Problem Patients

As a psychotherapist, I’ve seen the most perverse, even the most evil parts of human nature. Constantly, I get exposed to deception, conflict, manipulation, mistrust, betrayal, and even cruelty. Privy to people’s most secret, hidden selves, I see them at their worst or severe states. Depending on the severity of a patient’s condition, there is somehow a hint on the level of progress a therapeutic process will go.

Among therapists around the world, there is some consensus concerning factors describing problem patients. Let me cite some of the following characteristics that are usually observed by clinicians in difficult patients, that make prognoses poor or if any, slow:

* Patients with severe medical conditions, like head injury or stroke
* Patients who are hostile, argumentative, hysterical, or skeptical
* Patients with borderline personalities, sociopathic personalities, or other personality disorders
* Patients who refuse responsibility (“you fix me”)
* Patients who ignore boundaries (session absences, chronic lateness)
* Patients with hidden agendas (economic motive, legal requirement, compensation)
* Patients who are avoidant, seductive, or afraid of intimacy
* Patients who want something the therapist cannot give them
* Patients who are impatient
* Patients who feel hopeless or actively suicidal
* Patients with poor impulse control (offenders, addicts)
* Patients who are too superficial, concrete, and literal – unable to access or express deeper internal states

If you’re in therapy yourself, do you wonder why your process is progressing so poorly or slowly? For the most part, certain types of patterns of behavior or thought are inherently difficult to deal with.

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