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

Öz

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.

Anahtar Kelimeler

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

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

Öz

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.

Anahtar Kelimeler

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

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