dpd help needed

Discussion in 'Braaaaiiiinnnns...' started by gills, Jun 8, 2016.

  1. gills

    gills dead

    so i have dependent personality disorder (also BPD). it sucks ass. i'm not currently in therapy and i don't really have any resources to help manage it. please help?
     
  2. esotericPrognosticator

    esotericPrognosticator still really excited about kobolds tbqh

    what sort of help are you looking for? advice on what patterns of cognition are disordered? general advice? an outside opinion on things?
     
  3. gills

    gills dead

    resources i guess? like advice on "here is how to catch this thought pattern and redirect it" "here is how to be a functional adult when your depended isn't around" basically just....coping skills i think. i'm sorry i am not good at words right now
     
  4. esotericPrognosticator

    esotericPrognosticator still really excited about kobolds tbqh

    okay! I'm gonna ping @chaoticArbiter because I know they have DPD and I thiiiiink they might be in therapy for it? my impression is that they've got a good handle on it and themselves, anyway. so they might be able to give you some more personalized tips. here are a couple of articles I found regarding therapeutic treatment for DPD that look vaguely reputable, so maybe those'll be helpful? I'd also suggest going into the bibliographies and chasing citations that look helpful, if they aren't behind paywalls. also someone linked me to an excellent book about personality disorders a while back that I'm sure would have some info you could use, but unfortunately I lost the link. it'd be great if they could send it to me again, and I promise to save it this time!

    anyway, just skimming those articles gives me the impression that what works on DPD is CBT. what that would look like as self-help, I suspect, would be 1) identifying which cognitive patterns and behaviors are disordered (i.e., cause harm to yourself or others) and 2) attempting to change those, but there's a reason people usually get a therapist to help them: it's really hard to do that meaningfully by yourself. how good are you at identifying what in yourself is DPD and what is not, do you think? also I think something that might potentially be helpful is farming out the identification of disordered cognition and behavior to other people if you aren't sure, which is something that I think Kintsugi is well-suited for. you've already done that in a couple of threads, actually, and I think that helped you break a couple of disordered patterns of cognition and behavior. thing is, you've got DPD, and while reality checks are pretty unambiguously positive for things like depressive feelings of worthlessness or anxious fears, relying on other people to tell you what to do is... not going to help you with your disorder. so. there's a balance to be found there, I think.
     
    Last edited: Jun 8, 2016
  5. esotericPrognosticator

    esotericPrognosticator still really excited about kobolds tbqh

    okay, will do. or won't do, rather. sorry! I knew something was up with the tagging thingie, but I figured it was just my computer being a piece of shit like usual. thanks a lot for the link!

    edit: below's what that extremely reputable book has to say about therapy for DPD. there's also probably a bunch of other stuff in the DPD section that'd be helpful to you, if you've got the time/spoons to read it.

    Psychotherapy with the dependent personality generally has a good prognosis, although with their social support systems intact, most dependents do not seek therapy; their needs for protection, nurturance, and instruction are already met by others. When they do seek therapy, it is usually because some aspect of their social world has been disrupted. Whereas self-oriented personalities, such as the antisocial and narcissist, often terminate prematurely, most dependents are highly motivated to continue. The therapeutic relationship itself naturally supplies them with the very resources they feel are deficient in their everyday lives. In effect, the therapist becomes a kind of surrogate caretaker who listens attentively, offering acceptance, security, and empathy as a counterbalance to the criticism, blame, and guilt that dependents naturally heap on themselves. The strength and authority of the therapist is comforting and reassuring and provides the idealized omnipotent figure that dependents seek to rescue them in time of need. Moreover, dependents are usually ready to trust and to talk, and the therapist is ready to listen. Therapy almost inevitably gets off to an auspicious beginning, creating the impression that progress will be rapid and sure.

    THERAPEUTIC TRAPS

    The readiness of the dependent to please the therapist and the promise of quick improvement are the principal barriers to effective psychotherapy. The dependent talks when talking is required. The dependent listens when listening is desired. The dependent follows all instructions and basks in every word of praise and sign of approval.

    Not surprisingly, many beginning therapists, faced with intractable borderlines or insufferable narcissists, at first feel they have found the dream client in the dependent. Even experienced therapists with strong narcissistic and maternal needs are vulnerable. More narcissistic therapists are tempted to take up the reins and become more directive, responding to the dependent’s underlying message, “Help me, and I will do exactly what you say. I will please you, and I will admire, even worship, your intelligence, strength, and courage.” Such covert communications make the therapist feel powerful. The de-pendent gives up responsibility for the outcome and bonds closer and closer, and the therapist takes up the responsibility, subscribes to the delusion that he or she is actively curing the dependent, and glows godlike in projections of omnipotence and omniscience.

    Such therapeutic relationships are pathological, only recapture the client’s larger pattern of interpersonal dependency in the microcosm of the therapy office, and inevitably succumb to the same vicious circles that have defined the client’s life and provided the very reason for coming to therapy from the beginning. Similar outcomes are likely for therapists with strong maternal needs, for whom the interpersonal pull is to become even more supportive than usual. Here, the dependent effectively seeks to make the transition from lonely orphan to adopted child.

    THERAPEUTIC STRATEGIES AND TECHNIQUES

    The strategic goals in working with dependents are the same as for any other personality. Clients can only become a more functional variant of themselves; they cannot be transformed into something completely different. The sweet, innocent, needy dependent will not become a ruthless corporate executive or an intrepid explorer of new frontiers, and it would be pathological to hold him or her to such expectations. Instead, all personalities must learn to play their strengths and minimize their weaknesses. Doing so assumes both a knowledge of these weaknesses and a willingness to step in and interrupt old patterns of relating and perceiving that lead to vicious circles. None of this changes the basic personality pattern, but it does bring them within the normal range of functioning, from which more adaptive possibilities can emerge, both during and after therapy. As is always the case with personality disorders, the key lies in addressing the personality pathology at multiple levels simultaneously, though the exact combinations and order in which these techniques are applied depend on the individual subject.

    Interpersonally, dependents must learn to interact with others in a way that encourages individuation rather than submission. The key to a successful outcome lies in making use of dependency without indulging it. Although the therapist can be used as a secure base to which the dependent can return, both parties should understand from the beginning that dependency is precisely the problem and that the purpose of therapy is to outgrow the therapeutic relationship. The therapist is obligated to make the a social response (Kiesler, 1996), that is, to be sensitive to the emotional nuances of the therapeutic relationship—what psychotherapists call transference and countertransference—and relate to the dependent in a way that pulls for autonomy. An anxiety hierarchy of instrumental and assertive behaviors can be set up and implemented gradually. Role playing and modeling allow the dependent to rehearse independent living skills and new ways of relating in the safety of the therapy office. Assertiveness training can be used to target submissive behaviors as they occur in session. Group therapy may be particularly useful. Most groups are naturally accepting, and veteran group members are often adept in identifying maladaptive patterns of relating. Abandonment issues may be less intense in group therapy, as the dependent has more than just the therapist on whom to rely.

    The effectiveness of interpersonal techniques can be combined with cognitive techniques, which help confront the black-and-white thinking of the dependent. In fact, cognitive techniques may be most useful at the very beginning of therapy, for their black-and-white world causes most dependents to see therapeutic change as sink-or-swim and not a gradual deepening of adaptive competencies. Clients can be asked to record their perceptions and feelings in a thought diary throughout the week, and the contents can be processed in session as a means of illuminating automatic thoughts that put them in the submissive mode. Interactions with significant others are particularly important. Whatever cognitive technique is employed, the goal is to actively engage dependents in a more active style of problem solving that disconfirms life as an existence of total helplessness and total isolation and moves them toward a more competent self-image. Moreover, dependents can use the therapist as a sounding board during a session to perform a reality check for their automatic thoughts.
    Interpersonal and cognitive techniques are primarily useful in helping the individual understand pathological patterns in current functioning, but they do not explain the developmental basis from which these patterns arose. Psychodynamic exploration may be effective in helping dependents understand the source of such problems, though insight alone is unlikely to be sufficient in producing personality change. If dependents can be led to an understanding of the role of caretakers in their early lives, they will also understand that without their own conscious intervention, their future will be determined by their past. Understanding the role of introjection and idealization in the present is important in interrupting the reemergence of pathological patterns of relating once some level of progress has been achieved. Achieving less idealized images of others inevitably may involve confronting intense feelings of guilt related to more realistic images of parents and spouse as less than perfect, but the role of guilt in perpetuating submission and low self-esteem should be understood; otherwise, its background presence continually erodes any achievements of autonomy.

    Although dependents often make rapid progress, for every individual and every therapy, the solidity of gains is checked at termination. For the dependent, the end of therapy means a loss of attachment with the therapist and a possible return to feelings of alone- ness and helplessness: The crutch is gone. When the therapist begins to talk about the future, phobic symptoms and depressive feelings may suddenly escalate. If therapist and subject are somehow covertly aligned in maintaining the dependent pattern, they may spend many, many sessions trying to understand the meaning of these events, only to endure through yet another relapse as termination again approaches. Many therapists remain caught in this cycle, and eventually, most find it absolutely exasperating. The majority of cases, however, are likely to have a happier outcome.
     
    Last edited: Jun 8, 2016
  6. chaoticArbiter

    chaoticArbiter literally Eevee

    pops in
    hello I am here
    how can I be of assistance
     
  7. gills

    gills dead

    resources!!! good thank you!!!

    i....don't really think i'm too good at it. i pretty much got dx'ed and then my therapist moved across the country so i never really learned to deal with it.

    i can't tell what's a good balance and what isn't, really, unless i'm at a point of heavy dependency on a specific person. and....gosh how does this even work. is wanting reassurance reinforcing dependency? is asking for advice doing that? am i doing that right now??? i honestly don't know.
     
  8. gills

    gills dead

    anything you've got

    please share your wisdom
     
  9. chaoticArbiter

    chaoticArbiter literally Eevee

    okey
    I totally can
    but it's gonna have to wait until tomorrow because brain is presently mush because no food and no sleep
     
  10. gills

    gills dead

    that's ok that's for the best, i am stressed rn and cannot do words well
     
  11. esotericPrognosticator

    esotericPrognosticator still really excited about kobolds tbqh

    you're welcome!

    okay, then, I think working to identify disordered patterns of cognition and behavior by yourself and with other people's help is probably a good way to start improving your coping with your disorder. changing those patterns is a bit more advanced, I think, and might be best left until you have a little more experience. maybe a good thing to do would be to go through the list of DPD symptoms and try to identify which of your behaviors and thoughts match up with them? like if you were self-diagnosing, I guess. if you're as detailed as possible and really try to determine which things hurt you and other people, I think trying to remember that list and labelling those behaviors and thoughts a result of DPD as they occur would be a good start. does that make sense?

    I think a good balance involves working to not be so dependent on one person (or multiple people) that you're vulnerable to abuse or exploitation or can't function as an independent adult. and yeah, seeking reassurance and asking for help are kinda symptomatic, and so is the fact that you made this thread. on the other hand, they're not disordered if they're practiced in moderation! and based on what I read in those two articles and that section of the book, I think that actually asking for advice on a forum like this is probably better than only relying on one person all of the time. like, they said that group therapy was good for people with DPD, and this is kinda like group therapy, right?
     
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