Data-based versus symptomatic formulation of treatment: the case of a dependent personality

A 48-year-old female presented anxiety and avoidances following diagnosis of her daughter as diabetic. A comprehensive formulation of the case seemed unobtainable. Symptomatic treatment was thus initiated which led to improvement then relapse. Subsequent clinical observation led to a new formulation, namely, anxiety about independent decision making. This hypothesis was assessed. The patient was found to be excessively reliant on others and deficient in autonomous behavior. Accordingly, treatment was aimed at modifying anxiety about independent decision making, and this proved successful. Improvements maintained at an 11-month follow-up. The implications of this case for clinical practice are discussed.