An Interview with Psychologist Karin Sponholz
Dr. Sponholz is a licensed clinical psychologist with extensive experience employing a variety of modalities, such as dialectical behavioral therapy and relational therapy, and specializes in the treatment of: trauma, relationship issues, identity development, and codependency.
Maya Hsu: Thank you for joining us today on this installment of the Seattle Psychiatrist Interview Series. I'm Maya, Hsu, a research intern here at Seattle Anxiety Specialists and I'd like to welcome Dr. Karin Sponholz.
Dr. Karin Sponholz is a licensed clinical psychologist with a doctorate in clinical psychology from Pacifica Graduate Institute. She has extensive experience working with individuals, couples and groups employing a variety of modalities, such as dialectical behavioral therapy and relational therapy. She specializes in the treatment of many different issues including trauma, relationship issues and identity development, and has helped many people heal and recover from issues related to codependency. Dr. Sponholz, would you like to introduce yourself and tell us a little bit about what makes codependency interesting to you?
Karin Sponholz: Thank you for the introduction. I'm happy to be here and talking about one of my favorite things, which is about relationships and relationship dynamics, which includes codependency. I think I'm just fascinated by how people come together and the dynamics between them, whether it's healthy dynamics or not so healthy dynamics. And also, understanding what motivates or how people fall into these patterns and habits and how do we break out of them? That's what fascinates me about codependency.
Maya Hsu: Awesome. And would you mind defining codependency for our listeners who might be unfamiliar with that term?
Karin Sponholz: Sure. So, let me first start by saying that the term codependency is often misunderstood and often overused by a lot of people. And actually, believe it or not, the actual word codependency started from the legal use of a term to mean an agreement in contracts. Meaning, there's an action that is mutually dependent on two parties. And then it turned into more of a psychological term in the '80s and it's actually coined by Melody Beattie, who's a self help author. She famously wrote about codependency and she defines it as two people who impact each other. Meaning, someone's behavior influences the other person's behavior in such a way that their wants, needs, desires, sense of self is wrapped up in the other person. So, there's a lack of independence, so to speak, hence the word codependency and there's an addictive quality to that kind of enmeshment, is another way we often talk about codependency.
Maya Hsu: And what causes codependency? Or what things can lead somebody to be more predisposed toward developing codependent habits than someone else?
Karin Sponholz: Yeah. Oftentimes it's learned. We learn that in childhood from our parents or caregivers or modeled in the family somehow. Oftentimes you see it in families where there's one person who needs a lot of attention, whether it's because of their own mental health issues or health issues and all the emotional resources are funneled towards that person. So, the people in this family system learn that their sense of self and their way of being in the world is wrapped up in caretaking for that one person.
So, that's how the habit gets ingrained and then it gets reinforced. That, “Oh, this is how we should be, this is how we should relate to one another, which is through caretaking.” And there's a lack of reinforcement in learning to know what your own wants or needs are in life. So, it's more like, well, my wants and needs are about helping you and that's how-
Maya Hsu: Can you give a-
Karin Sponholz: Yeah.
Maya Hsu: Sorry to interrupt. Can you give a specific example of what that can look like within a family system early on? Just, I don't know, some common dynamics you've noticed?
Karin Sponholz: Sure. So, a common one that we often, we learned about in the '80s is often where one person has an addiction, whether it's an alcohol addiction or drug addiction. So, what happens is that the family system revolves around that one person. So, the whole caretaking is about trying to get that person into recovery and everything is geared towards helping that one person.
So, everyone else's own wants and needs are put on the side. The system then, everyone has a role in the system. There's the patient, the identified patient. And then there's people who are termed the enabler or caregivers. And people just stay stuck in these roles and they can be for years. So, especially kids that grew up in this environment learn that that's just how people should relate. So, there's a sense of reward in being able to either help somebody who's in need and forego their own wants and needs because there's a sense of reward there. Or there's an enabling aspect to it. So, the patient or the person who is struggling, they're enabled to stay stuck because the whole system, the whole dance is dependent on them staying stuck.
Maya Hsu: Right.
Karin Sponholz: So, that's why there is a codependent dynamic that happens.
Maya Hsu: The idea of roles is really interesting. I'm curious how it would look in families where addiction is not the issue, where there is nobody with an addiction. How would codependency arise in a family where that's not really a relevant issue?
Karin Sponholz: Sure. Yeah, great question. So, addiction might be the extreme example. So, oftentimes it might be somebody who may have mental health issues, whether it's an anxiety, they struggle with anxiety or someone might struggle with depression, more so maybe than the other family members. So, it's usually just one person who's struggling a lot or who has a lot of needs. Somebody who even might have a learning disability, again, not necessarily a disorder but just somebody in the family who has a lot of needs.
And the family system then, again, shaping itself around the person versus having more of a healthier balance with “sure, help the person” but also then meet your own needs as well.
Maya Hsu: Okay. Yeah, so it can range from more mild issues, just like anxiety, common everyday struggles, all the way to addiction.
Karin Sponholz: Right, exactly.
Maya Hsu: And is it also typical for, within a family unit, for every member aside from the most struggling person to develop codependency or is it usually one other member in the family?
Karin Sponholz: It's usually the person who's most empathetic. The most empathetic person is the one that tends to fall into this role. And it's interesting because you see roles in the family. So, you might see the person, the one with the empathy, tends to be the caretaker, tends to be the person who's the codependent one. And then you see the identified patient in the family, right? And then you see maybe the joker or the rebellious one. So, you see all the roles that people play. Or the avoidant one. And everyone has this unspoken contract to remain in these roles, which is why, especially again, with the extreme example of somebody who has an addiction, family therapy is so vital to breaking out of these habits because it's the system that is set in place to keep everybody stuck in these roles.
Maya Hsu: It sounds like if one person just seeks help on their own and gets therapy when they return back to the family unit the strength of the rest of the dynamic is so strong that that individual work is not enough. It has to be a cohesive, holistic approach.
Karin Sponholz: Exactly, exactly. Yup, exactly.
Maya Hsu: What happens when somebody who's learned and adopted codependent behaviors leaves the family unit and then starts to build other relationships or friendships or romantic partnerships? How does codependency then affect those future relationships?
Karin Sponholz: Right. Again, the terms that I'm using are pop psychology but people who tend to be more codependent find or date friends or date people who are more wounded birds. So, they're recreating the family system or the family dynamics. So, they're finding people that they can caretake because their whole sense of self and sense of approval is this deep need to caretake and to be needed by others. So, that's why it runs very deep. It's more than just people-pleasing. Because that's another term that often gets used in relation to codependency.
And to be fair to everybody, we all fall in and out of codependent moments or people-pleasing moments. The problem is when it becomes this rigid habit or way of relating to others. And it really gets in the way of relationships, as we're saying, because there's a one-sidedness to these relationships then. Someone always has to be struggling and the other one always has to be the caretaker.
And there's a huge sense of guilt or shame if you start to figure out what you're wanting and what your needs are. So, in extreme cases people who are very codependent have a hard time identifying something as simple as “what's your favorite dish?,” “what's your favorite color? or “what do you even want to do?” It's so wrapped up in what the other person wants or does. And even feelings. “I can't be happy unless you're happy.” That's often... We see that. Or “if you're sad I'm not allowed to be happy. I have to then also pull myself and be sad.”
Maya Hsu: Yeah. You mentioned that everybody falls in and out of codependent moments and empathetic moments. When somebody has codependency that's been ingrained in them from the beginning of life they might not even realize that they have codependent tendencies or codependent habits. Are there any big signals that you can say that would help somebody realize that this might be something that they could get help on if they just are unsure whether this is something that resonates for them and applies to their life?
Karin Sponholz: Sure. I'm going to read off a list because there's some common signs that I think that might be helpful for people to recognize in themselves. And again, any one of these signs in and of themselves doesn't mean that you have codependency. It's usually several of them clustered together over a period of time that you would maybe say someone might be codependent. So, I just want to put that caveat out there. So, I'll read just a few of these from the list that I have.
There's a deep seated need for approval from others. Again, that sense of approval comes from care taking and the recognition that what I'm doing for you is very strong.
Self-worth depends on what others think about you. So, again, your sense of self is wrapped up in what other people think or feel about you. It's what we call externalizing. There's no sense of who I am in and of myself.
A pattern of avoiding conflict. So, people who are codependent really just want to try to keep the dynamic as stable as possible but stable in this sort of enabling, enmeshed pattern.
A tendency to minimize or ignore your own desires.
Excessive concern about loved one's habits or behaviors. So, the upside of codependency, if you will, is that you really know what the other person wants and needs, which is great. At its core, there's a sense of thoughtfulness, empathy, almost a radar-like sense of what people might want and need-- helpful. But it needs to be tempered.
A habit of making decisions for others or trying to manage loved ones. So, again, in extreme examples we might say, somebody has an addiction and the person who's a caretaker or an enabler might say, "Oh, no that's not what they want. They want this." So, they would be speaking for the other person because there's such an enmeshment. And they might be right to some extent but there's such an over investment in the other person's life.
Guilt or anxiety when doing something for yourself. Like, “God forbid I decide that I want a dish that might be different from you.” Like if you wanted chicken and I decided I want beef there would be such anxiety about that.
And doing things that you don't really want to do simply to make other people happy. There's that people-pleasing aspect about it.
And then overwhelming fears of rejection and abandonment. And that's what keeps people locked into this dynamic, again, because their whole sense of self and self-worth is wrapped up in this other person and caretaking for them.
Maya Hsu: Wow. There's a lot there, a lot to unpack there.
Karin Sponholz: Yes. Are there any that stand out for you or that you have questions about that I can maybe explain more?
Maya Hsu: That was a really helpful list of just general ideas. It did get me thinking about gender and how codependent habits might manifest differently among different genders. Is that something you've noticed in your work with clients?
Karin Sponholz: No, it's pretty equal between men and women or other genders. I think the common denominator are the empathy piece. So, regardless of gender and how people identify, the person who's more empathetic, maybe HSP...
Maya Hsu: What’s HSP?
Karin Sponholz: Highly-sensitive persons. That's it, yeah. So, and that can be a whole ‘nother talk, but people who are more empathetic or highly sensitive tend to be those that fall more easily into this dynamic because they can pick up other people's situation. And the people who draw others into a codependent relationship with them tend to pick out those people who are sensitive.
Maya Hsu: Yeah. I'm thinking of how this might be a cyclical thing and how somebody with a parent struggling with addiction grows up with codependent habits and then gets into a relationship with somebody else who has a lot of need and a lot of struggles and then they recreate that dynamic and then they have children. The children will learn and pick up on that. It will just reinforce and self perpetuate.
Karin Sponholz: Exactly.
Maya Hsu: How does one break... What is the process like of breaking that cycle and of recovering and healing from and moving on from codependent tendencies.
Karin Sponholz: It really takes to be in relationship with somebody who is healthy, so to speak. So, a friend, maybe, who can recognize the signs of codependency and really help that person identify, “Oh wait, no, you decide what you want to do,” can really help the person, help push that friend to recognize what their wants and needs are.
Professional help is certainly a big key influence here. Whether it's individual and especially group psychotherapy. And the reason why I say group is because there's a... With a therapist certainly there's role modeling in what's a healthy relationship or healthy dynamic. With a group you also then are relating with peers in the group. And together you're also learning and holding a mirror to each other about dynamics. So, it's really, really helpful to experience because it's experiential learning that is necessary for breaking those habits. Knowledge is powerful for sure, understanding logically what codependency is. But it's really on the visceral level that really makes the permanent change.
To fuel the fear of like, oh my gosh, I want chicken and you want beef, right? And it sounds, to some people who aren't in it, it sounds maybe silly or rudimentary but to somebody who's had years and years of codependency, something that simple can feel so distraught and very horrific to them and difficult.
Maya Hsu: Yeah. So, therapy, professional help and then just experiencing it through healthy relationships is part of the process of unlearning codependency.
Karin Sponholz: Exactly. Exactly, yup.
Maya Hsu: Yeah. You touched on several of the downsides of codependency and some of the benefits, like being empathetic, observant, in tune. And the downsides being maybe dependent self-worth, things like that.
Karin Sponholz: Yeah.
Maya Hsu: I'm still curious, because it can be so scary to leave a codependent past and put yourself into a place of limbo where now you have to figure out who you are, figure out how to get self esteem and self-worth from not a source that is comfortable and familiar, what would you say is the enticing appeal of unlearning codependency? How different really is life once you have moved away from a codependent past?
Karin Sponholz: Right. There's a sense of freedom, right? There's a sense of freedom to be yourself in relationships, right? So, codependency can show you what you don't want in a relationship because what we really are striving for, all of us, is called interdependency. There's a sense of connection while there's also independence in the relationship. And that's really where there's space, there's freedom, at the same time there's connection to the person that you're with. And that's really what's important because we don't want to swing to the other extreme and just be independent and self-reliant and I don't need anybody.
And certainly people who are trying to break out of codependency can do that. They can swing to the other extreme. And sometimes there's a period of time we all need to do that, but we're relational beings. So, we're wired to our connection. So, I forgot now your question.
Maya Hsu: Well, you answered it by mentioning the freedom and interdependency piece of letting go of that codependent history.
Karin Sponholz: Right.
Maya Hsu: Yeah. What advice would you have for somebody who's thinking about maybe seeking help or leaping in to trying to figure out what a less codependent life would look like but who's scared?
Karin Sponholz: Yeah. I would say first start with a Google search. There's so many websites out there that define codependency. I'm sure there's some quick quizzes that you can take to see, are you codependent and take them and just start to see for yourself if you identify with any one of those.
And the other thing you can start to do is just practice every day. Decide what is it that you want, what is it you need? Start to figure out, what are your likes apart from what somebody else might want. And it might be a struggle. There might be some grief, loss, anger that might come up because, especially, again, if you've done years and years and years of just living for somebody else, your own house, so to speak, is empty. I always say you're jumping into somebody else's home and decorating and setting up shop and making it pretty over in their house while your own house has just boxes that are unpacked and it's hollow, so to speak.
So, there is a bit of a shock when you start to come back home to yourself and you realize, I'm using the metaphor of the house, there are no pictures up in the house. It's cold. There's no-- boxes are unpacked, there's no bed. And it feels like, “Oh my God,” it's like starting from scratch, to some extent. And that can be a stark reality. That can hit hard when you realize that you've neglected yourself for many, many years.
So, I would say be kind to yourself, be patient with yourself, again, practice with lower hanging fruit type things, of “I like this sweater because why?” Or “I like this color because... It doesn't have to be a because. I just like this color.” And then certainly get professional help if you feel like you need more support.
Maya Hsu: Thank you. The last topic that I wanted to cover was how codependency might intermingle with other mental health issues. And earlier when you were talking about the symptoms and how it manifests in different people I was thinking about social anxiety and I imagine there's a link there. Can you talk a little bit about how it relates to social anxiety and anything else that might come up really often with codependency?
Karin Sponholz: For sure. There is a comorbidity with anxiety and depression because again, their sense of self is so wrapped up in somebody else. And there's a sense of trying to control the other person. And I don't mean that in a pejorative way. They're trying to do it because their self-worth is wrapped up in the other person. But as we know, we can't control people, which then creates that sense of anxiety because I can't... I think we all know, although we might try, we just can't control the other person. So, there's a constant insecurity about that dynamic.
And then there's the depression because so much is getting ignored. And so the depression with a sense of self-worth, lack of getting your own needs met, lack of really attuning to yourself, a lot of that creates a sense of depression. And of course the anger that's developed through the years. You see a lot of unresolved rage and grief for people who've been codependent because when they start to do therapy they start to realize, “Oh my gosh, I was reinforced. My self-worth was reinforced in taking care of my brother.” Something as simple as “My little brother who had ADD, and then I got reinforced. I was never encouraged to do my own thing or to discover my own desires.” So, that needs to get worked through and unearthed. So, again, the anxiety, depression is often what we see in conjunction with codependency.
Maya Hsu: And that reinforcement with the younger brother who has ADHD, would that look like praise for being really thoughtful and being really in tune with the brother?
Karin Sponholz: Exactly. Yup, yup. Praise for “Oh, look you're such a good sister, you're such a good person.” Or for example, if you got invited to a birthday party but you decided to stay home because you had to take care of your brother. There's praise for that. “Oh see, you're such a good person. You didn't go to the party where all your friends are where you wanted to have fun.” No, you stayed home and that was reinforced, reinforced, reinforced. So, it makes sense that somebody, again, especially as a kid, who wouldn't want to feel that feeling of reward and praise?
Maya Hsu: Totally, totally. Yeah. It's a really fascinating topic and very complex.
Karin Sponholz: Mm-hmm (affirmative).
Maya Hsu: Thank you so much for all of the information. Is there anything else about codependency that you would like our listeners to know about?
Karin Sponholz: I would say to think about codependency on a continuum, whereas people-pleasing might be on one end. There's codependency and there's a newer term that people may not be familiar with. It's called fawning. And that often gets confused with codependency. So, again, think of that as a continuum. People-pleasing, again, we all kind of fall into that. It's not really problematic, per se, unless it becomes rigid. Codependency again, we can fall in and out of it, but, problematic if it becomes more rigid.
And codependency, we often think of an addiction, right? People say codependency is love addiction. Fawning comes out of a trauma response. So, there's less of an addictive quality about fawning and more of a life or death situation with fawning. It looks very similar to where people are staying in unhealthy, destructive relationships but they're doing it because there's, again, a life or death. If they don't fawn or people-please there's a sense of “Oh my God, I'm going to die if I don't do this.” So, there are terms that get thrown around and people quite don't understand the differences but that's one way to think about it.
Maya Hsu: Yeah. It almost sounds like a continuum of urgency where people-pleasing might be like “Oh, this is a common thing.” Codependency might be more of a habit and then the fawning is a very urgent, dire need to do that.
Karin Sponholz: Yes, great way to describe it. For sure. Yup, yup.
Maya Hsu: Wonderful, wonderful. Well, thank you so much. Dr. Sponholz.
Karin Sponholz: Yes.
Maya Hsu: It was really wonderful having you on the Seattle Psychiatrist.
Karin Sponholz: Thank you for having me. Thank you.
Please note: The views expressed by the interviewee are for educational and informational purposes only, are not meant to diagnose or treat any condition, and do not necessarily reflect the views of Seattle Anxiety Specialists, PLLC.
Editor: Jennifer (Ghahari) Smith, Ph.D.