Care Dependency May Help and Hurt Psychological Treatment: A Treatment-Analogue Study With Students in Clinical Training

Care dependency in mental health care has been considered a negative side effect of treatments. The current treatment-analogue study tested whether care dependency was (a) distinguishable from trait dependency, (b) related to a clearer passive stance and lower therapeutic alliance quality, and predicted (c) less symptom reduction and (d) a stronger wish to continue treatment. A total of 136 students following a training in psychotherapy participated in the study. The students received treatment for psychological symptoms as part of their professional schooling, conducted by a fellow student as their therapist. Students’ care dependency levels, passive stance, wish for treatment continuation, therapeutic alliance, and symptom levels were administered multiple times during treatment by means of self-report questionnaires. Results showed that 2 dimensions of care dependency, submissive stance and the lack of perceived alternatives, were positively associated with students’ passive stance. The latter also predicted students’ wish to continue treatment. A third dimension of care dependency, the need for contact, was positively associated with a better therapeutic alliance. These results suggest negative as well as potential positive effects of dependency. Future research should provide further insight into this dilemma and test whether the results could be generalized to patient settings