Cet article propose de faire le point sur les approches psychothérapeutiques chez les patients souffrant de personnalité dépendante et de dépendance relationnelle pathologique. Nous mettons en exergue les psychothérapies ayant fait l’objet d’une évaluation. La recherche évaluative sur le sujet est pauvre : seules huit études permettent d’évaluer des psychothérapies dans cette indication en 2005. Nous abordons les thérapies d’inspiration analytique, les psychothérapies comportementales, cognitives, humanistes et systémiques brèves. Nous considérons la dépendance comme étant une façon de s’adapter, de compenser une estime de soi altérée. En ce sens, la psychothérapie devra également s’attacher à restaurer l’estime de soi. L’évaluation du type de dépendance aiguille l’approche thérapeutique. Il faut rechercher les comorbidités et leur apparition dans le temps par rapport à la dépendance. Ainsi, la dépendance primaire, « héritée de l’enfance », précède les autres troubles psychiques. Dans cette situation, la thérapie se centre principalement sur l’estime de soi. La dépendance secondaire fait suite à un événement altérant l’estime de soi, comme une maladie mentale par exemple. Dans cette situation, outre le fait de favoriser la rémission de la maladie mentale, la thérapie visera l’accompagnement du patient vers l’autonomie et le « rétablissement ».

This article is a review of psychotherapies for patients suffering from dependent personality and interpersonal dependency.

We synthesized articles making reference to this question, notably those written by Bornstein, author who refers to the dependent personality. We highlighted the psychotherapies that have been the object of an evaluation. The research on the subject is sparse: only eight studies permitting assessment of psychotherapies in this indication in 2005. Besides these psychotherapies, we detailed other approaches which are used by practitioners in these indications.

The therapy does not aim at autonomy “at all costs”, but that the patient finds a dependence “adapted” to his/her environment. Before starting a therapy, an evaluation is useful to specify the type of dependence. First of all, is there a “pathological” dependence? Is the suffering of the patient secondary to his personality or not supportive enough? Does insight exist? What is the reaction of the patient if we suggest the hypothesis of a dependence on his/her part? Does he/she consider this idea or reject it? Finally, is the dependence primary or secondary? For that purpose, it is necessary to study the biography of the patient and the appearance of the comorbidity over time. The primary dependence is seen in childhood and precedes the other psychological disorders. The secondary dependence follows after the comorbidity and events of life that alter self-esteem (depression, for example). Various therapeutic strategies arise from various currents. The therapies of analytical inspiration recommend replaying the relationship of object and explicitly evoking the transfer. The behavioural and cognitive psychotherapies aim at making the patient identify the cognitions which underlie the dependence, then leading the patient to modify his/her cognition and to behave in a more autonomous way, using the theory of learning. The humanist therapies aim at a therapeutic relationship of acceptance and respect for the patient, so that he/she increases self-esteem and finds autonomy. The brief systemic therapy develops tools to deviate from the relationship of dependence in the therapy. It aims at the change through a modification in the beliefs of the patient. The dependence can be envisaged as a way of adapting itself, of compensating for altered self-esteem. In this way, the psychotherapy must also attempt to restore self-esteem in an implicit or explicit way.

The evaluation of the type of dependence helps the therapeutic approach. It is necessary to look for the comorbidity and its appearance over time with regard to the dependence. So, in primary dependence, the therapy focuses on the increase of self-esteem. In the secondary dependence, the therapy focuses on the adaptation to this event, the treatment of the mental illness, and then to the accompaniment in restoring and autonomy. If the patient doesn’t have insight, it is necessary either to enhance it, or to work in an indirect way.