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Codependence: Treatment of Dependent Personality Disorder

Issues and Goals in the Treatment of Dependent Personality Disorder

Posted on Monday, December 31, 2012 by Alison

“Mayan Haab Calendar” by Mimi Stuart ©
Guest Author SAM VAKNIN, PhD:

You have been diagnosed with Dependent Personality Disorder (Codependence, or Codependency) and you have decided to attend therapy. Here is a brief guide to the personal issues that you should tackle and the goals that you and your therapist should aspire to.


The codependent patient has alloplastic defenses and an external locus of control: though she believes that she is in full control of her life, her behavior is mostly reactive and she is buffeted by circumstances and decisions made by other people – hence her tendency to blame the outside world for every misfortune, mishap, and defeat she endures. She rarely takes responsibility for her choices and actions and is frequently surprised and resentful when faced with the consequences of her misconduct.

The patient is convinced that she is worthless and bad, a loser and no-good. She is masochistically self-destructive and self-defeating in her romantic relationships. These propensities are compounded by a predilection to decompensate and act out, sometimes violently, when her defences fail her.


To develop autoplastic defences and an internal locus of control: to learn to assume responsibility for her actions and refrain from self-destructive and self-defeating behaviors.


Having been deprived of it in her childhood, the patient is on a perpetual quest for ideal love: motherly, protective, engulfing, omnipresent, and responsive. Her mate should be handsome, sexy, and should draw attention from and elicit envy. He should be fun to be with and intelligent, although passive, malleable, compliant, and subservient.

Yet, the typical codependent has been exposed only to transactional and conditional love from her parents: love was granted in return for meeting their unrealistic and, therefore, inevitably frustrating expectations.

Such patients resort to fantasy and develop a deficient reality test when it comes to their romantic liaisons. The patient lacks self-awareness and sets conflicting goals for her intimate partners: they are supposed to provide sex, intimacy, companionship and friendship – but also agree to be objectified and to self-deny in order to fulfill their roles in the codependent’s “film”.


To develop realistic expectations regarding love, romance, and relationships as well as relationship skills.


The narcissistic codependent idealizes her intimate romantic partners and then devalues them. She seeks to “mold” and “sculpt” them to conform to her vision of the relationship. She deprives them of their self-autonomy and makes all decisions for them. In other words: she treats them as objects, she objectifies them. Such a patient is also a verbal and, at times, physical abuser. This impoverishes her relationships and hinders the development of real intimacy and love: there is no real sharing, no discourse, common interests, or joint personal growth.

Owing to the patient’s insecure attachment style and abandonment/separation anxiety, she tends to cling to her partner, monopolize his time, smother him, and secure his presence and affection with material gifts (she is a compulsive giver.) As she holds himself worthless and a loser, she finds it hard to believe that any man would attach to her voluntarily, without being bribed or coerced to do so. She tends to suspect her partner’s motives and is somewhat paranoid. She is possessive and romantically jealous, though not exceedingly so. This environment tends to foster aversions in her romantic partners.


To develop a productive and healthy attachment style and learn relationship skills.


The codependent’s proclaimed desire for stability, safety, predictability, and reliability conflicts with her lifestyle which is itinerant, labile, chaotic, and involves addictive and reckless behaviors. Her need for drama, excitement, and thrill (adrenaline junkie) extends to her romantic relationships. Owing to her low threshold for boredom and multiple depressive, dysphoric, anhedonic, and anergic episodes, she seeks distractions and the partner to provide them. She, therefore, shows a marked preference for men with mental health issues who are likely to lead disorganized lives and to react to her abuse dramatically and theatrically.


Learn how to choose partners who would bring stability and safety into the relationship and how to interact with them constructively. Learn anger management skills.


The narcissistic codependent has strong narcissistic defenses, especially when it comes to maintaining her grandiosity with the aid of narcissistic supply. She needs to feel chosen and desired (a flip coin of and antidote to her fear of rejection); be the centre of attention (vicariously, via her intimate partner); and to conform to expectations, values, of judgments or her peer group, relatives, and other role models and reference figures. See: Inverted Narcissist.


To develop a more realistic assessment of herself and her romantic partners and, thus, reduce her dependence on narcissistic defences and narcissistic supply.

by SAM VAKNIN, PhD, Author of “Malignant Self-love: Narcissism Revisited” — a comprehensive analysis of narcissistic personality disorder and correlated abuse.

Read “I Can’t Live Without Him/Her” by Sam Vaknin, PhD.

Read “I am Terrified that S/he will Abandon Me! I will Do Anything to Avoid It!” by Sam Vaknin, PhD.

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Jan/13/2013, 9:08 am Link to this post  

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