The Best Therapy for Dependent Personality Disorder

July 10, 2019
In this article, we’ll talk about dependent personality disorder (DPD) and find out how it affects people and what therapy can be used to cure it.

In cognitive therapy for dependent personality disorder (DPD), the patient becomes increasingly autonomous and gradually modifies their contradictory thinking about their own autonomy and abilities.

What Is 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, over-attachment, and a fear of separation. It begins in the early stages of adulthood and can be seen in several different contexts. It’s common to see at least five of the following symptoms:

  • It’s hard for them to make decisions on a daily basis 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 disagreement with others for fear of losing their support or approval.
  • They have difficulty initiating projects or doing things on their own. This is due to a lack of confidence in their own judgment or ability, and not due to a lack of motivation or energy.
  • They strive to get acceptance and support from others, to the point of voluntarily doing things that they don’t really want to do.
  • Sufferers often feel uncomfortable or helpless when they’re alone. This is due to an unfounded fear of being unable to take care of themselves.
  • When a close relationship ends, they urgently seek another relationship in order to be properly cared for and supported.
  • They feel an unrealistic worry or fear of being abandoned and of having to take care of themselves.

A Poor Self-Concept

A person with DPD has a poor self-concept because they think that they can’t do what they really want to do. They believe that others have to save them because they’re stronger than them and also believe that they’re inadequate or helpless.

When you have these thoughts about yourself, the normal reaction is to look for other people to take charge of your own life. Finding someone to protect and care for them is the perfect solution to feeling inadequate or weak in a hostile and frightening world.

Cognitive therapy in DPD seeks to diminish the intensity of this reaction by improving a patient’s self-concept. To achieve this, it uses cognitive techniques such as guided discovery and Socratic questioning. In addition to that, it uses behavioral experiments and other more specific techniques.

A depressed woman.

How Does Dependent Personality Disorder Develop?

This disorder develops as many others do: as a reaction to past childhood and adolescent experiences. What underlies this disorder is an extreme fear of loneliness. This is due to the belief that the person can’t defend themselves from the “attacks” of the world.

They’re often people who, in childhood, experienced a certain lack of closeness. Thus, they grow up with an inner emptiness that creates an intense suffering, which they try to relieve with different people (normally partners).

It can also occur in cases of adopted children or in those who have been ill for a long time and have no choice but to depend on other people.

When people come to rely heavily on their parents, and their parents have overprotected them, then it’s likely that they’ll develop dependent personality disorder.

In general, their partners tend to complement them. This, in turn, just intensifies the need for dependence and decreases their motivation to act on their own. Their partners are people with more narcissistic tendencies, who tend to impose their own decisions on other people. They have no qualms about expressing their opinions, even if no one asked for them.

Therefore, the dependent person doesn’t have to make any effort in their day to day lives. Their partner is responsible for what they’re going to eat, how they’re going to decorate the house, and how many children they’re going to have, etc.

Cognitive Therapy for Dependent Personality Disorder

Cognitive therapy, when used for dependent personality disorders, first seeks to analyze what the main cognitive distortion is in these patients. Their way of thinking is completely opposed to the whole idea of independence.

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

  • “I can’t survive if someone isn’t looking after me.”
  • “I’m incapable of coping with life with the resources I have or those I can acquire.”
  • “Independence means living completely on your own.”

Similarly, they manifest contradictory thinking regarding their abilities. When you ask them to do something, they usually think they’re incapable of doing it. They believe their partner can do it far better than they can, or they say to themselves that they’re no good and that they always mess up.

Helping Patients Become Autonomous

This distorted thinking about their own autonomy needs to change. Experts need to help the patients learn how to separate themselves gradually from all the people they depend on. They also need to separate themselves from the therapist as well.

It’s also important that terms such as “dependence” and “autonomy” aren’t used at the start of the therapy. The reason for this is that patients don’t usually recognize that this is part of their problem. It’s far better for patients to realize this on their own as the therapy progresses. This way, it’s far more likely that they’ll eventually verbalize this discovery. This will help to set them on the road to recovery.

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

Socratic Questioning

In these patients, Socratic questioning becomes very important because it ensures that the patient has an active role. It isn’t good for the therapist to try to explain why the patient is feeling one way or another or how they should be acting and reacting. If we do that, then we simply reinforce the dependence we’re trying to treat.

The patient is the one who, little by little, is going to give material for the therapy sessions. They’ll decide what topics will be touched on and spoken about. Through the different questions asked, they’ll draw their own conclusions.

The therapist must be cautious and not be tempted to act as the patient’s savior. Therapy with these types of patients is sometimes slow and frustrating. Quite often, there’s the temptation to “save” the patient and tell them what they have to do. However, this would cause more harm than good.

Set Professional Limits

It’s crucial to establish professional limits. It isn’t uncommon to find dependent patients who have even fallen in love with their therapist. It must be made clear right from the beginning that there’s no option to go beyond the limits set by the therapeutic framework itself.

As a technique, it’s common to make the patient write down the topics they want to discuss in the therapy sessions in a diary. Another useful technique is for them to keep a record of specific evidence of their own personal capacities and achievements.

For the latter, it’s useful to have a gradual exposure to situations that the patient previously avoided – situations that they believed wouldn’t be able to endure. It’s a good idea for the dependent person to elaborate a hierarchy of decision making. They’ll write down all types of decisions they need to make.

Rehm’s Self-Control 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 self-observe, self-evaluate, and establish realistic goals and obtain reinforcement.

This is very important because overly-dependent people tend to set overly high standards and also underestimate how they can obtain them. Self-control therapy can benefit them considerably in this area.

  • Beck, A., Freeman, A., Davis, D. Terapia cognitiva de los trastornos de personalidad. Paidós. 2º edición (2015)
  • American Psychiatric Association (APA) (2014). Manual de Diagnóstico y Estadísitico de los Trastornos Mentales, DSM5. Editorial Médica Panamericana. Madrid