Codependency And Clinical Care

There is oftentimes a very fine line between healthy and dysfunctional relationships. This is no more readily apparent than the relationships between many health care providers and their patients. Health care in many ways has become a highly codependent environment.

What exactly is a codependent relationship? Codependence is formally defined as “of or pertaining to a relationship in which one person is physically or psychologically addicted … and the other person is psychologically dependent on the first in an unhealthy way”. Codependent relationships display a tendency “to behave in overly passive of excessively caretaking ways that negatively impact one’s relationships and quality of life”. These types of relationships can be characterized by any number of traits including denial, low self-esteem, excessive compliance, or control patterns.

Where does all of this enter into the patient-clinician relationship? Sadly, it is an all-too-frequent occurrence.

Tell me if any of these sound familiar:

The clinician takes on the role of the fixer. The clinician has the patient believe that they have the extra-special skills to fix the patient. “If you come to me, I will put my hands on you and fix you”, they might say (or infer). Oftentimes, clinical experience and anecdote counts far more for them than evidence. They may have you believe that they have hands that are “highly trained” to detect the slightest variations in tissue texture or the like. They gain a great deal of self esteem based on their role as guru and their “laying on of hands”.

The patient takes on a passive role in their own care. They respond to the guru’s “special skills”. They want someone to solve their problem for them, and to do something on them or for them. Any kind of “treatment” that allows them to feel good is fine. They really don’t want to do anything that involves being responsible in their own self care – the more passivity, the better.

The vast majority of clinicians are of the guru mentality that utilize passive treatment techniques to “fix” patients. The passive patient gravitates towards this type of clinician, and vice versa. Both sides are psychologically dependent upon one another. They meet each others’ needs. They serve a dysfunctional, enabling role with each other. Outcome is not as important as dependency, control, self-image, and passivity. Health care as a whole suffers.

It is time for an intervention.

This codependency intervention needs to focus on the dynamics of each of the participants. Roles need to change. Both patient and clinician need to become more outcome-, evidence-, and self-care-driven. Interminable passive treatments need to become unacceptable to both patients and clinicians. Evidence needs to be the foundation for optimal outcomes, not just anecdote of patient successes which could be as much placebo or tincture of time as anything else.

But much like any addiction, it all begins with a choice: to change, or not.

In the meantime, we will watch this enabling behavior run rampant in our health care system. And we will watch it cost us billions of dollars in the process.

Note: Many thanks to physical therapist (and fellow McKenzie Diplomat) Curt Rickert, who participated in an informal discussion with me that provided the inspiration for this post.

Photo credits: brutalSoCal