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

Change processes in psychotherapy for patients presenting with histrionic personality disorder

“…Only partial relationships were found between therapist process improvements and outcome; that is, therapist relationship change was linked with changes in depressive symptoms, and therapist process guidance change was linked with general symptom change. In a study looking at change processes of COP in patients with dependent PD (Maccaferri et al, 2020 ), patient processes were not related to outcome, whereas changes in therapist relationship offer, understanding, and process directivity were related to symptom change in disorder‐specific dependency traits. Taken together, results suggest that improvements in therapist processes may be particularly important for a reduction of PD‐specific symptomatology.…”

“…More recent studies report smaller prevalence rates of 1–6% in clinical outpatient samples (Keown et al, 2002 ; Ranger et al, 2004 ; Zimmermann et al, 2005 ); however, it should be taken into account that the present sample was recruited at a centre specialized in the treatment of PD patients and is thus not representative of the average clinical population. Other specific PDs of the larger naturalistic trial that we draw from have been investigated in separate studies (e.g., Maillard et al, 2020 ; Maccaferri et al, 2020 ). The patients' diagnostic status and inclusion criterion at baseline was assessed with an interview of about 1 h conducted by trained raters (therapists in training) using the Structured Clinical Interview for DSM‐IV for personality disorders (SCID‐II; First & Gibbon, 2004 ).…”

“…Previously, the following process changes were shown in COP for other PDs and predicted treatment outcome: for client contribution to the clarification process, relationship changes, and changes in content (Maillard et al, 2020 ) and process (Kramer et al, 2020 ; Maillard et al, 2020 ) and for therapist contributions to the in‐session clarification process, process guidance (Kramer et al, 2018 ; Maccaferri et al, 2020 ), understanding of content (Maccaferri et al, 2020 ), and relationship variables (Maccaferri et al, 2020 ).…”

“…In a reanalysis of these data, Kramer et al ( 2020 ) found that optimal process quality was linked with the intensity of narcissistic symptoms and suboptimal process quality with a variety of general symptom loads and problematic personality traits. Further, Maccaferri et al ( 2020 ) demonstrated the effectiveness of COP in a naturalistic sample of N = 74 patients with dependent PD on symptom severity of depression, self‐efficacy, interpersonal problems, and dependent personality style.…”

Os transtornos de personalidade e abordagens terapêuticas

“…Padrão repetitivo de específicas expressões de necessidade, em particular a necessidade de ser cuidado, em associação com um padrão sistemático de submissão, falta de agência e dificuldade em tomar decisões no dia a dia. Estes indivíduos parecem ser complacentes, mas um subtipo de complacência na qual protestam em silêncio conta a opinião dos outros e que pode ser associada ao transtorno de ansiedade de separação em doentes com transtorno de uso de substâncias [27].…”