Residential and Day Treatment Therapies - Dependent Personality Disorder

Although hospitalization is sometimes necessary for the treatment of an Axis I disorder in individuals with dependent personality disorder, residential treatments are generally not indicated. However, residential and day treatment may provide support necessary to allow definitive psychotherapy to continue, when dependent personality disorder is complicated by recurrent depression, severe anxiety disorders, repetitive suicide attempts, other more severe personality disorders (such as borderline personality) or overwhelming life stress.

Several day treatment and residential programs for severe personality disorders have included individuals with dependent personality disorder. Active treatment days varied from 4 to 5 days per week over a range of 17-30 weeks and usually involved both group and individual sessions, most within a dynamic framework. All had moderate to large effect sizes. Piper et al. (1993) conducted a randomized controlled trial and found significantly greater changes in the day treatment than in the control groups. These data suggest a valuable role for these modalities when dependent personality disorder is not responsive to other outpatient therapies.

Conclusions

All of the treatment modalities reviewed in this chapter have been reported to be successful in some individuals with dependent personality disorder. Although large case series or controlled treatment trials specifically for dependent personality disorder are largely absent, the literature clearly suggests that a positive response to psychological treatments is common in most cases. The treatment is generally shorter and less difficult than for other personality disorders, such as borderline or antisocial personality disorder, although transference-countertransference problems may predispose to premature termination or delay improvement. At present, there is no clear indication whether the different therapies have differential treatment effects. The treatment literature would benefit from further case studies, as well as uncontrolled and controlled trials, in which specific treatment hypotheses and interventions are tested against patient outcome and follow-up.