Treatment of Dependent Personality Disorder
Table of Contents
Individuals with dependent personality disorder are usually quite needy, for
attention, valuation, and social contact. Clients with this disorder usually
don't present in a dramatic fashion, but will often make repeated requests for
attention to their complaints, whether these complaints are about their
lifestyle, social relationships, lack of meaning in life, medical, or education.
People who suffer from dependent personality disorder are often outwardly compliant with
clinicians' suggestion for treatment, and will usually be passive in their
overall treatment, no matter what form it takes. However, real gains in therapy
may not be made easily, because the client's compliance (due to the disorder) is
often only surface-deep. While the individual may be one of the easiest to see
week-after-week or month-after-month in therapy, they may also be one of the
most difficult because of their strong need for constant reassurance and
support. Dependency upon the clinician specifically and therapy in general
should be carefully monitored and avoided.
Psychiatrists and physicians should be aware that individuals with dependent
personality disorder will often present with a number of physical or somatic
complaints. While appropriate medications need to be prescribed for these as
necessary, the clinician should carefully monitor medication intake and
maintenance to ensure the patient is not abusing it. Physical complaints should
not be minimized or dismissed, as is often the case with someone who suffers
from this disorder, but they must not also be encouraged. A simple,
matter-of-fact approach works best in this case.
Clinicians in general should be wary of the therapeutic relationship with a
person suffering from dependent personality disorder. The needs of the
individual can be great and overwhelming at times, and the patient will often
try to test the limits of the frame set for therapy. Burnout among therapists
treating this disorder is common, because of the client's demands for constant
reassurance and attention, especially between therapy sessions. A clear
explanation at the onset of therapy about how treatment is to be conducted,
including a discussion of appropriate times and needs for contacting the
clinician in-between sessions, is vitally important. While rapport and a close,
therapeutic relationship must be established, the boundaries in therapy must
also be constantly and clearly delineated.
As with all
personality disorders,
psychotherapy is the treatment of choice.
Treatment is likely to be sought by individuals suffering from this disorder
when stress or other complications within their life have led to decreased
efficiency in life functioning. As with all other personality disorders as well,
they may present with a clear Axis I diagnosis and the personality disorder may
only become apparent after a few sessions of therapy.
The most effective psychotherapeutic approach is one which is focuses on
solutions to specific life problems the patient is presently experiencing.
Long-term therapy, while ideal for many personality disorders, is
contra-indicated in this instance since it reinforces a dependent relationship
upon the therapist. While some form of dependency will exist no matter the
length of therapy, the shorter the better in this case. Termination issues will
likely be of extreme importance and will virtually be a litmus test of how
effective the therapy has been. If the individual cannot end therapy
successfully and move on to become more self-reliant, it should not be seen as a
therapeutic failure. Rather, the individual was not likely seeking life-changing
therapy in the first instance but instead solution-focused therapy.
Examining the client's faulty cognitions and related emotions (of lack of
self-confidence, autonomy versus dependency, etc.) can be an important component
of therapy. Assertiveness training and other behavioral approaches have been
shown to be most effective in helping treat individuals with this disorder.
Group therapy can also be helpful, although care should be utilized to ensure
that the patient doesn't use groups to enhance existing or new dependent
relationships. Challenging dependent relationships the client has with others
that may be unhealthy for the client should generally be avoided at the onset of
therapy. As therapy progresses, these challenges can occur but must be done
carefully; restraint must be used if the individual is not ready to give up
these unhealthy relationships.
continue: Medications and Self-Help for DPD
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Reviewed: 04/2006
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