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Biering (1998) offered one of a few qualitative research studies in the field of codependency, his paper entitled: ‘Codependency – a disease or the root of nursing excellence?’, offererd a hermeneutic phenomenological research exploring the experiences of nurses. Due to its relevance to the methodology chosen for this study, a review of Biering’s (1998) study is offered here.

Biering’s study explore another assumption found in the literature on codependency that individuals may engage in caring professions as a result of unmet childhood needs, which according to these authors resulted in codependent behaviours. An example of this assumption was found in the work of Linda Arnold, a psychiatric clinical nurse specialist and assistant clinical professor at the University of

California. Arnold published a series of three opinion essays (Arnold 1990a, 1990b, 1990c), suggesting possible implications of codependency for nurses in health care practice. She introduced the contentious term: ‘codependent nurses’. According to this perspective, by helping others, practitioners achieve a sense of control and self- esteem, factors that which may not have been validated and fully developed during childhood.

Investigating this claim, Biering’s (1998) hermeneutic phenomenological research focused on how competent nurses (n=8), who reported dysfunctional childhoods, experienced the relationship between this upbringing and their chosen career. The group contained 5 nurses (not identified as codependents) who reported that they had previously engaged in 12-step self-help groups (not necessarily for codependency). The nurses were selected from an Icelandic nursing community. Dysfunctional childhoods were characterized rather restrictedly as being raised in families with alcoholism problems. A staged data analysis process was followed including reflective coding and conceptualization steps.

Several themes emerged from the interviews: escaping difficulties by becoming a nurse, coping roles guide nursing careers, sensitivity to the untold, transforming dysfunctional responses, and wounded hearts. The first theme, ‘escaping difficulties

by becoming a nurse’ described how growing up in dysfunctional families influenced

the participant’s decision to become a health professional. The second theme,

‘coping roles shape nursing careers’ described the roles these participants occupied

during their childhood helped to maintain a balance in their family of origin. Some of the roles described by these participants were: confidant of their parents, responsible child, mother’s helpers and others. These were thought relevant to their career choices. The theme ‘sensitivity to the untold’ explained how growing up in dysfunctional families encouraged the nurses to be more sensitive to their clients’ feelings and attitudes. The theme ‘transforming dysfunctional responses’ explained how painful family experiences were transformed into something positive as part of their professional lives. For example, a participant spoke about developing something like a ‘watchful sensitivity’ when she was a child as a response to her father coming home drunk. She believed that this enabled her to be more aware of the sounds and noises as she worked in an acute care unit. Finally the ‘wounded

heart’ theme described how these nurses used their traumatic family experiences

and their experience of recovery stories to the benefit of their clients. Overall the study demonstrated that although the participants reported dysfunctional families of

origin (i.e. alcoholism); they were able to successfully transform and use their experience in helping individuals who struggled with similar issues. These nurses reported having successful and fulfilling careers, and that they were able to live functional lives.

The findings of the study cannot be straightforwardly generalized as it focused on a small group of nurses who were all adult children of alcohol dependents. Furthermore the experiences of nurses with similar backgrounds, who did not succeed in the profession, were not explored. It is possible that participants of this study may have used the skills and coping strategies resulting from being raised in dysfunctional families as instruments of growth and career development. Other individuals may have different experiences. The study demonstrated that the assumptions found in the literature are not fundamentally the ‘only true reality’; individuals may construct personal realities based on their individual experiences. One could argue perhaps that codependency may not be necessarily a negative characteristic; instead this experience could and can be transformed positively into effective caring. The phenomenological methodology was useful as it changed the perspective in which the codependency construct was perceived. It highlighted that individuals raised in dysfunctional families may use early experiences positively to live productive and functional lives. The ‘stories’ provided by these individuals may not fall into any prescribed ‘codependency category’ (i.e. health professionals, relatives of substance misusers) suggested by early codependency authors. Furthermore people have unique stories and rich experiences which are not well captured by designs which focus on quantitative models and ratings on pre-set questionnaire items.

It could be argued that Biering’s study highlighted the need for further phenomenological research specifically exploring the experiences of individuals who identify with the concept of codependency. This would provide more clarity about the ways that these self-identified codependents find significance and develop coping strategies for their lives, in part through their identification with the codependency discourse. The review here also highlights the value of qualitative methodology, rarely used in this field, to hear people’s own accounts and interpretations less constrained by researchers’ pre-existing assumptions as embedded in their measurement scales.