Psychotherapy of Dependent Personality Disorder: The Relationship of Patient–Therapist Interactions to Outcome

Abstract

Objective

So far, only a few studies have focused on psychotherapy for Dependent Personality Disorder (DPD). DPD is marked by a repetitive pattern of efforts aiming at maintaining close relationships, which may present as a lack of assertiveness and as a difficulty in making routine decisions. The present study aims at exploring processes of change taking place during the working phase of a clarification-oriented psychotherapy (COP) by focusing on the in-session patient–therapist interaction, as it changes during treatment and their links with treatment outcome. Methods: N = 74 patients with DPD were recruited in a naturalistic setting; they underwent long-term COP. Sessions 15, 20 and 25 were video- or audio-recorded and analyzed using the Process-Content-Relationship Scale, an observer-rated instrument that measures the quality of the interaction processes from patient’s and therapist’s perspectives. Therapy outcomes were assessed with the Personality Inventory – Dependency Subscale, Beck Depression Inventory, Inventory of Interpersonal Problems and Self-efficacy Scale at intake and discharge of therapy. Three-level Hierarchical Linear Modeling was applied to test the hypotheses. Results: Improvement in interaction processes was observed in all patient’s and therapist’s variables over the sessions 15, 20, 25. Overall, this increase in quality of interaction process was unrelated with outcome, but decrease in dependency traits was predicted by increase in therapist’s quality of relationship offer, understanding of content and directivity over the course of the working phase of COP. Conclusions: Studying interaction processes in DPD provides an initial understanding of differential roles of potential mechanisms of change in effective treatment.

Acknowledgments

We would like to thank all the patients who participated in this study.

Data Access

The corresponding author and all other authors had full access to the data. The data are saved as per regular research protocol and can be made available with mutual agreement depending on the purpose for such demand, through approach to the corresponding author.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Notes on contributors

Giorgio E. Maccaferri

Giorgio E. Maccaferri, MD, is Medical Senior Lecturer and psychiatrist and psychotherapist in the Department of Psychiatry at the University of Lausanne, Switzerland. He is Head of Psychiatry Consultation-Liaison and Emergency-Crisis Units at the Northern Sector of Lausanne University Hospital (CHUV), Switzerland.

Daniela Dunker-Scheuner

Daniela Dunker-Scheuner is a Cognitive Behavioral Therapy (CBT) psychologist psychotherapist according to Swiss Federal Law. She is Head of CBT Unit Training in the Department of Psychiatry (Institute of Psychotherapy) at Lausanne University Hospital (CHUV), Switzerland.

Yves De Roten

Yves De Roten is Senior Researcher and Lecturer at the University of Lausanne and Head of Research at the Center for Psychotherapy Research (Institute of Psychotherapy, Psychiatry Department – CHUV), University of Lausanne, Switzerland.

Jean-Nicolas Despland

Jean-Nicolas Despland, MD, psychiatrist and psychotherapist, is a full professor at the University of Lausanne and Director of the University Institute of Psychotherapy in the Psychiatry Department (CHUV), Switzerland.

Rainer Sachse

Rainer Sachse, PhD, is a German psychologist and psychotherapist and developer of the Clarification Oriented Psychotherapy (COP). He is Professor of Clinical Psychology and Head of the Bochum Institute for Psychological Psychotherapy, Germany.

Ueli Kramer

Ueli Kramer, PhD, is Privat Docent, psychotherapy researcher, and clinical psychotherapist, according to Federal Law, in the Department of Psychiatry (University Institute of Psychotherapy and General Psychiatry Service, CHUV), at the University of Lausanne, Switzerland. He holds an adjunct appointment in the Department of Psychology at the University of Windsor, Canada.