Therapists often experience a major relational dilemma in working with individuals who have complex developmental trauma disorders. On the one hand, secure attachment is heralded as one of the most essential outcomes of successful therapy. We are thus taught to develop a therapeutic relationship on which the client becomes dependent for predictability and consistent repair. On the other hand, our clients’ unmet dependency needs evoke profound desperation and helplessness, which are major triggers for ongoing dissociation in clients, and intense countertransference reactions in therapists. We are thus taught to prevent our clients from becoming “too” dependent on us. How can we reconcile and navigate these apparently contradictory approaches? Implicitly or explicitly, much of the treatment literature discusses the therapeutic relationship in the context of a parent-child attachment model (for example, “the good enough mother”), in which our clients safely depend upon us to support relational repair. We will examine the pros and cons of using this kind of relational model with adult clients with profound developmental attachment difficulties. Then we will explore other possible relational models that emphasize collaboration on specific and shared treatment goals, and value ways to help our clients learn to accept compassionately their dependency needs. We will also explore the many facets of dependence in psychotherapy and how to work effectively with them in a window of emotional tolerance for both client and therapist. Therapists need to understand be able to address the need-shame-rage cycle in dependency that can lead to therapeutic impasse. We will explore differences in working with overly dependent as well as overly independent clients. Finally we will discuss ways to resolve inner conflicts about dependence among dissociative parts, supporting inner relations of adaptive inter-dependence that are a hallmark of integrative functioning.

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