Dependency on the Psychotherapist

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People depend on one another in most human relations, especially those involving professional services. Mental health care, and psychotherapy in particular, are characterized by various degrees of patient dependency, which can be managed to advance the purposes of diagnosis and treatment. The initial therapist-patient relationship can evolve into a working alliance that may come to resemble a partnership based on mutual respect and trust, in which the patient achieves a growing independence and sense of agency in directing his or her own life effectively. Some patients, whose earlier lives have left them with intense anxiety, feelings of inadequacy, and need for support and direction by others, place heavy and inappropriate demands on their therapists. Strategies for dealing with these situations start with recognizing them as unconsciously determined manifestations of underlying dynamics. These can be controlled by engaging the patient in learning why they happen and in gaining a sense of mastery through building internalized ways to regulate affects and meet needs appropriately. Success in this effort can have salutary effects on patients' sense of self, differentiation of self from others, sense of security with being in charge of their own lives, self-esteem, and relationships with others. (Journal of Psychiatric Practice 2009;16:50–53)

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