Dependent personality disorder: Effective time-limited therapy
Help turn neediness into flexible, adaptive behavior.
Shift responsibility. When you provide adequate structure early in treatment, the dependent patient will feel secure enough to open up and disclose troubling thoughts and feelings. Then, as therapy progresses, help the patient experience autonomy and competence within the therapeutic milieu by gradually requiring him or her to take on increasing responsibility for structuring treatment.10
Beware of countertransference. Many therapists infantilize dependent patients, and exploitation or abuse—financial or sexual—may follow. You must acknowledge and confront these problematic feelings when they occur, either in formal clinical supervision or in informal consultation with other mental health professionals.4,21
Two countertransference reactions are particularly common (and problematic) in therapeutic work with dependent patients:
- the fantasy of insatiability (believing that no matter how much support and reassurance the patient receives, it will never be enough)
- the fantasy of permanence (believing the patient will become so comfortable in therapy’s protective cocoon that he or she will never leave treatment).
Because some studies suggest that dependent patients may be at increased risk for suicide, monitor them continuously for negative indicators.8,9 Five danger signs (Table 4) suggest an increased risk of self-destructive behavior in dependent patients.
Table 4
5 warning signs of self-destructive behavior in dependent patients
| Recent relationship conflict or interpersonal loss |
| Excessive or unrealistic jealousy |
| Poor impulse control |
| Difficulty modulating negative emotions |
| Previous suicide attempts or suicidal gestures |
Because dependent persons often construct interpersonal milieus that foster and propagate their dependency, concurrent marital and/or family therapy may be warranted to disrupt entrenched dysfunctional patterns.16,17 Examine the rewards dependent patients obtain for behaving helpless and vulnerable and ways in which their dependency may reward friends, family members, and coworkers.
Related resources
- Baltes MM. The many faces of dependency in old age. Cambridge, UK: Cambridge University Press; 1996.
- Bornstein RF. The dependent personality: developmental, social, and clinical perspectives. Psychol Bull 1992;112(1):3-23.
- Millon T. Disorders of personality: DSM-IV and beyond. New York: Wiley; 1996.
The author reports no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products.
