“I Need You!” Patients’ Care Dependency Patterns During Psychotherapy for Personality Disorders and Its Association with Symptom Reduction and Wish for Treatment Continuation

Abstract

Different views exist regarding the nature of patients’ dependency in psychotherapy (trait versus contextual dependency), and its impact on treatment outcome and duration. Therefore we examined whether patients’ levels of care dependency changed over time during a 9-month treatment period, and whether care dependency was related to symptom reduction and patients’ wish for treatment continuation at the end of the treatment. Participants in this longitudinal study were 113 patients (Mage = 33.6, 78% female) with personality disorders receiving inpatient or daycare group psychotherapy. Both increases and decreases on different aspects of care dependency were found over the course of treatment. Decreases in dependency were related to larger symptom reduction, and higher levels of care dependency, especially patients’ lack of perceived alternative options for the current treatment, were related to patients’ stronger wish to continue their treatment. Changes in care dependency during treatment mainly supports the contextual view on patients’ care dependency, and decreasing levels of dependency may have beneficial treatment effects. However, dependency may also lead to prolonged treatment duration. Clinical implications for therapists are presented.