JULY 1990. VOL. S2.

NO I AORN JOURNAL

Codependency
PART 111: STRATEGIES FOR HEALING

Linda J. Arnold, RN
This is the final part of a three-part series on when it is time for them to seek help, because
codependency. Part I appeared in the May issue; it is a highly personal decision. The first step on
part II appeared in the June issue. the road to recovery, however, is to accept that
you are codependent.

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odependency, like life, occurs along a An interesting way to evaluate whether or not
continuum. Most people are taught that you may need help is to compare the percent
’there are two choices in life-the right of the time you are satisfied with your life with
way and the wrong way. Codependents often the time you are dissatisfied. If you are dissatisfied
believe they are bad people, and other people who a majority of the time, you may want to pursue
do not seem to be codependent, are healthy and some of the following strategies.
good. This black-or-white thinking is deceptive. Observation. This is a process of taking a new
Life just is not that simple. look at yourself. Most people have established
Some characteristics of codependency have a habits and patterns. Because they are habits, you
positive influence. Codependents can be caring may not be aware of them. As you observe
and sensitive people. They want to make yourself, begin to identify when your codependent
contributions to their professions, communities, antennae are especially sensitive. You also might
and families. They usually are reliable and can begin to take your own “emotional temperature.”
be counted on to help others. At the other end This will help you determine if you have
of this continuum are the negative characteristics codependent attacks. When your temperature
of codependency. starts to rise, how do you feel about yourself?
Do you want to work harder, or do you think
General Strategies
for Recovery
Linda J. Arnold, RN,MS, is a psychiatric clinical

A s with disease processes, recovery from

codependency also occurs along a
continuum. Codependents adapt informa-
tion to their own beliefs and characteristics, but
the journey will not always be as smooth or as
nurse specialist in private practice in San
Francisco. She also is an assistant clinical
professor, Universiy of California, San Francisco
Medical Center School of Nursing. She received
her nursing diploma from Lenox Hill Hospital
fast as they would like. If you believe that you School of Nursing, New York City; her bachelor
are codependent, the treatment plan has to include of science degree in nursing from Teacher’s
acceptance. College, Columbia Universiy, New York City; and
Crack the denial. If you identify with some her master of science degree in mental health
or all of the characteristics of codependency, you nursing from the Universiy of California, San
probably are codependent. It is hard to tell others Francisco.

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The more attention you pay to your

inner world, the easier it will be to answer
the question ‘who am I doing this for?’

that if only you had done something differently, being overwhelmed with activities.
everything would be all right? Has something in Sometimes the opportunity for time and space
the external world not lived up to your expec- is difficult to obtain. For example, this may occur
tations? These are signs of a codependent attack. if you are in the middle of scrubbing a case. Even
During an attack, you feel like a bad person. then, people get upset in the middle of a case
This, however, is not true. You are the same person and need to pause. If you value yourself, there
you were before the event. During the attack, it is always a way to find time and space. If you
is helpful to remind yourself that you are all right. are asked to complete a double shift and are
Boundaries. As you observe yourself, check tempted to say yes, even though you are exhausted,
your boundaries. It may be necessary to ask do not answer immediately. Give yourself time
yourself “does this have anything to do with me?” to decide if this is what you really want to do.
Because there is so much stimuli in the hospital,
this simple question becomes very important. Asking Two
Much of what happens in a hospital has nothing Pertinent Questions
to do with you.

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You establish your own boundaries by learning odependents focus on the external world,
what is and is not your problem. This lesson is not their internal world. The natural
absorbed slowly, and you probably will involve tendency, therefore, will be to do things
yourself in a few situations that are not your for others first. Codependents must ask themselves
business along the continuum toward health. If “who am I doing this for?’ and “what toll will
the day is chaotic and your usually friendly it take on me?”
coworker snaps at you or does not seem warm, It will feel strange to check with yourself first.
you must remember that his or her attitude has As with any behavioral change, you will feel
nothing to do with you. If the physician that you uncomfortable initially. Do not stop just because
have always been able to handle and keep calm it feels different. The more attention you pay to
does not respond in his or her usual way, this your inner world, the easier it will be to answer
behavior has nothing to do with you. If your best the question “who am I doing this for?”
friend, who is constantly having problems with The next question, “what toll will it take on
her husband, has a crisis, it is all right if you me?” is simple, but not easily answered.
do not try to fix it. Codependents tolerate huge amounts of stress.
All these situations are difficult, but you do Measuring your emotional temperature and
not have to make them better. Actually, you can checking the toll life is taking are similar. The
not make them better. It is up to the people process takes practice, and it helps to keep checking
involved to change their situation. with yourself. Learn to ask several questions: “Do
Time and space. Because of boundaries and I want to be doing this?’ “Is this hurting me?”
the sensitivity of your antennae, you should allow “Is this having a negative effect on my life?”
yourself time and space before making decisions. Because situations in life are not black or white,
It is not always in your best interest to make there will be times when doing an extra shift will
others happy or fix a situation. be all right and feel comfortable. There will be
In the extra time you allow yourself, you can times when scrubbing with a difficult physician
determine what you really want to do. You can takes too much of a toll. An important lesson
use this as a method to prevent yourself from to learn about our emotional tolerances is

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People who detach continue to live a

full and active life, but they let go of responsibility
for the problems of others.

understanding that our ability to handle stress can end up alone and hated. We can find an acceptable
change from one minute to the next. place between these two extremes.

Asking for Detachment

What You Want

T he issue of wanting can be difficult for

codependents. Because we have an external
focus, we have more experience at
D etachment frequently is confused with
withdrawal. We often believe that if we
become healthy and detach from
unhealthy situations and people, we will be alone
and never have any friends, lovers, or good work
determining what others want and need. Looking
inward is clouded with thoughts such as “I want situations.
‘x,’ but what will that mean to someone else?”, People who withdraw remove themselves from
or “if I ask for what I want, it may inconvenience life. People who detach continue to live a full
my coworker, my boss, my partner, or my and active life, but they let go of responsibility
children.” In the face of confusion, we find the for the problems of others. Detachment requires
short-term response of pleasing others easier and learning to ask “whose problem is this?”, “do
more comfortable. The long-term effect, however, I actually have some ability to assist in this
can be anger and resentment. situation?”, and “if I already have done as much
A difficult aspect of asking for what we want as I possibly can without taking a toll on myself,
is our belief that because we have learned how is it all right to let go?’
to read others’ minds, others should be able to Detachment means learning the difference
read ours. We wait for a person or situation that between caring and being codependent. Because
will take care of us as we have taken care of of the nature of their work with patients and
others. patient’s families, nurses can find this a difficult
Our goal is to let go of the fantasy that we process. Nurses know illnesses cause hardships on
can control others, observe ourselves in wanting families. They want to help and usually have an
situations, accept that it is uncomfortable and idea of the best way to cope. Codependent nurses,
confusing to ask, and allow ourselves enough time however, have to learn that people are not always
and space to practice. Codependents should be going to follow their rules or suggestions.
willing to accept their humanness and accept that For example, when I worked with families of
asking for what they want will be a struggle that dying children, many parents refused to accept
will not always be accomplished on the first try. the terminal diagnosis. This usually prompted
As we begin to take better care of ourselves, discussion among the nurses about how they
there may be a backlash from friends and family. should force the parents to see the truth as soon
We will not have as much time or energy for as possible. I usually would counsel the nurses
them, and their reaction could be anger. If this that their role was to support the parents while
happens, we may be uncomfortable, but we must they struggled with the difficult process of
be selfish and stand firm. acceptance in their own way, as long as their denial
We should realize that there are more than two did not interfere with the proper care of the patient.
choices. We do not have to take care of others This is detachment.
and be angry and resentful, nor do we have to Detachment means letting go of control.
take care of ourselves, ignore everyone else, and Detachment is acceptance of the fact that humans

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can act in self-defeating ways. We do not have Counseling. The expertise of a professional
the ability to control the negative behavior of those counselor can be very important and helpful. At
we love, and it is not our role to judge them. some time in our lives, most of us need an objective
If we choose to be with them, we must accept viewpoint to help us sort out our problems.
them as they are. If we can not do that, our struggle Individual and group therapy or a combination
may include letting go of them. of both are valuable.
Detachment is essential in the hospital situation. Self-help programs, support groups, or 12-step
We must accept that certain areas are not going programs are an important part of a recovery plan.
to change. There will always be staffing problems, We must find a group that is the most helpful
difficult people to deal with, and a certain level for us. These groups give us an environment in
of chaos and dysfunction. To survive in the which we are safe to be who we are, and a place
hospital, we must detach from areas in which we in which we can make mistakes and admit our
have no control, change areas where we can, and flaws and humanness without fear of judgment
learn the difference. or shame. The experience of acceptance and
Detachment frees tremendous amounts of freedom is a powerful addition to recovery. 0
energy. Because there is no need to control the
uncontrollable or change people who do not want
to be changed, we have the energy to perform
and enjoy our work. Nothing uses more energy 0

than trying to change and control other people

and situations, or holding onto the belief that we
are responsible for other people and their actions.
SURGEONS.. .
Meld the rehemugti of your skillat hands
Working Toward Recovery

A major strategy in dealing with codepen-

dency is reaching out for help and support.
This may be unfamiliar to people raised
in dysfunctional families. Admitting that we need
help is the first step in the recovery process. There
are many ways to get that assistance.
Literature. Reading is a wonderful beginning,
with the high tech
and it is helpful throughout the process. We should
be cautioned that not everything we read will MIDAS REX instrumentation
pertain to us. We should not allow our all-or- to effect improved patient care by:
nothing thinking to sabotage our reading. If
something is not applicable, do not focus on it. SHORTENED ANESTHESIA TIME
Spend time on what is helpful. 8 SHORTENED OPERATING TIME
Discussions. Talking with family and friends SHORTENED RECOVERY ROOM TIME
also can be a method for getting help. Talking SHORTENED HOSPITAL ST',
about feelings is a major step toward recovery.
There may be some friends and family, however, MIDAS REX Institute, Inc.
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and have a codependent attack. In this case, we
should seek another person who is more
understanding.

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