The effect of long-term dynamic psychotherapy on the personality structure of patients with Dependent Personality Disorder

Document Type : Original Article


clinical psychology, department of psychology, university of semnan, semnan, iran


Introduction:The present research aimed at investigating the effect of long-term dynamic psychotherapy with Kernberg’s object relations approach on the personality structure of patients with Dependent Personality Disorder (DPD).
Method: 30 clients with DPD were selected among the individuals referred tohealth centres of Tehran for psychotherapy, and based on DSM-5 diagnostic criteriathey met the inclusion criteria. The subjects were selected randomly among referred patients to clinics and randomly divided into two experimental and control groups. The informed consent was obtained from the subjects and the experimental group received DPHP sessions for 12 months in a twice weekly session framework. The control group was assigned to psychotherapy in order to observe the ethics of the study. The Semi-Structured Interview of the Personality Organization (STIPO) was initially taken from both groups and was repeated again after six months and the end of the treatment sessions.
Results:The results indicated that the experimental group had a significant reduction compared to the control group in the structural dimensions of defence mechanisms, personality rigidity and identity after 6 months of treatment and in the structural dimensions of object relations, personality rigidity, identity, morality and defence mechanisms at the end of the treatment.
Conclusion: According to the results of this research, long-term psychotherapy intervention with the Kernberg's object relations approach was found to be effective in changing the personality traits of patients with dependent personality disorder and clinical specialists are recommended to use this treatment for patients with DPD.


Main Subjects

1- Sperry L. Handbook of diagnosis and treatment of DSM‐IV‐TR personality disorders. 2nd ed. New York: Brunner‐Routledge. 2003.
2- American Psychiatric A. Diagnostic and statistical manual of mental disorders : DSM-5. 5th ed. Washington, DC: APA. 2013.
3- Seligman L, Reichenberg LW. Selecting effective treatments: A comprehensive, systematic guide to treating mental disorders. 3rd ed. San Francisco: Jossey‐Bass. 2007.
4- Fossati A, Beauchaine TP, Grazioli F, Borroni S, Carretta I, DeLinehan MM, et al. Dialectical Behavior Therapy for Borderline Personality Disorder. New York, NY: The Guilford Press. 2008.
5- Simon W. Follow-up psychotherapy outcome of patients with dependent, avoidant and obsessive-compulsive personality disorders: A meta-analytic review. International journal of psychiatry in clinical practice. 2009; 13(2): 153-65.
6- Bolton JM, Belik SL, Enns MW, Cox BJ, Sareen J. Exploring the correlates of suicide attempts among individuals with major depressive disorder: findings from the national epidemiologic survey on alcohol and related conditions. The Journal of clinical psychiatry. 2008; 69(7): 1139-49.
7- Loas G, Guilbaud O, Perez-Diaz F, Verrier A, Stephan P, Lang F, et al. Dependency and suicidality in addictive disorders. Psychiatry research. 2005; 137(1): 103-11.
8- Gagnon A, Davidson SI, Cheifetz PN, Martineau M, Beauchamp G. Youth suicide: A psychological autopsy study of completers and controls. Vulnerable Children and Youth Studies 2009; 4(1): 13-22.
9- Coolidge FL, Anderson LW. Personality Profiles of Women in Multiple Abusive Relationships. Journal of Family Violence. 2002; 17(2): 117-31.
10- Loas G, Cormier J, Perez-Diaz F. Dependent personality disorder and physical abuse. Psychiatry research. 2011; 185(1-2): 167-70.
11- Schuster JP, Limosin F, Levenstein S, Le Strat Y. Association between peptic ulcer and personality disorders in a nationally representative US sample. Psychosomatic medicine. 2010; 72(9): 941-6.
12- Disney KL. Dependent personality disorder: a critical review. Clinical psychology review. 2013; 33(8): 1184-96.
13- Loranger AW. Dependent personality disorder. Age, sex, and axis I comorbidity. The Journal of nervous and mental disease. 1996; 184(1): 17-21.
14- Morgan TA, Clark LA. Dependent Personality (Disorder)☆.  Reference Module in Neuroscience and Biobehavioral Psychology: Elsevier. 2017.
15- Caligor E, Kernberg OF, Clarkin JF. Hand book of dynamic psychotherapy for higher level personality pathology. 2nd ed. Washangton, DC: Am psychiatr publ. 2007.
16- Hadizadeh MH, Navabinezhad S, Valiollah F, Nouranipour R. Effectiveness of Dialectical Behaviour Therapy on Self-Efficacy and Interpersonal Problems of Women with Dependent Personality Disorder. Quarterly Journal of Woman & Society. 2016; 8(2).
17- Svartberg M, Stiles TC, Seltzer MH. Randomized, controlled trial of the effectiveness of short-term dynamic psychotherapy and cognitive therapy for cluster C personality disorders. The American journal of psychiatry. 2004; 161(5): 810-7.
18- Leichsenring F, Leibing E. The effectiveness of psychodynamic therapy and cognitive behavior therapy in the treatment of personality disorders: a meta-analysis. The American journal of psychiatry. 2003; 160(7): 1223-32.
19- Levy KN, Ehrenthal JC, Yeomans FE, Caligor E. The efficacy of psychotherapy: focus on psychodynamic psychotherapy as an example. Psychodynamic psychiatry. 2014; 42(3): 377-421.
20- Klein M. The Oedipus complex in the light of early anxieties. In Contributions to Psychoanalysis. London: Hogarth Press. 1945.
21- Mahler M, Pine F, Bergman A. The Psychological Birth of the Human Infant. New York: Basic Books. 1975.
22- Kernberg OF. Severe personality Disorder: psychotherapeutic strategies. New haven: Yale University press. 1984.
23- Kernberg OF. Identity: recent findings and clinical implications. The Psychoanalytic quarterly. 2006; 75(4): 969-1004.
24- Clarkin JF, Yeomans FE, Kernberg OF. Psychotherapy for Borderline Personality: Focusing on Object Relations. Washington, DC: Amer. Psychiatric Publishing. 2006.
25- Kernberg OF. Aggressivity, Narcissism, and Self-Destructiveness in the Psychotherapeutic Relationship. Yale University Press: New Haven and London. 2004.
26- Clarkin JF, Caligor E, Stern B, Kernberg OF. Structured Interrview of Personality Organization. Personality disorders institute. In: university. WmcoC, editor. 2007.
27- Bateman A, Fonagy P. Psychotherapy for borderline personality disorder Mentalization-based treatment. London: Oxford Medical Publications. 2004.
28- Bornstein RF. The dependent personality: developmental, social, and clinical perspectives. Psychological bulletin. 1992; 112(1): 3-23.
29- Clarkin JF, Cain NM, Lenzenweger MF. Advances in transference-focused psychotherapy derived from the study of borderline personality disorder: clinical insights with a focus on mechanism. Current opinion in psychology. 2017; 21: 80-5.
30- Kernberg OF. Countertransference, in Borderline Conditions and Pathological Narcissism. 1st ed. New York: Jason Aronson. 1975.
31- Kernberg OF. Object Relations Theory and Clinical Psychoanalysis. 1st ed. New York: Jason Aronson. 1976.
32- Kernberg OF. Internal World and External Reality: Object Relations Theory Applied. 1st ed. New York: Jason Aronson. 1980.
33- Clarkin JF, Levy KN, Schiavi JM. Transference focused psychotherapy: Development of a psychodynamic treatment for severe personality disorders. Clinical Neuroscience Research. 2005; 4(5): 379-86.
34- Delavar A. Educational and psychological research. 4th ed. Tehran: Virayesh publication institute. 2011.
35- Vahedi A, Makvand-Hosseini S, Bigdeli I. Diagnosis of Higher Level Personality Pathology by Using Short-Term Dynamic Psychotherapy. Journal of Clinical Psychology. 2012; 4(3): 75-85.
36- Doering S, Horz S, Rentrop M, Fischer-Kern M, Schuster P, Benecke C, et al. Transference-focused psychotherapy v. treatment by community psychotherapists for borderline personality disorder: randomised controlled trial. The British journal of psychiatry : the journal of mental science. 2010; 196(5): 389-95.
37- Monsen J, Odland T, Faugli A, Daae E, Eilertsen D. Personality Disorders: Changes and Stability after Intensive Psychotherapy Focusing on Affect Consciousness. 1995; 33-48.