By Rick Hardt, DDS

Codependency and cash flow

Oct. 1, 2011
Positive cash flow is something nearly everyone can get excited about.

Positive cash flow is something nearly everyone can get excited about. The freedom and security that financial independence offers is a visual image that can be easily tapped into. Ongoing uncertainty in our political and economic world has created new and unprecedented fervor in our quest to attain more security.

While increasing cash flow through business strategies is the most direct approach to achieving that goal, I believe there is an important underlying perspective that is much more effective in the long term and broader picture. It is free and accessible to anyone who has the passion and motivation to explore it.

This brings me to my topic —


The term codependency was first coined by treatment centers in the ‘70s to describe the traits and behaviors of those in a relationship with an active addict or alcoholic. Over the years it has developed into a catchphrase recognized by many, but it’s usually used as a negative label for one who is obsessed with another, as in the movie “Fatal Attraction.”

Many mental health professionals are taking a fresh look at this condition. Much like a tasty sauce that can be drizzled over your favorite food, they’ve boiled it down to a more palatable definition that can be tasted by a much broader audience.

The beauty of this reduction process is that it’s made the information usable for virtually anyone who is interested in ongoing character development, and in becoming the best, most effective person that they can.

I will briefly describe the condition, and then discuss its relevance to dentistry and cash flow.

Codependency springs from an imbalance in five core areas of character development

  • Self-esteem
  • Boundaries
  • Reality and perfectionism
  • Dependence
  • Maturity

In an ideal developmental environment, we gain abilities or skill sets in each of these areas that allow us to thrive in our relationships. These skill sets allow us to fully bloom into authentic and passionate people, while fostering trust and intimacy in all our relationships.

Consider the relationship aspect of the practice of dentistry

There are relatationships with:

  • Staff
  • Patients
  • Patients' families
  • Specialists
  • Labs
  • Supply companies
  • Supply reps
  • Accountants
  • Other dentists
  • The dentist's family and dependents
In less than ideal developmental circumstances, we tend to develop into extremes.
  • Low self-esteem vs. arrogance
  • No boundaries vs. walls
  • Bad and rebellious vs. good and perfect
  • Overly dependent vs. antidependent immature
  • Chaotic vs. mature and over controlling.

Imbalance in any of these areas can lead to a relationship breakdown through lack of trust.

To summarize, those who suffer from some level of imbalance in these areas have difficulty with

  • Self-esteem
  • Boundaries
  • Reality and perfectionism
  • Adequate and effective self-care (instead of learning great self-care, we depend on processes and addictions)
  • Moderation

These issues all work together to lead to symptoms.

See if you recognize any from the dental arena …

  1. Feeling victimized or resentful toward staff
  2. Feeling victimized or resentful toward insurance companies
  3. Feeling victimized or resentful toward patients
  4. Our sense of serenity and well-being is tied to cash flow
  5. We may treat patients and staff differently depending on cash flow
  6. We may have difficulty owning our mistakes and making them right, saying, for instance, “the lab did it”
  7. We may have difficulty owning our reality regarding employee performance (we hate employee reviews)
  8. We may present treatment differently to different patients depending on their appearance and our perceived level of affluence
  9. We may have difficulty presenting treatment to some because of the fear of hearing “no”
  10. We may give away free dentistry to unknowingly manipulate a patient's perception of us

Healthy Boundaries

Imagine how cash flow could be increased with the idea of healthy boundaries in doctor and staff. A doctor with good boundaries could effectively present comprehensive treatment with little or no attention on potential rejection. This same doctor could find it very easy to say no to certain patients who push him or her to go against his or her better judgment to refer.

The doctor could also be adept at managing the schedule in a way that he or she is more rested and less stressed and infinitely more productive when chairside. The need to compromise his or her health and wellness because of people pleasing could be minimized. A financial coordinator with good boundaries could be very comfortable with establishing financial arrangements before each procedure, thereby minimizing collection problems through great communication.

With those few changes alone, production and collection could be substantially and predictably increased over time. Dental professionals who become aware of and treat whatever level of codependency may be affecting them and their relationships will create a deep sense of trust and stability in all arenas.

The financial downpour of a booming economy will create a deep and slow moving river of relational and financial assets that survive drought rather than producing a flash flood of productivity that is here today and gone tomorrow.

To the interested party, I suggest — read, understand, discuss

Pia Mellody writes about what is discussed here. You can find her books on Internet bookstores. Melody Beattie is another well-known author whose work can be found on the web.

There are workshops provided by treatment centers that provide excellent experiential education and direction for a fee, similar to other continuing dental education. Most are four days to one week long. My two favorites are Survivors 1 and 2 at the Meadows in Wickenburg, Ariz., and Living Centered at Onsite Workshops near Nashville, Tenn.

I thought that the hardest part at the workshops was accepting the idea that codependency might exist in me. I couldn’t see what I was afraid to look for. In my opinion, the returns in cash flow alone are worth the investment.

Rick Hardt, DDS, practices general dentistry in Porterville, Calif. He serves as central California regional chair with the CDA well-being committee. The state committee works with component dental societies to provide intervention and monitoring for dental professionals who have trouble with drug and alcohol impairment. Reach Dr. Hardt at [email protected].

For more on this topic, go to and search using the following key words: codependency, cash flow, self-esteem, reality, perfectionism, Rick Hardt, DDS.

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