Don’t Give Up On the Difficult Patient

Forty years ago, I had my most angry professional moment. It happened at a weekly meeting that included all our faculty, staff, and trainees- about two hundred people. A young and arrogant, not very bright, third year psychiatry resident rose to complain bitterly about the ‘crappy patients’ he and his fellow other residents were being assigned for psychotherapy.

Feeling surprisingly furious at his insulting tone, I replied: “Never once in my life have I ever met a ‘crappy’ patient, but certainly I have come across some crappy doctors who didn’t appreciate them.”

Most therapists prefer ‘easy’ patients who don’t make waves. Whenever things aren’t going well in treatment, it is far too easy for the therapist to blame the patient, not himself or a bad match-up.

Not Fanny Marell, a social worker and licensed psychotherapist from Sweden, who likes to help people who most need help. She writes:

“Many professionals shy away from patients who have powerful personalities and strong self-destructive drives.

I think they are missing out on the best professional experiences any therapist can have. The most difficult patients often eventually form the deepest relationships and have the most satisfying outcomes.

Of course, treating people who are basically healthy is much easier. In fact, it is too easy — they would do well on their own even without therapy. We are most important and make the biggest difference in the lives of the people who need us most, even if the day to day is not always smooth.

The trick is to channel the patient’s power into productive, not destructive activities. With redirection, what was once the power to destroy can now become the power to heal and create.

Power that seemed a curse can become a gift. People who were once successful only at hurting themselves can become successful in sorting —> Read More