Breaking  the Shell

Breaking the Shell

Therapy can help people with dependent personality disorder develop healthy relationships

By Patti Carmalt-Vener 08/14/2014

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Dear Patti,


My husband and I have been blessed to have a wonderful daughter. Joanna, who is now in her late 40s, is extremely smart, speaks multiple languages and is always the first to volunteer whenever our church or local nonprofits need help. I sometimes think they take advantage of her kindness, but that’s another story. 


    She works as a waitress at a really dumpy restaurant. The manager and some of the other servers aren’t very nice to her, but she’ll never speak up and knows she’d get a bad reference if she ever quit. 


She’s afraid to live by herself and so she still lives with us and has never had a boyfriend. She relies on my husband and me to help her make decisions because she has zero confidence. I finally convinced her to see a therapist who told us she has a dependent personality disorder.


From what I’ve read, it sounds like this is impossible to treat. Is that true? I hate to see her wasting her life like this and worry what will happen when we’re no longer here for her.  

— Martha 

Dear Martha,


When it comes to interacting with others and experiencing emotions, everyone’s personality is different. Some people, for instance, take a confrontational approach if their feelings are hurt, while others may withdraw into a shell. If a particular behavior proves ineffective in responding to a problem, a mentally healthy person may still be open to trying something different. For someone with a personality disorder such as dependent personality (DPD), however, those options are limited. Specifically, the traits and experiences which shaped their outlook by the time they became teenagers causes them to operate under an inflexible, rigid and inappropriate set of rules. Their inability to embrace self-confidence and to enjoy intimate relationships leads to maladaptive responses to situations that are only considered to be personality disorders when they cause significant functional impairment.  


As stressed as they are about their lifestyles, people with DPD are often unaware that their own thoughts and actions are actually causing the problem. Thus, they tend to avoid seeking professional help. 


In turn, this makes their symptoms difficult to treat because they’re already convinced that their feelings and behaviors are normal. Often healing only becomes possible when they become motivated to regain control of their lives and commence work with an experienced psychotherapist who understands that individual’s particular patterns of coping.


People diagnosed with DPD have a constant need to be nurtured and reassured because they feel inadequate, uncomfortable and insecure about taking care of their own needs. This not only leads them to engage in submissive behaviors but to also assign responsibility for even the simplest decisions to someone else. 


Further, the fear of rejection and/or abandonment immobilizes them into a state of thinking they’re helpless. In order to maintain relationships which they believe validate their existence, they’ll go to extreme lengths, make extraordinary self-sacrifices and even submit to abuse or intimidation just so they won’t end up alone.


Depending on how many years it has taken for DPD to develop, successful psychotherapy treatment may indeed take a long time. Individuals like Joanna need to acknowledge their dependent behavior and the high price they’ve been paying to maintain such destructive patterns. The first step toward instilling personal motivation to explore healthy alternatives is getting the person to give up their self-imposed sense of helplessness. 


What a therapist will do is point out the painful results and, like the movie “Groundhog Day,” reinforce the message that things will keep happening over and over unless the individual takes personal responsibility for breaking that cycle.    


Psychotherapists who work with DPD cases also recognize that treatment goals shouldn’t contradict a patient’s basic personality.  Accordingly, they respect and support positive traits such as the ability to be thoughtful and considerate, be a team player, listen to the opinions of others and work toward a more functional version of these characteristics.  The treatment goal isn’t independence but autonomy, which is the capacity for independence and the ability to develop healthy relationships. With the help of a professional therapist, Joanna can learn to identify the sources of her stress, take accountability for her actions and free herself from an imprisoned life.

Patti Carmalt-Vener, a faculty member with the Southern California Society for Intensive Short Term Psychotherapy, has been a psychotherapist in private practice for 23 years and has offices in Pasadena, Santa Monica and Canoga Park. Contact her at (626) 584-8582 or email Visit her website,


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