Therapy For Dependent Personality Disorder

In cognitive therapy for dependent personality disorder, the patient becomes increasingly autonomous and gradually changes his conflicting ideas about his own autonomy and possibilities.

What is a dependent personality disorder?

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a person with dependent personality disorder experiences a dominant and excessive need to be cared for.

This leads to submissive behavior, excessive attachment and fear of separation. It starts in the early stages of adulthood and can be seen in a variety of contexts. It is common to see at least five of the following symptoms:

• It is difficult for them to make daily decisions without depending on the advice and peace of mind that other people can give them.

• They need others to take responsibility for the most important areas of their lives.
• The person has difficulty expressing a difference of opinion for fear of losing the support or approval of the other person.
• They have difficulty initiating projects or doing things independently. This is due to a lack of confidence in their own judgment or ability, not a lack of motivation or energy.
• They strive to gain acceptance and support from others, even when they have to voluntarily do things they don’t really want to do.
• The person often feels uncomfortable or helpless when alone. This is due to the unfounded fear of not being able to take care of oneself.
• When a close relationship ends, they immediately seek another relationship to be cared for and supported.

• They feel unrealistic worries or fear of being abandoned and having to fend for themselves.

Bad self image

A person with dependent personality disorder has a poor self-image because he thinks he can’t do what he really wants. They believe that others must save them because they are stronger than they are and also feel that they are inadequate or helpless.

When you have these kinds of thoughts about yourself, the normal response is to look for other people to take control of your own life. Finding someone to protect and care for them is therefore the perfect solution when they feel inadequate or weak in a hostile and terrifying world.

Cognitive therapy attempts to reduce the intensity of this response in a dependent personality disorder by improving the patient’s self-image.

To achieve this, it uses cognitive techniques such as  guided discovery and the Socratic method. In addition, it uses behavioral experiments and other more specific techniques.

How does dependent personality disorder develop?

This condition develops like many others: in response to past experiences of childhood and adolescence. The cause of this condition is an excessive fear of loneliness. This is due to the belief that the person cannot defend against the “attacks” of the world.

They are often people who experienced a certain lack of connection in childhood. Thus, they grow up with an inner emptiness, which causes intense suffering, which they try to alleviate through different people (usually partners).

It can also occur in adopted children or in children who have been ill for a long time and cannot help but depend on other people.

When people become highly dependent on their parents and their parents protect them too much, it is quite possible that they will develop a dependent personality disorder.

In general, their partners tend to complement them. This in turn justifies the need for dependence and reduces their motivation to act independently.

Their partners are often people with more narcissistic tendencies, who tend to impose their own decisions on other people. They have no qualms about expressing their opinion, even if no one asks.

Thus, the dependent person does not have to make any effort in his daily life. Their partner is responsible for what they are going to eat, how they are going to furnish the house, how many children they are going to have, and all the other big decisions.

Cognitive therapy for dependent personality disorder

When cognitive therapy is used for dependent personality disorders, it first tries to analyze what the most important cognitive impairment is in these patients. Their way of thinking is completely at odds with the whole idea of ​​independence.

People with dependent personality disorders tend to have beliefs such as:

• “I can’t survive if someone doesn’t take care of me.”
• “I am unable to cope with life with the resources I have or can acquire.”
• “Independence means living completely alone.”

Likewise, they manifest conflicting beliefs about their abilities. When you ask them to do something, they usually think they are incapable of doing it. They believe that their partner can do a lot better than them, or they tell themselves that they are not good and that they always screw up.

Helping patients regain control

This kind of twisted thinking about their own autonomy needs to change. Experts should help patients gradually separate themselves from all the people on whom they depend. They also eventually have to separate from the therapist.

It is also important that terms such as “dependence” and “autonomy” are not used at the beginning of therapy. The reason for this is that patients usually do not see that this is part of their problem.

It is much better for patients to realize this themselves as the therapy progresses. In this way, it is much more likely that they will eventually articulate this discovery. This will help put them on the road to recovery.

At the beginning of therapy there should be some degree of dependence. The reason for this is that the therapist will initially have to do more than half of the work. However, this pattern will change during the therapy sessions.

The Socratic Method

The Socratic method is very important in this disorder because it ensures that the patient plays an active role. It is not good for the therapist to keep explaining why the patient feels a certain way or how to act and react.

If the therapist does, he or she is still reinforcing the dependency he or she is trying to treat. The patient is the one who will gradually provide material for the therapy sessions. He or she will decide which topics will be touched and discussed. They draw their own conclusions because of the different questions that are asked.

The therapist should be careful and not be tempted to act as a savior for the patient. Therapy with these types of patients is sometimes slow and frustrating. Often there is the temptation to “rescue” the patient and tell him what to do. However, this would do more harm than good.

Set professional boundaries

Establishing professional boundaries is critical. It is not uncommon to find dependent patients who even fall in love with their therapist. It must be made clear from the outset that there is no option to go beyond the limits of the therapeutic framework itself.

As a technique, it is common for the patient to write in a journal the topics he or she wants to discuss in the therapy sessions. Another useful technique is to keep specific evidence of their own personal abilities and achievements.

With the latter, it is helpful to gradually experience situations that the patient has previously avoided—situations they thought they could not tolerate. It is a good idea for the dependent person to work out the hierarchy in decision-making. They will write down all kinds of decisions they have to make.

Rehm .’s self-monitoring therapy

Finally, Rehm’s self-control therapy has been proven to be an effective therapy for dependent personality disorder. This therapy trains the person to observe, evaluate, set realistic goals and gain reinforcement.

This is very important because overly dependent people tend to set too high demands and also underestimate how to achieve them. Self-monitoring therapy can help them significantly in this area.