Dependent Personality Disorder Cognitive-Behavioral Therapy

Turkat and Carlson reported two behavioral treatments of a patient with dependent personality disorder. The patient initially had been treated with behavioral techniques for anxiety-related complaints but had relapsed immediately after termination. The authors then reformulated the case, focusing on the dependency constructs of excessive reliance on others and deficient autonomous behavior, which resulted from long-standing anxiety over independent decision making. The therapist and patient constructed a hierarchy of situations with which the patient had little experience but about which the patient was required to make independent decisions. The therapist emphasized anxiety management skills, which had been taught previously. Treatment was given every other week over a 2-month period. The patient showed decreasing levels of self-rated anxiety over these situations as treatment progressed; these gains were maintained over a 1-year follow-up interval. Avoidance of situations requiring independent decisions also diminished.

A. T. Beck et al. described cognitive-behavioral treatment for dependent personality disorder, refined and expanded by J. S. Beck. As in dynamic treatments, they viewed the patient-therapist relationship as a microcosm of the patient's dependent beliefs and behaviors. The therapist must foster the therapeutic alliance early and adjust the therapy to maintain it. For instance, some patients need to begin a session by telling the therapist whatever is on their mind in order to cooperate with the more structured tasks. Treatment is based on a formulation, and each technique is used to foster accurate self-appraisal and independent decision making and behavior. The patient's dependent behavior is initially accepted, but the therapist encourages self-reflection and agenda setting for sessions.