Host Dr. James Flowers, Co-Host Robin French, and VIP Guest, Adam Swanson, discuss codependency in mental health and families, setting strong boundaries with family for helping navigate to end the repeated patterns, the process of healing from trauma and what barriers often get in the way.
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Listen to the podcast here
The Paradox Of Codependency And Mental Health With Adam Swanson [Episode 31]
Robin, how are you?
I’m good. How are you?
I’m super excited. We have a third co-host with us for this episode. It’s a triad.
We have two blondes on the show.
We have Dr. Louise Stanger with us co-hosting. Thank you for joining us as a co-host.
It’s my pleasure and honor. I’m so excited to be here.
Our special guest is a fellow Californian, Adam Swanson of Lido Wellness Center.
It’s nice to see you, guys.
It’s nice to see you. Thanks so much for doing this with us.
I wanted to do a little quick intro and then we’ll go into some more and have a good conversation here. Adam is a primary therapist at Lido Wellness Center. His goal is to bring into focus barriers preventing patients from thriving and help them cultivate their abilities to overcome challenges. Let’s see how he can help us.
Meet Adam Swanson
Adam, first of all, tell me about yourself, your background, and a little bit about you.
I am a California native so I was born and raised in LA County in Burbank. It’s a suburb of LA. Oddly enough, I fell in love with surfing. It’s been my pastime and passion since I was ten years old. I always wanted to get to the beach. I got myself to the beach and moved here. Not to give it a whole backlog history but I was a late bloomer in regard to figuring out what I wanted to do in this life and what my career was going to be.
You get asked that question a lot, “Why’d you become a therapist?” I almost felt tripped up sometimes with that question. Finally, I came to that place of accepting it. The answer is I followed a hunch. The intuition was like, “I think this is something I can do and be good at.” I remember my first day of our graduate program with that confirmation. I never liked school that much. I was never a bookworm. The school was just I had to do it.
I remember the first day of my program when I was like, “This is nothing I’ve ever experienced. I love this. I’m interested.” I was motivated. That lit that fire from then on. It was game on in regard to becoming a therapist and doing this work. Career-wise, like a lot of us therapists, I got my start interning in the nonprofit sector and working with a lot of families and younger children, which segued into getting into the addiction field, working with substance abuse treatment.
I suspect a lot of therapists in Southern California in particular will often fall into that almost because it’s such a mecca of treatment, especially for substance abuse in Southern California. I worked in that for years. I did my practice on the side, working with a lot of adolescents. I’ve always enjoyed working with adolescents because, in some ways, I do have that Peter Pan syndrome. I always question, “Do I want to grow up?” You work with adolescents. You can be like them for that session and be authentically there with them. I like that work.
At Lido Wellness, I’ve been working with primary mental health. That’s been fascinating and eye-opening for me coming from more of the addiction field and how to segue some of that into more primary mental health, the similarities, and the differences. It’s been a pure learning experience for me to be here for the last couple of years. I enjoy that. I love working with it again.
The best description of what I love working with is relationships and particularly codependency issues but on an individual level, working with the individual to help and navigate that. In some ways, it’s that notion, “Give me the one family member who is willing to do something about changing this family system.” I love digging into that. That’s the work I most enjoy doing.
That’s so cool. I can’t wait to hear more about Lido Wellness. We have a few things in common. I was a late bloomer as well. It took me a while to finish undergraduate school. I had way too much fun in undergraduate school. I loved my program. My undergraduate degree is in marketing and finance. I loved doing that but I knew that I wanted to do something else. That’s when I went in the direction of psychology and counseling but that expanded the time I took to graduate.
The other connection we have is Lisa Jane Vargas, which is why we’re here together. I used to work with Lisa Jane out in Arizona. I consider her a great colleague and a very good friend. She’s an amazing person in the field that we’re all in together around the country. Lisa Jane, I know you’re out there reading. Thanks for introducing us and making this happen. Kudos to you.
I’d love to know more about Lido wellness. Tell us about what Lido does but first, here’s a question before you tell us about Lido, if you don’t mind. You were talking about moving from addiction into mental health, and what that transition was like. It is different. Sometimes it’s very similar. We see people with comorbid addiction and mental health. Sometimes we see pure addiction, which is rare. Sometimes we see mental health with no addiction. What was that experience like for you? How do you see those two differing?
Addiction And Mental Health
The experience for me was very exciting at the front end. Like myself and a lot of therapists, you almost stumble into that field originally with substance abuse, not recovering myself. That was a huge learning experience in and of itself. I always had that lurking suspicion, “I wonder what it would be like to work with primary mental health.”
I was excited about it. It was maybe surprisingly similar where there were a lot of similarities in the therapy I was doing. That might be more indicative of how I do therapy. When working in substance abuse, it wasn’t like a dresshead on substance abuse. It would always be this back channel. Looking at mental health would usually drive substance abuse in many ways. I was already doing that, I suspect, without even putting my finger on it, than I was working with primary mental health in a way. That would then in turn fuel the recovery from addiction.
That’s why I was almost surprised at how not different my therapy sessions felt working with a primary substance abuse client versus working with a primary mental health abuse. It’s hard to tease out the difference between the populations or the facilities in particular but I noticed an advantage of the mental health field or working with that. There seems to be a stronger commitment, engagement, and motivation versus addiction. There seems to be these almost built-in resistances to it in a stronger way.
There just seems to be a stronger kind of commitment, engagement, and motivation in mental health versus addiction where there seems to be a built-in resistance.
I’m speaking in generalities. There are always outliers of crossover or change. There would be a little bit more of that resistance where you can almost feel the presence of the guard up because I suspect it had been, especially by the time they’d arrived in treatment. With clients, there seems to be a lot more repeat treatment episodes with that kind of population. In a way, that reinforces that resistance at times.
One of the big differences I noticed was a far greater motivation and openness to engage versus some of those almost unconscious resistance and guards that I would come across. Working in mental health seems to have more family involvement but maybe that might be pretty equal. There’s a particular challenge working with mental health primary. With substance abuse, there’s this objective, actual, existing outside of the person thing that the client, patient, or family can almost point to. It’s almost more tangible.
There are more measurable goals. It’s more like, “Have you remained sober for 1 month or 2 months?” There’s this easy goal to work toward and almost that tangible thing. With primary mental health, that’s gone in some way. It’s all internal. It’s how you measure the progress when it’s all a subjective report of the internal experience in a way. You could probably find some objective measures but it’s not easy like wearing the big, obvious substance. It is the thing out of them. That’s been my experience of the differences and similarities.
Segue into talking about primary mental health, tell us about Lido and what you guys do at Lido.
With Lido, I can only sing its praises. I know the context of what we’re talking about and I’m always very insecure about coming across as inauthentic but it is. The team of people here approaches a comprehensive treatment where you get a wraparound team of clinicians and almost abundance of therapists. I’ve joked about it with the leadership and ownership. It’s been two years and I’m waiting for the monster to come out of the closet. What’s the catch here? How you guys are able to have such a collaborative and compassionate team where none of the staff are overworked?
It’s completely very manageable caseloads. Pretty trauma-focused is what I would say as our specialty. Every patient who comes gets essentially a team of therapists where you have your primary therapist, which I am typically, who is more of the generalist and treats the whole spectrum. You get a specialist in trauma. You’re doing somatic experiencing or EMDR. You’re getting that team and having that focus. I haven’t experienced that in much other places, where we do focus on that collaboration and team approach. You get a family therapist. That’s a piece in there as well.
Adam, I’m bursting with questions and they know that. Before I ever start, I need to tell you that I love to hear the fact that you talked about surfing. Our family helped start the first water surfing school in the United States for women called Surf Diva, which has celebrated its another year at the Hawaiian Shores. It’s for anybody that can ride a wave. We do life-saving work. When we asked about Lido, I wanted to know how big it is and how many beds you have. In a perfect world, what would be your ideal client? I have the ability to either talk to people or refer to people all over the world. Tell me the age range or how big it is. That would be so helpful to all the audience of J. Flowers as well.
Also, for all the moms reading.
I would identify us as on the smaller side of what purpose. It’s a more intimate setting. We were an outpatient program. We don’t have residential. We work with partnered facilities for that piece when we need to refer out or when they’re referring for aftercare. We have a PHP and IOP program. For those of you who don’t know, that’s the treatment language. That’s either a full day of programming. It’s usually about 6 hours a day versus 3 hours a day. It’s this hydration or treatment down.
We have a mix of clients who are local and coming starting with us at that outpatient level. Some of our clients are coming from a residential program. They’re doing the next phase of treatment. Some are out of state so we do have supported housing. It’s not residential housing but supported housing to have some oversight, accountability, and supervision. Even in the housing component, you’re still coming to your treatment. You want some collaboration between those two entities but you also want to acknowledge that this is the next phase of treatment so you want to get to more freedom and responsibilities. You want a little bit of that separation at the same time.
We’re looking at a simultaneous separate PHP program and IOP running at the same time. We try to hold to that golden number of eight people in a group. There’s been times when we’ve had to split off and split our IOPs. We might have 2 IOP programs running and 1 PHP. That should give you an idea of the numbers of how big we are. It’s pretty small but more intimate.
That’s our forte if you will. We keep it small. We want to keep it to where you’re not coming into this giant facility and these big groups where you have that space to hide. The defense mechanisms can run amok. You have that oversight. There’s so much staff around. It’s very strong. I don’t know the numbers of the client-to-staff ratio, especially for clinical credentialed staff with the client ratio. It’s very strong where there are so many clinician therapists.
What’s the mental health range of diagnoses that you treat at Lido?
It sounds weird to say but we treat typical diagnoses, which can fall in post-traumatic stress disorder, major depressive disorder, or generalized anxiety. We’re comfortable extending into that range of the more acute diagnosis. There might be an eating disorder or some degree of psychosis that has maybe occurred. There might even be some psychotic features presenting themselves. As long as the patient is stable, it’s not necessarily a crisis situation. If those symptoms are almost swinging around and sabotaging the treatment progress, we’re comfortable managing that as well.
Our particular niche is more of the trauma piece and we’re working with that. You mentioned the ideal client, which is such a good question to ask. Our mission statement to paraphrase is essentially we want to be the last treatment facility that you should go to. It’s been my observation and I’m sure you guys are. It was the observation of our leadership team where we would see so many patients who almost get caught in the cycle of treatment. It’s a treatment episode or after treatment episode.
So many patients almost get caught in the cycle of treatment.
That’s why we pay particular attention to keeping that small setting with a wraparound team to catch those pieces that have been missed perhaps in the previous treatment episodes. That’s what we aim to do. The client that we seek is the one who’s fed up or can’t figure out why they keep getting in their way. “I’ve done this 3 times or five times over doing the same. Why do I keep getting it?” That’s our deal client.
Their age range isn’t targeted. We get anywhere from very young adults who are stagnated and developing and launching right into adulthood. I love working with that. We’ll have all the way up to the other types of phase of life transitions. It’s maybe the parents who are facing the whole empty nest syndrome and almost transitioning out of the work phase of life. It’s any kind of phase of life transition. From that phase of life into adulthood and that phase of life into almost retirement, that phase is where all the stuff starts manifesting. It’s a wide range.
Co-Dependency Within Families
Tell us about codependency within the families that you work with and how you work with codependency.
Codependency has been one of those things that interest me since coming from the world of substance abuse treatment where that term was even born out of. Not being in recovery myself, I was immersed in that kind of world. That’s what struck me as so interesting and tragic about how it unfolds with family systems and how you have these parents, spouses, or whoever the family members are who are surrounding the person suffering from addiction. It turns into what I call a paradox. I don’t know if I’m using the word right but we’re going to go with it.
I’ll call it a paradox of there’s so much love and care being poured out and so many protective reactions to fear that come in and do the classic rescue to the person from essentially facing the natural consequences of the actions that ensue when addiction takes hold. The question that everyone has and no one can answer is when does that become reinforcing to the addiction itself? It’s coming in, rescuing, and allowing the person to not essentially face rock bottom.
Is that perpetuating it? Is that creating more time and space for the miracle to happen? That is a horrific question to wrestle with as a parent when you have a child or a spouse who is suffering. You’re working on two extremely powerful drives in the human body, especially when it’s a parent. There’s an instinctual drive to protect our offspring at all costs and protect ourselves from pain.
You picture the parent who’s sitting there. They know their addicted child is out there and they have rescued them time after time, and nothing’s getting better. They’ve gone to Al-Anon and therapists who say, “You can’t let them back in the house.” We’ll keep it as simple as that example. “If you let them back in, this whole thing resets.” I always picture the parents sitting there. They know their child is out there on the street and they are facing all the dangers that that entails. Yet, they have to fight both of those instincts to protect them, bring them in, and also alleviate their fear.
They sit there for a whole night knowing they can’t let them back in. Sitting with that level of fear about the child is self-protection of their pain. No one wants to experience that kind of pain, knowing that could happen to their child. Those are powerful drives to try to get in. You have to do a counterintuitive thing and set the boundary, however that boundary might look.
Working with parents on that, for whatever reason, draws me in because of the empathy I feel for the parents and the family. I don’t know that many people understand the depth of that paradox and the difficulty of what it is to pull back and set the boundaries in that loving way. How do you do that? How do you square that even with your morality and value system? It’s so counterintuitive.
In my mind, families do the best that they can do with the resources they have. When they come to see someone like you or Lido or experience it, they learn how to do better. I think of mental health and you did mention that you specialize, or maybe Lido does or doesn’t. Probably the closest thing when you’re talking about addiction is you stop walking on eggshells. You all know Randy Krueger. I do agree with you on one thing, Adam. Families love it. If their loved one has a mental health problem, it is so much more palatable because the disease hasn’t taken them out. They haven’t lied, cheated, or stolen money. Sometimes they’re relieved.
Families do the best that they can do with the resources they have.
Sometimes they’d rather have a mental health diagnosis than a substance use disorder.
Both people with mental health or substance use disorders I found, and I’m sure you do too, are walking on eggshells. They don’t know what to do. They’ve done what they believe is the best they can do. Maybe your role, which I’m so excited that you’re so passionate about working with family, is to teach them new strategies and skills.
Lido Wellness Center
That’s been a somewhat unique challenge. I remember when I was segwaying into working with primary mental health. I was curious about how this whole codependency piece is going to manifest or how we are going to treat it here. We don’t have tangible substance to almost be the enemy. Almost in a way, you don’t have that advantage. There’s almost a different way it can manifest. It’s either good, where there isn’t that same stigma or bridges burnt, if you will. There are times where it is. It might not be a substance. Maybe it’s the personality features of a disorder that play into behaviors that push people away and burn bridges. It’s more difficult to deal with because those boundaries get a little more difficult to instruct on.
I love what you’re saying about the walk on eggshells. That’s such a good example of how boundaries might look a little different. With addiction, it’s a little more clear cut of don’t rescue but it comes to a family system where there’s a mental health issue and maybe it’s more of a personality feature even. The boundary is we can’t bite your tongue anymore around this. At every step along the way, you have to stop and say, “This is not okay the way you were addressing me. This is not okay what you’re saying to me.” Hold on to those boundaries and say no more walking on the eggshells. As a parent or spouse, I’m going to not shy around reality.
One variable, which we do have with mental health, is you’re the last resort so I’m sure you’re busy creating scaffolding. Medication management is a key indicator of mental health. For people who don’t want to take their medicine and don’t see that, that’s where they run into some kinds of problems. They probably end up back at Lido or take it until they feel better. “I’m all better. I don’t need it. I can go step down the Amazon or surf somewhere.”
Adam, it sounds like you are doing an amazing job at Lido.
Rapid Fire Questions
I had a couple of fun questions that I thought I’d ask to find out about Adam, the man, not Adam, the therapist. What’s your happy place? Where is it? Where are you?
The real happy place is my home with my family. It’s my wife and two young kids who I go home to. I love being on the floor. My favorite thing to do is sit on the floor and be a jungle gym to them. They love wrestling with me and climbing all over me. My wife always jokes about, “Dad’s the jungle gym.” They’re crawling all over and all kinds of that. That’s my happiest spot. The imaginary happy place is the ocean and surfing. I want the presence. Even imagining it is a happy place for me.
What music do you have on your playlist? Has it changed since COVID?
No. Music is an interesting one for me because I’ve never been the music guy where I go looking for and I have all these playlists built out. It’s some music that emotionally resonates or not. Believe it or not, the music that I like to listen to that inspires me is movie scores. I love listening to composers like Hans Zimmer, who is one of my favorites. There’s something about that magic inspirational score. I’ll put that on and listen to that while I work or drive home. I like modern rock folksy bands and stuff, too.
If someone wants to contact you, a mother, father, or family member who’s been reading, how would they contact you or Lido?
The easiest way, especially at this stage, is through virtual which are the websites. LidoWellnessCenter.com is for Lido. For my practice, it’s AdamSwansonMFT.com. The website builds out all the other contacts. You can find my phone number there or contact me directly. It’s the same with Lido. The phone number for admissions is there. It’s all built-in. That’d be the easiest way to contact.
That’s great. We love the work that you guys are doing at Lido Wellness. We wish you all the greatest success. Louise is going to come out and see you.
I’m so excited to meet you. I look forward to meeting you in person.
Thank you for your time.
Thank you so much. Sorry, we’re out of time.
This flew by. Thank you so much. I’m honored. It’s a privilege to meet you.
We look forward to meeting you in person someday. Thank you.
You’re so welcome. Take great care.
Be well. Have fun surfing. Catch that wave.
