Session 13: Dependent Personality Disorder (DPD)

Essential Feature:

Pervasive pattern of excessive need to be T.C.O with resulting S &
C behavior

taken care of, submissiveness, clinging

Prominent Features:

* P
* little to no self-I
* debilitating I
* self-D & belittling of own assets/abilitiies
* docile, admiring, U
* little tolerance for N affect

pessimism, initiative, immaturity, doubt, unquestioning, negative

Self Image:

Self as I, H and P

inadequate, helpless, powerless

View of Others:
•unsophisticated and C and I;
•Seen as C of shouldering life’s
responsibilities; Objectified for C
potential

childlike, Idealized, capable, caretaking

Relationships:
Necessary for S; indulgently T

survival, tolerant

Issues with Authority:
C and deferential; anxious eagerness to P

Compliant, please

Behavior:
▪Cooperative, P & yielding
▪ Highly A to thoughts, feelings of O
▪ M difficulties, avoid C
▪ R unpleasant thoughts & feelings

Passive, attuned, others, Minimize, conflicts, Restrict

Affect:
▪ Chronic, mild D or dysthymia
▪ F
▪ L
▪ Diffusely A

depression, Fatigued, Lethargic, anxious

Defenses:
•Primary = I
•M
•D
•D
•F

Introjection, Minimization, Denial, Distortion, Fantasy

Self-Created World
•Safety & Security > Personal growth & A
•Common beliefs:
* Being “really good” is the equivalent of being “really S”
•People really mean W, even when they do things we don’t U
•Being in a loving R is the only real way to be happy

authenticity, safe, well, understand, relationship

Protective Factors for Substances:
▪ Desire to accommodate O
▪ Low self-I

Others, initiative

Risk Factors for Substances:
▪ Anxiety and S fears
▪ S emotions that denied for fear of
A
▪ Intensely strong unmet I & emotional
needs
▪ Need to escape C
▪ Susceptibility to use if P is using

Separation, Suppressed, abandonment, interpersonal, competency, partner

Drugs of Choice:
A
P drugs
Same D, same T, same
A, via same R of administration as P

alcohol, Prescription, drugs, time, amount, route, partner

Treatment Recommendations:
•Look beyond presenting complaints of A, tension and/or D
•Remember dependence on external support = key to maintaining A (build ongoing healthy S)
•Assume compliance = A
•C issues: Domination----Rejection
(accept idealized projection as W all-knowing presence ...Feel A, impatient or suffocated by
N/clinging behavior: Know yourself and your
limits re: client dependency
•Encourage A self- appraisals, teach D making skills, self-S skills & R tolerance
• G increase expectation for autonomous decision making
• Assess cost/benefit of M intervention
• Consider G therapies inc AA/NA (with guidance and reinforcement re: peer choices)
• Assess social environment for sources of peer pressure or
encouraged D use

anxiety, depression, abstinence, supports, agreement, Countertransference, wise, annoyed, neediness, accurate, decision, soothing, rejection, Gradually, medication, Group, drug

Things to Avoid in Treatment:
• Make independent functioning I therapeutic goal
• Replicate D-S pattern of relationship
• Prematurely challenge clients to L abusive relationships
• Underestimate A fears
• Underestimate potential for D or V

initial, dominance-submission, leave, abandonment, disinhibition, violence

The therapeutic alliance & treatment of Personality Disorders (Bender)

▪ Concept of often traced back to F
▪ Observed the need to convey I & S to the patient

▪ DEFINITION: “The patient’s ability to form a rational alliance arises
from ‘the therapeutic split in the E which allows the analyst to work
with the healthier elements in the patient against resistance P”

▪ Recognizes:
▪ P parts of personality
▪ Need for clinician to be C in adaptive aspects

Freud, interest, sympathy, ego, pathology, Pathological, creative

Bender: Stages of Treatment

▪C (Behavioral)
▪ R (Affective/Empathic)
▪ Working P (Cognitive/Motivational)

Contractual, Relational, Phases

Head: