Dependent Personality Pattern and Therapeutic Alliance: An Illustration of Schema-Based Cognitive Therapy

Abstract

Dependent personality pattern (DPP) is common when compared to other personality disorders among outpatient population. Dependent people are characterized with strong reliance on others, feelings of defectiveness, impaired autonomy and clingy behaviors. They may involve compliant behaviors in order to maintain emotional nurturance. As can be expected, these features plays crucial role in therapeutic relationship. Since dependent patient’s view of self is based on their faulty assumptions of inadequacy, they tend to catastrophize even ordinary withdrawal behaviors of therapists such as vacations or lateness. Therefore, dependent people can display more assertive and destructive behaviors when they perceive their major relationships in danger.

From the perspective of personality disorders, cluster C group responds better to psychotherapy. Similarly, among cluster C disorders, patients with dependent personality disorder reveal better treatment outcomes. However, research regarding the effectiveness of different treatment approaches is limited.

In this regard, exploring specific techniques that are especially important for the treatment of the patients with DPP becomes more of an issue. DPP has complicated features and recent research that constantly emphasize the importance of therapeutic relationship in change process. Considering these notions, in the present study, schema therapy was employed as an integrated treatment approach that utilizes the negotiation of therapeutic alliance as a technique. Hence, as a major aim of the therapeutic process, Schema model of dependent personality is utilized with respect to the importance of negotiating therapeutic alliance in terms of schema related cognitions and schema modes.

The current paper aims to investigate specific aspects of dependency and their demonstration in the therapeutic relationship by referring clinical experience and the current literature findings. The literature findings are discussed based on the case of a patient with DPP for a more comprehensive understanding of the issue. Accordingly, the integrative approach of schema therapy combined with the help of the therapeutic experience and the active guidance of the therapist, the patient’s destructive ways of overcompensation and surrender coping styles are elicited and repression of the fragile thoughts and emotions in terms of schema overcompensation reduces. These successful attempts seem to increase the patient’s self-efficiency and motivation to take more autonomous behaviors. Hence, present study presents a demonstration of how to handle deteriorations in the therapeutic relationship and provides important insights regarding the role of therapeutic relationship in the therapy process of people with DPP.

Keywords

• Dependent personality pattern,therapeutic alliance,schema based cognitive therapy

Bağımlı Kişilik Örüntüsü ve Terapötik İşbirliği: ŞemaOdaklı Bilişsel Davranışçı Terapi Uygulaması

Abstract

Bağımlı kişilik örüntüsü (BKÖ) klinikte tedavi gören danışan örnekleminde oldukça yaygındır. BKÖ gösteren kişilerde diğerlerine aşırı güvenme, yetersizlik hisleri, zedelenmiş özerklik ve yapışkan davranışlar görülebilir. Hali hazırda sağlanan bakımı sürdürebilmek için duygusal açıdan bakım veren kişilere yönelik itaat davranışları görülebilir. Öte yandan, bu kişiler temel ilişkilerini tehlikede hissettiklerinde oldukça girişken ve iddialı davranışlarda da bulunabilirler. Kişilik bozuklukları perspektifinden bakıldığında da, C grubu bozukluklar genellikle psikoterapiye daha iyi cevap verirler. Bu grubun içerisinde de bağımlı kişilik bozukluğuyla yürütülen çalışmalar daha iyi tedavi sonuçlarına işaret etmektedirler. Ancak, farklı tedavi yaklaşımlarının bağımlı kişilik bozukluğunu tedavi etmedeki etkililiklerine yönelik araştırmalar kısıtlıdır. Bu çerçevede, bağımlı kişilik bozukluğu veya örüntüsüne sahip kişilerin tedavisinde hangi spesifik tekniklerin etkili olduğunun araştırılması önem kazanmaktadır. BKÖ’ne yönelik şema terapi modelleri, şemalarla ilişkili bilişler ve şema modları çerçevesinde,terapötik ilişkiyi ele almanın terapi sürecinde temel amaç oluğunu vurgulamaktadır. Bu yüzden mevcut vaka analizinde, bağımlılığın spesifik yönlerinin ve terapötik ilişkide bu yönlerin nasıl kendisini gösterdiğinin klinik deneyim ve mevcut yazın çerçevesinde incelenmesi amaçlanmıştır. Yazından elde edilen bilgiler, daha kapsamlı bir içerik sunabilmek için bağımlı kişilik bozukluğu tanısı alan 43 yaşındaki bir kadın danışan üzerinden tartışılmıştır.

Keywords

• Bağımlı kişilik örüntüsü, terapötik ittifak, şema odaklı bilişsel terapi

References

1. Alexander, J. F. ve Abeles, N. (1968). Dependency changes in psychotherapy as related to interpersonal relationships. Journal of consulting and clinical psychology, 32(6), 685.
2. Arntz, A.(2012). Schema therapy for cluster C personality disorders. The Wiley-Blackwell
3. Handbook of Schema Therapy: Theory, Research, and Practice, 397-414. Association, A. P. (2000). Diagnostic and statistical manual of mental disorders: DSM-IV-TR®:
4. American Psychiatric Pub. Baillargeon, P., Coté, R. ve Douville, L. (2012). Resolution Process of Therapeutic Alliance
5. Ruptures: A Review of the Literature. Psychology, 3(12), 1049-1058.
6. Beck, A. T., Freeman, A., ve Davis, D. D. (2007). Cognitive therapy of personality disorders: Guilford Press.
7. Bender, D. S. (2005). The therapeutic alliance in the treatment of personality disorders. Journal of
8. Psychiatric Practice®, 11(2), 73-87. Bordin, E. S. (1979). The generalizability of the psychoanalytic concept of the working alliance.

9. Psychotherapy: Theory, Research & Practice, 16(3), 252. Bornstein, R. F. (1992). The dependent personality: Developmental, social, and clinical perspectives. Psychological Bulletin, 112(1), 3.
10. Bornstein, R. F. (1993). The dependent personality: Guilford Press.
11. Bornstein, R. F. (2004). Integrating cognitive and existential treatment strategies in psychotherapy with dependent patients. Journal of Contemporary Psychotherapy, 34(4), 293-309.
12. Bornstein, R. F. (2011). An interactionist perspective on interpersonal dependency. Current
13. Directions in Psychological Science, 20(2), 124-128. Bornstein, R. F. (2012). Illuminating a Neglected Clinical Issue: Societal Costs of Interpersonal
14. Dependency and Dependent Personality Disorder. Journal of clinical psychology, 68(7), 766-781. Bornstein, R. F. ve Bowen, R. F. (1995). Dependency in psychotherapy: Toward an integrated treatment approach. Psychotherapy: Theory, Research, Practice, Training, 32(4), 520.
15. Diener, M. J. ve Monroe, J. M. (2011). The relationship between adult attachment style and therapeutic alliance in individual psychotherapy: A meta-analytic review. Psychotherapy, 48(3),
16. Faith, C. (2009). Dependent Personality Disorder: A Review of Etiology and Treatment. Graduate
17. Journal of Counseling Psychology, 1(2), 7. Hoffart , A. , Sexton , H. , Nordahl , H.M. and Stiles , T.C. ( 2005 ) Connection between patient and therapist and therapist ’ s competence in schema - focused therapy of personality problems. Clinical Psychology and Psychotherapy, 3 , 249 – 258
18. Lingiardi, V., Filippucci, L., ve Baiocco, R. (2005). Therapeutic alliance evaluation in personality disorders psychotherapy. Psychotherapy research, 15(1-2), 45-53.
19. Mitchell, J. L. (2008). The Relationship Between Interpersonal Dependency and Therapeutic
20. Alliance: Perspectives of Clients and Therapists: ProQuest. Martin, D. J., Garske, J. P. ve Davis, M. K. (2000). Relation of the therapeutic alliance with outcome and other variables: a meta-analytic review. Journal of consulting and clinical psychology, 68(3), 438.
21. Matusiewicz, A. K., Hopwood, C. J., Banducci, A. N. ve Lejuez, C. (2010). The effectiveness of cognitive behavioral therapy for personality disorders. The Psychiatric clinics of North America, (3), 657.
22. Overholser, J. C. (1997). Treatment of excessive interpersonal dependency: A cognitive-behavioral model. Journal of Contemporary Psychotherapy, 27(4), 283-301.
23. Rafaeli , E. , Bernstein , D. and Young , J. ( 2011 ) Schema Therapy: Distinctive Features . London :Routledge .
24. Rector, N. A., Zuroff, D. C. ve Segal, Z. V. (1999). Cognitive change and the therapeutic alliance:
25. The role of technical and nontechnical factors in cognitive therapy. Psychotherapy: Theory, Research, Practice, Training, 36(4), 320. Safran, J. D. ve Muran, J. C. (2006). Has the concept of the therapeutic alliance outlived its usefulness? Psychotherapy: Theory, Research, Practice, Training, 43(3), 286-291.
26. Soenens, B. (2007) “I will love you if you do as I say”: How psychologically controlling parenting undermines parent-child acceptance. ISIPAR Newsletter, 1(3), 1-3.
27. Soygüt, G. (1999). Bilişsel psikoterapide kişlilerarası süreçler: Terapötik ittifak ve terapötik ittifakta bozulma olguları. Türk Psikoloji Yazıları, 2(4), 1-14.
28. Soygüt, G. (2004). Bir düzeltici bağlanma ilişkisi olarak psikoterapi: Psikoterapi süreçlerinde
29. Bağlanma ve terapötik ittifak. Türk Psikoloji Yazıları, 7(13), 63-77. Sperry, L. (2003). Handbook of diagnosis and treatment of the DSM-IV-TR personality disorders: Routledge.
30. Strauss, J. L., Hayes, A. M., Johnson, S. L., Newman, C. F., Brown, G. K., Barber, J. P., . . . Beck, A. T. (2006). Early alliance, alliance ruptures, and symptom change in a nonrandomized trial of cognitive therapy for avoidant and obsessive-compulsive personality disorders. Journal of consulting and clinical psychology, 74(2), 337- 345.
31. Vane, J. D. (2002). Countertransferential reactions of therapists as a function of dependency and self-criticism: a schema-theory perspective. University of Texas at Austin.
32. Vreeswijk, van M., Broersen J., Bloo J., ve Haeyen, S (2012). Techniques within schema therapy. The Wiley-Blackwell Handbook of Schema Therapy: Theory, Research, and Practice, 299
33. Vreeswijk, van M., Broersen J. ve Spinhove, P. (2012). The impact of measuring: Therapy results and therapeutic alliance. The Wiley-Blackwell Handbook of Schema Therapy: Theory, Research, and Practice, 283-299.
34. Young, J. E. (1994). Cognitive therapy for personality disorders: A schema-focused approach
35. (revised): Professional Resource Press/Professional Resource Exchange. Young, J. E., Klosko, J. S. ve Weishaar, M. E. (2003). Schema therapy: A practitioner's guide: Guilford Press.