Advanced Codependency Treatment: A Complete Guide to CBT, Somatic, and Family-of-Origin Strategies to Disentangle Clients from Toxic Relationships and Recover Self

CPD

Speaker

Nancy L. Johnston, LPC, LSATP, MAC, NCC Related seminars and products

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Nancy L. Johnston, MS, LPC, LSATP, MAC, NCC, is in private practice in Virginia. With 49 years of clinical experience, Nancy is master addiction counselor and an American Mental Health Counselors Association (AMCHA) diplomate in substance abuse and co-occurring disorders. A sought-after speaker and trainer, Nancy has been a faculty member the Psychotherapy Networker Symposium, The Ferentz Institute, numerous other professional conferences including Cape Cod Symposium on Addictive Disorders, the American Mental Health Counselors Association’s Annual Conference, the Virginia Counselors Association’s Annual Conference, and Specialty Docket Training for the Virginia Supreme Court.

Her work was recently featured in a New York Times article on enmeshment in relationships. In addition to teaching clinical professionals, Nancy offers online self-recovery workshops and delights in designing and facilitating Codependence Camp biannually at a retreat center in Virginia. Nancy has authored four books on codependency, including You. Here. Today.: 200 Readings for Growth from Codependency to Self-Recovery (2026); The Clinician’s Codependency Treatment Workbook (2024); Disentangle: When You've Lost Your Self in Someone Else 2nd Edition (2020); and My Life as a Border Collie: Freedom from Codependency (2012). When she is not teaching or writing, Nancy enjoys extended time with family and friends, gardening, collaging, writing haiku, dancing, walking in the woods, and sitting by the river near her country home. To learn more about Nancy and her work, please visit www.nancyljohnston.com.

Speaker Disclosures:
Financial: Nancy Johnston receives compensation as a designer and facilitator of workshops and retreats. She receives royalties as a published author. Nancy Johnston receives a speaking honorarium and recording royalties from Psychotherapy Networker and PESI, Inc. She has no relevant financial relationships with ineligible organizations.
Non-financial: Nancy Johnston is a member of the American Mental Health Counselors' Association, the Virginia Counselors' Association, the National Association of Alcohol and Drug Abuse Counselors, and the Virginia Association of Addiction Professionals.

Additional Info

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Objectives

1. Identify functioning patterns exhibited by codependent individuals.
2. Use assessment tools to identify the dominant external orientation of codependent clients.
3. Choose psychoeducational interventions that clarify the precise nature of codependency to clients.
4. Examine how codependency influences responses to the person’s own feelings of vulnerability.
5. Evaluate the potential correlation between codependency and growing up in a family environment where children are parentified.
6. Identify the intra/interpersonal dynamics of codependency.
7. Evaluate the potential link between codependency and the selection of partners with problematic behavior.
8. Identify countertransference dynamics in codependency treatment.
9. Use thoughts, feelings, inclinations, and needs to develop an authentic sense of self.
10. Utilize cognitive therapy interventions to foster positive changes in self-awareness, self-image, and interpersonal communications within the context of codependency treatment.
11. Use somatic strategies to help clients safely ground and calm self so they can attend more fully to their body, mind, and emotions.
12. Choose skills sets to help codependent clients address their emotional expression, shame, guilt, assertiveness, and boundary setting.
13. Develop a working knowledge of self-attunement to help clients cultivate a secure, safe, and reliable relationship-with-self.

Outline

Intake and Assessment of Clients with Codependent Behaviors

• Identify codependency in a variety of clients – how it looks in therapy
  • Dominant external focus: other-centered
  • Loss of self in someone else
  • Behavior vs. label
• Assessment tools for codependent characteristics
• Relationship patterns/themes to look for
• Codependency in clients presenting with anxiety, depression
• Connect internally as a foundational treatment goal
• Research, risks and treatment limitations
• Case Study: a 57-year-old primary caregiver for his mother who is developing memory problems

Establish a Therapeutic Relationship with a Codependent Client

• Foster your client’s autonomy and join their stage of change
• Ingredients of change
• Avoid becoming the client’s external source of direction
• Strategies for self-empowerment from the very first session
• Manage countertransference & your own codependency
• Ethical considerations

Psychoeducation and Early Sessions

• Educate clients about external vs. internal focus
• Client-ready visual tools illustrate codependent dynamics
• Shift to an aware, responsive, internal focus
• Goal setting
• The 4 interlocking elements of self-recovery
• Case Study: Continue with the 57-year-old primary caregiver for his mother who is developing memory problems

Family of Origin and Parts Work to Help Clients Understand their Codependent Characteristics

• Influences on self-development: Individual, family systems, social/cultural/political/religious worlds
• Gather your clients’ trauma history
• Parts of self developed from formative experiences
• Grief that can arise and strengths embedded in self-understanding
• Case Study: 24-year-old in a serious relationship with a dominating partner

Somatic and Cognitive Techniques to Enhance Codependent Clients’ Awareness of Body, Mind, Emotions, and Spirit

• Mindfulness techniques
• Bottom-up grounding tools to calm and connect with self
• Cognitive strategies to increase awareness of thoughts
• Exercises to help clients correct their thoughts
• Emotional awareness and self-expression strategies
• Spirituality as an internal resource
• Case Study: Continue with 24-year-old in a serious relationship with a dominating partner

Skills to Transform Shame, Manage Guilt, Be Assertive, and Set Healthy Boundaries

• Recognize shame, sharing with safe others, and releasing
• Cognitive corrections for quieting guilty thoughts
• Learning to construct “I” statements
• Three-part boundary setting process:
  • Listen to self to discern your boundaries
  • Express boundaries to others
  • Live with your boundaries
• Case Study: 50-year-old mother of a chronically relapsing alcoholic adult daughter

Exercises and Practices That Help Clients Learn How to Count on Self

• Self-attunement and relationship-with-self
• Qualities of a secure relationship-with-self
• Exercises to deepen internal connections and offer supportive self-regard
• Gatekeepers – parts that keep clients from accessing self
• Release exercises – let go of what clients cannot control
• Cultivate self as a secure base and an anchor
• Case Study:  Continue with 50-year-old mother of a chronically releasing alcoholic adult daughter

Make Self-Recovery a Way of Being

• Maintain connection with goals and self-recovery strategies
• Daily practices for self-awareness and self-responsiveness
• Ongoing ways to use internal focus
• Tools to continue to develop their relationship-with-self

Clinical Applications

• Individual therapy
• Group settings
  • Value of group settings
  • Psychoeducational workshops
  • Outpatient/inpatient groups
• Usefulness to various populations

Target Audience

• Counsellors
• Social Workers
• Addiction Counsellors
• Psychologists
• Art Therapists
• Marriage and Family Therapists
• Other Mental Health Professionals
• Physicians