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Dependent Personality Disorder

Written by WebMD Editorial Contributors

Dependent personality disorder (DPD) is one of the most frequently diagnosed personality disorders. It causes feelings of helplessness, submissiveness, a need to be taken care of and for constant reassurance, and an inability to make everyday decisions without an excessive amount of advice and reassurance from others.

This personality disorder occurs equally in men and women and usually becomes apparent in young adulthood or later as important adult relationships form.

What Are the Symptoms of DPD?

People with DPD become emotionally overdependent on other people and spend great effort trying to please others. People with DPD tend to display needy, passive, and clinging behavior, and have a fear of separation. Other common characteristics of this personality disorder include:

Inability to make decisions, even everyday decisions like what to wear, without the advice and reassurance of others
Avoidance of adult responsibilities by acting passive and helpless; dependence on a spouse or friend to make decisions like where to work and live
Intense fear of abandonment and a sense of devastation or helplessness when relationships end; a person with DPD often moves right into another relationship when one ends.
Oversensitivity to criticism
Pessimism and lack of self-confidence, including a belief that they are unable to care for themselves
Avoidance of disagreeing with others for fear of losing support or approval
Inability to start projects or tasks because of a lack of self-confidence
Difficulty being alone
Willingness to tolerate mistreatment and abuse from others
Placing the needs of their caregivers above their own
Tendency to be naive and to fantasize

What Causes DPD?

Although the exact cause of DPD is not known, it most likely involves a combination of biological, developmental, temperamental, and psychological factors. Some researchers believe an authoritarian or overprotective parenting style can lead to the development of dependent personality traits in people who are susceptible to the disorder.

How Is DPD Diagnosed?

A diagnosis of DPD must be distinguished from borderline personality disorder, as the two share common symptoms. In borderline personality disorder, the person responds to fears of abandonment with feelings of rage and emptiness. With DPD, the person responds to the fear with submissiveness and seeks another relationship to maintain their dependency.

If most or all the (above) symptoms of DPD are present, the doctor will begin an evaluation by taking a thorough medical and psychiatric history and possibly a basic physical exam. Although there are no laboratory tests to specifically diagnose personality disorders, the doctor might use various diagnostic tests to rule out physical illness as the cause of the symptoms.

If the doctor finds no physical reason for the symptoms, they might refer the person to a psychiatrist, psychologist, or other health care professional trained to diagnose and treat mental illnesses. Psychiatrists and psychologists use specially designed interview and assessment tools to evaluate a person for a personality disorder.

How Is DPD Treated?

As is the case with many personality disorders, people with DPD generally do not seek treatment for the disorder itself. Rather, they might seek treatment when a problem in their lives -- often resulting from thinking or behavior related to the disorder -- becomes overwhelming, and they are no longer able to cope. People with DPD are prone to developing depression or anxiety, symptoms that might prompt the individual to seek help.

Psychotherapy (a type of counseling) is the main method of treatment for DPD. The goal of therapy is to help the person with DPD become more active and independent, and to learn to form healthy relationships. Short-term therapy with specific goals is preferred when the focus is on managing behaviors that interfere with functioning. It is often useful for the therapist and patient together to pay attention to the role of therapist in order to recognize and address ways in which the patient may form the same kind of passive reliance in the treatment relationship that happens outside of treatment. Specific strategies might include assertiveness training to help the person with DPD develop self-confidence and cognitive-behavioral therapy (CBT) to help someone develop new attitudes and perspectives about themselves relative to other people and experiences. More meaningful change in someone's personality structure usually is pursued through long-term psychoanalytic or psychodynamic psychotherapy, where early developmental experiences are examined as they may shape the formation of defense mechanisms, coping styles, and patterns of attachment and intimacy in close relationships.

Medication might be used to treat people with DPD who also suffer from related problems such as depression or anxiety. However, medication therapy in itself does not usually treat the core problems caused by personality disorders. In addition, medications should be carefully monitored, because people with DPD become dependent on them or misuse certain prescription drugs.

What Are the Complications of DPD?

People with DPD are at risk for depression, anxiety disorders, and phobias, as well as substance abuse. They are also at risk for being abused because they may find themselves willing to do virtually anything to maintain the relationship with a dominant partner or person of authority.

What Is the Outlook for People With DPD?

With psychotherapy (counseling), many people with DPD can learn how to make more independent choices in their lives.

Can DPD Be Prevented?

Although prevention of the disorder might not be possible, treatment of DPD can sometimes allow a person who is prone to this disorder to learn more productive ways of dealing with situations.

The development of personality structure is a complex process that begins from an early age. Psychotherapy aimed at modifying personality may be more successful when begun early, when the patient is highly motivated for change, and when there is a strong working relationship between the therapist and patient.

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Dependent Personality Disorder: What Is It and Who Does It Affect?

5 minutes

Written and verified by the psychologist Valeria Sabater.

Last update: 15 November, 2021

The inability to be alone, an almost suffocating dependence on others, insecurity, no personal responsibility and an obsessive fear of being abandoned … These are the draining symptoms of one of the most common disorders around, but one which is the least recognized and treated. We’re talking about dependent personality disorder.

To understand this type of disorder a little more, we’re going to start with a simple example. George is 42 years old and today he has a job interview. When he finishes getting dressed that morning, his wife suggests that he wear another tie: the one he’s wearing is too dark, too serious looking. George takes it quite badly, although he doesn’t say anything, and confusion sets in. He soon begins to wonder if the shirt and trousers he chose are the right ones too, and if the shoes are ok…

“The state of your life is only a reflection of the state of your mind”
–Wayne Dyer–

Bewilderment and exhaustion

Bewildered by doubts and fears, he tells himself that he’s not going to get that job. Almost without him realizing, his negativity starts to increase, and sends him spiraling into obsession. He starts thinking that if he doesn’t get that job, his wife will most likely end up leaving him. However, his wife, already knowing what will be going through his mind, tells him that this is not going to happen and that she is there to support him, that she trusts him and that there is no reason to have those irrational fears.

He seems to cheer up, but Eva, his wife, breathes deeply, feeling once again the sting of despair. She knows that she’ll have to be encouraging and giving him boosts all day long… and maybe the whole week. She knows that George may not feel strong enough to attend the job interview any more. She also understands that her husband’s behavior is not normal. Sometimes it is very difficult for her to live with him and she is feeling more and more exhausted. She thinks that it is just his personality, and that he’s never going to change.

However, it is here where the root of the problem lies: to think that this type of behavior is normal and that nothing can be done about it. We just link them with this personality pattern and let them do what they want and go where they want. We accept them without understanding that what they are suffering is a disorder, an illness. A type of behavior that nullifies the person and their environment.

Dependent personality disorder or the fragile ego

Among the 10 types of personality disorders included in the DSM-V (Diagnostic and Statistical Manual of Mental Disorders), the most common one is the dependent disorder. The disorder is characterized, in essence, by a remarkable lack of self-confidence and the constant need to receive reassurance, security and support. During adolescence signs can sometimes be detected, but the symptoms are far more extreme and obvious when someone reaches 40.

On the other hand, as we pointed out at the beginning, people with dependent personality disorder are rarely aware that what they are suffering from is an illness. They only ask for help when they get to the end of their tether and see that they can’t control what is going on.

Characteristics of people with dependent personality disorder

Inability to be alone
Avoidance of responsibilities
Extreme passivity
Difficulty accepting or facing criticism
Inability to cope with the break up of a relationship
Obsessive fear of being abandoned
Extreme passivity in interpersonal relationships
Lack of initiative: they can’t make decisions without the support or advice of others

What are the causes and how is it diagnosed? Who does it usually affect?

It is currently unknown what causes this disorder . It is clear that it appears in adulthood and that some patients experience an anxiety disorder associated with the physical separation of their parents in their childhood or adolescence. It should, however, be noted that this is not always the case.

On another note, the estimated prevalence of this disease in the general population is two percent (although we know that many people who never get diagnosed). It is also more common in women than in men.

Now, as regards how this diagnosis is carried out, it is important to highlight here the work of the doctors. They are almost always the first point of contact, the first step to diagnosis, and they should refer these patients to specialized professionals.

The patient will first of all have a blood test to rule out any possibility of hormonal imbalance. After that, the symptoms and the medical history of the patient will be analyzed.

Treatment for dependent personality disorder

As with any disorder, each patient is unique. Sometimes, there may be more complications, such as depression, anxiety disorders, personality avoidance disorder etc., which further increase the medical issues to be addressed.

It is surprising to see how all emotional problems are in our mind: even dependencies such as alcoholism or smoking. If we have the mental key to free ourselves, it is easy to do so. But yes: change can only be found within us, in our way of thinking
–Rafael Santandreu–

However, it should be remembered here that the combination of psychotherapy with medical treatment is in most cases very effective. Cognitive-behavioral therapy, for example, focused on thought-patterns, beliefs or the inability to make decisions. is the most successful one. We can’t forget that they are long-term treatments either, approaches that are often combined carefully with antidepressants or sedatives, and where progress is regularly assessed.

And finally, we mustn’t forget the support of the patient’s family and friends. This close contact is the third pillar in the treatment, where the sufferer must combine a continuous effort, commitment and a strong will to improve and to fight for a much better quality of life.

Images courtesy of MEGHAN HOWLAND

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If you have grown up a long time ago, but still cannot live without care, it may be time to see a doctor.

You can also listen to this article. If it's more convenient for you, turn on the podcast:

What is Dependent Personality Disorder

This is a mental disorder. People with dependent personality disorder find it difficult to make any decisions on their own, so they obey others. They often shift responsibility to someone else, are afraid to be alone, feel helpless and put other people's desires above their own. nine0003

Usually this deviation is found in young people. Both men and women suffer from it.

Other problems may appear along with the disorder: depression, phobias, anxiety, substance abuse. Sometimes people become victims of abusers. This is because, due to the fear of loneliness, it is difficult for them to part with a dominant partner.

Where addictive personality disorder comes from

No one knows for sure, but scientists suggest that it appears due to developmental and biological factors. For example, a person who grew up in strictness or overprotectiveness, in childhood was often ill and anxious due to separation from someone, is more at risk of experiencing a disorder. nine0003

How to recognize dependent personality disorder

The Diagnostic and Statistical Manual of Mental Disorders lists eight main symptoms. To suspect a dependent personality disorder, it is enough to notice five signs.

1. Difficulty making everyday decisions

A person with a dependent disorder often needs someone else's advice or guidance. For example, he may depend on a spouse who tells you what to wear, where to work, and who to hang out with. nine0003

2. The need to shift responsibility for one's life to someone else

People with disabilities see themselves as inferior and think that they cannot take care of themselves. They become followers in order to get others to patronize them. Any criticism is perceived as proof of its failure.

3. Fear of disagreeing

If the opinion of a person with this disorder differs from someone else's, it will be difficult for him to express himself. Because of the fear of losing approval, he is more likely to agree with what he does not like. Moreover, for fear of losing support, he will not be angry with his loved ones, even if anger is appropriate. nine0003

4. Difficulties with own projects

People with this disorder believe that they cannot do anything alone. Therefore, it is difficult for them to work independently or take on tasks that require personal responsibility. They consider themselves incompetent and seek someone's help. If the boss controls or approves, the person with a dependent disorder is more likely to act appropriately. But because of the fear of being abandoned, he is unlikely to have a desire to become a professional himself. nine0003

5. Willingness to make big concessions

Dependency disorder can cause a person to endure physical and emotional abuse, agree to unreasonable demands, and take on unpleasant assignments. He thinks that being submissive will help him get support.

6. Discomfort from loneliness

Staying with oneself is unpleasant for a person. He feels helpless and afraid that he won't be able to take care of himself.

7. Tendency to establish relationships with those who will help

People with the disorder tend to enter into relationships with those they can depend on. When the relationship ends, they immediately look for a replacement partner. The need for care leads to promiscuity.

8. Fear of being alone

Even if the threat of being left alone is unrealistic, a person with a dependent disorder will still be afraid of losing their "guardian".

How Dependent Personality Disorder is Treated

Most often, people are not even aware of the disorder. They seek help when problems arise that cannot be dealt with alone. For example, depression or anxiety. nine0003

If the patient has signs of an addictive disorder, the therapist starts an examination. First, he collects an anamnesis and conducts a basic examination. Sometimes people are sent for tests. This is necessary to exclude physical diseases, due to which the symptoms of the disorder may also appear.

The next step is a visit to a psychotherapist or psychiatrist. These specialists have questionnaires and tests to diagnose disorders. But even here it is not so simple. It is easy to confuse dependent disorder with borderline because of the similar symptoms. But still there are differences. For example, people with the first type, because of the fear of loneliness, become submissive or look for new relationships, with the second, they react with anger, they have a feeling of emptiness. nine0003

A psychiatrist or psychotherapist prescribes therapy when an accurate diagnosis is made.

Psychotherapy

This is the main treatment that helps people with addictive disorder to become more active and build normal relationships with others. There are several suitable types of psychotherapy.

Social skills training. Helps you understand verbal and non-verbal cues during communication, keep a conversation going and communicate with confidence. In therapy, the patient may be offered role-playing games and simulations. This type of treatment is often combined with others. nine0077
Cognitive behavioral therapy. Needed by patients to become more self-confident. In the classroom, people with a disorder try to change their opinion of themselves and their abilities, struggle with destructive beliefs and fear of judgment.
Circuit therapy. Based on the fact that a person has a set of behaviors that he repeats throughout his life. Some of them may turn out to be maladaptive, that is, incorrect. Treatment aims to reinforce healthy patterns and eradicate unhealthy ones. Another psychotherapist may emphasize the re-education of the patient in order to meet his childhood needs. For example, a doctor will praise, set limits, and provide secure attachment. Also during therapy, a person with a disorder gains knowledge about basic needs, functional and dysfunctional behavior. nine0077
Mindfulness-based cognitive therapy. Helps to assess yourself and your strengths. Patients who underwent therapy learned to be more attentive to their hunches, emotions, and communication with others. For example, some people realize that “I am helpless” or “I am weak” attitudes are just thoughts, not facts.

Medications

Doctors rarely prescribe drugs to treat addiction. But if a person has anxiety or depression, they may be prescribed monoamine oxidase inhibitors or selective serotonin reuptake inhibitors. nine0003

How to help yourself if you have a dependent personality disorder

Psychotherapy is the best way to get rid of the disorder. But treatment can be supplemented with self-help. Here are some tips to help you deal with addictive personality disorder faster.

Enjoy your company

Think about what you can do when you are alone. It could be yoga classes, ten minutes of meditation, or reading a book during your lunch break.

Pick up a hobby

Ask yourself some questions. What would you like to know about? What brought you joy as a child? What subjects did you like the most at school? Perhaps the answers will tell you what you would be interested in doing in your free time.

Maintain your independence

Make a list of the things someone else does for you. Then find one small task that you can take on. Consider this an opportunity to grow, hone your skills, and build your confidence. nine0003

Develop a healthy relationship with yourself

Start small: think about what you like about yourself and give a compliment. Relax and get some sleep. Try self-compassion meditation to accept your shortcomings and stop criticizing yourself.

Features of psychotherapeutic work with clients with a dependent personality structure

Year of publication and journal number:

2012, No. 2

The article will not talk about people dependent on various substances, but about clients with a dependent personality structure.

In classifiers of mental disorders, when describing people with a dependent personality structure, the terms “Dependent Personality Disorder” (heading “Disorders of Mature Personality and Adult Behavioral Disorders in ICD-10) and “Dependent Personality Disorder” (heading “Personality Disorders”) are used in DSM-IV). nine0003

The characteristic features of this personality disorder include: active or passive shifting to others of making most important decisions in one’s life, lack of self-control, lack of self-confidence, “gluing” to the object of addiction, lack of psychological boundaries, etc. These psychological characteristics are often accompanied by various symptoms. Among them are often found: psychosomatic diseases, alcoholism, drug addiction, deviant behavior, co-dependent and counter-dependent manifestations. nine0003

Most often, the dependent personality structure manifests itself in the form of dependent and codependent behavior. Therefore, dependence and co-dependence are different forms of manifestation of the dependent personality structure.

They have a number of personal properties in common: mental infantilism, pathological attachment to the object of dependence, with the only difference being that in the case of dependence such an object will be a substance, and in the case of co-dependence, another person.

The professional activity of a psychologist/psychotherapist often focuses on a codependent client. nine0003

Typical characteristics of a co-dependent person are involvement in the life of the Other, complete preoccupation with his problems and affairs. A co-dependent person is pathologically attached to the Other: a spouse, a child, a parent. In addition to the highlighted qualities, co-dependent people are also characterized by:

low self-esteem;
need for constant approval and support from others;
uncertainty of psychological boundaries;
feeling of powerlessness to change anything in destructive relationships, etc. [2, p. 22]. nine0077

Codependents make the members of their system dependent on them throughout their lives. At the same time, co-dependents actively intervene in the life of the addict, control him, know how best to act and what to do, disguising their control and intervention as love and care. The other member of the couple - the dependent - has, accordingly, the opposite qualities: he is lack of initiative, irresponsible, incapable of self-control.

It is traditional to view addicts as some kind of social evil, and co-dependents as their victims. The behavior of codependents, as a rule, is socially approved and accepted. However, from a psychological point of view, the contribution of the codependent to such pathological relationships is no less than the dependent. The co-dependent himself no less needs the dependent - he is dependent on the dependent. This is a variant of the so-called "human" addiction. nine0003

Co-dependents themselves maintain dependency relationships, and when they escalate to a symptom, then they turn to a specialist to “cure” the addict, that is, in fact, return him to his former dependent relationship.

Any attempts by the dependent to get out of the control of the codependent cause a lot of aggression in the latter.

The partner of the co-dependent - the addict - is perceived as an object and its function in the pair of co-dependent-addict is comparable to the function of the object of the addict (alcohol, drug. ..). This function is to “plug a hole” in the identity of the co-dependent with the help of an object (in our case, a partner) in order to be able to feel whole, to find the meaning of life. It is not surprising that for a co-dependent, the dependent, despite all his shortcomings (from the point of view of the co-dependent), is so important, because he provides the most important function for him - meaning-forming. Without it, the life of a codependent loses all meaning. The dependent has its own object for this. Hence such a strong attachment of the co-dependent to the dependent. nine0003

It is not surprising that the Other occupies such an important place in the picture of the Codependent World. But with all the importance and fixation on the Other, the attitude towards it is purely instrumental - as a function. In fact, there is simply no Other for the codependent, due to his egocentric position, as an individual person with his experiences, aspirations, desires. Yes, the Other is present in the picture of the Codependent World, even exaggeratedly, but only functionally.

The reason for the formation of both dependent and codependent personality structure is the incompleteness of one of the most important stages of development in early childhood - the stage of establishing psychological autonomy necessary for the development of one's own "I", separate from parents. In fact, we are talking about a second birth - psychological, the birth of the Self as an autonomous entity with its own boundaries. According to G. Ammon, “... the formation of the border of the Self in symbiosis is a decisive phase in the development of the Self and identity. This emergence of the border of the Self, which contributes to the distinction between Self and non-Self in terms of identity formation, becomes possible due to the primary functions of the child's Self. In forming the boundaries of the self, the child also depends on the constant support of the environment, his primary group, especially the mother" [1, p. 65]. nine0003

In M. Mahler's research, it was found that people who successfully complete this stage at the age of two or three years have a holistic inner sense of their uniqueness, a clear idea of their "I" and who they are. Feeling your Self allows you to declare yourself, rely on your inner strength, take responsibility for your behavior, and not expect someone to control you. Such people are able to be in intimate relationships without losing themselves. M. Mahler believed that for the successful development of a child's psychological autonomy, it is necessary that both parents have psychological autonomy [5]. The leading condition for such a birth of the I of the child is its acceptance by parental figures. In the same case, when parents, for various reasons, are not able to accept (unconditionally love) their child, he remains in a state of chronic dissatisfaction in accepting his own self and is forced all his life to unsuccessfully try to find this feeling or obsessively “cling” to another ( co-dependent), or by compensating for this feeling with chemical surrogates (dependent). nine0003

In terms of psychological development, dependent and codependent are approximately on the same level. Undoubtedly, this is the level of the borderline organization of the personality structure with its characteristic egocentrism, impulsiveness as an inability to retain affect, and low self-esteem. The dependent-codependent pair is formed according to the principle of complementarity. It is difficult to imagine a couple of a person with an autonomous self and a co-dependent.

They also have a pathological attachment to the object of addiction in common. In the case of a codependent personality structure, such an object, as mentioned earlier, is a partner. In the case of an addict, a “non-human” object. The mechanism of “choosing” an object is not clear, but in both cases we are dealing with a dependent personality structure. nine0003

How do people with this personality structure get into psychotherapy? Most often, a psychologist/psychotherapist deals with two types of request:

1. The request is made by a co-dependent, and the client of the psychologist/psychotherapist becomes a dependent (the co-dependent brings or sends the dependent to therapy). In this case, we are faced with a situation that is not standard for psychotherapy: the customer is a co-dependent, and the client becomes a dependent. This situation seems to be prognostically unfavorable for therapy, since here we are not really dealing with the client - one of the necessary conditions for therapy is not observed - the client's recognition of his own "contribution" to the current problem situation, as well as the denial of the existence of the problem itself. As an example of the situation under consideration, we can cite cases of parents asking to “fix” the child’s problem behavior, or one of the spouses who wants to rid their partner of a pathological habit. nine0003

2. The codependent seeks therapy himself. This is a prognostically more promising option for therapy. Here we deal in one person with both the client and the customer. For example, parents seek professional help with a desire to sort out a problematic relationship with a child, or one of the spouses wants with the help of a psychotherapist to understand the reason for his relationship with a partner that does not suit him.

If in the first case psychotherapy is impossible in principle, then in the second case the codependent client has a chance. Despite this, such clients usually do not respond well to psychotherapy, since the range of their problems is due to a basic defect in their psyche. Lack of self-control, infantilism, limited scope of interests, “sticking” to the object of dependence are a serious challenge for a psychologist/psychotherapist. nine0003

Dependent clients are easily recognized at the first contact. Most often, the initiator of the meeting is a co-dependent close relative of the addict - mother, wife ... Often, the first feeling of the client is surprise. And not by accident. After talking with the calling mother about the problems of her boy, you naturally wonder how old he is? To your surprise, you find out that the boy is 25, 30, or even more ... So you come across one of the central qualities of the addict's personality - his infantilism. The essence of mental infantilism lies in the discrepancy between the psychological age and the age of the passport. Adult men and women in their behavior demonstrate childish traits atypical for their age - touchiness, impulsiveness, irresponsibility. Such clients themselves are not aware of their problems and are not able to ask for help from the environment - usually their relatives ask for help or someone brings them to therapy literally “by the hand”. The psychotherapist will have to work with a "little child" who is not aware of his desires, needs, his separation from the environment. Dependents always remain for co-dependent children. nine0003

Working with both dependent and co-dependent clients is not limited to the therapist-client relationship, but inevitably draws the psychotherapist into the field relationship. The psychologist/therapist has to work not with one person, but with the system. He is constantly drawn into these systemic relationships. It is very important for a psychologist/therapist to be aware of this. If he is drawn into systemic relations, he loses his professional position and becomes professionally ineffective, since it is impossible to change the system while being in the system itself. nine0003

One form of "pulling" the therapist into the system is the so-called triangles. Triangles are a necessary attribute of the life of dependent-codependent. S. Karpman, developing the ideas of E. Bern, showed that the whole variety of roles underlying the "games that people play" can be reduced to three main ones - the Rescuer, the Persecutor and the Victim. The triangle that unites these roles symbolizes both their connection and constant change. This triangle can be viewed both interpersonally and intrapersonally. Each role position can be described by a set of feelings, thoughts, and characteristic behaviors. nine0003

A victim is one whose life is ruined by a tyrant. The victim is unhappy, does not achieve what he could if he were released. She is forced to control the tyrant all the time, but she does not succeed well. Usually the victim suppresses his aggression, but it can manifest itself in the form of outbursts of rage or auto-aggression. To support a pathological relationship, the victim needs external resources in the form of help from the rescuer.

A tyrant is one who persecutes the victim, often believing that the latter is to blame and provokes him to "bad" behavior. He is unpredictable, not in charge of his own life, and needs the other person's sacrificial behavior in order to survive. Only the departure of the victim or a steady change in his behavior can lead to a change in the tyrant. nine0003

Rescuer is an important part of the triangle, which gives “bonuses” to the victim in the form of support, participation, various types of assistance. Without a rescuer, this triangle would fall apart, since the victim would not have enough of his own resources to live with a partner. The rescuer also benefits from participating in this project in the form of the gratitude of the victim and the feeling of his own omnipotence from being in a position "on top". The psychologist/therapist is initially assigned the role of a rescuer, but in the future he can be included in other roles - a tyrant and even a victim. nine0003

Analyzing the therapeutic relationship in work with the described clients, it should be noted that they (relationships) are quite unstable due to resistance in work on the part of both the client (addicted-codependent) and the therapist.

The co-dependent (most often the customer of therapy) is dissatisfied with the results of the work, because the psychologist/psychotherapist does not do what he would like. He most often consciously resists therapy, prevents it in every possible way, using an arsenal of the most harmless methods - excuses of the addicted to therapy, to quite serious ones - threats to both the client of therapy and the therapist himself. nine0003

The addict (client) - on the one hand, consciously wants changes, on the other hand, unconsciously resists it in every possible way, since he is pathologically attached to the codependent. He is infantile, lacking initiative, he is held back by guilt and fear. He often unconsciously connects the objects of the system to the resistance.

The psychologist/therapist may also unconsciously turn on the mechanisms of resistance to work. The feelings that he experiences for the client can hardly be classified as positive: fear, anger, hopelessness. ..

Fear of arises as a result of the fact that the position of a psychologist/therapist is quite vulnerable, it can easily be harmed, since the content of psychological assistance is not clear enough to ordinary people. There are no clear objective criteria for the success of therapy in the work of a psychologist/therapist. The position of a psychologist/therapist is also vulnerable in legal terms - often he does not have a license for this kind of activity due to legislative peculiarities. The position of a specialist is also unstable in terms of competition with medical colleagues - "psychotherapists in law". Any complaint from a dissatisfied customer can create many difficulties for a psychologist / psychotherapist. nine0003

Despair is due to the fact that working with such clients is long and slow, and the changes are small and unstable.

Anger is due to the fact that the client is a manipulator, a borderline personality, he is a great specialist in breaking psychological boundaries, including the boundaries of therapy and the therapist.

When working with clients with a dependent personality structure, it is important to remember a number of important points.

In the case where the client is an addict, the therapist does not work with the client, but with a systemic phenomenon, the client is a symptom of a dysfunctional system. In this regard, it is impossible to work with the client as a symptom in individual therapy. In this case, the best thing a psychologist/psychotherapist can do is to try to bring the codependent into therapy. In working with a co-addict, it will be strategically important not to be included in systemic relationships (the system is stronger), but to maintain his psychological autonomy in the client. The general strategy in working with both addicts and co-addicts is to focus on their psychological maturation. nine0003

Codependent personality therapy is a maturation therapy. The origins of codependency, as we noted earlier, lie in early childhood. The therapist needs to remember that he is working with a client who, in terms of his psychological age, corresponds to a child of 2-3 years old. Consequently, the goals of therapy will be determined by the developmental tasks characteristic of this age period. Therapy with clients with a dependent personality structure can be seen as a client “growing” project; such therapy can be metaphorically thought of as a mother-child relationship. This idea is not new. Even D. Winnicott wrote that in “therapy we are trying to imitate the natural process that characterizes the behavior of a particular mother and her child. … it is the “mother-infant” couple that can teach us the basic principles of working with children whose early communication with their mother was “not good enough” or turned out to be interrupted” [3, p.31]. nine0003

The main goal of therapy with clients with a dependent personality structure is to create conditions for the "psychological birth" and development of one's own "I", which is the basis for its psychological autonomy. To do this, it is necessary to solve a number of tasks in psychotherapy: restoring boundaries, gaining the client's sensitivity, primarily to aggression, contact with their needs, desires, learning new models of free behavior.

The use of the metaphor "parent-child" in the psychotherapy of codependent clients allows us to determine the strategy for working with them. The psychologist/therapist should be nonjudgmental and accepting of the various manifestations of the client's self. This makes special demands on the therapist's awareness and acceptance of the rejected aspects of his own Self, his ability to withstand manifestations of various feelings, emotions and states of the client, primarily his aggression. The development of destructive aggression makes it possible to get out of pathogenic symbiosis and delimit one's own identity [1, p.111]. nine0003

The psychologist/therapist will have to put in a lot of effort in building a trusting relationship before the client allows himself more freedom to express his own feelings and experiences. The appearance at the next stage of the work of the client's counter-dependent tendencies with aggressive reactions towards the therapist - negativism, aggression, depreciation - must be welcomed in every possible way. The client has a real opportunity to experience in therapy the manifestation of his “bad” part, while maintaining the relationship and not receiving rejection. This new experience of accepting yourself as a significant Other can become the basis for accepting yourself, which will serve as a condition for building healthy relationships with clear boundaries. The therapist, at this stage of therapy, needs to stock up on a capacious "container" for "storage" of the client's negative feelings. nine0003

A separate and important part of the therapeutic work should be devoted to the client becoming sensitive to his Self and integrating it. For clients with a dependent personality structure, selective alexithymia is characteristic, which consists in the inability to recognize and accept the rejected aspects of one's Self - feelings, desires, thoughts. As a result, the co-dependent, according to the definition of G. Ammon, has a “structural narcissistic defect”, which manifests itself in the existence of a “defect of the boundaries of the Self” or “holes of the Self”. The task of therapy at this stage of work is the awareness and acceptance of the rejected aspects of the Self, which contributes to “patching holes” in the client's Self. The discovery of the positive potential of "negative" feelings is the client's invaluable insights in this work, and their acceptance is a condition for the integration of his identity. nine0003

The criterion for successful therapeutic work is the emergence in the client of his own desires, the discovery of new feelings in himself, the experience of new qualities of his Self on which he can rely, as well as the ability to remain alone.

An important point in the therapy of clients with a dependent personality structure is the focus in work not on the symptoms of dependent behavior, but on the development of the client's identity. It must be remembered that the Other, as described above, performs a structure-forming function that gives the codependent a sense of the integrity of his Self, and in general - the meaning of life. F. Alexander spoke about the "emotional gap" that remains in the patient after the elimination of the symptom. He also emphasized the danger of psychotic disintegration that may follow. This "emotional gap" just means a "hole in the Self", a structural deficit in the border of the patient's Self. Therefore, the goal of therapy should be to assist the patient in the formation of a functionally effective boundary of the self, which leads to the uselessness of dependent behavior that replaces or protects this boundary .

An important criterion for the success of working with such clients is to overcome their egocentric position. This is manifested in the fact that the client begins to notice in the therapist and in other people their humanity - vulnerability, sensitivity. One of the markers of such a neoplasm is the appearance of a feeling of gratitude in the client.

Psychotherapy of a client with a dependent personality structure is a long-term project. There is an opinion that its duration is calculated at the rate of one month of therapy for each year of the client's life.

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