Dependent Personality Disorder: Therapeutic Impasse

Compass Therapy asserts that a person's personality pattern is largely responsible for the problems in living that they face. In the case of a dependent person, this pattern makes them a personal slave to those around them, and this results in hidden anxiety, guilt, and depression that drives them into therapy.

The therapeutic impasse of every personality pattern centers on the point of greatest resistance to a more rhythmic and actualizing life. For Dependent Pleasers to move beyond this impasse requires giving up the need for others' support and approval in order to develop self-support and self-approval. The success of the therapeutic alliance and treatment outcome depends upon making this transition.

The therapist does well to recognize how spouses, children, or friends take the Dependent counselee for granted and order them around. One young woman’s parents lived sixty miles away, yet left a message on her answer-machine saying, “We’ll be out of town for a week. Be sure and feed the dog in the morning and evening.” 

This demeaning treatment bewilders the love-stuck person and heaps up piles of hurt and resentment in the basement of the unconsciousness. Even so, the dependent keeps trying to put on a happy face. As one husband put it, “I just keep smiling and being a doormat.”

On the other hand, the very reason for coming into therapy often involves a rupture in their co-dependent way of life, some fresh and painful experience of rejection or abandonment in which they feel their very existence is threatened.

It is a fact of life that Dependent counselees—in order to make progress in developing serenity and personal power—will receive disapproval, the withdrawal of support, and loss of protection from unhealthy persons who have thrived on their lack of identity, especially those who are themselves stuck in narcissistic or aggressive patterns. 

Compass Therapy suggests helping counselees develop insights not only about their own pattern, but also about the manipulations of anyone who takes unfair advantage, imposes guilt trips, or causes undue duress.

Once dependent counselees begin to open up, they will pour out long-buried feelings of insecurity, anxiety, disappointment, and dejection. This is an excellent development because even though they feel like they are coming apart at the seams, in actuality they are becoming less of a stereotype and more of an individual self. 

Therapeutic Questions for Dependent Pleasers

The therapist can frame the characteristics that comprise the thinking, feeling, and behavior of Pleaser-patterned counselees as questions, reflections, or interpretations designed to help them gradually understand and differentiate their core selves from the constraints of the pattern:

• Are you aware of an inner need to take care of others and make them feel loved?
• Whenever there is an argument do you automatically take a peacekeeping role?
• When you were growing up, did you feel responsible for making your parents happy?
• Were you discouraged from assertive behavior in the name of being a “good boy” or “good girl?”
• When faced with a decision do you usually worry about what other people will think?
• Do you feel guilty about spending time and money on yourself?
• Do you feel happy if people are approving of you—and sad, guilty, and anxious if they don’t?
• Do you have difficulty in understanding people’s motives, especially if they take advantage of you? 
• If someone compliments you, do you play it down and quickly forget it?

When the therapist stands in strong support of former people-pleaser counselees, they can draw courage to stand up for themselves, discover their authentic wants and needs, and negotiate more successfully with reality.

An effective book for Dependent Pleasers to read while in therapy:

THE SELF COMPASS

The Dependent Pleaser Pattern's Interior

Therapists encounter the dependent pattern frequently because people suffering from it are accustomed to seeking support and advice from others. The upper quadrants of the Self Compass are deactivated to such a degree that counselees possess little self-esteem (Strength Compass) or courage (Assertion compass point). An overly exaggerated Love compass point leads them to submissively seek approval by pleasing and placating, while an inflated Weakness compass point creates an undercurrent of anxiety.

The Pattern’s Interior

As in all personality patterns, the actualizing quality of a compass point is lost when taken to an extreme and left unbalanced by the opposite compass point. Therefore, even though dependent counselees want to give and receive love more than anything else in the world, genuine love—which requires the integration of Strength and Assertion with Love and Weakness—eludes them. The overblown Love compass point skews behavior toward self-sacrifice without self-preservation, submissiveness without assertion, and giving without receiving. Beneath their warmth and niceness lies a desperate search for acceptance and approval.

Rejection is feared more than aloneness, so the dependent person takes no risks toward individuality or independent thought or action that might lead to alienation from sources of nurturance.

Unconscious forces are set in motion by these dynamics. A dependent-patterned person can be seen as cooperative and gracious by others, yet has actually undergone identity foreclosure, meaning that self-development is arrested with a childlike focus on safety and gratification, much like a fetus needs the mother to feed it and provide oxygen through the umbilical cord. Not knowing they can cut the psychological umbilical cord by developing the healthy expressions of Strength and Assertion, they fear independence instead of acquiring it. Nor do they comprehend that healthy people would find them more lovable for replacing clinging vine dependency with authentic selfhood.

The over-exaggeration of the Love compass point alone strands a counselee in a sea of masochism. It’s not that dependent Pleasers like pain, because they don’t. It’s just that they don’t realize how this subservient pattern creates the fundamental reason for this distress: the pain of feeling constantly on edge about keeping people happy and the pain of needing other’s approval for whatever they do.

The dependent pattern exists as a pure prototype of fixation on the Love compass point, but can occur in combination with the adjacent compass points of either Strength or Weakness. When combined with the Strength compass point, counselees develop compulsive controlling features; combined with the Weakness compass point, the dependent develops avoidant depressive features. In all cases, however, the Assertion compass point is decommissioned.

For more on the Dependent Pleaser pattern see:

Compass Therapy In Action: Christian Psychology In Action

Fuller Seminary Professor Commends Compass Therapy Book

In the decades it required to develop Compass Therapy, I kept two principles in focus:

• most people want to know how to transform personality disorders and negative behavioral patterns into  health
• many people seek to integrate reason with faith, so they can actualize the divine endowment of human spirituality with psychological wholeness

Further, I sought to connect psychotherapy with Christianity, a religion that encompasses about one quarter of all human beings living today. Does this show a preset bias toward Christians? Does it mean that the principles of Compass Therapy won't work in clinical practice where faith in God plays no role?

I do acknowledge that I am a Christian, and I choose to view the world through the lens of the Bible and Christian orthodoxy.

I respectfully leave to other colleagues the integration of counseling with Buddhism, Islam, New Ageism, Hinduism, agnosticism, or scientific atheism.

Yet I've learned from years of training graduates students in counseling that Compass Therapy theory and techniques can enrich the skill-sets of therapists using psychoanalysis, transactional analysis, gestalt therapy, family systems therapy, humanistic therapy, behavior therapy, or cognitive therapy.

Beyond clinical work in counseling centers and private practice, Compass Therapy opens new horizons to pastors, pastoral counselors, chaplains, and spiritual directors, for it unites Christian personality theory with practical counseling tools for healing human brokenness, whether in individuals, families, or churches.

These psychological and spiritual horizons can help any person successfully solve the three most universal human needs: identity, intimacy, and community.

In 2008 I emailed the final draft of the new Compass Therapy book to the senior professor of theology and ministry at Fuller Theological Seminary, to see if what I had said resonated with his lifelong mastery of theology. When he responded overnight with the commendation cited below, I exploded with joy!

From that moment Dr. Ray S. Anderson become a theological mentor and dear colleague. Through innumerable phone conversations we covered vast amounts of territory: historical theology, progressive theology, evangelical theology, feminist theology, liberation theology, and post-modernism. I found Ray quick in wit, strong in humor, and vibrant in faith. 

I dedicate this post to the memory of Ray Anderson. 

His words encourage me even now. "Dan, you've got to bring out your unique brand of compass knowledge to pastors, to Christians, and to the world..." 

And he kept providing creative ideas for doing so, right through his last months of painful fatigue from daily kidney dialysis, before he joined Jesus Christ in heaven.

Now I say this to Ray, as he stands among the cloud of witnesses who have faithfully served the Lord throughout time: "Thank you so much! I could not do this without your help."

Ray S. Anderson, Ph.D.

Ray S. Anderson, Ph.D.

Senior Professor of Theology and Ministry

Fuller Theological Seminary, writes:

"At the core of Compass Therapy is the divine endowment of human spirituality in each person that comes to expression through the mental, emotional and physical spheres of the self. Through diagrams and dialogue this book takes the reader directly into the counseling experience where a therapeutic alliance between the therapist and the counselee is created, releasing the innate spiritual capacity of the self to overcome negative and counter-productive personality patterns of behavior. 

"Dan Montgomery rightly views emotional and mental health as more than merely removing pathology; rather it is the movement of the self in relation to others where identity, intimacy and community are actualized as an achievement of the holistic self.

 

     "I am not aware of any other book that succeeds as well as this one in providing both professional therapists as well as Christian counselors with a theoretical and practical model that combines psychology and theology in an integrated way. It has a profound simplicity that covers a wide range of personality disorders. Readers will say, ‘Now I see why typical patterns of dysfunctional and disruptive behavior have a common root but also a specific cause.' Put this book on top of your reading list!" 

To learn more about Compass Therapy, read: 

 Compass Therapy: Christian Psychology In Action

 

Using The Self Compass In A Therapy Session

Incorporating the Self Compass diagram in a session is simple.   

The therapist can show a graphic of the Self Compass and say something like, “One of the building blocks of your therapy is this compass diagram. Notice that it’s divided into four compass points that are essential to every person. The Love compass point stands for all the love and caring you’ve ever received or given, but its opposite, the Assertion compass point, is just as important. Loving helps you care for others; Assertion lets you express yourself and stand up for your feelings and values. Now I wonder if you might explore how the Love/Assertion polarity relates to you.”

By asking counselees to locate and elaborate on their own experiences within the Self Compass, you involve them in assessing and describing their own behavior. Two things happen. First, they begin to develop an observing self that will help them reflect on their behavior throughout the therapy. Second, they enjoy talking about themselves in compass terms by sharing significant life experiences that relate to a given compass point. This prepares for continued exploration of the relationship between their current functioning and their actualizing growth toward holistic health.

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Once you have explored the terrain of a counselee’s reflections on love and assertion, you launch the next expedition. You might say, “This second polarity represents times in life when you’ve felt especially weak or particularly strong. Weakness equals anxiety, vulnerability, and uncertainty. Strength describes your experiences of confidence and adequacy. How would you say these two compass points relate to you?”

As vital information from your counselee’s life history comes forth, you discern how he or she has typically handled the Weakness/Strength polarity. Is he stuck overly exaggerating weakness at the expense of strength? Has she developed a superior attitude to compensate for her fear of showing weakness?

 The rapport you build and the insights you gain help form a diagnostic impression of the counselee’s personality configuration. You may find out that the man who is a confident physics professor at work is a dependent depressive at home. Or the woman who has mastered yoga for relaxation goes to pieces when stressed by her hyperactive three-year-old son.

You and the counselee are working together like Sherlock Holmes and Watson, searching for relevant clues and deducing growth goals that will help to solve the mystery of self-growth that has eluded the counselee. The spirit of mutual curiosity and discovery generated by exploring the Self Compass adds momentum to motivation, self-reflection, and personality integration—key ingredients for awakening counselees to full engagement in their own change process.

Here’s a glimpse of how such dialogue can work. Let’s say you’ve just heard Nancy’s disclosure about how she sees herself and her significant relationships in terms of the Self Compass. You begin to formulate a treatment strategy with her.

Therapist: “So Nancy, it sounds like you could benefit from more assertion in order to hold your own with your husband. Is that right?”

Nancy: “Yes, he just makes so many choices about furniture, vacations, and where we eat out without getting my input. I don’t think he’s trying to be bossy. But I do need to let him know what I’d like more often.”

Therapist: “One of our goals can be strengthening your use of the Assertion compass point. Working on how to diplomatically express yourself instead of not saying anything. Now what about strength and weakness?”

Nancy: “Well, in my nursing work I feel very confident. Everyone treats me with respect. So that’s okay. But where I get shaky inside is with my teenage daughter. She wants so many things! I give in too easily. I think I feel intimidated by her.”

Therapist: “It’s like you feel strong at work but weak in the presence of your daughter, especially when she puts pressure on you to buy her something.”

Nancy: “Exactly. I’ve tried to set boundaries but she just keeps on until I give in.”

Therapist: “Well, we can build your staying power through some role-playing and help you develop more self-confidence in her presence.”

Nancy: “That would be great.”

The Self Compass is a user-friendly tool that helps a therapist:

• develop a diagnosis-to-treatment strategy. 
• form an estimate of how many sessions may be needed. 
• generate action techniques for intervention and growth-enhancement.
• monitor a counselee’s progress.
• determine when therapy is ready for termination. 

Sharing the Self Compass demystifies therapy and engages counselees as dialogue partners in the therapeutic enterprise. Counselees get excited when they know they can directly influence their own functioning.