Academic journal article Journal of Cognitive Psychotherapy

Cognitive-Behavioral Treatment of Excessive Interpersonal Dependency: A Four-Stage Psychotherapy Model

Academic journal article Journal of Cognitive Psychotherapy

Cognitive-Behavioral Treatment of Excessive Interpersonal Dependency: A Four-Stage Psychotherapy Model

Article excerpt

This article describes a four-stage model for the cognitive-behavioral treatment of excessive interpersonal dependency. Stage 1 involves active guidance on the part of the therapist to help the client make small but immediate behavioral changes. Stage 2 attempts to enhance the client's self-esteem through the use of cognitive techniques. Stage 3 builds upon the strengthened self-image to promote client autonomy through the use of problem-solving training, the Socratic method, and self-control strategies. Stage 4 uses relapse prevention strategies to reduce the likelihood that the client will behave in an excessively dependent manner in the future. In each stage, desirable outcomes that must be achieved before progressing to the next stage are described. Also, strategies are discussed for managing various impediments to client progress.

For several reasons, psychotherapy is often the treatment of choice for personality disorder patients. First, psychosocial factors may play a strong role in the etiology of many personality disorders (Millon, 1981) and these variables may be amenable to psychotherapeutic change. Second, the effectiveness of biologically based treatments is limited. Psychotropic medications are not available to change basic personality styles (Esman, 1985), but instead are used to suppress the secondary symptoms of emotional distress (Lauer, 1976; Liebowitz, Stone, & Turkat, 1985). Furthermore, the addictive potential of certain medications can be dangerous (Tyrer, 1988).

Historically, most cognitive-behavioral treatment methods have focused on acute (Axis I) conditions. Recently, cognitive-behavioral approaches have been developed to treat individuals with personality disorders (Alford & Fairbank, 1985; Beck, Freeman, & Associates, 1990; Pretzer & Fleming, 1989; Young, 1990). These authors have begun the important process of tailoring intervention strategies to the unique features of individual personality disorders.

This article extends these recent efforts by outlining guidelines for the cognitive-behavioral treatment of excessive interpersonal dependency. Excessive interpersonal dependency is defined according to the diagnostic criteria for the dependent personality disorder (American Psychiatric Association [APA], 1987), but views dependency on a continuum. This definition includes individuals with a dependent personality disorder as well as nondiagnosed cases suffering from moderate levels of dependency that interferes with their ability to function in an autonomous manner. A stage model is used to depict the changes that occur throughout the course of treatment. An important aspect of treatment for dependency involves the use of a sequential series of stages so that treatment is adapted to the changing needs of the client. A slow but systematic progression occurs over sessions as the therapeutic relationship is developed and utilized (McCullough & Carr, 1987) to help clients reduce their dependent behavior and increase their ability to function autonomously.

The goals and treatment strategies used at each of four stages are described: active guidance, enhancement of self-esteem, promotion of autonomy, and relapse prevention. In addition, as recommended by McCullough and Carr (1987), desirable outcomes that clients must achieve before advancing to the next stage of treatment are reviewed. Impediments to client progress are likely to be encountered throughout the therapeutic process, and management strategies to overcome them are discussed. Although considerable overlap exists among the stages, the proposed model adds a temporal perspective to the cognitive-behavioral treatment of dependency. Brief case examples are used throughout to clarify the treatment principles being described.

Several issues related to assessment and diagnosis underlie the proposed treatment model. First, a dimensional approach acknowledges that many people display the quality of dependency in some situations or on certain occasions. …

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