Abstract
A dependent personality orientation is associated with increased risk for a broad array of Axis I and Axis II disorders. Although traditional treatment interventions have modest ameliorative effects on problematic dependency, the multifaceted nature of dependency suggests that integrated treatment strategies may hold more promise than traditional treatment approaches. This article outlines one potentially useful integrated treatment strategy, combining elements of cognitive and existential therapy to alter dependency-related thought, behavior, and emotional responding. Procedures for implementing an integrated cognitive-existential treatment model are outlined, and challenges in use of the model are discussed.
Similar content being viewed by others
References
Alexander, J. F., & Abeles, N. (1968). Dependency changes in psychotherapy as related to interpersonal relationships. Journal of Consulting and Clinical Psychology, 32, 685–689.
Baer, R. A. (2003). Mindfulness training as a clinical intervention: A conceptual and empirical review. Clinical Psychology: Science and Practice, 10, 125–143.
Ball, S. A. (1998). Manualized treatment for substance abusers with personality disorders: Dual-focus schema therapy. Addictive Behaviors, 23, 883–891.
Barber, J. P., & Morse, J. Q. (1994). Validation of the Wisconsin Personality Disorders Inventory with the SCID-II and PDE. Journal of Personality Disorders, 8, 307–319.
Bargh, J. A., & Chartrand, T. L. (1999). The unbearable automaticity of being. American Psychologist, 54, 462–479.
Becker, E. (1973). The denial of death. New York: Free Press.
Beitman, B. D. (1992). Integration through fundamental similarities and useful differences among the schools. In J. C. Norcross & M. R. Goldfried (Eds.), Handbook of psychotherapy integration (pp. 202–230). New York: Basic Books.
Black, D. W., Monahan, P., Wesner, R., Gabel, J., & Bowers, W. (1996). The effect of fluvoxamine, cognitive therapy, and placebo on abnormal personality traits in 44 patients with panic disorder. Journal of Personality Disorders, 10, 185–194.
Blatt, S. J. (1992). The differential effect of psychotherapy and psychoanalysis with anaclitic and introjective patients. Journal of the American Psychoanalytic Association, 40, 691–724.
Blatt, S. J., & Ford, R. Q. (1994). Therapeutic change: An object relations perspective. New York: Plenum.
Bonanno, G. A., & Castonguay, L. G. (1994). On balancing approaches to psychotherapy: Prescriptive patterns of attention, motivation, and personality. Psychotherapy, 31, 571–587.
Bornstein, R. F. (1992). The dependent personality: Developmental, social, and clinical perspectives. Psychological Bulletin, 112, 3–23.
Bornstein, R. F. (1993). The dependent personality. New York: Guilford Press.
Bornstein, R. F. (1996). Beyond orality: Toward an object relations/interactionist reconceptualization of the etiology and dynamics of dependency. Psychoanalytic Psychology, 13, 177–203.
Bornstein, R. F. (2001). A meta-analysis of the dependency-eating disorders relationship: Strength, specificity, and temporal stability. Journal of Psychopathology and Behavioral Assessment, 23, 151–162.
Bornstein, R. F. (in press). The dependent patient: A practitioner’s guide. Washington, DC: American Psychological Association.
Bornstein, R. F., Bowers, K. S., & Robinson, K. J. (1995). Differential relationships of objective and projective dependency scores to self-reports of interpersonal life events in college students. Journal of Personality Assessment, 65, 255–269.
Bornstein, R. F., & Languirand, M. A. (2003). Healthy dependency. New York: Newmarket Press.
Coen, S. J. (1992). The misuse of persons: Analyzing pathological dependency. Hillsdale, NJ: Analytic Press.
Colgan, P. (1987). Treatment of dependency disorders in men: Toward a balance of identity and intimacy. Journal of Chemical Dependency Treatment, 1, 205–227.
Corrie, S., & Milton, M. (2000). The relationship between existential-phenomenological and cognitive-behaviour therapies. European Journal of Psychotherapy, Counselling, and Health, 3, 7–24.
Crits-Christoph, P., & Barber, J. P. (1991). Handbook of short-term dynamic psychotherapy. New York: Basic Books.
Edwards, D. J. A. (1990). Cognitive-behavioral and existential-phenomenological approaches to therapy: Complementary or conflicting paradigms? Journal of Cognitive Psychotherapy, 4, 105–120.
Ekselius, L., Lindstrom, E., Knorring, L., Bodlund, O., & Kullgren, G. (1994). Comorbidity among the personality disorders in DSM-III-R. Personality and Individual Differences, 17, 155–160.
Elliott, R. (2002). Process-experiential psychotherapy. In D. J. Cain (Ed.), Humanistic psychotherapies: Handbook of research and practice (pp. 279–306). Washington, DC: American Psychological Association.
Finn, S. E. (2003). Therapeutic assessment of a man with “ADD.” Journal of Personality Assessment, 80, 115–129.
Florian, V., Mikulincer, M., & Hirschberger, G. (2002). The anxiety-buffering function of close relationships: Evidence that relationship commitment acts as a terror management mechanism. Journal of Personality and Social Psychology, 82, 527–542.
Hassenfeld, I. N. (1999). “Generative caring” psychotherapy for patients who are reluctant to talk. American Journal of Psychotherapy, 53, 495–500.
Hayward, C., & King, R. (1990). Somatization and personality disorders in nonclinical volunteers. Journal of Personality Disorders, 4, 402–406.
Higgins, E. T. (1987). Self-discrepancy: A theory relating self and affect. Psychological Review, 94, 319–340.
Hopkins, L. K. (1986). Dependency issues and fears in long-term psychotherapy. Psychotherapy, 23, 535–539.
Horney, K. (1945). Our inner conflicts. New York: W. W. Norton.
Markus, H., & Nurius, P. (1986). Possible selves. American Psychologist, 41, 954–969.
May, R. (1981). Freedom and destiny. New York: Norton.
May, R., & Yalom, I. (2000). Existential psychotherapy. In R. J. Corsini & D. Wedding (Eds.), Current psychotherapies (pp. 273–302). Itasca, IL: F. E. Peacock.
Messer, S. B. (1992). A critical examination of belief structures in integrative and eclectic psychotherapy. In J. C. Norcross & M. R. Goldfried (Eds.), Handbook of psychotherapy integration (pp. 130–165). New York: Basic Books.
Moore, R. G., & Blackburn, I. M. (1996). The stability of sociotropy and autonomy in depressed patients undergoing treatment. Cognitive Therapy and Research, 20, 69–80.
Nelson-Gray, R. O., Johnson, D., Foyle, L. W., Danial, S. S., & Harmon, R. (1996). The effectiveness of cognitive therapy tailored to depressives with personality disorders. Journal of Personality Disorders, 10, 132–152.
Nietzel, M. T., & Harris, M. J. (1990). Relationship of dependency and achievement/autonomy to depression. Clinical Psychology Review, 10, 279–297.
Ottens, A. J., & Hanna, F. J. (1998). Cognitive and existential therapies: Toward an integration. Psychotherapy, 35, 312–324.
Overholser, J. C. (1987). Facilitating autonomy in passive-dependent persons: An integrative model. Journal of Contemporary Psychotherapy, 17, 250–269.
Overholser, J. C. (1996). The dependent personality and interpersonal problems. Journal of Nervous and Mental Disease, 184, 8–16.
Overholser, J. C. (1997). Treatment of excessive interpersonal dependency: A cognitive-behavioral model. Journal of Contemporary Psychotherapy, 27, 283–301.
Overholser, J. C., & Fine, M. A. (1994). Cognitive-behavioral treatment of excessive interpersonal dependency: A four-stage psychotherapy model. Journal of Cognitive Psychotherapy, 8, 55–70.
Pincus, A. L., & Gurtman, M. B. (1995). The three faces of interpersonal dependency: Structural analysis of self-report dependency measures. Journal of Personality and Social Psychology, 69, 744–758.
Pincus, A. L., & Wilson, K. R. (2001). Interpersonal variability in dependent personality. Journal of Personality, 69, 223–251.
Pysczynski, T., Greenberg, J., & Solomon, S. (2000). Proximal and distal defense: A new perspective on unconscious motivation. Current Directions in Psychological Science, 9, 156–160.
Rathus, J. H., Sanderson, W. C., Miller, A. L., & Wetzler, S. (1995). Impact of personality functioning on cognitive-behavioral treatment of panic disorder. Journal of Personality Disorders, 9, 160–168.
Rector, N. A., Bagby, R. M., Segal, Z. V., Joffe, R. T., & Levitt, A. (2000). Self-criticism and dependency in depressed patients treated with cognitive therapy or pharmacotherapy. Cognitive Therapy and Research, 24, 571–584.
Schneider, K. J., & May, R. (1995). The psychology of existence: An integrative clinical perspective. New York: McGraw-Hill.
Stewart, S. H., Knize, K., & Pihl, R. O. (1992). Anxiety sensitivity and dependency in clinical and non-clinical panickers and controls. Journal of Anxiety Disorders, 6, 119–131.
Stricker, G., & Gold, J. R. (Eds.) (1993). Comprehensive handbook of psychotherapy integration. New York: Plenum.
Turkat, I. D. (1994). Personality disorders: A psychological approach to clinical management. New York: Pergamon Press.
Watson, J. C., Gordon, L. B., Stermac, L., Kalogerakos, F., & Steckley, P. (2003). Comparing the effectiveness of process-experiential with cognitive-behavioral psychotherapy in the treatment of depression. Journal of Consulting and Clinical Psychology, 71, 773–781.
Yalom, I. D. (1980). Existential psychotherapy. New York: Basic Books.
Young, J. E. (1994). Cognitive therapy for personality disorders: A schema-focused approach. Sarasota, FL: Professional Resources Press.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Bornstein, R.F. Integrating Cognitive and Existential Treatment Strategies in Psychotherapy With Dependent Patients. J Contemp Psychother 34, 293–309 (2004). https://doi.org/10.1007/s10879-004-2525-7
Issue Date:
DOI: https://doi.org/10.1007/s10879-004-2525-7