How do you know if you’ve crossed the line from trying to be wholehearted and deeply empathetic, to being co-dependent?

This was a question that came up in a couple of conversations at the recent (and incredible!) End Well conference. I’ve thought about it quite a bit over the years, as there is without doubt a certain line that we have to watch, particularly when we are seeking to provide authentically empathetic and humanizing care to our patients and their caregivers.

First, a brief reminder on what co-dependency is:

It is a circular relationship in which one person needs the other person, who in turn, needs to be needed. The co-dependent’s self-esteem and self-worth come from sacrificing oneself for another (source).

As you can imagine, there is no perfectly clean or easy answer. But these are some starting points I want to highlight, after thinking and talking with others about this question.

1. The ‘line’ will look different in every single patient / family relationship we establish.

We have different levels of chemistry with every single patient and their caregivers. There are some we connect with immediately, and it can appear that we have almost immediately crossed the line to being ‘too personal.’ But a naturally easy connection doesn’t necessarily equate to codependency. It can make for a smooth, wonderfully therapeutic patient/provider dynamic where trust and openness result in ideal care for the patient and caregiver. It can, of course, become a situation where it is easier to slip into codependency if we are not self-aware or careful.

I’ve signed up to be a primary nurse in a couple of cases where I saw the complexity of the patient case, and I had very good rapport with the parents. I got close with the parents and opened up parts of my life that felt like relevant connecting points to the situation at hand. But I also gave myself permission to take breaks from being with them every single shift, and when some asked to stay in touch after their child was no longer in our hospital, I declined politely and deferred to hospital policy to help me with that boundary. 

I certainly carried emotions about them into my personal life, but I processed those on my own by way of prayer, writing, exercising and grieving for them in my own space. I didn’t necessarily hold back from quietly shedding tears with the parents in particularly difficult moments for them, but I was very mindful about primarily processing my own emotions about their children outside of my work shifts. 

2. There will probably always be some element of healthy and less-than-healthy, unselfish and selfish, in our motivations as healthcare providers.

This is simply a part of being human. None of us are 100% magnanimous 100% of the time. It’s also not wrong to want our work to feel meaningful as healthcare providers. God knows how much of our work can feel dehumanizing to us, so it feels great to have meaningful interactions, to feel appreciated and valuable because we actually got to invest quality time into our patients.

What I think is important, when considering the question about whether we’ve crossed over into codependency, is the courage and wisdom to ask ourselves on a regular basis:

Do I find that this relationship seems to be more about me, or more about them, when I honestly assess my emotions or my particular draw towards a certain patient case? If I find it’s the former, what is my active plan to tend to my personal emotional health so that I don’t put the weight of it on my caregiving relationships at work?

Detecting signs of unhealthiness doesn’t necessarily mean we have to (or can) pull away from the patient entirely, but it is something to keep tabs on and perhaps find peer support with as we continue to navigate future interactions.

3. There are questions we can ask ourselves to try and stay emotionally healthy.

Can I feel secure in who I am, and confident about the care I provide, even if I don’t get a ton of gushing thanks or affection from a patient/family that I care deeply for? 

Do I give myself permission to not be the one who tries to meet every need or desire of a patient (i.e. signing up for primary nursing, if I know my own emotional health doesn’t have the capacity for it right now)? Can I be content in knowing the patient is being well cared for by people other than me?

If the answer is no to any of the above, what is my plan for how I can tend to my emotional health and security? I have personally found peer support and therapy to be immensely helpful. I also come back again and again to my deep roots of knowing I am intimately known and loved by God. 

This is a big topic, and this post just scratches the surface. But I find these to be helpful starting points and important to consider if we want to stay both whole-hearted and healthy in our care at the bedside.