Adult Treatment Planner
11: Dependency
SNOMED Terms
- Adult victim of non-domestic physical abuse
- Adult victim of physical abuse
- Avoidant personality disorder
- Borderline personality disorder
- Dependent personality disorder
Goals
- Develop confidence that he/she is capable of meeting own needs and of tolerating being alone.
- Achieve a healthy balance between independence and dependence.
- Decrease dependence on relationships while beginning to meet own needs, build confidence, and practice
assertiveness.
- Establish firm individual self-boundaries and improved self-worth.
- Break away permanently from any abusive relationships.
- Emancipate self from emotional and economic dependence on parents.
Behavioral Definitions
- Inability to become self-sufficient, consistently relying on parents to provide financial support, housing,
or caregiving.
- A history of many intimate relationships with little, if any, space between the ending of one and the start
of the next.
- Strong feelings of panic, fear, and helplessness when faced with being alone as a close relationship ends.
- Feelings easily hurt by criticism and preoccupied with pleasing others.
- Inability to make decisions or initiate actions without excessive reassurance from others.
- Frequent preoccupation with fears of being abandoned.
- All feelings of self-worth, happiness, and fulfillment derive from relationships.
- Involvement in at least two relationships wherein he/she was physically abused but had difficulty leaving.
- Avoidance of disagreeing with others for fear of being rejected.
Diagnoses
- Dysthymic Disorder
- Physical Abuse of Adult, Victim
- Avoidant Personality Disorder
- Borderline Personality Disorder
- Dependent Personality Disorder
Objectives and Interventions
- Describe the style and pattern of emotional dependence in relationships.
- Explore the client's history of emotional dependence extending from unmet childhood needs to current
relationships.
- Verbalize an increased awareness of own dependency.
- Develop a family genogram to increase the client's awareness of family patterns of dependence in
relationships and how he/she is repeating them in the present relationship.
- Assign the client to read Codependent No More (Beattie), Women Who Love Too Much (Norwood), or
Getting Them Sober (Drews). Process key ideas.
- Verbalize insight into the automatic practice of striving to meet other people's expectations.
- Explore the client's family of origin for experiences of emotional abandonment.
- Assist the client in identifying the basis for his/her fear of disappointing others.
- Read with the client the fable entitled "The Bridge" in Friedman's Fables (Friedman). Process the
meaning of the fable.
- List positive things about self.
- Assist the client in developing a list of his/her positive attributes and accomplishments.
- Assign the client to institute a ritual of beginning each day with 5 to 10 minutes of solitude where
the focus is personal affirmation.
- Identify and replace distorted automatic thoughts associated with assertiveness, being alone, or keeping
personal responsibility boundaries.
- Assist the client in identifying the basis for his/her fear of disappointing others.
- Explore and identify the client's distorted, negative automatic thoughts associated with
assertiveness, being alone, or not meeting others' needs.
- Explore and clarify the client's fears or other negative feelings associated with being more
independent.
- Assist the client in developing positive, reality-based messages for self to replace the distorted,
negative self-talk.
- Verbalize a decreased sensitivity to criticism.
- Explore the client's sensitivity to criticism and help him/her develop new ways of receiving,
processing, and responding to it.
- Assign the client to read books on assertiveness (e.g., When I Say No I Feel Guilty by Smith).
- Verbally reinforce the client for any and all signs of assertiveness and independence.
- Increase saying no to others' requests.
- Assign the client to say no without excessive explanation for a period of one week and process this
with him/her.
- Train the client in assertiveness or refer him/her to a group that will facilitate and develop
his/her assertiveness skills via lectures and assignments.
- Report incidents of verbally stating own opinion.
- Train the client in assertiveness or refer him/her to a group that will facilitate and develop
his/her assertiveness skills via lectures and assignments.
- Assign the client to speak his/her mind for one day, and process the results with him/her.
- Identify own emotional and social needs and ways to fulfill them.
- Ask the client to compile a list of his/her emotional and social needs and ways that these could
possibly be met; process the list.
- Ask the client to list ways that he/she could start taking care of himself/herself; then identify
two to three that could be started now and elicit the client's agreement to do so. Monitor for
follow-through and feelings of change about self.
- Report examples of receiving favors from others without feeling the necessity of reciprocating.
- Assign the client to allow others to do favors for him/her and to receive without giving. Process
progress and feelings related to this assignment.
- Verbalize an increased sense of self-responsibility while decreasing sense of responsibility for others.
- Assist the client in identifying and implementing ways of increasing his/her level of independence
in day-to-day life.
- Assist the client in developing new boundaries for not accepting responsibility for others' actions
or feelings.
- Facilitate conjoint session with the client's significant other with focus on exploring ways to
increase independence within the relationship.
- Verbalize an increased awareness of boundaries and when they are violated.
- Assign the client to keep a daily journal regarding boundaries for taking responsibility for self
and others and when he/she is aware of boundaries being broken by self or others.
- Assign the client to read the book Boundaries: Where You End and I Begin (Katherine) and process key
ideas.
- Ask the client to read the chapter on setting boundaries and limits in the book A Gift To Myself
(Whitfield) and complete the accompanying survey on personal boundaries. Process the key ideas and
results of the survey.
- Increase the frequency of verbally clarifying boundaries with others.
- Reinforce the client for implementing boundaries and limits for self.
- Increase the frequency of making decisions within a reasonable time and with self-assurance.
- Confront the client's tendency toward decision avoidance and encourage his/her efforts to implement
proactive decision making.
- Give positive verbal reinforcement for each timely thought-out decision that the client makes.
- Attend an Al-Anon group to reinforce efforts to break dependency cycle with a chemically dependent partner.
- Refer the client to Al-Anon or another appropriate self-help group.
- Develop a plan to end the relationship with abusive partner, and implement the plan with therapist's
guidance.
- Assign the client to read The Verbally Abusive Relationship (Evans); process key ideas and
insights.
- Refer the client to a safe house.
- Refer the client to a domestic violence program and monitor and encourage his/her continued
involvement in the program.
Index