The Co-Dependent Therapist

By Jordan Mayfield, LSCSW, LCAC

Co-dependency is a pop psychology buzz word that is often used by therapists and laypeople alike. I will start off by saying that I am not a huge fan of the word co-dependent and rarely use it in my practice. A working definition of co-dependence is “a relationship in which each person involved is mentally, emotionally, physically and/or spiritually reliant on the other” (Emotions in Harmony). This idea came out of studies on families in which addiction was present. The non-addict in the relationship was seen as co-dependent and often enabling the addiction of the individual by doing things such as giving them drugs/alcohol, bailing them out of trouble, and taking them back over and over despite having set boundaries. The reason I do not utilize the word co-dependent is because the connotation is rooted in sexism. This is because “women are traditionally nurturers and historically have been in a nondominant (and dependent) role due to economic, political and cultural reasons” (Codependency for Dummies).

The above example of the addict/co-dependent also does not consider that participating in the enabling behavior at times is necessary for self-preservation. It also promotes the idea that the enabler is to blame for the addict’s behavior which can be detrimental for both parties. A similar but different word which is more appropriate and has less of a gendered history is “enmeshed.” The idea of enmeshment comes from Structural Family Therapy. It is when families or people in relationships have “high levels of communication but low levels of distance, both physically and emotionally” (Very Well Mind). Additionally, it is when boundaries between two people are “permeable and unclear” (New Haven RTC). Whichever word you use, co-dependent or enmeshed, the idea and damage that it does is the same. People involved in co-dependent or enmeshed relationships lose a sense of self, struggle with emotional regulation, and are prone to boundary violations or having their boundaries violated.

Since co-dependence can happen in any kind of relationship, it would make sense that it can occur in a therapeutic relationship. Most often this is seen with the client becoming dependent on the therapist. This can look like a client wanting extra reassurance or validation outside of sessions, not wanting to move toward termination because they feel incapable of managing their symptoms without the therapist’s support, or taking what the therapist says as “gospel” while not considering their own wants, needs, experiences and whether the feedback makes sense for them.

While client co-dependence needs addressing as part of the therapeutic process, it is a relatively normal experience and can even be related to several mental health diagnoses. The therapist helps the client by setting firm but gentle boundaries. This then can allow the client to set firm and gentle boundaries with others in their life. But what happens when the client is not the co-dependent in the therapeutic relationship and the therapist is? The co-dependent therapist is a rarely, if ever, discussed part of mental health treatment and the damage it can cause clients they work with is vast.

Historically, individuals who became mental health professionals such as psychiatrists and psychologists were often older, white, and male. Like most medical practitioners of the past, they treated clients from an authoritative position. They were deemed the expert, what they said should not be questioned, and the clients they saw were seen as damaged, incapable and in need of their guidance. This type of power differential, coupled with a large ego is a breeding ground for developing co-dependence. Not only in fostering the dependence of the client on the therapist, but the therapist’s dependence on the client to feel better about themselves and to gain a sense of power.

Recently I discovered that a friend has been seeing the same therapist, twice a week for over 15 years. To say this type of treatment is unethical is an understatement. If a client needs twice a week therapy for fifteen years then something the therapist is doing is not working. That means that the client either needs a higher level of care (such as inpatient treatment) to stabilize their symptoms OR more likely the therapist has developed dependence on the client and vice versa. Just like any other medical field, therapy is not an ongoing medical treatment. It is something to seek out episodically, when symptoms are present, and something to discontinue when symptoms resolve. If for some reason symptoms do not resolve in an expected length of time OR symptoms worsen, then a referral should be made.

In the therapy process you begin with the end in mind. A common question at an initial assessment is “what are your goals?” and “when would you know you had achieved them?” Modern therapists are trained that the client is the expert in their own treatment, not the therapist, and that the client’s goals are the ones steering the ship. It is in direct contradiction of therapists in the late 19th and early 20th centuries. And as the example shows above, unfortunately these types of therapists are still out there practicing.

Ego and power are two reasons that therapists foster co-dependency in clients. The need to “fix” and “caretake” can be other traps therapists fall into which creates dependence. “Often people become psychotherapists to meet unfulfilled childhood needs, to better understand themselves, or to repeat a pattern of care taking learned in their family” (Solomon, 1989). Often, modern therapists have mental health diagnoses themselves. This can result in therapists being even better equipped to help clients cope with trauma and their own symptoms, but it also makes it that much more important that the therapist stay on top of their own mental health, so that they are not reenacting trauma bonds or responses with their own clients.

Most clients will inevitably outgrow therapists. This is normal and should be celebrated. Clients should terminate from therapists when their symptoms resolve but can also successfully terminate when they have gotten all they can from that therapist and/or the process. Therapists are not never-ending wells of knowledge and insight. Each therapist has a certain skill set, amount of knowledge and niche that they specialize in. It would be unreasonable to expect one person to be able to treat every possible problem or need at all stages of a person’s life. Just like a primary care physician cannot do this and refers out to specialists the same should be true for therapists.

A third reason that therapists create a dependent relationship with their clients is money. Like any business, the more often you provide a service the more money you make. If you make a client believe they need two sessions a week or allow them to schedule two sessions a week, you get paid for two sessions a week. Luckily insurance companies are trying to crack down on this type of fraud but unfortunately, it still happens. Investing money in advertising, marketing, and finding new clients costs more money than retaining the ones you have. Some clients do need weekly therapy for years, but this is the VERY RARE exception to the rule and likely is only relevant in cases of severe and persistent mental illness. The average client seeking services does not need such an intense amount of treatment.

A client I previously worked with came to me after having experienced an intense therapy process similar to the one outlined above. One of my first observations was that this client needed less therapy, not more. It took a little while for the client to get on board with this idea. However, once therapy frequency, was reduced, and the client had a chance to go practice the skills they had learned in all their years of therapy, they gained confidence in their ability to manage their symptoms on their own and thrived as a result. For many clients in a long-term treatment regimen the frequency could in fact be making them “sicker” than they were to begin with. Certainly, in this case, less was more.

No matter what license a therapist holds, their code of ethics states that the most paramount objective is to do no harm. Therapists who create dependency in their clients are unequivocally harming them by exploiting them for either financial reasons, emotional reasons, or both. As a client, it is important to understand your rights and understand that our goal as therapists is to work ourselves out of a job so you can utilize your own inherent strengths, skills and supports to live your best life.