Unhelpful Cognitions (thoughts) and Distortions

By Mitchell Webb | Webb Therapy, Surry Hills Sydney

We all have moments in relationships where we give too much, worry too much, or lose ourselves a little in someone else. That is not codependency — that is being human. But when those moments become the architecture of the entire relationship, when your sense of self, your emotional stability, and your very identity become organised around another person’s needs, moods, and wellbeing, something more significant may be at play.

Codependency is one of the most misunderstood and underdiagnosed relational patterns in clinical practice. It is frequently mistaken for love, devotion, or simply being a caring person. Yet the research is consistent: left unaddressed, codependent patterns cause significant harm to both people involved — and they rarely improve on their own.

This article explores what codependency actually is, what the current evidence says about how to identify it, and — critically — what you can do if you recognise yourself in it.

What Is Codependency, Really?

The term “codependency” originated in the addiction treatment field in the 1970s and 1980s, used initially to describe the partners and family members of people with substance use disorders. Clinicians noticed that the people surrounding someone with addiction often developed their own set of dysfunctional patterns — enabling behaviour, emotional enmeshment, a compulsive need to control or fix the other person — that were distinct from, yet deeply intertwined with, the addiction itself.

Over the following decades, the concept broadened. Researchers and clinicians came to understand that codependency was not unique to addiction contexts. It appeared in relationships involving chronic illness, mental health conditions, emotional immaturity, narcissistic traits, and even in ostensibly “normal” relationships where one person had learnt, usually in childhood, that love was conditional on their usefulness or selflessness.

The American Psychological Association (2023) now broadly defines codependency as an emotional and behavioural pattern characterised by excessive reliance on others for approval, identity, and self-worth — typically at the expense of one’s own needs, boundaries, and sense of self.

Mental Health America describes it as a “relationship addiction”: a pattern where people form or maintain relationships that are one-sided, emotionally exhausting, and often damaging — yet feel compelled to stay because their sense of purpose and worth has become fused with the relationship itself.

Importantly, current research frames codependency not as a character flaw or a deliberate choice, but as a learned relational strategy — one that almost always has its roots in early experiences where a child learnt that to be loved, they needed to be needed.

The Difference Between Normal Relationship Behaviour and Codependency

This is perhaps the most important clinical question, and one that causes enormous confusion. Most people, at some point in a relationship, will:

• Put their partner’s needs before their own
• Worry excessively about someone they love
• Suppress their own feelings to keep the peace
• Feel their mood affected by their partner’s emotional state
• Struggle to maintain boundaries with someone they care about deeply

None of these, in isolation or temporarily, constitute codependency. Relationships involve genuine interdependence — research by Rusbult and Van Lange (2003) in the Annual Review of Psychology demonstrates that healthy mutual reliance is not only normal but essential to human flourishing. We are wired for attachment, and feeling affected by those we love is a feature of that, not a flaw.

The distinction lies in pattern, pervasiveness, proportion, and — critically — motivation.

In healthy relationships, care for another is chosen freely from a stable sense of self. You can be deeply affected by your partner’s pain without feeling responsible for fixing it. You can prioritise their needs without abandoning your own. You can be close without losing the thread of who you are.

In codependent relationships, the dynamic is structurally different. The table below outlines the key distinctions that clinicians look for:

That last row is one of the most clinically telling features of codependency. When a codependent person’s partner recovers, stabilises, or no longer needs them in the same way, it can trigger a profound identity crisis — because the caretaking role was not just something they did; it was who they were.

Evidence-Based Signs You May Be in a Codependent Relationship

The following indicators are drawn from validated clinical frameworks, including the work of Darlene Lancer (a leading researcher in codependency treatment), the Codependency Assessment Tool (CAT), and broader attachment and self-determination research.

1. Your emotional state is governed by the other person’s

You feel happy when they are happy, anxious when they are struggling, guilty when they are upset — regardless of whether you had any role in it. Their mood functions as the weather system you live inside. This is clinical enmeshment: a blurring of the emotional boundary between self and other.

2. You feel responsible for managing their emotions

Not just concerned — responsible. You find yourself working to regulate their feelings, prevent their distress, or shield them from the consequences of their behaviour. You walk on eggshells. You rehearse conversations. You adjust yourself to pre-empt their reactions.

3. Your self-worth is tied to being needed or useful

You feel most secure, most loveable, most like “yourself” when the other person is relying on you. When they don’t need you — when they are doing well, managing independently, or connecting with others — you feel vaguely anxious, unsettled, or unnecessary.

4. You have significant difficulty saying no

Not simply a preference for harmony, but a deep fear of what will happen if you assert a need, a limit, or a disagreement. Saying no feels dangerous — not mildly uncomfortable, but genuinely threatening to your sense of safety in the relationship.

5. Your own needs feel unimportant, illegitimate, or too much to ask

You consistently prioritise the other person’s needs, minimise your own, and feel guilty or ashamed for having them at all. Other people’s needs feel urgent and real; yours feel like an inconvenience.

6. You enable behaviour that harms the other person (or you)

You cover for them, make excuses, absorb consequences, or rescue them from situations they need to face. You know, somewhere, that this is not helping — but stopping feels impossible, cruel, or too frightening.

7. The relationship has become your primary source of identity

Outside of this relationship, you are not sure who you are, what you want, or what matters to you. Your social connections, interests, and sense of purpose have narrowed to the point where the relationship has become your whole world.

8. You experience disproportionate fear of the relationship ending

Beyond the normal grief of losing someone important, the prospect of this relationship ending feels like annihilation — as though without it, you would cease to exist in any meaningful sense.

What Causes Codependency? The Evidence

Current research strongly implicates early attachment experiences as the primary driver of codependent patterns. Studies in developmental psychology consistently show that children who grow up in environments characterised by:

• Emotional unpredictability or neglect
• A parent or caregiver with addiction, mental illness, or chronic instability
• Conditional love (affection given in exchange for performance, caretaking, or compliance)
• Parentification (being required to manage a parent’s emotional world)

…are significantly more likely to develop the relational strategies we now recognise as codependency. These children learn, at a pre-verbal and deeply embodied level, that love is not unconditional — that it must be earned through service, vigilance, or self-erasure.

Attachment theorists describe this as an anxious or disorganised attachment style: a chronic hypervigilance to the emotional states of others, combined with an unstable or underdeveloped sense of self.

Critically, Mental Health America notes that codependency is a multigenerational pattern — one that is modelled, transmitted, and reinforced across families and generations, often without anyone recognising it for what it is. This is why it so frequently feels normal. To the person in it, it simply feels like love.

How to Navigate a Codependent Relationship: What the Evidence Recommends

Recognising codependency is significant. What comes next matters enormously. The following steps reflect current evidence-based approaches, including schema therapy, attachment-focused therapy, and self-determination theory.

Step 1: Name it without shame

Codependency is not a character defect. It is a survival strategy that once served a purpose. The self-critical spiral of “why can’t I just stop?” is itself part of the pattern — a form of the same self-erasure that drives codependency in the first place. Begin by acknowledging what is true, with as much compassion as you can manage.

Step 2: Seek individual therapy — not couples therapy, at least not first

This is one of the most consistent recommendations in the clinical literature, and one of the most frequently ignored. The instinct in a codependent relationship is to focus on the relationship — to fix the dynamic, to work on “us.” But codependency is fundamentally an individual pattern that predates the current relationship. Individual therapy is the appropriate first step.

Evidence-based modalities with strong outcomes for codependency include:

• Schema Therapy: Identifies the early maladaptive schemas (core beliefs about self and relationships) that drive codependent behaviour, and systematically reworks them
• Attachment-focused therapy: Addresses the insecure attachment patterns at the root of codependency, building what attachment researchers call “earned security”
• Acceptance and Commitment Therapy (ACT): Builds psychological flexibility, value-based action, and a stable sense of self that does not depend on external validation
• Dialectical Behaviour Therapy (DBT): Particularly helpful where emotional dysregulation and enmeshment are prominent features

Step 3: Begin the work of differentiation

Differentiation — the developmental process of becoming a distinct self within a close relationship — is at the heart of codependency recovery. In practical terms, this means:

• Identifying your own feelings, needs, and values separately from the other person’s
• Practising sitting with the other person’s distress without rushing to fix it
• Rebuilding connections, interests, and a sense of identity outside the relationship
• Gradually practising the expression of needs and limits — starting small, building tolerance

This is not a process of becoming cold or detached. Research on interdependence consistently shows that the more securely differentiated a person is, the more genuinely intimate they can be. As The Bridge to Recovery notes, this is what attachment researchers call the “dependency paradox”: the more safely you can depend on someone, the freer and more authentically connected you become.

Step 4: Address enabling behaviours directly

If the relationship involves someone with an addiction, mental health condition, or chronic instability, the codependent person is almost certainly engaging in enabling — behaviours that, with the best of intentions, prevent the other person from experiencing the natural consequences that might otherwise motivate change.

This is extraordinarily difficult to stop, not because the person doesn’t understand it intellectually, but because it is underpinned by deep anxiety and a terror of what will happen if they don’t intervene. Therapeutic support is usually required to navigate this safely.

Step 5: Consider whether the relationship can become healthy

This is a question that must be held with honesty. Some relationships, with both parties doing meaningful work, can move from codependency toward genuine interdependence. This typically requires both people to be willing to acknowledge the dynamic, engage in individual therapeutic work, and — often — couples therapy once both have established some individual stability.

Other relationships cannot sustain that shift. If the other person has no interest in change, or if the dynamic is also characterised by coercive control, abuse, or sustained exploitation, the most honest clinical recommendation is that the healthiest path forward may be to leave.

This is not a failure. It is, in many cases, the most courageous and self-respecting act available.

Step 6: Build the life you paused

Recovery from codependency is not simply the removal of a problematic pattern. It is the construction of something new: a stable, internally anchored sense of self; relationships characterised by genuine reciprocity; a life in which your own needs, values, and wellbeing are not an afterthought but a foundation.

This takes time. It is not linear. But the research is clear that it is possible — and that the therapeutic work, while challenging, produces lasting and meaningful change.

A Note on Seeking Support in Australia

If you recognise yourself in this article, please know that you are not alone and that effective help is available. A number of pathways are worth considering:

• Individual therapy with a psychologist or psychotherapist experienced in attachment, schema, or relational trauma
• SANE Australia (sane.org) — mental health support and resources
• Beyond Blue (beyondblue.org.au) — resources and access to counselling
• Co-Dependents Anonymous (CoDA) Australia — a peer support programme based on the 12-step model, with meetings available nationally and online

The fact that you are asking these questions is already significant. Awareness is where change begins.

Mitchell Webb is a counsellor and psychotherapist based in Surry Hills, Sydney, with a focus on relational patterns, attachment, and identity. Webb Therapy offers individual counselling and psychotherapy for adults navigating complex relationship dynamics.

References

American Psychological Association. (2023). APA Dictionary of Psychology. apa.org

Mental Health America. Codependency. mhanational.org

Rusbult, C. E., & Van Lange, P. A. M. (2003). Interdependence, interaction, and relationships. Annual Review of Psychology, 54(1), 351–375.

Feeney, B. C., & Van Vleet, M. (2010). Growing through attachment: The interplay of attachment and exploration in adulthood. Journal of Social and Personal Relationships, 27(2), 226–234.

Lancer, D. (2014). Conquering shame and codependency. Hazelden Publishing.

Young, J. E., Klosko, J. S., & Weishaar, M. E. (2003). Schema therapy: A practitioner’s guide. Guilford Press.

The word ‘trauma’ originates from the Greek word ‘wound”, which at the time, was primarily used to refer to physical injuries. Today, trauma is also frequently used to refer to “emotional wounds” that can cause psychological symptoms any time after the traumatic event has occurred, including years later. Emotional and psychological trauma can be lifelong.

The word ‘trauma’ has been popularised, and is arguably used carelessly or inaccurately, to indicate almost any kind of unpleasant experience or stressor by an individual (Haslam, 2016). A stressful life experience is more commonly being labelled as trauma or a traumatic experience. While both stress and trauma can impact our wellbeing, we must differentiate the two for diagnostic and treatment purposes within the mental health field.

Emotional and psychological trauma is associated with significant unexpected incidents that are, or perceived as, threatening to a person. The most recognised examples of traumatic events include unexpected natural disasters, a serious car accident, war, rape, bullying/intimidation, or losing a loved one. Traumatic experiences are often described as overwhelm the nervous system and experienced as deeply distressing events, and adverse short or long-term impacts are commonly experienced. It is also worth noting that some people may not recognise they have experience trauma. I once heard a story of a boy in high school who accidently severed a major artery of his peer with a school prop while joking around. His peer was taken to hospital and survived, but ears later he began having night terrors of the incident.

The following is a definition from the Substance Abuse and Mental Health Services Administration (SAMHSA) in the United States: “Individual trauma results from an event, a series of events or a set of circumstances that is experienced by an individual as physically or emotionally harmful or life threatening and that has lasting adverse effects on the individual’s functioning and mental, physical, social, emotional, or spiritual well-being.” (SAMHSA, 2014a, p. 7)

“Traumas can affect individuals, families, groups, communities, specific cultures, and generations. It generally overwhelms an individual’s or community’s resources to cope, and it often ignites the “fight, flight, or freeze” reaction at the time of the event(s). It frequently produces a sense of fear, vulnerability, and helplessness.” (SAMHSA, 2014b, p. 7)

The determinants of acquiring post-traumatic symptoms are influenced by how individuals interpret their circumstance(s), their developmental stage, cultural beliefs, availability of resources and support, and the physical and psychological disruptions they experienced (SAMHSA, 2014b). I have heard the word ‘trauma’ used to describe neglect and abuse during childhood. It’s important to note that while some caregivers may have neglected the emotional and psychological needs of a child, or used ‘smacking’ (positive punishment) to discipline children, not all individuals will develop symptoms that meet the current criteria by the Diagnostic and Statistical Manual (DMS) for Trauma. It is fair to say that all people have likely experienced life stressors that have conditioned them to think, behave, and react emotionally in specific or general social contexts, and will effect their quality of life and health.

As a rule of thumb, for trauma to be classified as a clinical psychological or emotional condition, I consider the 4 D’s: is there post-traumatic symptoms of DISTRESS, DYSFUNCTION in daily living, DANGER (to self or others), or DEVIANT behaviour. I think the word ‘deviant’ has prejudicial connotations so to clarify, it means departing from usual or accepted standards, especially in social or sexual behaviour.

Thank you for reading. Of course, there’s plenty more to say on the topic of emotional and psychological trauma, especially how cultures differentiate it from more commonly experienced yet individually meaningful life stressors. Stress that doesn’t fit the clinical criteria of ‘trauma’ is still valid and can be detrimental to our health. It can be helpful to seek psychological or psychiatric treatment, or spiritual alternatives to traditional Western health care.

References:

1. Haslam, N. (2016, August 15). The problem with describing every misfortune as ‘trauma’. Chicago Tribute. From website.
2. Substance Abuse and Mental Health Services Administration (SAMHSA, 2014a). SAMHSA’s concept of trauma and guidance for a trauma-informed approach. Substance Abuse and Mental Health Services Administration. From website.
3. Substance Abuse and Mental Health Services Administration. (2014b).  A treatment improvement protocol: Trauma-informed care in behavioral health services TIP 57. From website.

There continues to be an ongoing gap between how addiction gets treated and how it actually works.

Knowledge and behaviour are handled by different systems. Insight lives largely in the prefrontal cortex — the part of the brain that plans, weighs consequences, and holds “I know this is bad for me.” But addiction increasingly reshapes subcortical circuits involved in craving, habit, and stress reactivity. Under cue exposure or stress, those older circuits can override the newer, knowledge-holding ones. This is why someone can recite their relapse triggers perfectly in a therapist’s office or recount pages of 12-step literature from memory and still act against that knowledge the moment they’re actually standing in the triggering situation.

Wiers and colleagues’ work on “dual process” models of addiction — explicit cognition versus automatic, implicit approach biases — captures this well. Cognitive bias modification research grew directly out of the finding that explicit knowledge doesn’t touch these automatic processes.

The transition from goal-directed use to habit. Everitt and Robbins’ work describes how repeated substance use shifts control from goal-directed brain circuits (which respond to consequences and knowledge) to habitual, and eventually compulsive, circuits centred in the dorsal striatum. Compulsive behaviour is, by definition, less responsive to knowing better. Decades of use can entrench this shift very deeply.

For example:

Early: goal-directed. Bad day → “I want to relax” → decide to drink. The action is chosen and tied to an expected outcome. If consequences got bad enough, the person could still stop — this runs through prefrontal cortex and ventral striatum.

Middle: habit. After years of stress → drink → relief, the sequence no longer needs a decision. Walking in the door at 6pm triggers pouring a drink before any conscious “do I want this?” moment happens. The cue now drives the action directly. Control has shifted to dorsolateral striatum — same circuitry as driving a familiar route on autopilot.

Late: Compulsive. In Everitt and Robbins’ animal studies, drug-seeking gets paired with a mild shock. Most animals stop once punished. But a subset — roughly a third, matching the rate of severe addiction in humans — keeps seeking the drug even though it now reliably delivers a shock. That’s the model for compulsion: behaviour persisting despite known, immediate harm.

The human version: Someone with DUI’s, lost relationships, health scares — every piece of proof the behaviour is destructive — still relapses. Not from lack of knowledge; they’ve lived the consequences repeatedly. The circuitry driving the behaviour at this stage doesn’t consult the consequence-tracking system the way it did early on.

This is also why pure education or insight-oriented therapy often under-performs at this stage — it’s arguing with a system that isn’t listening. Interventions that interrupt the cue-response link itself (contingency management, environmental restructuring, craving-blunting medication, removing triggers) tend to have more traction, because they target the habit/compulsion circuit rather than trying to out-inform it.

Koob and Volkow’s allostasis model. Their research reframes chronic addiction as a shift from positive reinforcement (seeking a high) to negative reinforcement (avoiding a increasingly severe dysphoric, anxious, irritable state without the substance). Long-term users aren’t chasing a reward anymore — they’re fleeing a state. That flight response is fast, automatic, and largely indifferent to intellectual understanding.

Unresolved comorbidity. A large fraction of people with treatment-resistant, decades-long relapse patterns have under-treated trauma, complex PTSD, personality disorders, or conditions like ADHD sitting underneath the substance use. If the underlying driver isn’t directly addressed, coping skills training treats the symptom while the engine keeps running. This is a common finding in dual-diagnosis literature — outcomes are much worse when co-occurring conditions go unaddressed even amid extensive substance-focused treatment.

Recovery capital, not just recovery knowledge. William White’s work on recovery capital argues sustained recovery depends on social, financial, physical, and community resources — stable housing, relationships, purpose, employment — not just internal coping skills. Someone can have excellent DBT (Dialectical Behaviour Therapy) skills and still relapse repeatedly if their environment, relationships, or life structure haven’t meaningfully changed.

Relapse as expected, not exceptional. Prochaska and DiClemente’s stages-of-change model treats relapse as a normal part of the cycle, not a failure of knowledge. But when relapse repeats over decades despite intensive treatment, researchers increasingly look at severity markers — poly-substance use, genetic loading, age of onset, impulsivity and risk-taking — that predict a harder course regardless of how much psychoeducation someone has absorbed.

The consistent variable across all of this: Insight is necessary but nowhere near sufficient. Addiction at that level of chronicity behaves more like a deeply conditioned neurobiological and habitual process than an information deficit. That’s also part of why chronic relapse is increasingly framed like a chronic illness — closer to diabetes or hypertension in its relapsing-remitting course — rather than something insight alone should be expected to resolve.

Here’s what the literature and clinical guidelines point to for people who’ve cycled through standard treatment repeatedly without sustained success. I’ll organise by approach type.

Pharmacological — often underused

• For opioid use disorder, methadone and buprenorphine substantially outperform abstinence-only approaches in treatment-resistant populations — this is some of the strongest evidence in the entire addiction field, yet many long-term relapsers have never actually been offered maintenance medication, often due to program philosophy (abstinence-only 12-step programs) rather than clinical reasoning.
• For alcohol, naltrexone (blocks the reward), acamprosate (reduces post-acute withdrawal dysregulation), and disulfiram (aversive) are under-prescribed. Naltrexone specifically blunts the reward signal that drives compulsive use — targeting the biology rather than relying on willpower.
• Emerging: psychedelic-assisted therapy (psilocybin, ketamine) is showing promise in trials for alcohol and other use disorders, though this is newer evidence and not yet standard of care everywhere.

Interrupting the cue-response cycle directly

• Contingency management — tangible rewards for verified abstinence — has some of the best effect sizes in the literature, particularly for stimulant use disorders where no strong pharmacological option exists. It works by directly competing with the habit circuit rather than arguing with it.
• Environmental restructuring — changing routes, routines, social circles, physically removing cues — matters more than intellectual insight at this stage, because the behaviour has become cue-triggered rather than decision-driven.

Treating what’s underneath

• Systematic assessment for under-treated trauma, complex PTSD, ADHD, and personality disorders. Trauma-focused therapies (EMDR, prolonged exposure, Seeking Safety) address the driver rather than just the symptom, and are often skipped in standard programs focused on the substance alone.
• Integrated dual-diagnosis treatment (treating psychiatric conditions and addiction concurrently, by the same team) outperforms sequential or parallel treatment where the person bounces between separate providers.

Building recovery capital, not just coping skills

• Housing First and supported employment models — stabilising the environment before or alongside treatment — show better outcomes than clinical treatment alone in chronic, treatment-resistant cases. William White’s recovery capital framework: outcomes track with social support, stable housing, purpose, and community as much as with therapy itself.
• Recovery community centres and mutual-aid alternatives beyond 12-step (SMART Recovery, Refuge Recovery) matter for people whose repeated 12-step involvement hasn’t translated to sustained sobriety — fit between the person and the model isn’t universal.

Reframing the model of care itself

• Treating addiction like a chronic relapsing-remitting illness (the diabetes/hypertension model) rather than an acute, curable event changes what “treatment resistant” even means. Long-term, low-intensity, indefinite maintenance care (medication, periodic check-ins, ongoing peer support) shows better outcomes than repeated cycles of intensive short-term treatment followed by discharge.
• Harm reduction as a bridge or destination — not necessarily full abstinence — for people who haven’t achieved abstinence-based sobriety after years of trying. This reduces mortality and morbidity even when abstinence isn’t currently achievable, and can sometimes become a pathway toward it later.
• Multidimensional Family Therapy / systemic approaches — treating the family/relational system rather than the individual alone — show better outcomes for people whose relapse is tangled up in unchanged relational dynamics.