The Lived Experience of Codependency: an Interpretative Phenomenological Analysis

Abstract

Codependency is a complex and debatable concept, which has been used over the years by mental health professionals to inform their practices. Researchers have attempted to identify the main problems associated with codependency; however, their evidence is still inconclusive. This is the first time that interpretative phenomenological analysis (IPA) has been used to explore the lived experience of codependency from the perspective of self-identified codependents. Eight participants recruited from local support groups for codependency in the UK, offered in-depth information about their subjective experiences, and embedded in their lifeworld. Data was gathered through interviews and a visual method. The shared experience of codependency was portrayed by the participants as a complex but tangible multidimensional psychosocial problem in their lives. It incorporated three interlinked experiences: a lack of clear sense of self, an enduring pattern of extreme, emotional, relational, and occupational imbalance, and an attribution of current problems in terms of parental abandonment and control in childhood.

Full text

ORIGINAL ARTICLE
The Lived Experience of Codependency: an Interpretative
Phenomenological Analysis
Ingrid Bacon
1
&Elizabeth McKay
2
&Frances Reynolds
3
&Anne McIntyre
3
#The Author(s) 2018
Abstract
Codependency is a complex and debatable concept, which has been used over the years by
mental health professionals to inform their practices. Researchers have attempted to identify
the main problems associated with codependency; however, their evidence is still inconclusive.
This is the first time that interpretative phenomenological analysis (IPA) has been used to
explore the lived experience of codependency from the perspective of self-identified codepen-
dents. Eight participants recruited from local support groups for codependency in the UK,
offered in-depth information about their subjective experiences, and embedded in their
lifeworld. Data was gathered through interviews and a visual method. The shared experience
of codependency was portrayed by the participants as a complex but tangible multidimensional
psychosocial problem in their lives. It incorporated three interlinked experiences: a lack of
clear sense of self, an enduring pattern of extreme, emotional, relational, and occupational
imbalance, and an attribution of current problems in terms of parental abandonment and
control in childhood.
Keywords Codependency .Lived experience .Phenomenology .Self .Childhood
International Journal of Mental Health and Addiction
https://doi.org/10.1007/s11469-018-9983-8
*Ingrid Bacon
I.Bacon@SGUL.Kingston.ac.uk
Elizabeth McKay
E.McKay@napier.ac.uk
Frances Reynolds
fa.reynolds@hotmail.co.uk
Anne McIntyre
Anne.McIntyre@brunel.ac.uk
1
Faculty of Health, Social Care and Education, Kingston and St George’s University of London,
London, UK
2
School of Health and Social Care, Edinburgh Napier University , Edinburgh, Scotland, UK
3
College of Health and Clinical Sciences, Brunel University, London, UK
(2020) 18:754–771
Published online: 21 August 2018
Content courtesy of Springer Nature, terms of use apply. Rights reserved.

Codependency is a complex and contested concept, which has been used over the years by mental
health professionals to inform their practices (Harkness 2003; Sadock and Sadock 2004; Dear
et al. 2004; Denning 2010; Marks et al. 2012). It has had a strong presence in the psychological
self-help literature (Schaef 1986; Mellody 1989,1992; Beattie 2011,1992; Jellen 2014).
The concept of codependency emerged in the 1940s in the context of treatment for substance
misuse in the USA. Its resilience has been demonstrated by the amount of academic papers and
exploratory research published across the world, for example: in Italy (Lampis et al. 2017), in Iran
(Askian et al. 2016), India (Bhowmick et al. 2001;Sarkaretal.2015;Kaur2016), Taiwan (Chang
2012,2018), Australia (Marks et al. 2012), Brazil (Bortolon et al. 2016), Turkey (Ançel and Kabakçi
2009; Ulusoy and Guçray 2017), Korea (Kwon 2001), and Sweden (Zetterlind and Berglund 1999).
Our review of the literature elicited a complex and interconnected range of definitions,
assumptions, and models associated with codependency (Wegscheider-Cruse 1981;Whitfield
1984;Cermak1986; Potter-Efron and Potter-Efron 1989; Wright and Wright 1991;Fischer
et al. 1991; O'Brien and Gaborit 1992; Dear and Roberts 2005; Abadi et al. 2015).
A review of the historical development of the term demonstrated that early interpretations
of codependency began to appear in the 1940s in the USA. These were associated with
behaviours presented by wives of alcoholics (Price 1945; Mac Donald 1956). The develop-
ment of the concept of codependency was influenced by the perspectives associated with the
Alcoholic Anonymous’(AA) communities in the USA during the 1960–1970s. The influence
of the AA culture in shaping the concept of codependency as an illness offered the idea that
people who were close to the substance user were themselves suffering from an illness
(O’Briean and Gaborit 1992). These people were viewed as enablers and coalcoholics
(Cotton 1979). Codependency began to appear more prominently in the clinical and popular
literature from the 1980s onward. Three models came to the forefront in this period, providing
different viewpoints in codependency. These are termed and well-documented in the literature
of codependency as the disease model (Whitfield 1984,1987), the personality model (Cermak
1986), and the interactionist model (Wright and Wright 1991). The disease model considers
codependency within the boundaries of clinical interventions and is concerned with diagnosis
and treatment. The personality model of codependency highlighted the role of personality and
constitutional factors in predisposing individuals to develop codependency (Cermak 1986).
The interactionist model proposes a combination of both interpersonal and intrapersonal
factors in the development and maintenance of codependency (Wright and Wright 1991).
Although these models form the basis of some quantitative research carried in the field
(Abadi et al. 2015;Marketal.2012; Wells et al. 2006;Martsolfetal.2000; Hughes-Hammer
et al. 1998;O’Brien and Gaborit 1992), they arguably have a reductionist perspective, limiting
the understanding of the experience of codependency within the boundaries of psychological
categories, traits, and illness.
A systematic analysis of the main definitions of codependency found in the literature to date
identified a thread of four elements repeatedly mentioned by the different theorists: external
focusing, self-sacrifice, interpersonal conflict and control, and emotional constraint (Dear et al.
2004). However, there are no universally used definitions or diagnostic criteria, and codepen-
dency is not listed in the DSM-V (Diagnostic Statistical Manual V, American Psychiatric
Association 1994). The concept has attracted much criticism due to lack of clarity, strong
stereotyping, and negative labelling attributes (Gierymski and Williams 1986; Chiauzzi and
Liljegren 1993;Uhle1994;Anderson1994;Orford2005; Calderwood and Rajesparam 2014.
The literature review demonstrated that the concept of codependency lacks a clear theoret-
ical conceptualisation and, as a result, has generated a fair amount of discussion and
International Journal of Mental Health and Addiction
(2020) 18:754–771 755
Content courtesy of Springer Nature, terms of use apply. Rights reserved.

contradictory evidence and theory among researchers. Most of the empirical evidence is
formed by a body of quantitative research, attempting to categorise and quantify this conten-
tious human experience. For example, across decades, researchers have attempted to identify
the main psychological factors associated with codependency without clear agreement
(O’Brien and Gaborit 1992; Carson and Baker 1994;Irvin1995; Hughes-Hammer et al.
1998; Wells et al. 2006; Hoeningmann-Lion and Whithead 2007; Marks et al. 2012;Lampis
et al. 2017). There has been an attempt to provide evidence for codependency in families with
substance misuse problems (Prest and Storm 1988;Bhowmicketal.2001;Sarkaretal.2015;
Bortolon et al. 2016;Askianetal.2016). The results of these studies highlight that the
evidence is still inconclusive. Codependency appears to take many forms; like a chameleon
concept, it does not seem to be fully understood within the confines of pre-determined
psychological traits, categories, or measurement tools.
Current studies still follow traditional routes of enquire, attempting to categorise the
concept quantitatively and within the framework provided by debatable early models of
codependency. For example, Chang (2018) used self-reported measures to assess the link
between codependency, differentiation of self, and family dysfunction in sample of Taiwanese
University students; Hawkins and Hawkins (2014) examined the relationship between code-
pendency, assessment measures, gender traits, personality, and family alcoholism in American
undergraduate students; Abadi et al. (2015) conducted a systematic review of treatment
interventions for codependency and Reyome and Ward (2007) explored the relationship
between childhood maltreatment and codependency in nursing students. Although offering
useful insights, these studies are limited to populations of students or people with not real
experience of codependency. They are also based on self-report scales, measuring traits with
limited psychometric validation. Overall, they still reflect a rather limited and arguably
superficial perspective of this complex experience and do not offer an understanding of the
concept informed by the individual lived experience. A more in depth, qualitative perspective
is needed considering the wholeness and individuality of the person, capturing the depth of
their unique views, experiences, personal contexts, and narratives. This idiographic perspective
is needed to complement the nomothetic perspective presented in the literature so far.
Moreover, the literature review identified a clear lack of qualitative research investigating
the lived experience of codependency from the perspective of people who identify themselves
as codependents. A close examination of this literature revealed that most qualitative studies
were limited to a sociological perspective (Rice 1992; Irvine 2000; Blanco 2013). They were
mostly concerned with social political and cultural aspects of 12 steps groups for codepen-
dency. As a whole, they offered a rather negative view of codependency, implying acceptance
of unhelpful stereotyping and did not capture participants’own understandings. These studies
did not address the idiographic experiences of individuals who consider themselves to be
codependents and who may seek recovery groups as a way of dealing with difficulties in their
lifeworlds. They left many questions unanswered and invited further psychosocial research
investigating how codependency is internalised, experienced, and shared by people who
identify with it. These limitations suggest that a phenomenological and idiographic study
was needed, focusing on the meaning of codependency for self-identified codependents and
considering their perspectives and experiences of recovery.
One of the aims of qualitative research is to offer an in-depth perspective of an individual’s
lived experience, which leads to a more empathic informed practice (Cassidy et al. 2011). The
debates and uncertainties about the subjective meanings of codependency and the lack of
research from an insider’s perspective suggested that an inquiry into individuals’experiences
International Journal of Mental Health and Addiction
(2020) 18:754–771
756
Content courtesy of Springer Nature, terms of use apply. Rights reserved.

from the perspective of the self-identified codependent was pertinent. The research study
presented in this paper offered a response to this call. The aim of this research was to explore
the meanings, and personal understandings associated with codependency, as understood by
the individuals who identify with this concept, shown by seeking support from a recovery
group, and who find it meaningful to explain the origins and development of their lived
experiences. This paper furthermore will suggest how the findings of this phenomenological
study might be useful to inform mental health clinical practice.
This is the first time that interpretative phenomenological analysis (IPA), as a specific
research methodology has been used to explore the experience of codependency. Currently,
there is an increasing development of IPA research looking to obtain insiders’perspectives into
mental health (Knight et al. 2003;Hornetal.2007;HagenandNixon2011) and addiction
problems (Larkin and Griffiths 2002; Rodriguez and Smith 2004;ShinebourneandSmith
2008,2010,2011; Hill and Leeming 2014). These authors have agreed that the methodology
seeks both an empathic and critical understanding of the lived experience, not often captured
by other forms of research.
Method
Methodological Approach
At the initial consultative stage of this research project, it was important to determine which
qualitative methodology would be most suitable to address the proposed research question:
What is the lived experience of codependency among people who have sought support from a
recovery group for codependents?
Several methodologies were explored, for example: biography, ethnography, phenomenol-
ogy, grounded theory, case study, and discourse analysis (DA). A phenomenological position
was considered most suitable to guide this exploration. This is because the researchers were
concerned in capturing an in-depth perspective of the individual who finds the term codepen-
dency useful to frame their lived experiences. They were interested in obtaining the insider’s
perspective of a number of self-identified codependents, with shared experience of attending
recovery groups. For this aim, the researchers looked for methodology which addressed the
detailed and specific narrative accounts of their lived experience of codependency, fostering an
in-depth understanding of the complex, idiographic, and shared aspects of this.
IPA is an approach to qualitative research, concerned with the personal lived experience,
and the meanings attributed by the participants, in so far as they can be interpreted by the
researcher (Smith et al. 2009). It is a methodology in its own right and offers an in-depth
exploration of the participants’lifeworlds. Given the negative assumptions widespread in the
quantitative literature on codependency, it was deemed helpful to take an empathic, albeit
questioning approach, following the argument (Smith and Osborn 2003; p.51) that IPA Bis
concerned with trying to understand what it is like, from the point of view of the participants,
to take their side.^
There are three key fundamental theoretical principles in IPA: phenomenology, hermeneu-
tics, and idiography (Smith 2004; Smith et al. 2010). IPA adopts a hermeneutic approach to
phenomenology (Larkin et al. 2006). This interpretative component situates the IPA analysis
within an interpretative circle, involving the perspectives of both the participant and the
researcher (Smith 2004). Reflexivity is a fundamental aspect of IPA research (Langdridge
International Journal of Mental Health and Addiction
(2020) 18:754–771 757
Content courtesy of Springer Nature, terms of use apply. Rights reserved.

2007;Finlay2008). In this study, through ongoing reflexivity, the researchers became critically
aware of their position and reflected on how their personal experience, thoughts, beliefs,
opinions, and interpretations, influenced the research process and outcome (Finlay 2008). For
example, authors were familiar with the concept and its critiques through clinical practice and
teaching in mental health.
Sampling
The IPA methodology values purposive and small samples, as there is a strong idiographic
approach and commitment to in-depth data analysis (Smith 2011a,b). Specific contexts with
small sample sizes are encouraged to ensure the richness of the information collected and
appropriate analysis (Larkin et al. 2006; Eatough and Smith 2006). Adhering to this, eight
participants (five women and three men) were recruited from local support groups for
codependency in the UK. The decision to recruit from local support groups was informed
by our review of the popular literature available, which informed that individuals who consider
themselves to be codependents typically seek codependency anonymous groups as a way of
dealing with their codependency (Beattie 2011,1992;Mellody1992,1989). The support
group selected for this study follows an eclectic theoretical framework underpinned by
medical, spiritual, and behavioural principles.
The participants were selected based on their shared the experience of codependency. This
was deemed sufficient to enhance the homogeneity of the sample, as required in IPA studies
(Smith et al. 2010), although it is accepted that participants’network of other relationships
would be intertwined with their lived experience of codependency. Therefore, sensitivity to
participants’perspectives, relational experiences, and interpreted contexts was an important
aspect of this IPA research, which aimed to capture their unique and shared experiences of
codependency (Yardley 2008). This recruitment procedure was fully compatible with IPA
methodology (Smith et al. 2010).
All of the participants were fluent speakers of the English Language. The inclusion criteria
for the study specified that participants identified themselves as codependents. This was
important because the study intended to understand subjective process, which led these
participants to frame their own experiences in terms of codependency, with a shared recovery
philosophy. To ensure the welfare of the participants and researcher, participants were also
expected to be receiving some form of support for codependency, i.e. attending self-support
groups, or receiving individual counselling or support.
See Table 1below for more information on participants.
Table 1 Participant’s details
Pseudonym Age Family status Occupation Number of interviews
Timothy Mid forties Divorced with children Media Pilot + 2
Helena Mid forties Divorced with children Health and theatre Pilot + 1
Heather Mid sixties Married with adult children Housewife 3
Selma Mid thirties Single mother with children On state benefits 3
Mathew Early forties Divorced, single father with children Businessman 2
Patricia Late fifties Married with children Law 3
Jonathan Late thirties In a relationship, and has children IT 2
Misha Early forties Single, no children Media 2
International Journal of Mental Health and Addiction
(2020) 18:754–771
758
Content courtesy of Springer Nature, terms of use apply. Rights reserved.

Ethics
The study conformed with the host university’s Ethics Committee’s requirements and received
full approval, adhering to principles of autonomy, confidentiality, beneficence, non-malefi-
cence, and justice. Potential participants who had their names and contact details on the group
website were sent a message explaining the purpose of the study and inviting their participa-
tion. After this initial contact, if agreed, the participants received an information pack
explaining the process of the study, the inclusion criteria, and the consent form. A limited
amount of snowballing was also used, which included referrals from participants (Smith et al.
2010). All of the participants gave written and verbal consent. Anonymity was ensured as
participants were given pseudonyms, and all identifiable information was removed from the
data. The research project was informed by a team of advisors composed of three self-
identified codependents, who volunteered to offer an insider’s perspective and to contribute
to the research in a consultative and collaborative role, for example by advising on information
sheets and interview questions.
Data Collection Procedure
In IPA studies, data collection is a dynamic process that seeks to uncover and
understand in depth the participants’lived experience in so far as they can narrate
this. In this study, the data collection process occurred over 6 months by means of a
maximum of three in-depth semi-structured interviews and a visual method (for more
information on the visual method see Bacon et al. 2017). The first author was the
interviewer throughout. Each one of the interviews lasted approximately one and half
hours. The repeated interviews had the intention to promote in-depth conversations over
an extended period of time, as well as allowing time for the explorations of the
experience through the visual methods. The visual method invited participants to bring
an image or object that characterised their experience of codependency to be discussed
during the second interview. This was a useful method to access a more in-depth
narrative from participants and potentially encourage new insights and metaphorical
understandings (Shinebourne and Smith 2011). A brief interview topic guide, with pre-
determined (6–10) questions was used as a guiding tool for the interviews. The
schedule was designed to offer guidance regarding possible questions to be explored
over the three interviews. Questions were open ended and aimed at encouraging
participants to express themselves in their own words. During the participant’sinter-
view, the phrasing of some questions of the topic guide was changed or omitted,
depending on the details already offered, and no particular order was followed. See
Tab le 2for an example of interview topic guide.
Table 2 Examples of interview questions
Opening questions Main questions Closing questions
If we could start by you telling
me about yourself, perhaps
your story and journey so far?
How did you become aware of
codependency?
What does codependency mean
to you?
What does it mean to you to be
identified as a codependent?
Could you tell me what you would
recommend to other people who
may find themselves in the same
situation?
International Journal of Mental Health and Addiction
(2020) 18:754–771 759
Content courtesy of Springer Nature, terms of use apply. Rights reserved.

Data Analysis
The interviews were transcribed verbatim and were analysed following a distinctive,
systematic but flexible process recommended by Smith et al. (2010) and Smith (2011a,b),
namely: initial encounter with the text, case by case analysis, with the identification of themes,
clustering of themes, refinement of clustering of themes, cross case analysis identifying
superordinate themes, labelling of super-ordinate themes, and writing of a narrative report.
The researchers had an attitude of openness and immersed themselves in the data, consistent
with the attitude taken on data collection. The case was very much central to the analysis, and
the researchers attempted to understand as much as possible about each individual case before
moving to the next. At the cross-case analysis stage, the researchers remained faithful to the
individual case, focusing on the lifeworld of each participant, whilst searching for common-
alities or convergences of meaning (Eatough and Smith 2006). The researchers corroborated
the themes inferred through discussion.
Having clarified the theoretical and practical aspects of the IPA methodology and proce-
dure, the following section offers a detailed examination of the findings.
Results
The eight participants offered in-depth, vivid, and rich information about their subjective
experiences of codependency embedded in their lifeworld. Four main themes are presented in
the Diagram 1below:
Codependency feels real and tangible: BIt explains everything.^
Firstly, all participants revealed an understanding and lived experience of codependency as
something that to them felt real and tangible, forming an important and central feature in their
lifeworlds. They had all struggled to understand their enduring social and emotional difficulties
until they discovered the concept of codependency. Adopting the codependency way of
framing experience did not happen easily for these participants. It was gradual discovery
which offered meaning to complex and confusing experiences. For them, it came as a relief to
understand codependency as a socially recognised psychological problem which exerted
Lack of sense
of self
Emotional and
occupational
imbalance
Codependency
feels real and
tangible
Sense of
abandonment
and control in
childhood
Chameleon-self,
who blends in
Codependency
experienced as
real and tangible:
‘It explains
everything’
Seesawing
through extremes
in life: ‘Like a
seesaw…I feel
very out of
control’
Finding meaning
in codependency
through exploring
childhood
experiences:
‘Down to
childhood’.
Diagram 1 The lived experience of codependency
International Journal of Mental Health and Addiction
(2020) 18:754–771
760
Content courtesy of Springer Nature, terms of use apply. Rights reserved.

distinct influences over their lives. The quote below from Selma demonstrates the significance
that codependency held in their lives:
…but I needed something to explain it, I needed something to explain everything. And
it (codependency) doesn’t explain nothing, it (codependency) explains everything!
The participants all appeared to have found in Bcodependency^a simple, singular, and all-
embracing explanation for a range of life difficulties and problems. For them, codependency
was something so real that it felt concrete and touchable, like an illness or an underlying
addiction problem, related to many forms of addictive behaviours, as illustrated by Misha:
I think all addiction patterns come from codependency. Codependency is the mother
ship of all addictions!
None of the participants expressed stigma in relation to framing their experiences in this way.
Instead, the concept of codependency offered meaning and hope that they could manage their
difficulties more effectively.
The Chameleon-Self, Who Blends In
For all participants, the experience of codependency was associated with their enduring
difficulties with self-concept. They all shared the experience of struggling to locate and define
a clear sense of self. The participants spoke about the frustration with their lack of self-
definition, which according to them resulted from an over-willing blending into situations.
Several used the metaphor Bchameleon^to describe this process of adaptation to the social
environment and relationships. Selma’s quote illustrates the theme:
…it is like the chameleon, you know, trying to fit in with every situation rather than
allowing myself to be who I am …
Participants spoke about their attempts to change and modify themselves to fit in socially, in
order to feel liked, to belong and feel accepted, to gain a sense of self-esteem, yet taking this to
an extreme where they lost sight of self.
Modifying myself in a chameleon like fashion to fit in, losing a sense of constancy
around my values, my needs …(Selma)
All participants expressed feeling locked in to subservient and passive roles within close
relationships. These relational difficulties had various negative consequences; for example,
participants expressed feeling overruled, staying in the relationship in spite of its detrimental
and often destructive effects, and choosing partners who had problematic psychological issues.
They described the experience of becoming imprisoned in their relationships and finding
themselves Blocked^into these situations, feeling powerless, and unable to break free. For
example, Mathias conveyed a sense of being locked into the relationship and unable to
dissociate himself from his partner. He remained in the relationship in spite of feeling that it
was not working. He described his over-riding sense of obligation, as something that was
similar to an arduous military duty that was given to him by God.
I would be in relationships that were unhealthy, unequal, umm unpleasant umm and I
would stay in them, you know, no matter what, like a marine, umm …It’s my duty, God
gave me this!
International Journal of Mental Health and Addiction
(2020) 18:754–771 761
Content courtesy of Springer Nature, terms of use apply. Rights reserved.

He suggested that as a codependent, he became too adapted to each role, to a point where he
would become the role and lose a sense of self. All participants described experiencing a
dysfunctional degree of adapting themselves to situations as something negative and related to
their codependency. Resonating with this need to subsume personal needs within relationships,
most of the participants explained further various, and sometimes dysfunctional attempts to
obtain a clear and better defined sense of self, as described next.
Seesawing Through Extremes in Life: BLikeaSeesaw…I Feel Very Out of Control^
The experience of codependency, according to participants, was manifested through difficul-
ties in living a balanced existence, suggesting a perceived lack of internal stability. Participants
all related their lack of self-definition with continuing occupational and emotional
unmanageability. Participants described the experience of lack of balance in their lives, with
an excessive tendency to go to extremes of engagement in activities, and oscillating from one
extreme to the other in a range of situations, for example working too much, using drugs or not
looking after themselves. This was portrayed by the metaphor of the seesaw:
Maybe (my life) is a seesaw, maybe is something like a seesaw, you know …Ican
swing from self-care to self-deprivation, self-care to self-deprivation. …And it’snot
very consistent, the two ends of it …if I push, and put too much weight on one end, you
know, I feel very out of control, but if it is balanced, it would be easier (Misha).
Participants spoke about the experience of imbalance as a negative, portraying a sense of
duality, or split; for example, stating that they felt Bup and down emotionally,^swinging Bfrom
self-care to self-deprivation.^This experience of imbalance caused a sense of struggle as they
searched for more stability as explained by Helena:
I actually think, I needed to go down that particular path to come back to the middle, that
is my experience in almost everything to be honest. I tend to flick to each end of the
scale and eventually balance somewhere in the middle.
They described a Bneed or urge^to do activities in what they regarded as excess and
intensively, such as excessive drinking, drugs, and sex with multiple partners, seeing this as
self-destructive, but associated with a need to escape feelings of inner emptiness:
…I would drink too much, and then smoke too much weed, and like the sexual acting
out as well …big part of the highs and the lows and all of it, just combined to it, just this
craziness it was all. The majority of it was internal …a constant feeling of devastation
…it’s just like this paradox of devastation and emptiness …(Selma)
Participants spoke about a series of possibly destructive actions and compulsions that they had
eventually attributed to codependency. They described not coping well with a quiet, routine, or
empty life. It is possible that they may have needed to experience the rush of activities, so as to
escape this experience of inner emptiness or to experience a sense of being alive.
In order to relax I have to burn out almost, I don’t know how to just relax, ‘cause I
somehow have to go to the extremes …Yeah, I don’t work very brilliantly with the
mundane; it is the steady life ……if I don’t get to the edge of what it feels like to be
alive, then I don’t feel alive, then I get grumpy …anything that feels like life stops, it’sa
terrifying space …(Helena)
International Journal of Mental Health and Addiction
(2020) 18:754–771
762
Content courtesy of Springer Nature, terms of use apply. Rights reserved.

Participants recounted what they perceived as an excessive tendency to go to extremes of
engagement in activities. It appeared that, for some participants, this heightened activity was
associated with a need to escape a sense of void or inner emptiness, described by Patricia as
B…that feeling of a hole in the soul.^
They interpreted this as a problem related to their codependency and spoke about their
struggle to establish a more balanced life experience.
Finding meaning in codependency through exploring childhood experiences: Bdown to
childhood.^
The last convergent theme related to participants’attributions for their problems to expe-
riences in their family of origin. Participants had all clearly engaged in a deep analysis of their
childhood experiences to provide causal attributions for their perceived difficulties, framed as
codependency.
I do believe that it is down to childhood experiences and the individual child’s
perception of those experiences …considering that all of my siblings are messed up
as well …(Selma)
Participants shared a negative perception of being raised in home environments where they
experienced various forms of excessive control, criticism, and perfectionism. Most recalled a
rather paradoxical interpersonal family dynamic described as excessive parental rigidity and
control combined with lack of support.
A closer investigation of their accounts revealed a further interesting aspect: reference to a
parental figure who was perceived as physically and/or emotionally absent by most of the
participants. This absence of a safe parental figure, typically the father, was portrayed by five
participants and associated with their later experience of codependency.
…my father who was, quite passive, actually often quite absent, he worked, sometimes
he worked in the evenings, sometimes he worked at weekends …he wasn’t the men’s
man …my mother bossed him about, my mother ran the house …(Jonathan)
The theme also conveys a sense of extreme duality, as participants described the paradoxical
experience of feeling both controlled and abandoned. This duality was portrayed most
explicitly by Misha, as she reflected on both her parents’contribution to her upbringing,
conveying a sense of Bsplit^felt as a result of difficulties experienced when growing up:
Maybe there was a sort of half factor, maybe one half of my family was not supporting
me and maybe (the other half) my mother was judging me …(Misha)
In summary, as participants sought to understand the difficulties they experienced in their lives
they felt the need to revisit their childhood experiences. In doing this, they looked for possible
faults and gaps in their upbringing as it offered meaning to their experience of the complex and
varied experiences that they had come to frame as codependency.
Summary
The IPA methodology helped the researchers to understand how a small sample of self-
identified codependents made sense of experiences in their particular lifeworlds, searching
for the meaning they attribute to these. The shared experience of codependency was portrayed
by the participants as a real and tangible psychological problem in their lives, which appeared
to follow a pattern, incorporating three interlinked subjective factors: a profound lack of clear
International Journal of Mental Health and Addiction
(2020) 18:754–771 763
Content courtesy of Springer Nature, terms of use apply. Rights reserved.

sense of self, an enduring pattern of extreme, emotional, relational, and occupational imbal-
ance, and an attribution of current problems in terms of parental abandonment and control in
childhood. Participants reflected on the dynamic of abandonment and control as leading them
to feel a sense of duality or split. They described a lack of internal instability, as they lived their
lives between extremes of experience, encountering difficulties in locating and defining self,
behaving like chameleons, and overly adapting to environments and relationships to obtain a
sense of safety and belonging.
Discussion
The main themes which emerged from the analysis of the interviews created a rich picture of
the lived experience of codependency shared by the participants and revealed participants’
understandings of codependency as something real, forming an integral part of their lives. It
was a concept that gave meaning to a complex set of confusing and compulsive behaviours.
The interpretations suggested that the participants in part carried a rather medical understand-
ing of codependency and found relief in encountering a diagnostic label for their previously
unexplained and enduring problems. They understood codependence as a socially recognised
form of addiction, which explained and offered meaning to their painful and hitherto puzzling
lived experiences. This contradicted the views of early critics in the field who suggested that
these individuals became labelled or stigmatised, and as such would become disempowered or
lost in the sick role attributed to the label (Gierymski and Willams 1986;Gomberg1989;
Harper and Capdevilla 1990;Collins1993; Chiauzzi and Liljegren 1993;Anderson1994;
Uhle 1994;Irvine2000). On the contrary, the findings revealed that for these participants,
codependency offered a controllable socially shared meaning for their complex and chaotic
lived experiences. The concept’s lack of conceptual clarity and simplistic framing device may
have served to make it attractive and suitable to capture, attribute meaning, and socially
validate a diverse range of experiences. Codependency served as a chameleon concept
adapting to the needs of the people who identified with it.
The participants attended codependency groups, individual therapy, and read widely on the
topic. They acted as Bmeaning makers^(Langdridge 2007 p. 30), using their received
understandings of codependency to make sense of their personal lived experiences. Symbolic
interactionism posits that meanings are central to human life and are formed through a process
of social interpretation, with people adopting the socially accepted metaphors and scripts
available in their reference groups (Blumer 1986; Giugliano 2004). This is noticed by the way
participants acted in relation to finding relief in the common understandings of codependency
achieved in their support groups, therapy, and associated reading. Medical or psychiatric labels
can be stigmatising and yet by objectifying codependency as a delineated psychosocial
problem, these participants benefited from attributing a more widely accepted, socially shared
meaning to their own varied and distressing life difficulties.
Social attribution theory may also be applicable as it describes people’s need for a label,
such as codependency to explain distressing, non-normative experiences (Heider 1958;Kelley
1973; Kelley and Michella 1980; Weiner 2008). Attribution theorists argue that when faced
with adversity, people ask themselves causality questions, which in turn prompt causal
searches (Kelley 1973; Kelley and Michella 1980). The theory proposes also that explanations
for undesired situations are likely to be attributed to causes outside one’s control to protect self-
esteem (Elliott et al. 2012). Here, the participants appeared to have engaged in an ongoing
International Journal of Mental Health and Addiction
(2020) 18:754–771
764
Content courtesy of Springer Nature, terms of use apply. Rights reserved.

process of resolving some of their intra- and interpersonal problems through their identification
with the codependency label. The codependency attributions may have provided a way to
explain and understand situations that happened in their lives in the past, serving also as a
framework for future actions, decisions, and behaviours.
In addition, from the perspective of these participants, codependency went beyond the
medical model; it was also associated with existential issues associated with problems with a
sense of self. The second theme revealed the participants’struggles and search to obtain a
better defined, more authentic sense of self. They portrayed some of their struggles in finding
themselves behaving like chameleons, adapting and conforming over-readily to situations,
which caused frustration and dysfunction in their lives. The issues associated with an unde-
fined sense of self played an important part in the lived experience of the participants of this
study; nevertheless, research in the field offered only a partial perspective on this, failing to
capture the depth and significance of this experience for the self-identified codependent
(Carson and Baker 1994; Crothers and Warren 1996; Irvine 2000; Dear and Roberts 2005;
Chang 2018).
The IPA methodology grants that diverse and psychological and philosophical perspectives
are integrated into the research to interpret and elucidate the findings (Smith et al. 2010; Smith
2011a,b). Two further traditional theoretical frameworks have been useful to interpret the
participants’existential and relational difficulties identified as codependency (Winnicott
1960a,b,1965a,b; Bowen 1974,1978). Bowen (1974,1978)proposedthatthedegreeto
which the person develops a cohesive and differentiated sense of self is determined by the
differentiation this person obtained from the family of origin. People with low level of
differentiation may have internalised a more fragile sense of their own thoughts, emotion,
and needs, tending to accommodate and conform to the situations to a point that they lose their
sense of individuality and authenticity. Here, we suggest that by behaving like chameleons, the
participants highlighted their undifferentiated sense of self.
Furthermore, Winnicott’s(1965a,b) views resonate with the notion of the inauthentic, non-
validated, and undifferentiated sense of self described by the participants. He posited that when
individuals do not have their needs validated in childhood, they tend to accommodate to the
needs of their parents, developing a defensive or undifferentiated organisation of self, termed
Bfalse self,^similar to the chameleon type of behaviour described by the participants here. He
added that people with a Bfalse sense of self^present a tendency to obtain a sense of value and
esteem through excessive engagement in activities. Interestingly, this was described by the
participants as they believed that their codependency was manifested in the marked occupa-
tional and emotional imbalance in their lives. They spoke about having difficulties with
balance, sharing a perceived lack of internal stability, communicating a profound fragility of
self, which they thought fostered experiences of intense and enduring emotional and occupa-
tional imbalance. Participants described engaging in activities to obtain a sense of esteem and
validation. These participants experienced a Bsenseofvoid,^described by one as a Bhole in the
soul,^and seemed to have engaged in a frantic pursuit of activities in order to fill this. These
rich accounts add further insights into some of the generalisations about codependency (e.g.
emotional suppression and external focusing) previously associated with codependency in the
quantitative research literature (Dear and Roberts 2005).
Finally, the study also uncovered the participants’specific social attributions of their
difficulties to dynamics within their family of origin, perceived as control by one parent and
abandonment by the other. Like naïve psychologists (Heider 1958), the participants appeared
to have engaged also in the process of external causal attribution (Kelley1973; Kelley and
International Journal of Mental Health and Addiction
(2020) 18:754–771 765
Content courtesy of Springer Nature, terms of use apply. Rights reserved.

Michella 1980), whereby they searched for past childhood experiences as distal causes for their
identified codependency. However, the identified contradictory parenting pattern of control
and abandonment was not necessarily associated with parental substance misuse as suggested
by early theorists in the field (Mellody 1989; Beattie 1989,2011; Whitfield 1984,1987,1991),
nor by quantitative researchers who have examined the relationship between childhood family
experiences and codependency in populations of students (Crothers and Warren 1996;Cullen
and Carr 1999; Fuller and Warren 2000;ReyomeandWard2007; Knudson and Terrell 2012;
Hawkins and Hawkins 2014).
The personal significance of early family interactions in the lives of participants can be
better understood within Bowen’s(1974,1978) and Winnicott’s(1960a,b) theoretical views
about differentiation in childhood. Winnicott suggested that the presence of a Bholding
environment^is key to facilitating optimal psychological development (Winnicott 1960a,b,
p. 591). Here, participants reflected on their family environments as negative, rigid, and
unsupportive. Such environments may have prompted them to feel that they may have no
other option rather than conform to an unauthentic existence and to resent the freedom to make
choices and express themselves.
Critical Evaluation and Limitations
A number of quality measures were used to ensure the rigour, trustworthiness, and credibility
of the study (Yardley 2008;Smith2011a,b). The process of multiple interviewing helped to
gain deeper insights and go beyond rehearsed narratives likely to have been told many times in
support group meetings. In spite of this, the study is limited by factors related to methodo-
logical and participants’sensitivities. According to Shinebourne and Smith (2011), support
group forms a good sample representation, as it adequately meets the IPA criteria of a
purposive, context-specific, expert knowledge group. This recruitment procedure was planned
with the positive intention of increasing homogeneity within the small sample; nonetheless, it
may have limited the study in some ways. Limitations around received, rehearsed, and edited
narratives had to be considered, as this group appeared to be well informed about lay and
psychological theories about codependency, for example they attended groups and read widely
about codependency. It was not possible to entirely disentangle Bfirst hand^experience from
the framing applied from this learning within the support group and beyond. Despite its aim to
stay experience-close, IPA research into other contested conditions, such as chronic fatigue
syndrome and addictions, has faced similar issues (Dickson et al. 2007,2008;Shinebourneand
Smith 2008). However, concurring with other research carried out in support groups
(Shinebourne and Smith 2011), participants’accounts varied considerably, and were not in
any obvious sense scripted.
In addition, although the sample was large for IPA research (Smith et al. 2010), it could
nonetheless be considered relatively small and specific, and therefore findings are not straight-
forwardly generalizable to other contexts. The participants volunteered to take part in the
study, so they may have been highly motivated to share their experiences and understandings
of codependency. Other self-identified codependents may have different views and experi-
ences, especially those who have not yet encountered or found value in support groups.
This is a qualitative study, so we are not claiming that the findings can be generalised
simplistically, in particular to people who identify with codependency yet do not attend formal
support groups. We nonetheless argue for a theoretical transferability (Smith et al. 2010).
Smith (2011a,b; p7) suggested that the particular aspects explored through IPA Btakes us
International Journal of Mental Health and Addiction
(2020) 18:754–771
766
Content courtesy of Springer Nature, terms of use apply. Rights reserved.

closer to the universal.^Therefore, we propose that the findings may guide further research
and inform clinical practice.
Conclusion and Clinical Implications
It is important that therapists working in this field need to be sensitive to the importance of this
label, and the attributions that it implies, to this client group. Receiving such a label may not
necessarily come with negative connotations despite some previous sociological and feminist
debate on this matter; on the contrary, it may offer a socially recognised explanation for
complex, enduring, and distressing life experiences. The findings highlighted the need for
therapists to be aware of issues related to fragile self-concept and the experience of problematic
parenting experiences in childhood when offering support to codependents. People with
codependency issues would benefit much from empathic listening as it can bring a sense of
acknowledgement and validation of their life experiences, contributing to the restoring of their
sense of self. A thoughtful therapist–client relationship, focusing on embracement, holding,
and support thereby proving a stable secure therapeutic environment could help these indi-
viduals as they engage in a process of self-construction. Therapists working with these clients
should be conscious of their extreme oscillation in engagement in activities. They can plan
psycho-educational interventions, which are aimed to assist these clients to consider a more
balanced lifestyle. Stress management techniques and emotional regulation strategies can be
offered to assist to regulate their emotional and occupational instability. The extremes of
oscillation in feelings and activities may also create barriers to forming a strong therapeutic
alliance and therapists may need to use supervision to manage the emotional effects of such
oscillations on self.
It is hoped that the results of this study will provide a base for developing a more empathic
and contextualised understanding of the experience of codependency, which in turn will enable
mental health professionals to offer support which is relevant to these individuals’experiences.
Compliance with Ethical Standards
Conflict of Interest Ingrid Bacon, Elizabeth McKay, and Frances Reynolds declare that they have no conflict of
interest. The study did not receive external research funding.
Informed Consent All procedures followed were in accordance with the ethical standards of the responsible
committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as
revised in 2000 (5). Informed consent was obtained from all patients for being included in the study.
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International
License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and repro-
duction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a
link to the Creative Commons license, and indicate if changes were made.
References
Abadi, F. K. A., Vand, M. M., & Aghaee, H. (2015). Models and interventions of codependency treatment,
systematic review. Journal UMP Social Sciences and Technology Management, 3(2).
International Journal of Mental Health and Addiction
(2020) 18:754–771 767
Content courtesy of Springer Nature, terms of use apply. Rights reserved.

American Psychiatric Association. (1994). DSM-IV-TR, diagnostic and statistical manual of mental disorders.
(4th Ed.)
Anderson, S. C. (1994). A critical analysis of the concept of codependency. Social Work, 39(6), 677–685.
Askian, P., Krauss, S. E., Baba, M., Kadir, R. A., & Sharghi, H. M. (2016). Characteristics of co-dependence
among wives of persons with substance use disorder in Iran. International Journal of Mental Health and
Addiction, 14(3), 268–283.
Bacon, I.G.F.I.; McKay, E.A.; Reynolds, F.; McIntyre, A. (2017). The Lady of Shalott. Insights gained from
using visual methods and interviews exploring the lived experience of codependency. Qualitative Methods in
Psychology Bulletin, Issue 23, Spring.
Beattie, M. (1992). Codependent no more: how to stop controlling others and start caring for yourself.New
York, NY: Harper San Francisco.
Beattie, M. (2011). Codependent no more: workbook. Center City, Minn.; Enfield: Hazelden: Publishers Group
UK distributor.
Bhowmick, P., Tripathi, B. M., Jhingan, H. P., & Pandey, R. M. (2001). Social support, coping resources and
codependence in spouses of individuals with alcohol and drug dependence. Indian Journal of Psychiatry,
43(3), 219–224.
Blanco, A. E. R. (2013). Resilient women: From victimhood to autonomy. Case study in the self-help groups
codependent anonymous. Acta Colombiana de Psicologia, 16(2), 71–79.
Blumer, H. (1986). Symbolic interactionism: perspective and method. Los Angeles: CA University of California Press.
Bortolon, C. B., Signor, L., Moreira, T. D. C., Figueiró, L. R., Benchaya, M. C., Machado, C. A., et al. (2016).
Family functioning and health issues associated with codependency in families of drug users. Ciência &
Saúde Coletiva, 21(1), 101–107.
Bowen, M. (1974). Alcoholism as viewed through family systems theory and family psychotherapy. Annals of
the New York Academy of Sciences, 223,115–122.
Bowen, M. (1978). Family therapy in clinical practice. New York, NY: Jason Aronson.
Calderwood, K., & Rajesparam, A. (2014). A critique of the codependency concept considering the best interests
of the child. Families in Society: The Journal of Contemporary Social Services, 95(3), 171–178.
Carson, A. T., & Baker, R. C. (1994). Psychological correlates of codependency in women. The International
Journal of Addictions, 29(3), 395–407.
Cassidy, E., Reynolds, F., Naylor, S., & De Souza, L. (2011). Using interpretative phenomenological analysis to
inform physiotherapy practice: an introduction with reference to the lived experience of cerebellar ataxia.
Physiotherapy Theory and Practice, 27(4), 263–277.
Cermak, T. L. (1986). Diagnosing and treating co-dependence: a guide for professionals who work with
chemical dependents, their spouses, and children. Minneapolis, MN: Johnson Institute.
Chang, S, (2012). A cultural perspective on codependency and its treatment. Asia Pacific Journal of Counselling
and Psychotherapy, 3(1), 50–60.
Chang, S. H. (2018). Testing a model of codependency for college students in Taiwan based on Bowen's concept
of differentiation. International Journal of Psychology, 53(2), 107–116.
Chiauzzi, E. M., & Liljegren, S. (1993). Taboo topics in addiction treatment. An empirical review of clinical
folklore. Journal of Substance Abuse Treatment, 10,303–316.
Collins, B. G. (1993). Reconstructing codependency using self-in-relation theory: a feminist perspective. Social
Work, 38(4), 470–476.
Cotton, N. S. (1979). The familial incidence of alcoholism: a review. Journal of Studies on Alcohol, 40(1), 89–116.
Crothers, M., & Warren, L. W. (1996). Parental antecedents of adult codependency. Journal of Clinical
Psychology, 52(2), 231–239.
Cullen, J., & Carr, A. (1999). Codependency: an empirical study from a systemic perspective. Contemporary
Family Therapy, 21(4), 505–526.
Dear, G. E., Roberts, C., & Lange, L. (2004). Defining codependency: a thematic analysis of published
definitions. In S. Shohov (Ed.), Advances in Psychology (Vol. 34, pp. 189–205). New York, NY: Nova
Science Publishers.
Dear, G. E., & Roberts, C. M. (2005). Validation of the Holyoake codependency index. The Journal of
Psychology, 139(4), 293–314.
Denning, P. (2010). Harm reduction therapy with families and friends of people with drug problems. Journal of
Clinical Psychology, 66(2), 164–174.
Dickson, A., Knussen, C., & Flowers, P. (2007). Stigma and the delegitimization experience: an interpretative
phenomenological analysis of people living with chronic fatigue syndrome. Psychology and Health, 22(7),
851–867.
Dickson, A., Knussen, C., & Flowers, P. (2008). ‘That was my old life; it's almost like a past-life now’:identity
crisis, loss and adjustment amongst people living with chronic fatigue syndrome. Psychology and Health,
23(4), 459–476.
International Journal of Mental Health and Addiction
(2020) 18:754–771
768
Content courtesy of Springer Nature, terms of use apply. Rights reserved.

Eatough, V., & Smith, J. A. (2006). ‘I was like a wild person’: understanding feelings of anger using
interpretative phenomenological analysis. British Journal of Psychology, 97, 483–494.
Elliott, M., Maitoza, R., & Schwinger, E. (2012). Subjective accounts of the causes of mental illness in the USA.
International Journal of Social Psychiatry, 58(6), 562–567.
Finlay, L. (2008). A dance between the reduction and reflexivity: explaining the phenomenological attitude.
Journal of Phenomenological Psychology, 32,1–32.
Fischer, J. L., Spann, L., & Crawford, D. (1991). Measuring codependency. Alcoholism Treatment Quarterly,
8(1), 87.
Fuller, J. A., & Warner, R. M. (2000). Family stressors as predictors of codependency. Genetic Social and
General Psychology Monographs, 126(1), 5–24.
Gierymski, T., & Willams, T. (1986). Codependency. Journal of Psychoactive Drugs, 18(1), 7–13.
Giugliano, J. (2004). A sociohistorical perspective of sexual health: the clinician’srole.Sexual Addiction &
Compulsivity, 11(1–2), 43–55.
Gomberg, E. L. (1989). On terms used and abused: The concept of ‘codependency’.Drugs and Society, 3,113–
122.
Ançel, G., & Kabakçi, E. (2009). Psychometric properties of the Turkish form of Codependency Assessment
Too l. Archives of psychiatric nursing, 23(6), 441–453.
Hagen, B., & Nixon, G. (2011). Spider in a jar: women who have recovery from psychosis and their experience
of the mental health care system. Ethical Human Psychology and Psychiatry, 13(1).
Hawkins, C. A., & Hawkins II, R. C. (2014). Codependence, contradependence, gender-stereotyped traits,
personality dimensions, and problem drinking. Universal Journal of Psychology, 2(1), 5–15.
Harkness, D. (2003). To have or to hold: codependency as a mediator or moderator of the relationship between
substance abuse in the family of origin and adult-offspring medical problems. Journal of Psychoactive
Drugs, 35(2), 261.
Harper, J. M., & Capdevilla, C. (1990). Codependency: a critique. Journal of Psychoactive Drugs, (22) 285–292.
Heider,F.(1958).The psychology of interpersonal relations. New Jersey, NJ: Lawrence Erlbaum Associates,
Inc..
Hill, J. V., & Leeming, D. (2014). Reconstructing ‘the alcoholic’: recovering from alcohol addiction and the
stigma this entails. International Journal of Mental Health and Addiction, 12(6), 759–771.
Hoenigmann-Lion, N. M., & Whitehead, G. I. (2007). The relationship between codependency and borderline
and dependent personality traits. Alcoholism Treatment Quarterly, 24(4), 55–77.
Horn, N., Johnstone, L., & Brooke, S. (2007). Some service user perspective on the diagnosis of borderline
personality disorder. Journal of Mental Health, 16(2), 255–269.
Hughes-Hammer, C., Martsolf, D. S., & Zeller, R. A. (1998). Depression and codependency in women. Archives
of Psychiatric Nursing, 7(6), 326–334.
Irvine, L. J. (2000). Even better than the real thing: Narratives of the self in codependency. Qualitative Sociology,
23(1), 9–28.
Irwin, H. J. (1995). Codependence, narcissism, and childhood trauma. Journal of Clinical Psychology, 51(5),
658–665.
Jellen, D. V. (2014). My resurrected heart: a codependent journey to healing. n/a: WestBow Press.
Kelley, H. H. (1973). The processes of causal attribution. American Psychologist, 28(2), 107.
Kaur, S. (2016). A descriptive study to assess depression and codependency among wives of alcoholics in a selected
rural community of Gurdaspur, Punjab. Asian Journal of Nursing Education and Research, 6(2), 183.
Kelley, H. H., & Michela, J. L. (1980). Attribution theory and research. Annual Review of Psychology, 31(1),
457–501.
Knight, M. T., Wykes, T., & Hayward, P. (2003). People don’t understand: an investigation of stigma in
schizophrenia using interpretative phenomenological analysis (IPA). Journal of Mental Health, 3(12),
209–222.
Knudson, T. M., & Terrell, H. K. (2012). Codependency, perceived interparental conflict, and substance abuse in
the family of origin. The American Journal of Family Therapy, 40(3), 245–257.
Lampis, J., Cataudella, S., Busonera, A., & Skowron, E. A. (2017). The role of differentiation of self and dyadic
adjustment in predicting codependency. Contemporary Family Therapy, 39(1), 62–72.
Langdridge, D. (2007). Phenomenological psychology. theory, research and method. London: Pearson Education
Limited.
Larkin, M., Watts, S., & Clifton, E. (2006). Giving voice and making sense in interpretative phenomenological
analysis. Qualitative Research in Psychology, 3, 102–120.
Larkin, M., & Griffiths, M. D. (2002). Experiences of addiction and recovery: the case for subjective accounts.
Addiction Research & Theory, 10(3), 281–311.
MacDonald, D. E. (1956). Mental disorders in wives of alcoholics. Quarterly Journal of Studies on Alcohol,
17(2), 282.
International Journal of Mental Health and Addiction
(2020) 18:754–771 769
Content courtesy of Springer Nature, terms of use apply. Rights reserved.

Marks, D. G., Blore, R. L., & Hine D.W. and Dear, E.G. (2012). Development and validation of a revised
measure of codependency. Australian Journal of Psychology, June 1–8.
Martsolf, D. S., Sedlak, C. A., & Doheny, M. O. (2000). Codependency and related health variables. Archives of
psychiatric nursing, 14(3), 150–158.
Mellody, P. (1989). In M, M (Eds.), Facing codependence: what it is, where it comes from, how it sabotages our
lives. San Francisco, CA: Harper San Francisco.
Mellody, P. (1992). In M, M (Eds.), Facing love and addiction: giving yourself the power to change the way you
love: the love connection to codependence. New York, N.Y.: Harper San Francisco.
O'Brien, P. E., & Gaborit, M. (1992). Codependency: a disorder separate from chemical dependency. Journal
Clinical Psychology, 48(1), 129.
Orford, J. (2005). Coping with alcohol and drug problems: the experiences of family members in three
contrasting cultures. London: Routledge.
Potter-Efron, R. T., & Potter-Efron, P. S. (1989). Assessment of codependency with individuals from alcoholic
and chemically dependent families. Alcoholism Treatment Quarterly, 16(4), 37.
Prest, L., & Storm, C. (1988). The codependent relationships of compulsive eaters and drinkers: drawing
parallels. The American Journal of Family Therapy, 16(4), 37.
Price, G. M. (1945). A study of the wives of 20 alcoholics. Quarterly Journal of Studies on Alcohol, 5(4), 620–
627.
Reyome, N. D., & Ward, K. S. (2007). Self-reported history of childhood maltreatment and codependency in
undergraduate nursing students. Journal of Emotional Abuse, 7(1), 37–50.
Rice, J. S. (1992). Discursive formation, life stories and the emergence of codependence: ‘power/knowledge’and
the search for identity. The Sociological Quarterly, 33(3), 337–364.
Sadock, B., & Sadock, V. A. (2004). Kaplan and Sadock’s concise textbook of clinical psychiatry (2nd ed.).
Philadelphia, Pennsylvania: Lippincott Williams & Wilkins.
Schaef, A. W. (1986). Co-dependence: misunderstood-mistreated. San Francisco, CA: Harper San Francisco.
Sarkar, S., Mattoo, S. K., Basu, D., & Gupta, J. (2015). Codependence in spouses of alcohol and opioid
dependent men. International Journal of Culture and Mental Health, 8(1), 13–21.
Shinebourne, P., & Smith, J. A. (2008). Alcohol and self: an interpretative phenomenological analysis of the
experience of addiction and it impact on the sense of self and identity. Addiction Research & Theory, 17(2),
152–167.
Shinebourne, P., & Smith, J. A. (2010). The communicative power of metaphors: an analysis and interpretation of
metaphors in accounts of the experience of addiction. Psychology and Psychotherapy, 83,59–73.
Shinebourne, P., & Smith, J. A. (2011). It is just habitual: an interpretative phenomenological analysis of the
experience of long-term recovery from addiction. International Journal of Mental Health Addiction, 9,282–
295.
Smith, J. A. (2004). Reflecting on the development of interpretative phenomenological analysis and its
contribution to qualitative research in psychology. Qualitative Research in Psychology, 1,39–54.
Smith, J. A. (2011a). Evaluating the contribution of interpretative phenomenological analysis. Health Psychology
Review, 1(5), 9–27.
Smith, J. A. (2011b). ‘We could be diving for pearls’: the value of the gem in experiential qualitative psychology.
Qualitative Methods in Psychology Bulletin, 12,6–15.
Smith, J. A., Flowers, P., & Larkin, M. (Eds.). (2009). Interpretative phenomenological analysis (2nd ed.).
London: Sage.
Smith, J. A., & Osborn, M. (2003). Interpretative phenomenological analysis. In J. A. Smith (Ed.), Qualitative
psychology: a practical guide to research methods (pp. 51–80). London: Sage.
Kwon, S. Y. (2001). Codependence and interdependence: cross-cultural reappraisal of boundaries and
relationality. Pastoral Psychology, 50(1), 39–52.
Uhle, S. (1994). Codependence: contextual variables in the language of social pathology. Issues in Mental Health
Nursing, 15,307–317.
Ulusoy, Y., & Guçray, S. S. (2017). Adaptation of composite codependency scale to Turkish: a validity and
reliability study. Journal of International Social Research, 10(49).
Wegscheider, S. (1981). Another chance: hope and health for the alcoholic family. Palo Alto, CA: Science and
Behaviour Books.
Weiner, B. (2008). Reflections on the history of attribution theory and research: people, personalities, publica-
tions, problems. Social Psychology, 39(3), 151–156.
Wells, M. C., Hill, M. B., Brack, G., Brack, C. J., & Firestone, E. E. (2006). Codependency's relationship to
defining characteristics in college students. Journal of College Student Psychotherapy, 20(4), 71–84.
https://doi.org/10.1300/J035v20n0407.
Whitfield, C. L. (1984). Co-alcoholism: recognizing a treatable illness. Family & Community Health: The
Journal of Health Promotion & Maintenance, 7(2), 16–27.
International Journal of Mental Health and Addiction
(2020) 18:754–771
770
Content courtesy of Springer Nature, terms of use apply. Rights reserved.

Whitfield, C. L. (1987). Healing the child within: discovery and recovery for adult children of dysfunctional
families. Deerfield Beach, Florida: Health Communications.
Whitfield, C. L. (1991). Co-dependence: healing the human condition: the new paradigm for helping profes-
sionals and people in recovery. Deerfield Beach, Fla.: Health Communications, Inc..
Winnicott, D. W. (1965a). The maturational processes and the facilitating environment: studies in the theory of
emotional development. New York, NY: International University Press.
Winnicott, D. W. (1965b). The maturational process and the facilitating environment: studies in theory of
emotional development. New York, NY: International University Press.
Winnicott, D. W. (1960a). Ego distortion in terms of true and false self. The Maturational Processes and the
Facilitating Environment, 140–152.
Winnicott, D. W. (1960b). The theory of the parent-infant relationship. The International Journal of Psycho-
analysis, 41,585.
Wright, P. H., & Wright, K. D. (1991). Codependency: addictive love, adjustive relating, or both? Contemporary
Family Therapy, 13(5), 435–454.
Yardley, L. (2008). Demonstrating validity in qualitative psychology. In J. A. Smith (Ed.), Qualitative psychol-
ogy: a practical guide to methods (2nd ed.). London: Sage.
Zetterlind, U., & Berglund, M. (1999). The rate of co-dependence in spouses and relatives of alcoholics on the
basis of the Cermak co-dependence scale. Nordic Journal of Psychiatry, 53(2), 147–151.
International Journal of Mental Health and Addiction
(2020) 18:754–771 771
Content courtesy of Springer Nature, terms of use apply. Rights reserved.

1.
2.
3.
4.
5.
6.
Terms and Conditions
Springer Nature journal content, brought to you courtesy of Springer Nature Customer Service Center
GmbH (“Springer Nature”).
Springer Nature supports a reasonable amount of sharing of research papers by authors, subscribers
and authorised users (“Users”), for small-scale personal, non-commercial use provided that all
copyright, trade and service marks and other proprietary notices are maintained. By accessing,
sharing, receiving or otherwise using the Springer Nature journal content you agree to these terms of
use (“Terms”). For these purposes, Springer Nature considers academic use (by researchers and
students) to be non-commercial.
These Terms are supplementary and will apply in addition to any applicable website terms and
conditions, a relevant site licence or a personal subscription. These Terms will prevail over any
conflict or ambiguity with regards to the relevant terms, a site licence or a personal subscription (to
the extent of the conflict or ambiguity only). For Creative Commons-licensed articles, the terms of
the Creative Commons license used will apply.
We collect and use personal data to provide access to the Springer Nature journal content. We may
also use these personal data internally within ResearchGate and Springer Nature and as agreed share
it, in an anonymised way, for purposes of tracking, analysis and reporting. We will not otherwise
disclose your personal data outside the ResearchGate or the Springer Nature group of companies
unless we have your permission as detailed in the Privacy Policy.
While Users may use the Springer Nature journal content for small scale, personal non-commercial
use, it is important to note that Users may not:
use such content for the purpose of providing other users with access on a regular or large scale
basis or as a means to circumvent access control;
use such content where to do so would be considered a criminal or statutory offence in any
jurisdiction, or gives rise to civil liability, or is otherwise unlawful;
falsely or misleadingly imply or suggest endorsement, approval , sponsorship, or association
unless explicitly agreed to by Springer Nature in writing;
use bots or other automated methods to access the content or redirect messages
override any security feature or exclusionary protocol; or
share the content in order to create substitute for Springer Nature products or services or a
systematic database of Springer Nature journal content.
In line with the restriction against commercial use, Springer Nature does not permit the creation of a
product or service that creates revenue, royalties, rent or income from our content or its inclusion as
part of a paid for service or for other commercial gain. Springer Nature journal content cannot be
used for inter-library loans and librarians may not upload Springer Nature journal content on a large
scale into their, or any other, institutional repository.
These terms of use are reviewed regularly and may be amended at any time. Springer Nature is not
obligated to publish any information or content on this website and may remove it or features or
functionality at our sole discretion, at any time with or without notice. Springer Nature may revoke
this licence to you at any time and remove access to any copies of the Springer Nature journal content
which have been saved.
To the fullest extent permitted by law, Springer Nature makes no warranties, representations or
guarantees to Users, either express or implied with respect to the Springer nature journal content and
all parties disclaim and waive any implied warranties or warranties imposed by law, including
merchantability or fitness for any particular purpose.
Please note that these rights do not automatically extend to content, data or other material published
by Springer Nature that may be licensed from third parties.
If you would like to use or distribute our Springer Nature journal content to a wider audience or on a
regular basis or in any other manner not expressly permitted by these Terms, please contact Springer
Nature at
onlineservice@springernature.com