Codependency (Part 1) - by Johan Obbes

Codependency is one of the issues which I encounter  in the counselling environment on a daily basis. This silent destroyer has been made famous by the world renowned writer Melody Beattie with her best sellers (Codependent No More) and (Beyond Codependency). Other authors include Pia Melody (Facing Co-dependence) and Shirley Smith (Set Yourself Free).

Yet so many people still have a misconception of what codependency is, and it’s devastation it has on our society as we only started to identify it in the late 70’s. It was through the recovery of alcoholics that we started seeing that the partners of the alcoholics are as many a times, just as sick as the addict self. To date the ongoing research is growing by leaps and bounds, as therapists are discovering just how deep does the rabbit hole go.

 Definition - Codependency (or codependence, co-narcissism or inverted narcissism) is a tendency to behave in overly passive or excessively caretaking ways that negatively impact one's relationships and quality of life. It also often involves putting one's needs at a lower priority than others while being excessively preoccupied with the needs of others and can even be seen as an addiction of sorts.  Codependency can occur in any type of relationship, including in families, at work, in friendships, and also in romantic, peer or community relationships.  Codependency may also be characterized by denial, low self-esteem, excessive compliance, and/or control patterns

Historically, the concept of codependence comes directly out of Alcoholics Anonymous, part of the realization that the problem was not solely the addict, but also the family and friends who constitute a network for the alcoholic. It was subsequently broadened to cover the way that the codependent person is fixated on another person for approval.  As such, the concept overlaps with the older psychoanalytic concept of the 'passive dependent personality' ... attaching himself to a stronger personality.

For me as a counsellor the first sign which I look for in a client to see if they might be codependent is their inability to clearly identify their emotions and feelings. One of the dangers in our society is that we over encourage the person who goes the extra mile at work, church or even charity work. Yet should this person be a codependent, then the very applause and affirmation which this behaviour is bringing them might also be the petrol on the fire which silently fuels their addiction. They find their value, worth and identity in the fact that they are “doing” instead of finding their value, worth and identity their “being”.

Patterns and characteristics of codependency

Codependency describes behaviors, thoughts and feelings that go beyond normal kinds of self-sacrifice or caretaking. For example parenting is a role that requires a certain amount of self-sacrifice and giving a child's needs a high priority, although a parent could nevertheless still be codependent towards their own children if the caretaking or parental sacrifice reached unhealthy or destructive levels. Generally a parent who takes care of their own needs (emotional and physical) in a healthy way will be a better caretaker, whereas a codependent parent may be less effective, or may even do harm to a child.

Many codependents feel completely trapped in cycles of drama without even knowing why or how they got into it in the first place. Some travel from a Victim mentality, to a Persecutor to a Rescuer all in one breath as they feel their emotions (which are complete strangers to them) abuse them like a bulldog with a playing ball. The Karpman drama triangle is one of many useful tools in helping codependent people realise the dysfunctional behaviour which they are addicted to.

Co-Dependents Anonymous offers these patterns and characteristics as a tool to aid in self-evaluation.

Recovery from co-dependency is possible and although it takes a hard work and therapy, the words of Melody Beattie in her book Beyond Codependency can describe the healing the best; The important idea here is we’ve lost our invisibility. We’re recognising ourselves, and others are recognising us too. More help and hope has become available to us – from teddy bears that says it’s okay to feel what  we feel, to in-patient co-dependency treatment programs where we can deal with our inner child (the part of us that feels, plays, and needs to be nurtured) and where we can address our family of origin issues (our messages from the past that control what we do today)…We’re saying simply and clearly, enough is enough, and we’ve suffered enough. It’s time to do things differently.

Written by Johan Obbes - Exerts from this article has been taken from http://en.wikipedia.org/wiki/Codependency as well as the book Beyond Codependency by Melody Beattie.

The tales of intrepid travellers Pinky & Liezl - by Liezl Cromwell

The day began in good spirits albeit at 3am.  Pinks, duly collected at 4am as planned (Phew…she is not a morning person, see the pics of her in our latest fun day – Ed note) and check in also proceeded smoothly for our flight from Cape Town to East London, as this would be just a quick trip, in and out for a couple of hours to attend a meeting. Then, things took the first dramatic turn when a suspicious sharp object was seen on the X ray during the security check.  On closer inspection (and after profuse denial of packing anything that could harm fellow passengers), a pair of scissors innocently residing in a pencil case was apprehended and confiscated. Not to mention that this pair of scissors had managed to fly to Durban and back, undetected the previous week!

A strong cup of coffee was needed to calm the nerves, which of course were aggravated as said travellers left a lap top behind at security check point after the scissor incident. During a quick toilet stop before boarding we were horrified to hear our names over the public system to please go to gate A9. This was a first for me Liezl, (uhuh – Ed note) who was frustrated as we were only five minutes late. With Pinks giggling and myself still grumpy for having being called to board, we stumbled on the awaiting bus only to meet glares and sarcastic comments and then set off for the plane. As the red cheeks subsided and settled in our seats we were informed of a delay in take off due to the dense fog conditions. Argggg

Arrival and progression to Queenstown, where our meeting was to take place was incident free. In fact the journey to Queenstown was scenic and serene. AAAAAAAAAAAAA absolute serenity. The meeting was productive and successful and afterwards we searched for a restaurant in this unknown town, as our last meal was early morning. Then we encountered a  bump in the road, or shall we say one long bumpy road. Having decided on The Spur we set out walking (in our high heels) as the locals said that it is only a two minute walk ….which literally grew into a long walk to find something to eat although often reassured by the locals that it’s not far, it’s just around the corner.  Several blocks later we found the elusive Spur and enjoyed a good meal. Hunger satisfied, we had to make the long trek back to the car… in the now pouring rain…in our high heels and trying to save our hairdo’s from going into a praise and worship mode standing in all directions. We made it back drama free to East London, not a heel broken and returned the rental car intact and on time.

On checking in we discovered that the only flight (ours) leaving for Cape Town was overbooked. No! The check in clerk tried very hard to convince us to take the 2pm flight the next day, offering free overnight accommodation, free flight and what not. We just wanted to get home and hopefully vote the next day.  To be on the safe side we went straight to the departure lounge, only to find out that the flight had been delayed for another hour. Long, tedious hours were then spent waiting to board, when suddenly late at night it was all systems go. The next moment we found ourselves speeding down the runway, tired but relieved to be finally heading home. Then, fifteen minutes into the flight the pilot announced that we would need to detour to Port Elizabeth as no planes where landing in Cape Town due to bad fog conditions. The darkened aircraft was filled with shocked silence, as we circled over Port Elizabeth harbour for forty-five minutes to burn off the excess fuel. Around and around we flew only te grow more dizzy and nauseous from this circular movement. This was the lowest point for both of us.

 On landing close to midnight we were then shuttled to a hotel for the night, starving and with little other than the clothes on our backs.  Oh yes, we did have an umbrella and stress ball which was part of the training kit, but fatigue prevented us from using it as all I heard from my fellow traveller at this point was hayi suka wena! We were grateful to receive toothpaste and toothbrushes at the hotel, although a highly distressed Pinky could not convince them to also supply some clean underwear! We managed to sweet talk a closing restaurant to provide us will a meal at midnight.

The following morning began early, at 6:20 am.  I saw how my bewildered colleague, who is not a morning person struggled to come to terms with the fact that our 7am shuttle was already waiting for us.  She desperately needed strong coffee to cope. I won’t go in to detail of how the coffee machine stopped working and like a ship through the night, a geisha on stiletto’s or shall we say a extrovert without caffeine the before mentioned colleague left a poor young blonde in her dust as she elbowed her way through to the shuttle.

When checking in, the system would not allow us access as it was past the boarding time, leading to some scrabbling around by officials as they were faced with a long queue of sleep deprived people…and two Cape Town girls fuming silently in the anticipation of maybe missing another flight! Finally take off and homeward bound!!  No announcement of detours to George. Phew!

Article Written by Liezl Cromwell

Somerset West, VCT Site (Voluntary Counsellng and Testing) - by Johan Obbes

One of the many features of the Philippi Trust is it’s three highly successful VCT sites. One of which is located at the Head Office in Somerset West. Whereas so many horror stories exist of clinics operating in absolute chaos, this non clinical site has proved to be a story of hope and integrity.

Today we would like to introduce this stunning team of women, whom has made this site their pride and joy, but indirectly also changed a community!

The site was opened in 2008 as a collaboration between the Philippi Trust, The Desmund Tutu Trust, PEPFAR and the Department of Health. The site is located in the Alexandra building on the Somerset West main road and managed by Sister Pumla Ramatola, who is assisted by Cornelia Jantjies and their friendly professional counsellors Julia Ngqaqhu, Jenina Matthys, Monia Adams and Maureen Majikela with Sister Pumla’s husband Ernest as their driver for whenever they go an outreach into the communities.

Whereas many non clinical sites only do HIV testing, this site does not only do HIV/Aids Awareness but also does the counselling and testing for HIV, TB, Blood Pressure, Glucose, BMI, Pregnancy and family planning.

The site is welcoming, clean, wall to wall carpets and very well kept with a waiting area, three counselling rooms, and main office. What stands out about this site is that it constantly used by all races, which I thought spoke volumes in terms of its non-discriminatory conduct.  It is easily accessible from the main road and is known as a trusted, confidential service provider in Somerset West. The staff’s level of work is outstanding, and you can clearly tell that these ladies are not just enjoying but also taking a lot of pride in their work. An average of eight to fifteen clients a day walk through these doors where the staff has a focus to build a relationship with every person to ensure that they will return for follow up tests and counselling.

Speaking with Sister Pumla, you encounter a passion and a knowledge that has been developed from years of experience and a heart for people with no exclusivity. “I see the younger generation’s infection rate declining as they are more informed about safer sex, than the older generation. It is so much easier for them to openly speak about sex and condom use, that I think the next generation will be even less infected that this one. Looking at the infection statistics through the various generations it is evident how important education in this field is.”

One of the challenges which the personnel experience is when a person whom has tested HIV positive is referred to a hospital for ARV’s but then never turns up, out of fear to be recognised by hospital staff, other patients in the waiting room or purely medical staff disclosing their positive status. Discrimination and stigma is still so rife in our society that people are willing to gamble with their lives, instead of taking a chance to obtain medication in many hospitals and roll out clinics.

The question then remains, why is stigma still so strong in our day and age? The challenges are still found in Socio-Cultural circumstances where spouses suspiciously frown upon condom use in a “supposedly” monogamous relationship. Women are being treated less than men, and their voices are often silenced through domestic violence when confronting an unfaithful spouse. Sex is still a topic that is not openly discussed and with the increase of poverty, we find that people move around geographically in an effort to find work, yet spreading the virus faster than should their community have had less human movement.

The bottom line is, this VCT site has proved itself trustworthy, safe and definitely a story of hope. We can only pray that this attitude of professional conduct, confidentiality and integrity is spread to our communities in an effort break down stigma.

To have a look at this amazing site, please visit the Philippi website at http://www.philippitrust.co.za/

Article Written by Johan Obbes

Post Traumatic Stress Disorder - by Johan Obbes

“Post Traumatic Stress Disorder is a disease just like cancer, diabetes, or many other medical problems and disorders. PTSD is an anxiety disorder which is triggered after exposure to an intensely terrifying event”

What is Post Traumatic Stress Disorder

The disorder occurs when a person experience such an overload of horror that the only way for them to survive this trauma is for their cognitive and emotional behaviour to separate. When in danger, it’s natural to feel afraid. This fear, triggers many split-second changes, in the body to prepare one to defend against the danger or to avoid it. This “fight-or-flight” response is a healthy reaction meant to protect a person from harm. But in PTSD, this reaction is changed or damaged and the sufferer might even feel that the trauma has not ended yet, but is still continuing with every trigger. PTSD can sometimes last for up to 40 years or more, if the person have not received appropriate treatment and therapy. Some war veterans still suffer from PTSD, but as it is not correctly diagnosed it is more commonly referred to as “shell shock”.

Traumas can be various and examples of the most obvious ones are; living through or experiencing a violent crime, being raped, attacked, taking part in a war, surviving a natural disaster, physical or sexual abuse, surviving an accident (car, train, plane) etc.

We also find traumas which are continuous, long term or subtle where sufferers are trapped in horrifying circumstances for years, being traumatized every day, like domestic violence or severe bullying at school. Some sufferers don’t even know that they are being traumatized as they might not be aware of the trauma or even remember what has happened. These traumas are experienced more often when growing up or by being in an abusive relationship, yet these examples are not exclusive but only an indication. These traumas could be abuse (all forms of abuse), emotional neglect or even an intense, continuous mocking & teasing at school. People react differently to different situations, but regardless of the trauma the damage to the sufferer is real and the intensity of the symptoms vary from person to person.

Most people with PTSD go through intense suffering due to a huge part of society not understanding it. Sometimes the symptoms begin immediately after the event, but as each person is different the symptoms can sometimes be experienced weeks, months or even years after the event. When they do finally occur, it is usually in response to or have been triggered by a series of stressful events or losses. This causes the sufferer to experience the traumatic event over and over again. – READ THE PERSONAL STORY OF LISA KELVER ON OUR WEBSITE at http://www.philippitrust.co.za/counselling_success_stories.php

Most common symptoms of PTSD can include:

1. Re-experiencing symptoms:

• Flashbacks—reliving the trauma over and over, including physical symptoms like a racing heart or sweating (these flashbacks are so real that the person feel as if they are right back in the trauma as if it is happening right now)
• Bad dreams
• Frightening thoughts.

Re-experiencing symptoms may cause problems in a person’s everyday routine. They can start from the person’s own thoughts and feelings. Words, objects, or situations that are reminders of the event can also trigger re-experiencing. This is extremely shameful to the sufferer as they cannot control the triggers and usually experience it as intense as if they were back in the moment of the trauma being inflicted.

2. Avoidance symptoms:

• Staying away from places, events, or objects that are reminders of the experience
• Feeling emotionally numb
• Feeling strong guilt, depression, or worry
• Losing interest in activities that were enjoyable in the past
• Having trouble remembering the dangerous event.
• Memory lapses in everyday life
• Delayed responses after being asked a question

Things that remind a person of the traumatic event can trigger avoidance symptoms. These symptoms may cause a person to change his or her personal routine. For example, after a bad car accident, a person who usually drives may avoid driving or riding in a car.

3. Hyper arousal symptoms:

• Being easily startled
• Feeling tense or “on edge”
• Having difficulty sleeping, and/or having angry outbursts.

Hyper arousal symptoms are usually constant, instead of being triggered by things that remind one of the traumatic event. They can make the person feel stressed and angry. These symptoms may make it very hard to do daily tasks, such as sleeping, or concentrating.

The main treatments for people with PTSD are psychotherapy (“talk” therapy), medications, or both

Recovery from PTSD

Recovery from PTSD is a long process and should not be rushed at all. The sufferer might experience intense feelings of shame as the triggers and symptoms are uncontrollable, and extremely traumatic. Although each person experience the healing process differently, one can closely compare the process to that of the healing process of abuse.

Abuse can be considered as a process having four overlapping stages.

First there is the impact stage. It lasts for a few hours to several days and is characterized by shock, disbelief, anxiety, and fear. Often victims are confused about whether to report the abuse and frequently there is fear that the abuse may recur. Sometimes the impact is made worse because the abuse victim feels overwhelmed by too many professionals or police officers asking questions.

Stage two involves denial. In order to cope with the stress, the victim tries to push aside the trauma of abuse and return to a pre-crisis stage of functioning. Victims at this time need to feel secure, organized and in control. To others, and even to the victims themselves, it may appear that everything has returned to normal, but the hurt is still present and will need to be dealt with before complete healing occurs. The denial stage may be over within a few days, although for some it lasts for years.

Stage three, the process stage, begins when the experience of assault can no longer be suppressed. Often some crises event of emotional distress may trigger the old feelings and the victim is flooded with anxiety, depression, nightmares, flashbacks, and constant thinking about the assault. This is a period when the victim needs to talk, to express feelings, to struggle with guilt and anger, and to feel counsellor support.

The final stage of integration comes as the individual begins to feel no longer controlled or dominated by the effects of the abuse.

Article was written by Johan Obbes. For more information on PTSD please refer to http://www.sahealthinfo.org/mentalhealth/aboutptsd.htm or find out more from one of the excellent books from Recovery Books at http://www.recoverybooks.co.za