework
At the end of group, hand out the “Control Within the Family System” worksheet found at the end of this lesson plan. Have clients complete the worksheet and bring it to group next week.
Homework: Control Within the Family System
1. Define control. Give an example of a situation requiring control within your life or family.
2. Who has the most control in your life or family? The least control?
3. Do you want more control? If so, how can you gain it?
4. Is your manner of exercising control passive or aggressive? It is effective?
5. Is your manner of exercising control healthy or destructive? Give examples of each.
6. Give examples of ways in which you don’t adequately deal with anger.
• resentment • shame
• envy • guilt
• fear • hurt
• grief
Class 3
Check-in
D. Concept: Control
Intervention 1: Didactic Presentation (See Concepts and Skills section)
E. Skill: Differentiating Between What You Can and Can’t Control
Intervention 1: Didactic Presentation (See Concepts and Skills section) Intervention
3: Soliciting Examples From Clients (Use homework)
Example:
Leader: I’d like everyone to look at their homework – the worksheet passed out last week. I’d like everyone to share one example of what you can control and another example of something you can’t. [Note: When they get to the latter example, ask them if their manner in attempting control is passive, aggressive, destructive, or some other style.]
Frank: My first example is that I can do something about my personal psychology – I’m going to individual counseling and this group. I can’t control my mom’s personality. She loves to travel; and every time she talks about it, I worry that she’s unhappy here in our home.
Leader: So what do you do?
Frank: Sometimes I just keep it in and then get overly mad about something else. Sometimes I get on her case for not being happy at home. It eats me up.
Leader: Does that work?
Frank: No! She just gets mad at me and we end up fighting. It never works.
Leader: It sounds like neither the passive nor the aggressive approach works. Now, I’d like to talk about the last statement on the sheet: ways in which feelings aren’t dealt with adequately. When we don’t adequately address our feelings, then we tend to get into controlling behaviors. Would someone like to share an example?
Loren: I’ve always had trouble with hurt. I just push it down and hope it goes away. Then I get resentful at the person who hurt me, and I avoid him. I’m drunk a lot because of hurt.
Class 4
Check-in
F. Concept: Compassionate Detachment Versus Caretaking
Intervention 1: Didactic Presentation (See Concepts and Skills section)
Intervention 2: Mini-Evaluation Briefly entertain questions.
Intervention 3: Soliciting Examples From Clients
At this juncture, tie in the concept of detaching with that of letting go of control. Point out that detachment does not mean cutting someone or something out; it’s not a rigid reaction. The key is to tie the skill of differentiating what can and can’t be controlled (Concept E) to the concept of detachment (Concept R). Have everyone come up with an example of caretaking from his/her own life.
Intervention 6: Problem Solving
This intervention focuses on how clients are failing to fulfill their needs. When faced with a problem, they handle it in old ways that are no longer adequate. After this process is clarified, clients can then formulate new options that serve them and the problem better.
Example
Leader: Let’s take a look at this caretaking behavior and see if you can’t come up with some different options, behaviors based on compassionate detachment: letting others be responsible for their own problems, you for yours.
Alexis: I used to make excuses for my friend’s drinking. I’d minimize how much he drank; I’d say he was under pressure. Down deep inside I didn’t believe it – but I wanted to.
Leader: What might be a way of compassionately detaching?
Alexis: Next time I’m not going to make excuses for him. He has to be responsible for his own drinking. I love him, but next time someone says something to me, I’m not going to bad-mouth him; but I won’t cover up for him or excuse him either. Maybe I’ll just shrug in agreement.
Leader: How do you feel about changing your behavior this way?
Alexis: Well, its kinda scary. What if I can’t do it?
Leader: If you don’t succeed, don’t give up. Just try it again the next time the situation comes up. Changing a way of responding is difficult, particularly when it involves letting someone you care about cope with their own problems – and floundering sometimes.
Intervention 4: Group Process
Class 5
Check-in
G. Skill: Identifying Feelings
Intervention 1: Didactic Presentation (See Concepts and Skills section)
Intervention 2: Mini-Evaluation Briefly entertain questions.
H. Skills: Communicating Feelings
Intervention 1: Didactic Presentation (See Concepts and Skills section)
Intervention 3: Soliciting Examples From Clients
Use the script given in the Concepts and Skills section (I feel_____, etc.). Have clients think of something that happened recently and have them fill in the script with the appropriate feelings, actions, and reasons.
Then have group members recall an incident in which they were in a caretaking role with someone. Have them reflect on their feelings about the person’s behavior, and then use the script to express themselves. This is an introduction to the idea that expressing feelings is a healthy alternative to controlling or co-dependent behavior.
Example 1
Leader: Who would like to give an example using the feeling script?
Luke: I feel sad when I come to group because I hear all these things I identify with, and it makes me remember lots of things from the past that I had forgotten.
Leader: Okay. Now can someone use the script at a time when you’ve been in a caretaking role?
Stacy: This one is for my boyfriend Roger. I feel angry when you don’t show up when you say you will, because I get all worried and obsessed with where you are. I go looking for you all over town. I guess I feel like you don’t care about me and that I must be pretty worthless.
Intervention 4: Group Process
Homework
Prepare at least three ‘feeling scripts’ (I feel_______ when you _______ because_____) regarding people you care about. Attempt to say at least one of them out loud.
Class 6
Check-in
Have group members give examples from their homework.
I. Skill: Dealing With Difficult Feelings – Fear, Shame, and Resentment
Intervention 1: Didactic Presentation (See Concepts and Skills section)
Intervention 2: Mini-Evaluation Briefly entertain questions.
Intervention 4: Group Process
Group process at this juncture should focus on people’s experiences of fear, shame, and resentment. Keep these three goals in mind:
1. Have them use the feeling script for expressing these three feelings.
2. Whenever appropriate, point out how these feelings keep people stuck (not growing emotionally and psychologically).
3. Aid clients in searching for and examining underlying feelings and past events.
Intervention 6: Problem Solving
Group members have discussed how fear, shame, and resentment get in their way and how they don’t adequately deal with these feelings. Now have them brainstorm new ways of coping.
Homework
Keeping in mind what you said and heard in the group, think of one way in which you can deal differently with fear, shame, or resentment.
Class 7
Check-in
Explore group members’ plans to cope differently with fear, shame, or resentment.
J. Concept: Boundaries
Intervention 1: Didactic Presentation (See Concepts and Skills section)
Intervention 2: Mini-Evaluation Briefly entertain questions.
Intervention 5: Family Sculpting
Boundaries help you to be in a relationship by defining who you are. That way you can always be with someone without losing the sense of who you are, what you like, and what you need. This sense of self is necessary for intimacy.
Over-closeness or enmeshment is not intimacy. You can get so entangled with someone that neither of you can stand on your own. Leaning on that other person is so much a part of you that if s/he leaves, then your balance is thrown off. With good boundaries, two people stand side by side, connected by mutual desire but each firmly balanced on his or her own.
With this in mind, let’s sculpt some enmeshed relationships. “Let’s use examples from your own life.” As clients sculpt enmeshment, have them get a good feel for, and view of, the entanglements.
“Next, let’s have some sculpting examples of relationships with good, healthy boundaries.” Appropriate boundaries are quickly sculpted.
K. Skill: Setting Limits
Intervention 1: Didactic Presentation (See Concepts and Skills section)
Intervention 7: Role-playing
Role-playing is used to help clients practice setting boundaries in an enmeshed situation. You can use the situations illustrated by their sculptures.
Example
Leader: (after observing Nell’s sculpture) I see you’re feeling trapped and dragged down by your boyfriend. You were talking earlier about his resistance to your working part-time. Do you have any ideas what it would sound like for you to set some boundaries?
Nell: No.
Leader: John, play Nell’s boyfriend and tell her you don’t like her working. Nell, verbalize to your boyfriend how you feel. Use the script: “I feel ____________when you _____________because__________.”
John: (playing boyfriend) Nell, I want you home after school. I need you to be here with me. You’re my girlfriend and that’s your role.
Nell: John, I feel humiliated when you order me around like that because it makes me into a helpless child.
John But I love you. I know what’s best for you!
Leader: (coaching) Okay, Nell – now’s the time to set some limits.
Nell: Well, John, you may love me and I love you – but it’s my life and the decision to go to work part time is mine. That’s what I’m doing.
John: But what about me! I need you.
Nell: I’m not turning my back on you. I’m not leaving my family. I need to do this for me so I can be happier.
Leader: Good job, Nell. How did that feel?
Nell: Wow! Really different! I feel as if I can stand up tall and breathe!
Repeat this process with a number of enmeshed situations. Be sure to practice asserting consequences where appropriate.
Intervention 4: Group Process
If there’s time, you may want to process what this brings up for group members.
This intervention is optional, depending mainly on how much time is left.
Homework
Identify at least one situation in which you need to protect your boundaries with someone close to you. Prepare a limit-setting statement. You can either practice setting the limit or get support from the group next week to do so.
Class 8
Check-in
Discuss limit-setting homework.
L. Concept: Honesty, Openness, and Willingness: “HOW” To Recover
Intervention 1: Didactic Presentation (See Concepts and Skills section)
The concept of willingness to trust in a Higher Power may be added here. Given that some people have difficulty accepting this concept, it’s best presented as an optional resource. For example, “Many people find the concept of a Higher Power useful in their path to recovery. This concept involves the notion that there is a power greater than you in the universe. This power, not you, runs the universe. In order to live by this concept, you must be willing to let go of control and then be open to and accepting of whatever happens.”
M. Skill: Congruity
Intervention 1: Didactic Presentation (See Concepts and Skills section)
Intervention 3: Soliciting Examples From Clients
“Let’s go around the room and have each of you give an example of congruent behavior.” Clients do so. “And now, can you think of a time recently when you behaved in an incongruent manner?” Have clients give examples. Those who are stuck can get help from other group members who have possibly noticed their incongruent behavior in the group, or might remind them of incongruent behavior they’ve reported.
Intervention 4: Group Process
Process should assimilate concepts of HOW (honesty, openness, willingness) and congruity.
Class 9
Check-in
N. Concept: Self-Esteem
Intervention 1: Didactic Presentation (See Concepts and Skills section)
Intervention 2: Mini-Evaluation
O. Skill: Self Appraisal
Intervention 1: Didactic Presentation (See Concepts and Skills section)
Intervention 4: Group Process
Have each group member list five strengths. Then have them list three weaknesses. The next step is to tie the weaknesses to their strengths.
Example:
Bob: My strengths are that I’m strong, hard-working, insightful, sensitive, and caring. My weaknesses are that I overwork, I get easily disappointed, and I’m impatient.
Leader: Can you relate your weaknesses to the strengths you have, even those strengths that you haven’t mentioned?
Bob: My overworking comes from my being a hard worker! I get disappointed easily because I’m sensitive, and my impatience comes from my ability to see the big picture and from my intelligence.
Spend the rest of the group session processing this material and any other related issues that may come up.
Class 10
Check-in
P. Skill: Assessing Wants and Needs
Intervention 1: Didactic Presentation (See Concepts and Skills section)
Make sure that everyone understands the difference between wants and needs. Also go over the four categories of difficulty in meeting wants and needs. Writing them on a board may be helpful. Refer to Mellody (1989) for a complete explanation.
Also mention that moderation is an important issue here. In co-dependency, we tend toward too much or too little. Moderation needs to be cultivated.
Intervention 6: Problem Solving
Divide everyone into groups of two or three. The assignment is for each person to talk about his or her wants. Then each person is to identify his or her needs. If a client gets stuck, the others are to help. Advise group members to jot down their personal lists. These will be used later.
Intervention 4: Group Process
Example
Leader: What did you discover about your wants and needs?
Carmen: I had a very hard time with my needs. I know what I want, but I’ve never thought about what I need.
Luke: I had the opposite problem – what do I want? I know my needs.
Leader: What did you come up with?
Luke: I’ll have to think some more, but I’m pretty sure that I want a mate. I’m so independent and I have lots of friends; but I think I’d like to get married. Also, I’d like to finish school go into of the Navy. Do something different in my life.
Carmen: Safety in my home. I realize how unsafe I feel where I live. I also want to have more fun.. My life is so serious!
At this point, discussing moderation may be in order. Use a group discussion format if necessary.
Homework
Continue working on a complete list of wants and needs.
Class 11
Check-in
Q. Skill: Expressing Wants and Needs
Intervention 1: Didactic Presentation (See Concepts and Skills section)
Intervention 7: Role-playing
Here the emphasis is on practicing a brief assertive script.
Example
Leader: Think of something that you want in relation to someone you know pretty well. How could you express your desire, using the three-part assertive script: situation, feeling, want?
Miranda: My mother’s always yelling at me and giving me advice on how to take care of myself. I end up feeling incredibly criticized.
Leader: Okay, what do you want in the situation?
Miranda: Support, not criticism.
Leader: Fine, but try to be more concrete about what you mean by support. How could your mother act supportively?
Miranda: Just say what she appreciates about what I’m doing. And if she’s worried about something, fine. But also tell me what I’m doing right.
Leader: How does her advice or criticism make you feel?
Miranda: Stupid, a failure, angry.
Leader: Can you try putting it together into an assertive script?
Miranda: “Mom, you often point out problems and and what I’m doing wrong and give me advice. But I don’t hear what you appreciate about me as a mother. I end up feeling stupid, like I’m not doing it right. And sometimes angry at you. Could you talk more about the things I do well that you appreciate? About what I do right? And balance the advice out with what you see that you like?
Leader: That really worked. The situation, feelings, and wants were very clearly expressed.
Try to role-play one assertive request with each person in the group. Emphasize that the situation should be described in nonblaming terms. Feelings should be expressed in terms of I-Statements. Wants should be specific rather than general, and behavioral rather than attitudinal.
R. Skill: Self-Care
Intervention 1: Didactic Presentation (See Concepts and Skills section)
Intervention 3: Soliciting Examples From Clients
Have group members give examples of self-care. As with last week, include the concept of moderation when necessary.
Intervention 4: Group Process
Homework
Using your list of wants and needs from last week, come up with a list of ways to care for yourself, Try and expand on your current repertoire of self-care behaviors. In addition, practice expressing a want or need to at least one person, using the three-part assertive script.
Class 12
Check-in
Homework review.
S. Concept: Tying It All Together
Intervention 1: Didactic Presentation (See Concepts and Skills section)
Intervention 4: Group Process
Start group with Robert Schuller’s quote, “The ‘I am’ determines the ‘I can’ ”. The leader can use this quote to emphasize how self-esteem (‘I am’) underlies everything we do. The better you feel about yourself, the more you believe you can achieve, and therefore do achieve. This group meeting integrates all the information covered in weeks 1 through 11. Ask group members to briefly review what they’ve gotten from the group. Finally, bid everyone farewell and good luck. Don’t be surprised if you get requests for another group.
Criteria for Measuring Change
The main criteria for measuring change are:
- A growing understanding of co-dependency terminology and concepts, as indicated by correct usage of terms during group and self-report of change in co-dependent behavior.
- An increase in the ability to identify and communicate feelings.
- An increase in self-esteem as manifested by improved assertiveness, more self-nurturing behavior, improved boundaries, and an increase in self-acceptance.
- An understanding and improvement in boundary issues, such as knowing likes and dislikes, and an identifying of unacceptable behaviors.
- The development of trust among group members.
General Information
Problems Specific to the Group
Nonparticipation is more prevalent during the first few sessions. This can be addressed by gently saying, “We haven’t heard from all the group members. How about someone else contributing?” If someone is particularly silent, it’s advisable to comment on it: “George, you’ve been so quiet today. What’s going on for you? Could you share some of it with us?”
Another problem can be caused by one member who tends to dominate the group. Usually the signs of this tendency are visible early. The best strategy is to address the imbalance as soon as possible, before it becomes a chronic pattern. For example, “Thanks for being so open. I’m going to have to ask that we let someone else have their turn now. It’s great that you can talk so freely – but with only an hour and a half for group, we have to make sure there’s time for others to share as well.”
Relapse Prevention
Since this is a beginning group, relapse simply means returning to a previous level of problematic functioning. Once clients are educated on the topic of co-dependency, a return to ignorance is impossible. Relapse behavior usually means that the client chooses to return to old behaviors for one reason or another. It’s a conscious choice. Therefore, the only prevention is to predict in the group that such behavior is possible. The choice ultimately belongs to the client.
Resistance
Resistance is not usually a problem. Sometimes a certain topic is difficult for clients to accept or begin acting on. This is not resistance; it’s usually fear. Work from the fear perspective and the trouble eventually dissolves, because you have aligned with your clients and they feel supported and understood in their trouble.
References
Beattie, M. Beyond Co-dependency. San Francisco: Harper and Row, 1989.
Bradshaw, J. Bradshaw On: The Family. Deerfield Beach, Florida: Health Communications, Inc., 1988.
Cermak, T. Diagnosing and Treating Co-Dependence. Minneapolis: Johnson Institute Books, 1986.
Duhl, F.J.; Kantor, D.; and Duhl, B.S. “Learning, space and action in family therapy: A primer of sculpture.” In Techniques of Family Psychotherapy: A Primer. Edited by D.A. Bloch. New York: Grune & Stratton, 1973.
Hall, L., and Cohn, L. Self-Esteem: Tools for Recovery. Carlsbad, California: Gurze Books, 1991.
Mellody, P. Facing Co-dependence: What It Is, Mere It Comes From, How It Sabotages Our Lives. San Francisco: Harper Collins Publishers, 1989.
Satir, V. Peoplemaking. Palo Alto, California: Science and Behavior Books, Inc., 1972.
Vannicelli, M. Group Psychotherapy with Adult Children of Alcoholics. New York: The Guilford Press, 1989.
Wegscheider-Cruse, S. Choicemaking. Pompano Beach, Florida: Health Communications Inc., 1985.
Competency Exit Interview
- Identify the characteristics of your dependency [thoughts, feelings and behaviors].
- Differentiate between what you can and can’t control. Give specific examples that are related to you dependency characteristics.
- Give specific examples of experiences which are emotionally charged for you and describe the feelings that occur.
- Give an example of how you would now communicate those feelings.
- Identify which of the difficult feelings of fear, shame or resentment hold the most power for you. Indicate how you intend to deal with that emotion in the future.
- Discuss the limits that you have and how you will communicate these limits to others.
- Explain what congruity is. Discuss experiences in which you have felt a lack of congruity.
- Discuss how your own examination of self image has changed.
- Discuss how you assess your own personal wants and needs.
- How would you express these wants and needs to others?
- Discuss the meaning of self care and how it applies to you.
- Tell us your goals and implementation plans in regard to dependence.