Dear Patti, 

My father recently passed away after a long illness. My younger sister, Ivy (45) has always lived with him. Unfortunately, Ivy always had Dad to be around to take care of her. Ivy has never had a boyfriend, let alone been married. She’s a sweet person, kind to others, but lacks self-esteem, self-confidence and has absolutely no social life. Ivy never lived by herself and relied on Dad to make all her decisions. She works part-time as a receptionist where they constantly take advantage of her, but she never says anything as she’s afraid of conflict. There’s enough money in the estate that Ivy could get a small apartment after we sell Dad’s house, but that’s not the problem.

Ivy is afraid to live alone and wants to come and move in with me. Even if I had the room (which I don’t), I can see what’s happening here and it worries me; specifically, I would become the one making all her decisions and running her life for her. I encouraged her to see a psychotherapist who explained that Ivy has a dependent personality disorder (DPD). He also said it is difficult to treat.

Is my sister doomed to an empty life or is there hope she can get better? I’m afraid she’s going to wake up someday, realize her life has been wasted, and it’ll be too late. Am I unrealistic in believing Ivy’s problem is fixable?     

  — Jean

Dear Jean,   

First of all, I commend you for urging Ivy to seek professional help. While many individuals who have DPD are anxious and depressed about their lives, they often avoid seeking help because they’re unaware that their own actions and thoughts are part of the problem. The reason therapists have difficulty treating this condition is because the patients have convinced themselves that their feelings and behaviors are normal. Only when they become motivated and inspired to change is healing possible. It is, therefore, critical to choose an experienced psychotherapist with an understanding of your sister’s coping mechanisms.

Everyone, of course, has unique ways of responding to/coping with stressful situations. Some will withdraw while others may become confrontational. As a result of experiences that shaped their personality by the time they became teens, it’s not uncommon for those with DPD to operate on a rigid, inflexible and inappropriate set of rules that impact their ability to have self-confidence and quality relationships. Such maladaptive responses to situations are only considered to be personality disorders when they create significant functional impairment.

People with DPD feel intensely insecure, inadequate, and uncomfortable about self-care and, accordingly, have an all-encompassing need to be nurtured. This leads them to engage in submissive behaviors as well as hand over responsibility for even the simplest decisions to someone else. A fear of rejection and/or abandonment immobilizes them into believing they are helpless. In order to maintain relationships which they think validate their existence, they’ll go to extreme lengths, make extraordinary self-sacrifices, and even submit to abuse/intimidation so as not to end up alone.

In answer to your question, successful treatment of DPD may take a long time, as the problem probably started to develop before 12 years of age. With therapeutic help Ivy can learn to acknowledge her dependent behavior and the high price she’s been paying to maintain these destructive patterns. Getting your sister to give up helplessness is the first step toward instilling motivation to explore healthy alternatives. The therapist may repeatedly point out the painful results and reinforce the message that things keep happening over and over until the individual decides to break the cycle.   

It’s also important that DPD treatment goals shouldn’t contradict the basic personality of the patient. Under the guidance of a trained psychotherapist, Ivy will work toward a more functional life and make decisions for herself. The treatment goal is not independence but autonomy — which is the capacity for independence and the ability to develop intimate relationships.

With the help of a professional therapeutic relationship, Ivy can learn to identify the sources of her stress and insecurity, take accountability for her actions and free herself from an imprisoned life of expecting others to always take care of her needs and make decisions for her.  


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 pcarmalt@aol.com. Visit her website, patticarmalt-vener.com.