Working With The Dependent Personality

Dependent personality is a kind of narcissistic personality. But, unlike its famous cousin, dependent personality appears weak and often comes to therapy rather than refusing to come. All of the personality disorders have their unique difficulties.

DPD is difficult because it dominates with weakness; it controls the therapist by being pathetic.  

In the beginning this presentation usually triggers an empathetic response from therapists. They see a person who is weak and pathetic and they want to help. But, as soon as they start to help the patient escalates and becomes weaker, refusing to change and demanding support. The patient might say, “Oh I’m not feeling well. I’ve had a horrible week. My daughter-in-law screamed at me and then my water heater started to leak. It’s just been horrible.” The patient then requests support either directly or indirectly. They might say, “It’s so good to have someone to talk to. You are such a good listener and that’s what I need: a good listener.”  That really means: don’t try and do therapy, instead shut up and listen.

People with narcissistic personality try to dominate whatever situation they are in.

They tend to use bullying and intimidation so it’s obvious. People with DPD also try to dominate but they do so by manipulating the caring feelings of the therapist. As therapy progresses, DPD’s become weaker and weaker, but also more and more demanding. “You know my CFS is worse in the morning. And, I can’t get a ride from my daughter-in-law until the afternoon. It’s ridiculous to ask me to come in at 10 AM. What else do you have? And don’t say the morning!”

Eventually you realize that you have been handing the patient the power and control of the therapy by being kind and nice.

You must understand this is not really weakness, it is manipulation. Then you must think of how you would help someone with narcissistic personality. You would focus on what they need to change. Then you change your approach to treatment and focus on change. You might say, “Yes. I see that you’ve had a horrible week and you are not feeling well. I’m sorry about that. I’m wondering what you would like to work on today? What would you like to change?”

You ask it right out: what do to want to change? Such a question can trigger a power struggle and illicit more weakness. “Oh I’m so upset about the election I think my depression is getting worse. I can’t believe how stupid people are. I want to change those idiots! That’s what I want to change.” Again you ask, what would you like to change?  They might accuse you of poor attunement. “Why are you doing this? You’re making me upset. You know I get depressed this time of year. I need you to listen and calm me down.”

Then you say, “I’m truly sorry you are struggling so much. But we are not doing therapy when I simply listen. Therapy is about change… That’s my job.

There are people on my waitlist I can help, if you are not ready for change. But I think you might be ready. But you must tell me the things about yourself you want to change. Then I can do what you hired me to do: help you change.