Psychology

Diagnosis Dependent Personality Disorder, Axis II, Cluster C anxious and fearful
Symptoms Agnes displays six of the eight specified criteria provided by The Diagnostic and Statistical Manual of Mental Disorders IV text revision (as cited in Perry, n.d.) indicated by the following
Need for others to assume responsibility for her life. She has become extremely reliant on her daughter and she insists that she accompany her in everything she does

Difficulty in expressing disagreement with others. This is manifested in the submissive and passive role she assumes in the relationship with her husband

Lack of self confidence. Agnes has difficulty in initiating projects or doing things on her own. Agnes made no effort to pursue a college degree despite yearning for one

Intense desire to obtain approval and support from others, which was evident in being a teachers pet and suspending her own education to help her husband finish college

Exaggerated fear of being unable to take care of herself. Agnes once had a panic attack at the thought of becoming isolated and

Agnes is preoccupied with fears of being left to take care of herself. Agnes misinterprets episodes of anxiety as heart disease for four years.

Some features of dependent personality disorder overlap with those of borderline, histrionic and avoidant personality disorders, but there are differences as well. For example, both borderline and dependent personalities fear abandonment. However, Agnes does not have the pattern of intense and stormy relationship that the borderline has. Histrionic and dependent personalities both have strong needs for reassurance and approval but the style of histrionic is much more gregarious, flamboyant and actively demanding of attention (Carson, Butcher Mineka, 2000), whereas, Agnes is more docile and self-effacing.

Therapy plan
Initiation The therapist must facilitate short-term weekly sessions where Agnes can realize and air out how her life problems have occurred and why it has gone on for so long and to such a high degree. The therapist must avoid becoming another authority figure Agnes will be submissive to. Long-term therapy, while ideal for many personality disorders, is contra-indicated in this instance since it reinforces a dependent relationship upon the therapist. Further, prior research by Winston and colleagues (1994) has found that short-term psychotherapy that is both active and confrontational results to significant improvement in patients with Cluster C disorders.

Maintenance Group therapy with assertiveness-training activities that provide clearly defined goals to encourage boldness, confidence and initiative may be integrated to Agness program. Care should be utilized to ensure that Agnes does not use groups to enhance existing or new dependent relationships. Challenging dependent relationships Agnes has with others that may be unhealthy for her should generally be avoided at the onset of therapy and is ideally done when initial improvement has been made. As therapy progresses, restraint must be used if she is not ready to give up these unhealthy relationships.

Termination Cessation of therapy is an extremely important issue to consider. While termination should always be a joint decision between the clinician and the client, people with this disorder often think they require more treatment. The therapist may need to prod Agnes toward ending therapy. As the end of therapy approaches, Agnes may re-experience feelings of insecurity, lack of self-confidence, increased anxiety and perhaps even depression. This is typical of individuals with this disorder so terminating therapy should be treated appropriately. The clinician should not allow the patient to use these new symptoms as a way of prolonging the current therapy. The objective is to end a relationship at an agreed-upon time and way. Agnes should be reinforced for the positive gains made in therapy and encouraged to explore their new-found autonomy or improved management of their anxious feelings. (Dependent Personality, 2006).