Interactive video in dealing with difficult patients

[whopper]

My wife, thanks to her doctorate program, was able to get on Behavioral Tech's website and undergo a course in dealing with difficult patients. For those of you who may not know, that website is owned and operated by Marsha Linehan's company.

The course is what I wish I had in residency, where the person is given a video of some classic borderline DO patients among others, and the person makes some of the classic responses we see in real life but no text book tells you how to deal with them. It asks for responses on what you would do and gives feedback in an interactive manner.

I was very impressed with this course and I'm thinking of paying to do one myself after sitting with my wife while she did it.

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[heyjack70]

Do you have a link to the specific page on Behavioral Tech's website? After a cursory look I couldn't find an online course for difficult patients. thanks.

 

[whopper]

Wife's dealing with the kid right this moment. Next opportunity we have to get the specific links, I'll post them. I don't know how expensive they are. She got the course included in her tuition.

 

[sunlioness]

I would be interested in that as well.

 

[whopper]

http://behavioraltech.org/ol/

It's called

Transforming Difficult Moments in Therapy

It's quite expensive though! Click on the buy option and you'll see. Maybe if you're part of an institution you can get them to pay for it.

 

[sunlioness]

$200 isn't horrible, but I wish they offered CME for it instead of just the CEs for therapists. I know I could use it for Category 2, but there's just something so shiny about Category 1 CME credit.

 

[whopper]

I too have had this frustration. Many of the DBT courses out there are CEUs only. I bet you could still use it as a professional expense come tax time though I'm not 100% certain about this given that it's not a CME.

It's an irony. So many borderlines are referred to us for help yet psychiatrists rarely have the training for it. IMHO they ought to have a CME for this type of stuff.

OT but the head of the mental health board in the area I work in told me a few weeks ago that antisocial PD qualifies for disability payments but PTSD does not. So rapist can get disability payments for being a rapist, but person who was raped and was traumatized by it for the rest of her life cannot. She was by no means defending it. She doesn't understand it either.

 

[F0nzie]

Speaking of difficult patients I just recently had a patient yell at me in the waiting room "YOU DON'T GIVE A **** ABOUT ME!".... it went really well . (One of my benzo taper patient alcoholics I inherited from another mental health provider who was giving her high doses of Xanax and wondering why it wasn't helping her anxiety at higher doses thus referring to the medical center because apparently we have a multidisciplinary approach with advances in medicine and novel new medications).

 

[whopper]

I'd recommend the taper but remember the guy might have some other comorbid issue such as GAD and see if that may need treatment, also don't forget that some meds can help such as Campral, Neurontin, or Naltrexone.

Of course maybe the guy just has as I call it Axis II: A-Hole NOS.

 

[F0nzie]

I'd recommend the taper but remember the guy might have some other comorbid issue such as GAD and see if that may need treatment, also don't forget that some meds can help such as Campral, Neurontin, or Naltrexone.

Of course maybe the guy just has as I call it Axis II: A-Hole NOS.

This patient refuses to quit drinking alcohol, refuses therapy, refuses going to AA. Continues to drink a 12-pack per day with mixed drinks- claims she's a functional alcoholic. Doesn't want to be tapered off a long-acting benzo because Valium, Clonazepam, etc have all side effects that gave her extreme throat swelling and asphyxiation that resulted in her having to go to the ED. Only benzo she is willing to take is Xanax. Right now I'm just throwing in some motivational interviewing and keeping this patient safe from potential respiratory collapse with all the benzos and ETOH. But basically the previous provider was giving out Xanax like candy which I believe was very reinforcing and now I'm the bad guy. I know anxiety and panic goes hand-in-hand with alcoholism, but I feel like I'm in no position to do anything about these underlying disorders at this point in time. I'll say "sprinkles of A-Hole NOS" just to be fair.

 

[whopper]

I just sat through with my wife on some of the video session and they don't pull any punches. There's a lot of patients making some very common difficult statements such as "screw you, I don't feel like doing my homework" (in reference to home DBT assignments), or suicidal statements meant in a manipulative manner and then you have a choice of making responses, some of which are pretty obvious in that it'll tick the patient off...and when you do that, these patients do exactly what you'd expect them to do such as fly off the handle or leave the therapy session.

Linehan lectures about several of the situations, explaining what can be done and some of the often failed approaches by several mental health therapists. E.g. she mentions that some clinicians will refuse to do psychotherapy on a patient until they're not suicidal and she mentions how ridiculous that is because the person needs help for that reason, but the clinician will now refuse to treat the person because they're now not an easy patient. The clinician in effect only wants easy patients.

I never got training on how to deal with this in residency. When we got patients like this, the weaker outpatient or ER doctors just admitted them to inpatient with no real recommendation on what to do, the authoritarian doctors just knocked them out with Haldol or Thorazine, and then discharged them, and the psychotherapy ignorant doctors just gave them a med that really didn't do anything to fix the situation.

All-in-all that pretty much were all the doctors I had in residency when it came to borderline PD. No one really taught me what to really do with borderline patients. I hope the residents these days aren't getting that type of teaching.

 

[BobA]

Speaking of difficult patients I just recently had a patient yell at me in the waiting room "YOU DON'T GIVE A **** ABOUT ME!".... it went really well . (One of my benzo taper patient alcoholics I inherited from another mental health provider who was giving her high doses of Xanax and wondering why it wasn't helping her anxiety at higher doses thus referring to the medical center because apparently we have a multidisciplinary approach with advances in medicine and novel new medications).