PSYCHOANALYTIC PSYCHOLOGY, 13(2), 177-203 Copyright © 1996 Lawrence Erlbaum Associates, Inc.

Beyond Orality: Toward an Object Relations/Interactionist Reconceptualization of the Etiology and Dynamics of Dependency
Robert F. Bornstein, PhD
Gettysburg College

Although the classical psychoanalytic model of dependency contends that dependent personality traits are rooted in infantile feeding and weaning experiences and should be associated with various oral behaviors, empirical evidence supporting these assertions is weak. In this article I (a) review the empirical literature testing three key hypotheses regarding the dependency-orality relation, (b) briefly review extant object relations models of dependency, and (c) describe an integrated object relations/interactionist model of dependency that accounts for the entire range of behaviors exhibited by the dependent person but does not invoke the concept of orality to explain dependency-related personality dynamics. Evidence supporting the object relations/interactionist model is reviewed, and the clinical implications of this model are discussed.

In classical psychoanalytic theory, dependency is inextricably linked to the events of the infantile, oral stage of development (Freud, 1905). Frustration or overgratification during the oral stage is hypothesized to result in oral fixation, and in an inability to resolve the developmental issues that characterize this period (e.g., conflicts regarding dependency and autonomy). Thus, classical psychoanalytic theory postulates that the orally fixated (or oral dependent) person will (a) remain dependent on others for nurturance, guidance, protection, and support and (b)

Requests for reprints should be sent to Robert F. Bornstein, PhD, Department of Psychology, Gettysburg College, Gettysburg, PA 17325.

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continue to exhibit behaviors in adulthood that reflect the infantile oral stage (i.e., preoccupation with activities of the mouth, reliance on food and eating as a means of coping with anxiety). Early in his career, Freud (1908, p. 167) discussed in general terms the links between fixation and the development of particular personality traits, noting that "one very often meets with a type of character in which certain traits are very strongly marked while at the same time one's attention is arrested by the behavior of these persons in regard to certain bodily functions." Following Freud's (1905, 1908) initial speculations regarding the etiology and dynamics of oral dependency, several psychoanalytic writers (e.g., Abraham, 1927;Fenichel, 1945; Glover, 1925; Rado, 1928) extended the classical psychoanalytic model, suggesting that two variations in the infant's early feeding experience could lead to oral fixation and the development of oral dependent personality traits: (a) frustration during infantile feeding and weaning and (b) overgratification during the infantile feeding and weaning period. Goldman-Eisler (1948, 1950,1951) further refined the hypotheses of Abraham (1927), Fenichel (1945) and others, contrasting the personality characteristics of frustrated oral pessimists with those of overgratified oral optimists. Although subsequent studies failed to confirm the utility of the oral optimist-oral pessimist distinction (Masling, 1986; Masling & Schwartz, 1979), the concept of orality (along with the associated concepts of oral fixation and oral dependency) has continued to exert a strong influence on psychoanalytic theory (see Fisher & Greenberg, 1985; Parens & Saul, 1970). Not only has the concept of oral dependency had a profound influence on psychoanalytic models of personality development and psychopathology (Ainsworth, 1969; Eagle, 1984), but this concept has also played a central role in recent theoretical formulations regarding transference dynamics and the nature of the psycho therapeutic process (Blatt & Ford, 1994; Horowitz, 1988).1 During the past several decades, the focus of psychodynamic theory and research has shifted from a drive-based metapsychology derived from the classical psychoanalytic model to a more object relations-oriented approach wherein personality development and dynamics are conceptualized in terms of self-other interactions and internalized mental representations of the self and significant figures (see Galatzer-Levy & Cohler, 1993; Greenberg & Mitchell, 1983). Although the classical psychoanalytic model of dependency has to some degree been supplanted by more recent object relations frameworks, which describe the etiology and dynamics

Although several psychoanalytic writers have distinguished oral aggression from oral dependence (e.g., Fenichel, 1945; Glover, 1925), the vast majority of empirical studies in this area have assessed the affiliative, receptive iispects of orality (see Fisher & Greenberg, 1985; Masling & Schwartz, 1979). Thus, my review of the empirical literature of necessity focuses primarily on laboratory and field evidence related to oral receptivity and affiliative oral strivings.

1982. even nonpsychoanalytic models of personality and psychopathology frequently utilize some variant of the orality concept to explain normal and pathological personality development (Bornstein. Apparently. this model predicts that frustration (e.g.. Interestingly.g.&Milich. the notion that dependent behavior is linked with a preoccupation with food. 1993. 1993). drinking. THE DEPENDENCY-ORALITY RELATION: HYPOTHESES DERIVED FROM THE CLASSICAL PSYCHOANALYTIC MODEL At least three testable hypotheses stem directly from the classical psychoanalytic model of oral dependency. the terms orality and oral dependence continue to be widely used in the psychoanalytic literature. but which does not invoke the concept of orality to explain personality development and dynamics.. In fact. I briefly review extant object relations models of dependency. and researchers.Lachmann. the hypothesis that dependent personality traits in adults should be associated with various oral behaviors (e. Finally. Although the orality-dependency link continues to be widely discussed among psychoanalytic theorists. Specifically. Next. I argue that it is time for psychoanalysis to go beyond orality and develop a theoretical model of dependency that does not invoke the concepts of oral dependence and oral fixation. I first discuss the central hypotheses regarding the dependency-orality relation as this relation is described in classical psychoanalytic theory and then review the empirical literature testing these hypotheses. 1992. clinicians.arid mouth-related activities has become so widely accepted among psychoanalysts that this hypothesis is now "detached" from its classical psychoanalytic roots and continues to influence psychodynamic thinking even among those who reject many aspects of the drive model.g. . 1983. evidence supporting this hypothesized relation is weak. even among theoreticians and researchers who conceptualize personality development and dynamics primarily in object relations terms (see Greenberg & Mitchell.. from abrupt weaning or the parents' use of a rigid and inflexible feeding schedule). or overgratification (e. this model predicts that high levels of dependency should result from variations in the infant's feeding and weaning experiences. 1995). I present a reformulated object relations/interactionist model of dependency which is consistent with research in this area.Tabin. Simply put. 1985).Silverman. The purpose of this article is to argue that the psychoanalytic concept of orality has outlived its usefulness and that we should now turn our attention to developing and refining theoretical models of dependency that do not attempt to link dependent behavior with oral behavior. smoking) has continued to thrive. eating.BEYOND ORALITY 179 of dependent personality traits (Bornstein. First.

& Levin. Sears..and mouth-related imagery (if a projective test is used) or should report high rates of food. 1963. insofar ^& each of these disorders is characterized by behaviors that reflect a preoccupation with oral activities. 1957.and mouth-related activities (if a self-report test is used). observational. Stendler.180 BORNSTEIN from an overly long nursing period) should produce high levels of dependency in offspring. Nowlis. 1950s. 1963. to the extent that a person obtains a high dependency score on an objective or projective test. projective. Second. Although there was some variation in the hypotheses tested in these studies. 1953. I focus primarily on the most well-controlled. & Sears. such a review may be found in Bornstein (1993).. 1951. Rau. 1948.g. Researchers investigating the feeding/weaning-dependency relation predicted that exaggerated dependency needs in childhood. Whiting. In the following sections I review empirical studies testing these predictions. there was enough overlap among these hypotheses that they can be summarized in general terms. the person should also show high rates of food. and tobacco addiction. 1950. thumbsucking. eating disorders (i. Third. Thurston & Mussen. Maccoby. Thus. Sears. and 1960s. Sears & Wise.e. 1954. numerous researchers investigated the link between infantile feeding and weaning experiences and subsequent dependency levels in children. 1950. . nail biting).and mouth-related activities should covary in normal and clinical participants. adolescence..e. or adulthood would result from (a) either a very long (i. Because there have been dozens—if not hundreds—of investigations in this area. & Alpert. or interview-based measure of dependency (Goldman-Eisler. dependent individuals should show increased risk for alcoholism. the classical psychoanalytic model predicts that high levels of dependency should be associated with increased risk for psychological disorders that have a prominent oral component. Heinstein. anorexia and bulimia). this model predicts that dependent behaviors and preoccupation with food. well-designed studies related to these three hypotheses. obesity. individuals who show high levels of dependency should also exhibit various oral behaviors (e. adolescents. 1965. Sears. 1951). Infantile Feeding and Weaning Experiences As Predictors of Later Dependency During the 1940s. In addition. Sears. Thus. overgratifying) or very brief Although a comprehensive review of the empirical literature on the etiology and dynamics of dependency is beyond the scope of this article. The general approach used in these studies involved ob [aining retrospective reports of feeding and weaning behaviors from the mother and assessing the relation between these variables and participants' scores on some objective. and adults.

In this investigation. Nonsignificant results were also obtained by Sears (1963). one important methodological limitation of these investigations warrants mention.05: Breast-fed boys had significantly higher TAT dependency scores in late childhood (i.. self-presentation bias. the relations between three feeding/weaning variables (i. In Sears et al. Heinstein examined the relation of two feeding/weaning variables (i. so that memories of events such as "rigidity of feeding schedule" might not have been completely accurate in these studies. which is almost exactly what would have been expected on the basis of chance alone.e. Heinstein's (1963) large-scale longitudinal study of the feeding/weaning-dependency link also failed to produce strong.. studies in this area have almost invariably relied on mothers' retrospective reports of feeding and weaning practices. need for approval.vs. (1965). Four of the 90 comparisons were significant atp < . Sears etal.'s (1957) study.e. abrupt) weaning. Although studies in this area have generally produced results that do not support the hypothesis that infantile feeding and weaning experiences predict later dependency levels.. Of the 16 comparisons between predictor and criterion variables in Heinstein's study. consistent findings.e. age of weaning. although studies to date have offered little support for an hypothesized feeding/weaning-dependency link. Sears et al.vs. These investigations produced mixed results. Moreover. As noted earlier..BEYOND ORALITY 181 (i. It is possible that the mother's ongoing interactions with her child influenced her memories of past mother-child interactions. Thus.e. rigidity of feeding schedule.. and numerous other factors might have compromised the accuracy of these reports. breast. a rigorous test of this hypothesis would require a prospective investigation wherein parents' .e. (c) bottle-feeding rather than breast-feeding. only one produced results significant at p < .47) and boys (r. bottle-feeding and length of the nursing period) to several indices of later dependency (i. (b) a rigid (as opposed to flexible) feeding schedule. and (d) severe (i. Thurston and Mussen (1951) also found no relation between mothers' reports of several feeding and weaning variables and their adolescent children's dependency levels assessed via the Thematic Apperception Test (TAT). Although Sears et al.39) in a sample of 40 nursery school children. preschool and late childhood interview ratings of dependency. (1953) found that mothers' reports of severity of weaning predicted subsequent teacher-rated dependency levels in both girls (r. frustrating) nursing period. even if mothers' memories for this information were accurate. This yielded 90 separate feeding/weaning-dependency comparisons.e. bottle-feeding) and 30 TAT indices of dependency were assessed.05.. (1957) were unable to replicate these results in a mixed-sex sample of 379 kindergarten children.. TAT and Rorschach dependency scores) in a mixed-sex sample of 252 children. and Stenidler (1954). the children's dependency levels were unrelated to severity of weaning or rigidity of feeding schedule. between ages 9 and 11) than did bottle-fed boys. breast..

Heinstein.. Consistent with the findings of Blum and Miller (1952). 1957. Moreover. Relation Between Dependency and Preoccupation With Food. In general.g. Juni & Cohen. nail biting and pen chewing (Kline & Storey. 1980). both Beckwith (1986) and Mills and Cunningham (1988) failed to find significant relations among various indices of oral behaviors in samples of community and college student participants. 1980. 1985. or interview-based dependency measures and their score s on indices of preoccupation with oral activities. adolescent. Gottheil and Stone (1968).. Heinstein.. Barnes (1952). these studies failed to find any strong or consistent relations between participants' scores on objective.g. as Masling (1986. help-seeking) and the frequency with which they exhibited various oral behaviors (e. 1957. Kline & Storey. In each of these . Blum & Miller. the magnitudes of these relations were quite small. nail biting). Factor-analytic studies assessing the intercorrelations of dependent and oral traits also produced results which do not support the hypothesis that these traits would covary in viirious participant groups. In those few studies wherein statistically significant relations between participants' orality and dependency scores were found (e. and Armor (1966. such a study has never been conducted.g. Klerman. These studies involved both children and adults and utilized participants from clinical as well as nonclinical samples.. 1985). these observed dependency-orality relations may well have been due to a third factor—immaturity—which underlied the participants' high dependency scores as well as their high rates of such oral behaviors as thumbsucking. and playing a wind instrument (as opposed to another type of musical instrument) in a school orchestra (Kline & Storey. or adult participants. 1980). Among the oral behaviors tested in these investigations were thumb-sucking (Beller. Unfortunately. using factcr-analytic and cluster-analytic approaches. 1952). Juni and Cohen (1985). Kline (1973). 1963). Jamison and Comrey (1968).182 BORNSTEIN feeding and weaning practices are observed and rated as they occur and then these feeding and weaning variables are used to predict subsequent dependency levels in child. 1979) pointed out. projective. Masling & Schwartz. 1980). and Lazare. assessment of the link between objective dependency scores and pen-chewing frequency in college students). preferring oral sex (i.and Mouth-Related Activities Several studies have tested the hypothesis that dependent persons would show higher rates of oral behaviors than nondependent persons (Beller. 1963. 1952. exhibiting "nonpurposive mouth movements" during school (Blum & Miller. 1970) all assessed the relation between participants' self-reports of the frequency with which they exhibited dependent behaviors (e. Kline & Storey's. and others.e. cmnilingus and fellatio) over other forms of sexual activity (Juni & Cohen.

1984.g. and in most cases these observed relations failed to reach statistical significance.06) between Rorschach dependency and food/mouth-related imagery scores in their mixed-sex college student sample. r . 1969. Conley.g. three studies have assessed the relation between the frequency of dependency-related imagery and the frequency of food. McCord. 1952). 1962). The results of these investigations were mixed. Although Bornstein. Dependency As a Predictor of "Oral" Psychopathology Most correlational studies assessing the relation between dependency and alcoholism suggest that alcoholic participants obtain higher dependency scores than do nonalcoholic controls (Bertrand & Masling. the magnitude of the dependency-orality correlation was small (e. these correlational studies do not address the question of whether dependency actually predisposes individuals to alcoholism. and Vaillant (1980) conducted prospective studies of the dependency-alcoholism rela- . 1980. Hoffman. Finally. three studies produced nonsignificant results in this area. All three studies used Masling. 1985. Verinis. In fact. these relatively small dependency-orality relations were likely due. to the presence of a third underlying factor such as immaturity (Masling & Schwartz. Kline. 1984). An equally plausible interpretation of these results is that the onset of alcoholism somehow causes an increase in dependent feelings. and Blondheim's (1967) Rorschach Oral Dependency scoring system to assess participants' dependency-related and food/mouth-related Rorschach responses. Krukonis.09..and mouth-related imagery produced by adolescent and adult participants on the Rorschach test.21. However. 1979) or trait anxiety (Bornstein. McCord. Blum & Miller. Evans.BEYOND ORALITY 183 studies.. & Thurber. Rabie. Craig. 1993) that underlied participants' dependency-related behaviors as well as their oral behaviors. 1988). 1971. Poldrugo & Forti..37) in a mixed-sex sample of college students. Of course. Kammeier. and Mastrosimone (1993) found a significant positive correlation between these two Rorschach variables (r . finding no relation between dependency levels and alcohol use (Blane & Chafetz. Jones (1968). 1973). As was the case for behavioral studies of the dependency-orality link (e. Longitudinal studies of the dependency-alcoholism link clearly support the latter hypothesis. and Loper (1973). thoughts and behaviors. Manning. When the dependency-food/mouth-related imagery correlations obtained in these three investigations are pooled using meta-analytic techniques (Rosenthal. Shilkret and Masling obtained a small (albeit nonsignificant) inverse correlation (r = -. Rossner. & Wexler. 1992. the overall relation between these variables is . in whole or in part. both Bornstein and Greenberg (1991) and Shilkret and Masling (1981) found no relation whatsoever between participants' dependency and food/mouth-related imagery scores in psychiatric inpatients and college student participants.

Although several studies found that obese participants obtain significantly higher objective and projective dependency scores :han normal-weight participants (Masling et al. although it is clear that there is some relation between dependency and eating disorders. 1991. In addition. 25% received borderline personality disorder diagnoses. 1990. most studies of the dependency-eating disorders relation have compared the frequency of dependent personality disorder (DPD) symptoms in eating-disordered participants and noneating-disordered controls (Bornstein. self-doubt) showed significant increases following the onset of alcoholism in his sample of male participants who were assessed periodically on a variety of personality and psy:hopathology measures between the ages of 20 and 50. these investigations also found that eating-disordered participants show elevated rates of several other personality disorder diagnoses. and 18% received diagnases of obsessive-compulsive personality disorder. American Psychiatric Association. 1993).'s inpatient sample met the Diagnostic and Statistical Manual of Mental Disorders (3rd ed. Mills & Cunningham. Zimmerman & Coryell.. 23% received histrionic personality disorder diagnoses.. Levin and Hyler (1986) also found that several other personality disorders were at least as common as DPD in a sample of eating-disordered psychiatric outpatients. & Goodman. Thus. and it is likely that observed dependency-eating disorder links simply reflect the greater overall levels of psychopathology typically found in eating-disordered participants relative to controls (Bornstein. Levin & Hyler. as Masling and Schwartz (1979) pointed out. 1990. 1967. 1993). Moreover. although 32% of the eating-disordered participants in Wonderlich et al. Lenihan & Kirk. so that observed dependency-obesity relations in these investigations might reflect. there are several methodological problems with studies of the dependency-obesity link.184 BORNSTEIN tion and obtained highly consistent results. 1992. Wonderlich. studies in this area have generally failed to control for overall level of psychopathology. Vaillant found that a variety of dependency-related traits (e. & Mason. As is the case far studies of the dependency-alcoholism link.. In each of these investigations. For example.g. other similar experiments found no relation between dependency and obesity (Black. 1986. in whole or in part. However. 1987) diagnostic crkeria for DPD. 1989). Bornstein & Greenberg. Slotnick. Keith & Vandenberg. the specificity of this relation remains open to question. 32% of these participants also met the diagnostic criteria for avoidant personality disorder. passivity. Swift. 1989. Rev. as was the case for studies of the . premorbid dependency levels did not predict subsequent risk for alcoholism. Most important. 1974). the effects of higher overall levels of psychopathology in obese participants relative to controls. Although these investigations have generally found that anorexic and bulimic participants show higher rates of DPD symptoms and diagnoses than do matched control participants (Jacobson & Robins. 1970). In contrast to studies of the dependency-obesity link. pessimism.. 1988: Weiss & Masling. studies of the dependency-obesity relation have produced mixed results. Goldstein.

In this context. and. 1971..and mouth-related activities to cope with anxiety. see Bornstein.g. Second. at best. but studies have also demonstrated that there is a significant positive correlation between level of dependency and smoking frequency (Jacobs & Spilken. it is entirely possible that a longitudinal study of the dependency-smoking link involving today's college students would yield precisely the opposite results from those obtained by Vaillant. teachers. an alternative interpretation of these results is that the increased rates of smoking observed in the dependent men in Vaillant's sample reflect dependent persons' increased susceptibility to social influence. the results of studies assessing the dependency-orality relation do not offer strong support for the classical psychoanalytic model of dependency. empirical studies do not support the hypothesis that dependent traits and behaviors may be traced to variations in infantile feeding and weaning experiences. although studies of the relation between dependency and preoccupation with oral activities and studies of the relation between dependency and various oral psychopathologies have produced mixed results..ed relations is. Not only do cigarette smokers show significantly higher dependency levels than nonsmokers (Jacobs et al. thoughts and behaviors follow. the onset of eating disorder symptoms. this evidence is . evidence supporting these hypothesi2. Vaillant's results suggest that dependency may actually predispose individuals to cigarette smoking. it may be that the dependent men in Vaillant's sample were more strongly influenced than nondependent men by peer pressure to smoke during adolescence. rather than precede. Kline & Storey.. 1965. it is noteworthy that the participants in this sample typically initiated smoking during the 1950s. Of course.BEYOND ORALITY 185 dependency-alcoholism link. Veldman & Bown. The only oral psychopathology that has clearly been shown to be related to underlying dependency needs is tobacco addiction. weak. Vaillant (1980) further found that level of dependency assessed at age 20 predicted subsequent smoking frequency in a sample of 184 male college graduates. Jacobs et al. 1969). First and foremost. as noted earlier. given the dependent individual's desire to please figures of authority (e. 1966. 1980). Although Vaillant's (1980) results are consistent with the hypothesis that dependent persons rely on food. rather than being a correlate or consequence of tobacco addiction. 1992) and the strong antismoking messages conveyed by many figures of authority today. parents. the social pressures surrounding tobacco use have changed considerably during the past several decades and. Specifically. OTHER LIMITATIONS OF THE CLASSICAL PSYCHOANALYTIC MODEL Clearly. it may be that increases in dependent feelings. the causal relation between dependency and eating disorder symptomatology remains open to question. before strong cautionary messages regarding the dangers of cigarette smoking were commonplace.

it is important to note that in most cases these flaws would tend to inflate observed dependency-orality relations. Although dependent persons often yield to nondependent persons in interpersonal negotiations. Although many empirical studies of the dependency-orality link are methodologically flawed. 1982). raise serious questions about the validity and utility of the classical psychoanalytic model of dependency. therapist). Furthermore. Glover (1925). This assumption pervades the writings of early psychoanalytic theorists.. 1987).g. However. In short. 1981) and ask for help when attempting to solve difficult problems in the laboratory more frequently than do nondependent persons (Shilkret & Masling. teacher. those dependency-orality relations that have been obtained in laboratory and field studies likely represent overestimates of the degree to which dependency levels are actually associated with oral behaviors and psychopathologies. requests for "emergency" sessions) than do nondependent persons (Emery & Lesher. in his general behavior present a disinclination to take care of himself. studies in this area indicate that the dependent person often behaves in an active. and others offered similar arguments regarding the dependency-passivity link. dependent persons make more demands upon physicians and therapists (e. To the extent that links between dependency and oral activities and between dependency and risk for oral psychopathologies actually exist.186 BORNSTEIN participant to alternative interpretations.. in and of themselves. Although the aforementioned findings. First." Abraham (1927). p. he will. and require others to look after him. 1981). Taken together. two other limitations of this framework also warrant brief mention here because these limitations turn out to have important implications for other theoretical models. findings from 50 years of research assessing the dependency-orality link indicate that there are few (if any) strong or consistent relations between these variables. 391) assertion that "if a person remains fixated to the world of oral wishes. although dependency is associated with help-seeking behavior and a desire to obtain and maintain nurturant. In fact. these assertions are not supported by research on the psychodynamics of dependency.. Thus.g. Masling. they show the opposite pattern of behavior (i. & Poynton. studies show that dependent persons ask for feedback on psychological tests more readily than do nondependent persons (Juni. supportive relationships. For example. and is illustrated nicely by Fenichel's (1945. decreased yielding relative to nondependent persons) when they believe that refusing to yield will please a figure of authority (Bornstein. dependency is not invariably . a fundamental tenet of the orality model is that dependency is invariably associated with passivity. assertive manner. Rado (1928). these links most likely reflect immaturity and insecurity on the part of the dependent person and a general elevation in risk for many forms of psychopathology—not only those related to food and oral activities—in persons who show exaggerated dependency needs.e. physician. parent. particularly when he or she believes that behaving in this manner will s trengthen ties to a potential nurturer or caretaker (e.

deficit. dependency is also associated with such positive traits as the ability to infer accurately the attitudes and beliefs of other people (Masling. TOWARD AN OBJECT RELATIONS/INTERACTIONIST RECONCEPTUALIZATION OF THE ETIOLOGY AND DYNAMICS OF DEPENDENCY Given the lack of firm empirical support for an hypothesized dependency-orality link. object relations theory provides a particularly fruitful starting point for these efforts. 1988).BEYOND ORALITY 187 associated with passivity. 1974). assertive manner is determined primarily by the demands and situational constraints that characterize a given situation (see Bornstein. The degree to which the dependent person behaves in a passive.. However. 1992. a desire to perform well in classroom settings (Bornstein & Kennedy. In the following sections I briefly review existing object relations models of dependency and present a reformulated object relations/interactionist model that accounts for the entire range of behaviors—passive and active. a willingness to seek treatment quickly when symptoms appear (Greenberg & Fisher. 1992. acquiescent manner or in an active. see Bornstein. 1993). and a tendency to comply rigorously with medical and psychological treatment regimens (Poldrugo & Forti. 1993). or flaw in functioning. for a discussion of this issue). the empirical literature confirms that high levels of dependency are in fact associated with a number of negative consequences (e. increased risk for physical disorders. & Saturansky. Instead of simply being a problem. To be sure. 1995.3 Extant Object Relations Models of Dependency Despite the fact that object relations models of personality and psychopathology almost invariably attribute great importance to the infant-caretaker relationship as A detailed review of extant object relations models of dependency is provided by Greenberg and Mitchell (1983). A second limitation of the classical psychoanalytic model of dependency is its strong emphasis on the negative consequences of dependent personality traits. increased risk for certain forms of psychopathology. as many theoreticians and researchers have suggested. As I have pointed out elsewhere (Bornstein. coupled with other important limitations of the orality model. 1977). dependency is associated with both positive and negative qualities. Johnson. . and maladaptive—that are exhibited by the dependent person. Psychoanalytic theorists have been virtually unanimous in their contention that dependency represents a flaw or deficit in functioning. adaptive.g. it is time to turn our attention to developing alternative theoretical models of dependency. 1994).

the emergence of a cohesive sense of self ultimately comes to play a central role in the individual's capacity for connectedness. Pine. 1983. dependency is discussed primarily in terms of the infant's progression from more-or-less complete reliance on the primary caretaker for nurturance and support to a more autonomous state wherein the child is increasingly capable of meeting physiological (and psychological) needs on his or her own (see Eagle. 1984. both Jacobson (1964) and Mahler et al. Galatzer-Levy & Cohler. Moreover. Klein (1945). the work of Kohut and others makes clear that although early dependence upon the primary caretaker plays a key role in the construction of the self-representation. Beginning with Freud's (1924. while simultaneously remaining connected to—and intimate with—other people. and Silverman et al. Fairbairn (1952) contended that heal thy development does not require a high degree of independence from others. Kohut (1977). 168) recognition that the "course of childhood development leads to an ever-increasing detachment from the parents. Guntrip (1961). the use of psychotropic drugs to quell anxiety. 1984." many psychodynamic thinkers have discussed the consequences of the child's struggle to resolve the ostensibly conflicting needs for care and nurturance on the one hand and autonomy and self-directedness on the other (see Silverman et al. In many object relations frameworks. (1975) argued (albeit in somewhat differen t terms) that infants and young children experience an ongoing tension between the struggle for individuation and the wish to re-merge with the omnipotent. Approaching this issue from a very different perspective. In this context. 1989. but instead entails a progression from complete dependence upon the parents for biological and psychological gratification to a state of flexible interdependence wherein the individual is capable of experiencing the self as autonomous and self-directed. for a detailed discussion of this issue). theorists as diverse as Homey (1945). Using somewhat different terminology. 1993).188 BORNSTEIN a primary determinant of personality development and dynamics. Sullivan (1947). . Mahler. p. 1982. intimacy. (1982) pointed out.. the concept of dependency has net played as central a role as one might expect in these models. Greenspan. Greenberg & Mitchell. a variety of psychological phenomena reflect this ongoing tension between the individual's strivings for separation and independence and the desire to regress and re-merge with the primary caretaker of infancy. 1975). omniscient caretaker of infancy. and Kernberg (1975) have discussed the central role that early relationships (especially early relationships with the primary caretaker) play in the development of an autonomous sense of self and in the evolution of the individual's capacity for mature intimacy. & Bergman. Greenberg and Mitchell (1983). Winnicott (1965). and healthy interdependence (see Eagle. and the strong identification that many persons develop with members of various religious and social groups. As Galatzer-Levy and Cohler (1993). These phenomena include (but are not limited to) the experience of romantic love.

(1985) pointed out. and support to the dependent person (Kernberg. Main. Developmental research on parent-child interactions confirms that parenting styles that lead the child to view the self as powerless and weak do in fact lead to high levels of dependency in offspring (Blatt & Homann. dependent behavior can stem from strategic self-presentation needs rather than from high levels of underlying dependency strivings (Jones & Pittman. and behaviors (see also Bowlby. internalized working models of the self and others) play a central role in the acquisition and development of dependent traits.. 1985). Blatt's (1974. Thus. 1980).g. it is important to note that the construction of a helpless self-representation is not the only means through which dependent traits and behaviors may assume a prominent role in inter.e. 1983) have argued that dependent personality traits in children and adults result primarily from the internalization of a mental representation of the self as weak and ineffectual.. 1992). Although many object relations models suggest that dependent traits and behaviors are rooted in a representation of the self as powerless and ineffectual.1980). Kaplan. especially in those situations wherein exhibiting dependent behavior appears to be an effective means of manipulating and controlling the behavior of others (Bornstein. although it is clear that a representation of the self as powerless and ineffectual is an important factor in the etiology and development of dependent personality traits. 1993). care. other people.and intrapersonal functioning. it is important to keep in mind that other disposition^ and situational variables may also play a significant role in the inter.. attachment theorists go beyond many early object relations models by making explicit the idea that mental representations of the self. a conclusion that has been echoed by researchers who conceptualize dependency within the context of attachment theory and invoke the concept of internalized working models of self and others to describe personality development and dynamics (Main et al. 1977) and as a means of bolstering the self-esteem of significant others whose identity centers around providing nurturance. and self-other interactions (i. 1991) theoretical framework has been the most influential object relations model of dependency. Ainsworth (1969) and others (e.4 In recent years. For example. protection.g. & Cassidy.. Blatt and his colleagues (e. dependent behaviors can serve as a defense against unrequited narcissistic impulses (Kohut. Alternatively. Integrating concepts from object relations theory and self psychology with ideas and findings from research on cognitive development. and support when he or she is confronted with stressful events or challenging situations. These theories extended earlier object relations conceptualizations of dependency by acknowledging the role that mental representations of the self and other people play in the etiology and dynamics of dependent personality traits.and intrapersonal dynamics of dependency. Blatt & Shichman. . a central component of the dependent personality orientation is a belief on the part of the dependent person that other people will be available to offer guidance. 1982).BEYOND ORALITY 189 The critical importance of the child's transition from dependency and helplessness to autonomy and interdependence as a factor in normal and pathological personality development was also echoed in the attachment theories of Bowlby (1969. 1975). attitudes. As Main et al. In this respect. beliefs. 1985). 1969.

Blatt & Homann. approval. (c) affective (i. Blatt & Shichman. support. During the past several years I have utilized the central tenets of Blatt's (1974. 1993. The central elements of an object relations/interactionist model of dependency are summarized in Figure 1..e. behaviors.e. Cornell. 1993. 1992). 1991) contention that the self-representation plays a central role in the etiology and dynamics of dependency provides an overarching conceptual framework that allows for an integration of empirical research on dependency with concepts and principles derived from object relations theory and self psychology (see. 1994). 1993). i marked need for guidance. authoritarian parenting fosters dependency in children by preventing the child from .e. the child (a) looks to others to provide protection and support (Bornstein. a tendency to become anxious and fearful when required to function independently.. including heart disease and cancer (Blatt. the etiology of individual differences in dependency lies primarily in two areas: overprotective. and reassurance from others).190 BORNSTEIf i As the child internalizes a mental representation of the self as weak and ineffectual. 1974).. authoritarian parenting and se>.e. and (d) behavioral (i. motivations. especially when the products of one's efforts are to be evaluated by others).. With these four components in mind. & Eshkol. help-seeking manner (Bornstein. a perception of the self as powerless and ineffectual. Overprotective. Blatt's (1974. Preliminary discussions of this object relations/interactionist model may be found in Bornstein (1992.g. 1993). and emotional responses interact to influence the functioning of the dependent person in various situations and settings. (d) shows increased risk for depression and other anaclitic psychopathologies (Blatt & Homann). (c) behaves in a dependent. An Object Relations/interactionist Perspective on Dependency Any integrated conceptual model of dependency must begin with the recognition that there are four central components to a dependent personality orientation: (a) motivational (i. guidance. 1995). Blatt & Ford. approval. a tendency to seek help. and support from others). 1992. 1991) theoretical framework to elaborate and refine an object relations/interactionist model of dependency which brings together a number of important theoretical and empirical findings in this area. 1994. it is possible to specify the developmental antecedents of dependent personality traits and to explore the ways that dependency-related cognitions. along with the belief that others are comparatively powerful and can control the outcome of situations).-role socialization (Bornstein. and (e) develops a predisposition to several forms of physical illness.. As Figure 1 shows. e. 1983). In the following section I briefly describe the most important features of the model. (b) becomes preoccupied with fears of abandonment (Blatt. (b) cognitive (i.

a perception . compliance ^Affective Sequelae: Performance anxiety. & Pancake. 1983). Lack of Interpersonal Sensitivity Rejection by Peers. Authoritarian Parenting. Belief that others are powerful and in control Motivational Sequelae: Desire to obtain and maintain nurturant. yielding. fear of negative evaluation Good Social Skills. I 'A help-seeking. fear of abandonment. Although either parental overprotectiveness or parental authoritarianism can lead the child to perceive himself or herself as incapable of functioning independently. supportive relationships Behavioral Sequelae: Suggestibility. Fox. 1962. Supportive Relationships Not Maintained High Anxiety. Supportive Relationships Maintained Low Anxiety. Low Stress 1 Poor Social Skills. Interpersonal Sensitivity Successful in Eliciting Help. Sex Role Socialization ^ Cognitive Effects: Representation of self as L powerless and ineffectual. High Stress I i I V' Risk tor Depression Immune System Deficits Risk for Physical Illness I FIGURE 1 An object relations/interactionist model of dependency. developing the sense of mastery and autonomy that follows successful learning experiences (see McCord et al. Sroufe.BEYOND ORALITY 1 91 Overprotective..

Parental overprotectiveness and authoritarianism play a key role in the construction of a representation of the self as powerless and weak. expectations. 1993). and it is likely that global indices of parenting style predict important aspects of a parent's sex-role socialization practices. authoritarian parenting will encourage the child to believe that he or she must rely on others for guidance. overprotective. parental authoritarianism will lead children to believe that the way to maintain good relationships with others is to acquiesce to their requests. Similarly. authoritarian parenting practices and traditional sex-role socialization experiences will tend to work in concert to promote dependent behavior. protection. while simultaneously engaging in the kinds of child-rearing practices that discourage independent decision-making and autonomous behavior. Not surprisingly. and affective responses of the dependent person in predictable ways. cultural factors play a role in the etiology of dependency.e.192 BORNSTEIN of the self as weak and ineffectual is particularly likely to result when parents exhibit both of these traits (Baumrind.. For example.and object-representations) that are formed in response to early experiences within the family w ill influence the motivations.. first and foremost. 1969. Main et al. self. 1985). In young girls. This turns out to have very different implications for boys and girls. 1992. behaviors. 1971). Baumrind. and dependency in girls more strongly than in boys (Spence & Helmreich. parental overprotectiveness will lead to an expectation on the part of children that they will be nurtured and cared for by others. Clearly. 1971). the model summarized in Figure 1 suggests that cognitive structures (i. have motivational effects. . 1992). Sex-role socializ ation practices may further foster the development of a dependent self-representation in girls. studies wherein dependency levels are assessed via self-report tests almost invariably find that female participants obtain significantly higher dependency scores than male participants (Bornstein et al. and support. and demands (Ainsworth. with sex differences in dependency appearing by middle childhood and remaining stable through most of adult life (Bornstein. authoritarian parenting—these sex-role socialization effects foster dependency in women far more strongly than in men. it is i uportant to note that parenting style and sex-role socialization practices are not completely independent A great deal of sex-role socialization takes place within the family. 1971). acquiescence. the interactive effects of parenting practices and sex-role socialization experiences are more complicated in that authoritarian parents will be likely to encourage sex-role-type i behaviors in boys. Thus.5 In addition to fostering the development of a representation of the self as weak and ineffectual. In young boys. 1978). research indicates that highly authoritarian parents tend to encourage traditional sex-role-related behaviors in children to a greater degree than do less authoritarian parents (see Baumrind. A person with 5 In this context. insofar as traditional sex-role socialization practices encourage passivity. A perception of oneself as powerless and ineffectual will.. Because early experiences with the parents create particular expectations for future interpersonal relationships (Blatt & Homann. although—in contrast to the effects produced by overprotective.

Similarly. behaviors. In other words. Consequently.g. affective responses systematically influence the cognitions. need for support). compliant behavior in certain contexts and active. and behaviors of the dependent person. Simply put. dependent behavior is more likely to be exhibited. a representation of the self as powerless and ineffectual will have important affective consequences (e. assertive behavior in certain situations. As noted earlier.g. fear of negative evaluation). Specifically. motivations.. assertive behavior in others merely represents an attempt on . supportive relationships (see Millon. the individual's dependencyrelated motivations will increase. These self-concept-based motivations in turn produce particular patterns of dependent behavior: The person who is highly motivated to seek the guidance.. the dependent person becomes active and assertive. performance anxiety) strengthen and reinforce dependency-related motivations (e.BEYOND ORALITY 193 such a self-concept will be motivated to seek guidance. The results of studies in this area further suggest that one central goal underlies much of the dependent person's interpersonal behavior: obtaining and maintaining nurturant. though. when an event or situation stimulates a dependency-related affective response. support. 1981). dependent individuals exhibit behaviors that maximize their chances of obtaining and maintaining supportive relationships. 1992. a feedback loop is formed wherein affective responses that initially resulted from particular beliefs about the self and other people ultimately come to reinforce and strengthen those very same beliefs. and nurturance from other people. dependency-related affective responses (e. Exhibiting passive. The model summarized in Figure 1 provides a useful framework for understanding why dependency is associated with active. protection. empirical studies confirm that the dependent person will behave in an assertive manner if there is the belief that doing so can strengthen ties to potential nurturers and protectors. Most important. Although cognitive structures produced in response to early parenting and socialization experiences mediate the motivations. This goal has been referred to as the core motivation of the dependent person (Bornstein. when a dependency-related affective response is stimulated. dependency-related affective responses strengthen and reinforce the dependent person's belief in his or her own ineffectiveness. the dependent person chooses to behave in a passive manner. and support of others will behave in ways that maximize the probability that they will obtain the protection and support that they desire. protection..g. When passive. and affective responses of the dependent person. Similar feedback loops characterize the affect-motivation and affect-behavior relations. and it represents the link between dependency-related passivity and dependency-related assertiveness. affective responses ultimately come to play a particularly important role in the dynamics of dependency. When active. 1993). As Figure 1 shows. assertive behavior seems more likely to achieve this goal. Finally. compliant behavior seems likely to achieve this goal. fear of abandonment.

supportive relationships is consistent with the finding that overprotective. for discussions of the dependency-social skills and dependency-interpersonal sensitivity relations). As Figure 1 shows. long-term consequences of dependency (see Bornstein. caretaking figures. The hypothesis that the dependent person* s core motivation is to obtain and maintain nurturant. Second. the dependent person has sought out and obtained a guide/protector who functions much like the overprotective. authoritarian parenting predicts subsequent dependency levels in children. this represents the best possible long-term consequence of dependency. With respect to psychological functioning. Because the core motivation of the dependent person is to obtain and maintain nurturant. two less-than-positive consequences of this long-term outcome are also worth mentioning i n this context. Put another way. anxiety and stress should be minimized. and Masling. insofar as the presence of a nurturant. authoritarian parent of infancy and early childhood. good social skills should be associated with success in eliciting social support and with the ability to cultivate nurturant. This increased anxiety and stress has implications for both psychological and physical adjustment. the absence of supportive relationships will lead to increased anxiety and stress in the dependent person. supportive relationships. the degree to which a dependent individual exhibits good social skills and is sensitive to interpersonal cues will have important implications for the. adolescents.194 BORNSTEIN the part of the dependent person to fulfill their underlying goal of cultivating relationships with nurturant. supportive other serves as an anxiety and stress-reducer for the dependent person. In other words. recapitulated the earlier parent-child dynamic that led to his or her dependency in the first place. The dependent person with less effective social skills will not be as successful in cultivating nurturant. it is clear that the beaaviors exhibited by the dependent person in various contexts and settings reflect the core motivation of the dependent person. the presence of a nurturer/protector will serve to reinforce the dependent individual's helpless self-concept. Figure 1 illustrates the connection between early parenting experiences and the core motivation of the dependent person. and adults. To the extent that dependent persons are able to obtain and maintain such supportive relationships. 1992. As Figure 1 shows. in effect. In Figure 11 have divided the population of dependent persois into those with good social skills and those with poor social skills to illustrate the effects of this variable on the long-term consequences of dependency. supportive relationships. First. high levels of . supportive relationships. it is important to note that the dependent person in this situation has. the dependent person will continue to believe that the self cannot function without the protection and help of others. This core motivation may be traced to beliefs regarding the self and other people. to the extent that the dependent person continues to rely on other people for protection and support. which in turn may be traced to particular experiences within the family. 1986. Working backwards through the model. However. In a sense.

. the question remains: Why have the terms orality and oral dependency persisted in the psychoanalytic literature? Several factors underlie psychoanalysts' continued use of these terms. .BEYOND ORALITY 195 stress and anxiety will lead to increased risk for depression in the dependent person (Overholser & Freiheit. Thus. ultimately leading to increased risk for various physical illnesses that are mediated by the immune system (Blatt et al. There is a long tradition underlying the use of these terms. First. In this context. 1980). Bern. at best. it is ironic that—although interpersonal sensitivity and social skills may play a key role in determining the long-term outcome of dependency—both of the outcomes depicted in Figure 1 ultimately lead to the same end: reinforcement of the dependent person's helpless self-concept. Second. help-seeking behavior (Bornstein. and dependent on others for protection and support will increase. the terms orality and oral dependency have been used by psychoanalysts for nearly 100 years. this conclusion is not surprising. 395) Similar arguments regarding the self-perpetuating nature of dependency have been offered by Birtchnell (1988) and Millon (1981). the onset of physical or psychological illness will reinforce even further the dependent person's helpless self-concept. Ironically. high levels of anxiety and stress will lead to diminished immunocompetence in the dependent individual. Numerous studies have demonstrated that individuals typically behave (and process self-referent information) in such a way as to protect and reinforce pre-existing beliefs about the self and other people (Greenwald.. CONCLUSIONS In light of the fact that evidence supporting an orality model of dependency is. and the concept of orality is very much a part of the culture and history of psychoanalysis. . and Eilder (1989) suggested that dependency as an interactional style may well be even more self-perpetuating than [other personality styles] because dependent individuals are positively motivated to select and construct environments that sustain their dependency. the concept of orality provides a rich and evocative vocabulary for theorists and . Caspi. equivocal. (p. With respect to physiological functioning... 1993).. these individuals become increasingly skilled at evoldng from others those nurturing responses that reinforce their dependency. as Masling (1986) pointed out. ineffectual. To the extent that the dependent person assumes the "sick role" following the onset of physical or psychological illness. 1993). dependent persons recruit and attach themselves to others who will continue to provide the nurturance and support they seek. Numerous studies have shown that the onset of illness is often followed by increases in dependent. he or she will perceive the self as powerless. 1994). In a sense.

empirical research on dependency has supported a number of subsidiary hypotheses that stem from the classical psychoanalytic model (e. 1993. if future studies suggest that such relations do in fact exist. motivations..g. and behaviors. Thus. & Stepanian. 1992. Leaving aside unresolved questions regarding the orality-dependency link. many psychoanalytically-oriented clinicians are resistant to altering their theoretical conceptualizations based on the results of controlled empirical studies (Fisher & Greenberg.g.196 BORNSTEIN clinicians to use when describing dependency-related personality dynamics. but has not offered strong support for the key hypotheses that underlie the orality-dependency relation (e. and studies of the relation between dependency and various oral psychopathologies have not provided compelling support for an orality conceptualization of dependency. In any case. To some extent. 1985). Masling & Schwartz. It may be that tine most fruitful approach for testing hypotheses regarding the orality-dependency relation is to utilize experimental approaches that allow researchers to assess whether manipulating an individual's underlying dependency levels produces measurable changes in food. future research in this area should begin to utilize experimental manipulations that allow researchers to draw firmer conclusions regarding causal relations between orality and dependency.g. first described by Abraham (1927) and others r as been confirmed repeatedly in laboratory and field investigations (Blatt & Homann. In general. although as Masling and Cohen (1987) pointed out. Bornstein. much of this clinical evidence reflects a kind of self-fulfilling prophecy wherein clinicians selectively attend to (and remember) only those patient-therapist interchanges that support their a priori beliefs. the dependency-depression link). 1992). 1994). studies of the orality-dependency link conducted to date have tended to employ correlational designs (Bornstein. Silverman et al. these terms have persisted simply because they provide a compelling language for describing the behavior of patients in clinical settings. Silverman's (1983. the feeding/weaning-dependency link). thoughts.. clinicians have been able to describe many examples of clinical interactions that appear to support the concept of orality. Although studies of the feeding/weaning-dependency link. 1982) subliminal psychodynamic activation paradigm would be an obvious starting point for experimental work in this area.. several hypotheses regarding the psychody namics of oral dependency have received at least moderate empirical support. as numerous researchers have noted. Hill.and mouth-related fantasies. Rossner. it is not the case that the orality model has yielded uniformly negative results. studies of the covariation of dependent and oral behaviors. 1979). Bornstein. although recent studies have delineated several other potentially useful approaches to manipulating underlying dependency needs in clinical and nonclinical participants (see. e. it is clear that in several respects an integrated object relations/interactionist model of . Most importantly. As Fisher and Greenberg (1985) noted.. Finally. the hypothesized relation between dependency and depression.

1993) and many aspects of this model await empirical verification. motivations. supportive relationships. 1992. overprotective. maladaptive behaviors in clinical and nonclinical participants..e. and affective responses is consistent with recent studies of the interpersonal dynamics of dependency in clinical and nonclinical participants (Bornstein. The object relations/interactionist model's contention that cognitive structures (i. Similarly. the hypothesis that dependency and interpersonal stress combine to result in diminished immunocompetence and increased risk for physical illness was confirmed by Blatt et al. and emotional responses and helps to explain the causal links between high levels of dependency and risk for various forms of psychological and physical pathology. Finally. In addition. behaviors. adaptive behaviors as well as problematic. For example. the object relations/interactionist model suggests that insight-oriented psychotherapy with dependent persons should focus. this model accommodates two key sets of results that are not easily accounted for by the orality model: (a) findings which indicate that dependent persons often behave in an active. confirmed by Overholser and Freiheit (1994). Most importantly. As several clinicians have noted. the model's assertion that situational variables are an important determinant of dependency-related passivity and dependency-related assertiveness has been confirmed by a number of recent findings in this area (Bornstein.. the model specifies some key causal relations among dependency-related cognitions. 1988. 1982). As Hopkins (1986) . However. on altering problematic beliefs regarding the self and other people. self and object representations) play a key role in determining dependencyrelated motivations. Although the object relations/interactionist model was developed very recently (Bornstein. assertive manner in order to obtain and maintain nurturant. For example. recent findings from laboratory and field studies of dependency offer reasonably strong support for the model. authoritarian parenting and dependency-fostering sex-role socialization practices) are consistent with a number of empirical findings in this area. Emery & Lesher. Beyond this. at least in part. several issues related to the clinical implications of the model warrant brief discussion in this context.e. the hypothesis that poor social skills and an absence of social support leads to increased risk for depression in dependent persons was. and (b) findings which suggest that high levels of dependency are associated with positive. behaviors. 1994). the object relations/interactionist model's assertions regarding the antecedents of dependent personality traits (i.BEYOND ORALITY 197 dependency has greater heuristic value than the traditional orality model. 1995).'s (1993) findings regarding the dependency-stress-illness link. It would be premature to speculate unduly regarding the clinical implications of the object relations/interactionist model of dependency until this model receives unequivocal empirical support. the strong transference reactions exhibited by many dependent patients provide numerous opportunities to explore (and eventually challenge) the patient's beliefs regarding his or her powerlessness and ineffectiveness and regarding the perceived power and potency of others (Cashdan.

in many respects the conclusions that emerge from clinical work with dependent patients dovetail with those that stem from the object relations/interactionist model: In both instances.. To the extent that clinicians. Bryan & A. Selected papers on psychoanalysis (pp. the same factors that cause dependent patients to initiate therapy quickly following symptom onset and adhere conscientiously to therapeutic regimens may also make termination more difficult for both patient and therapist (see Bornstein. Ealint (1964. childish relationship with his doctor.. attitudes. A." Rather. which push the patient into a dependent. adolescents." Goldfarb (1969) further contended that. Strachey (Eds.). and researchers become aware of the entire spectrum of dependencyrelated behaviors exhibited by clinical and nonclinical participants. REFERENCES Abraham. Ironically. in general.. the help-seeking orientation of the dependent patient can make termination difficult. theoreticians. . for a detailed discussion of this issue). (1927). our understanding of the etiology and dynamics of dependency will increase. Like other personality traits that ostensibly seem to represent flaws or deficits (e. how much dependence constitutes a good starting point for psychotherapy. and when does it turn into an obstacle. In C. In this context. dependency can be an asset in some situations and a weakness in others. 39-^10) argued that "there are many factors. This is inevitable. the patient will be likely to adhere conscientiously to a variety of therapeutic regimens (see Poldrugo & Forti. . introversion.. it is not surprising that dependent patients tend to remain in inpatient and outpatient treatment far longer than do nondependent patients.g. dependency is neither "all good" nor "all bad.. D. it is clear that dependency can represent either a deficit or a strength. Future reseaxch involving the object relations/interactionist model should examine in detail the strengths and weaknesses associated with high levels of dependency in children. London: Hogarth. The only question is. patient dependency can be used to therapeutic advantage if the therapist does not interfere with a dependent transference early in therapy. depending upon the circumstances in which it is exhibited and the particular way in which dependent feelings. if handled correctly. pp. Thus. help-seeking behaviors as therapy progresses.198 BORNSTEIN pointed out. Because termination involves relinquishing a relationship with an omniscient.. the patient's dependency on the therapist can. and adults. and our ability to work productively with dependent psychotherapy patients will be enhanced. The influence of oral erotism on character formation. for evidence supporting this assertion). and behaviors are expressed. narcissism). actually facilitate psychotherapy: To the extent that the patient is concerned with pleasing the therapist and strengthening the therapist-patient relationship. omnipotent authority figure. 1993. 1988. but increasingly discourages the patient from exhibiting dependent. K. 393^-06).

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