The individual with dependent personality disorder or with histrionic personality disorder is not avoidant of therapy as many other individuals, including those with certain other personality disorders. The dependent individual or the histrionic individual is often enthusiastic about therapy and the therapist, but in some semi-conscious or unconscious Machiavellian manner. As he or she is characterologically damaged or stunted to function in a healthy mutually reciprocal fashion with a partner, he or she is similarly handicapped to relate with the therapist. The dependent or histrionic individual does not bring emotional or psychological health or stability into relationships, but secretly hopes that relationship will stabilize or heal his or her emotional and psychological devastation. The partner often fails to or does not adequately attend to the secret agenda. He or she is drawn into a dependent or histrionic rabbit hole. Up is down and down is up. Attention is proof of not caring. Caring is disrespectful. Safety creates insecurity. Good is bad and bad is good. While the disordered individual may not previously been in formal therapy, all his or her intimate relationships have been instinctive therapeutic attempts to gain or repair developmental deficits in attachment and identity. The fatal flaw to the strategy has been that the partners were not in on the deal. They had not realized that they were signing on to be the vehicles to get the disordered person to where he or she was desperate to reach. Nor, were they aware of how hurt, angry, and/or betrayed the person would be when failure ensued.
Individual therapy avails the therapist theoretically to systematically, sequentially, and progressively heal and rebuild the emotional and psychological foundations for individual to reach his or her goals. With developing, attaining, and maintaining a capacity to have and sustain intimacy, the therapist sends the client out to the real world to practice. The individual brings back his or her experiences: successes, failures, frustrations, joys, and questions back to therapy for more processing, much as a racecar returns to the pit or the garage for repair or fine tuning. Or, therapy promotes psychic growth to the point the client can finally venture forth into real relationships. Couple therapy in contrast is akin to repairing a car engine while it is going 90 miles an hour and careening off walls and bouncing through ditches... with a misfiring spark plug... on a flat tire... through a driving thunderstorm... with broken windshield wipers! With the driving instructor yelling how it’s such a horrible driver/vehicle! Since the dependent and histrionic individual is likely to want the therapeutic relationship, the therapist works not so much on building rapport or attachment but on creating healthy intimacy. Developing and enforcing a realistic and healthy therapeutic contract among partners and the therapist is a key to therapy. Identifying and avoiding dependent or histrionic or other dysfunctional relationship contracts are thus also keys. Therapy and couple therapy must shift fundamentally to address such foundational relationship forces. In couple therapy, these two strategies in therapy provide a model for the disordered individual’s partner and for their relationship at home.
The vehicle... the individual... the partner... the relationship needs repair. It needs to slow down, stop bouncing off walls and driving through ditches. The spark plug needs to be replaced- the spark in the relationship restored. The flat replaced and the wipers repaired along with fixing other dysfunctional parts to the relationship. Shutting up the driving instructor- the critical parent and shaming voices is important. The thunderstorm continues as life and life challenges of work, children, money, and so forth continue. Getting out of the storm or finding better shelter can be explored. Dependent, histrionic, or other ineffective dysfunctional processes to weather life stresses, intimacy needs, and ego traumas need to be identified, validated as rudimentary immature survival mechanism from vulnerable times. The same mechanisms can then be challenged and adapted to meet current demands. Each disorder, characterological tendency, or behavioral pattern has internal human survival logic. As such, each has more or less available therapeutic entries for the therapist. The therapist needs to remember that dependent, histrionic, or other defensive styles have worked to some degree historically. The therapist should honor the needs and the mechanisms for survival. This is the path to also confronting the individual that they no longer work so well or that their collateral consequences have become more severe, more rigid, and the individual’s life has more circumcised. And especially, that the individual must deal with the couples relationship now being at some critical crisis as a result. “How is that working for you? If it is not what you want, are you willing to do and be something different? Really different?”
The theory behind therapy prepares the therapist, but then it is still up to the artistic skills of the therapist to move the immovable. The theoretical concepts and the strategies discussed may be helpful, but in-the-session artistic skill remains a key. If the individual wants the relationship enough, can introspectively examine deep vulnerabilities, or has come to hate life so much, then he or she may be willing to be challenged and try to change. If not, then the personality disorder- dependent, histrionic, or other may be too entrenched and powerful. The dependent individual may still insist that his or her partner and/or the therapist are the sun, the moon, and the stars. Identity as a dependent celestial asteroid orbiting the important force of the universe may be too embedded. The histrionic individual may continue to not only insist on being his or her partner’s sun, moon, and stars, but be an insatiable black hole of demand for attention. His or her frailty may be too deep and too sensitive to tolerate the light of examination in therapy, in the relationship, or in life. The therapist’s professional ego may humbled to find that the individual just be too fragile despite the therapist’s theoretical insight and therapeutic skills. Or, there may be some small entry based on the conceptual suggestions of this book. Though with limited control over the sun, the moon, and the stars, the therapist can enter the universe of the couple and exert new influence. Perhaps, a big bang can be ignited! Or, the course of heavenly bodies altered enough to prevent cosmic catastrophes. Or, a slightly healthier balance may be achieved. It is not all up to the therapist. He or she is not the sun, the moon, and the stars! Perhaps, however with knowledge and skills, the therapist can help can shift the universe.