Needs a good Psych term

[bustbones26]

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I apologize in advance as you all are often asked questions as this, but is there a term to explain the following.

Let us say that you have a patient with a medical complaint. They are desperate for help, demand to be seen ASAP because they can no longer live with said condition, it is utterly ruining their life and you must help them now. That being stated, they find a problem with every treatment that you offer and suddenly minimize the once prior urgent life altering condition once you start to recommend treatment.

In other words," please help me, but I won't accept the help that you offer to me, but help me!"

Any good terms for this type of scenario?

 

[birchswing]

I'm not sure why it needs a term, but it seems rather easy to understand.

You get to a point where you're stuck, then get to a point where you have options, then feel relief.

It's the way that right before I go to bed I have all these plans and they seem easy and I feel optimistic about all the things I'll do the next day, and the next day they seem like they'll be impossible. Right before I'm going to bed I'm optimistic because I don't actually have to get up and do those things, but I feel like I have options the next day. Actually doing things is a lot harder than being in this ephemeral place of considering doing things.

So, I guess the question then is why the patient can't have the feeling of options and that feeling of purgatory (not moving forward, not moving backward) without a doctor. Why does the presence of a doctor offering options convey relief? There are plenty of people who live in suspended animation without a doctor's aid. I guess it's maybe the patient trying to make an effort to gain some inertia but can't go all the way? I dunno.

 

[deleted314290]

The term that comes to my mind is "help-rejecting."

 

[birchswing]

The term that comes to my mind is "help-rejecting."

I would argue that they got the help they wanted.

 

[FlowRate]

Sounds a little borderliney. Chaotic with overvaluing/undervaluing.

 

[nitemagi]

Help-rejecting complaining defense mechanism.

 

[thoffen]

care-seeking care-rejecting

 

[birchswing]

I already answered above, but as I fall asleep, I think about things and a term came to me:

Windowshopping

 

[Shikima]

I have a couple of these on my case load too. There is a strong character-logical component to it. Enabling will only destroy them further.

 

[WingedOx]

The term I use a lot in our treatment team meetings is "wants our attention but not our help"

 

[milesed]

I call them help rejecting complainers.

 

[MacDonaldTriad]

“I’m dying I’m dying and don’t you dare help me” speaks to a very strong need to be identified in the sick role. People can become very dependent on their obstacles to success. Without them, external critics may expect some performance. “I’m being mistreated and don’t you dare offer me breast milk or I will spit it out in your face.” Our role is to feel sorry for them, not to offer assistance. Assistance is contrary to the person’s belief system. Heaven forbid if their sorry state is a matter of choice and not the product of bad luck. Unless you can insure they will hit the lottery, every other salvation is just too much work.


Peter O’toole in My Favorite Year: “I'm not an actor, I'm a movie star!”

 

[Shikima]

“I’m dying I’m dying and don’t you dare help me” speaks to a very strong need to be identified in the sick role. People can become very dependent on their obstacles to success. Without them, external critics may expect some performance. “I’m being mistreated and don’t you dare offer me breast milk or I will spit it out in your face.” Our role is to feel sorry for them, not to offer assistance. Assistance is contrary to the person’s belief system. Heaven forbid if their sorry state is a matter of choice and not the product of bad luck. Unless you can insure they will hit the lottery, every other salvation is just too much work.


Peter O’toole in My Favorite Year: “I'm not an actor, I'm a movie star!”

How do you address this in your experience? I've got 2 of them on my case load. One is invested in the sick role, the other just is not interested in improving himself, psychotherapy, and only wants medications - in fact, he just got out of a 24 day rehab stint for going on a bender for ETOH and Cocaine.

 

[MacDonaldTriad]

In most cases, mooching off of the kindness of others is much less ego dystonic for these cases than for most people. The therapy needs to focus on the price this strategy costs in terms of burning out support systems and making people dislike them. Often these cases already have a hard time keeping meaningful relationships, but this can be a fairly concrete place to start if they complain about isolation. In your patient’s case, the substance abuse is the elephant in the room that needs to be plan A, B and C. No one will accept help if they find their recreational drug use more rewarding than success in life.

 

[Shikima]

In most cases, mooching off of the kindness of others is much less ego dystonic for these cases than for most people. The therapy needs to focus on the price this strategy costs in terms of burning out support systems and making people dislike them. Often these cases already have a hard time keeping meaningful relationships, but this can be a fairly concrete place to start if they complain about isolation. In your patient’s case, the substance abuse is the elephant in the room that needs to be plan A, B and C. No one will accept help if they find their recreational drug use more rewarding than success in life.

The lack of commitment to exploring substance and anger is puzzling me. Most times I can break through, but when I hear "I'm not going to talk about my feelings." and persistently have "I don't know" as a very quick, dismissive answer, I don't know what to do next. I could easily refer him on down the road, but took the opportunity to grow clinically from this.

 

[sunlioness]

"Help rejecting complainer"


Sent from my iPhone using Tapatalk

 

[Ceke2002]

I'd probably refer to it as 'Mum'.

"I feel awful, I have a migraine, just hang on a sec whilst I drape myself across the bed in the most dramatic fashion possible and clutch a vinegar rag to my forehead - wait I think I might have a brain tumour, and now my stomach hurts too, and my bowels feel funny, it could be colon cancer, quick the pain is getting worse, drive me to hospital so I can stand in the middle of the ED and start screaming for Pethidine whilst throwing histrionics about how nobody cares..."

Refuses to take medication as prescribed, refuses to make any recommended lifestyle or dietary changes, but she's sick dammnit!



(to be fair she no longer does this, or at least not to the same extent as before...funny how developing an actual life threatening condition makes playing the overly dramatic sick role seem not so appealing anymore)

 

[Ceke2002]

How do you address this in your experience? I've got 2 of them on my case load. One is invested in the sick role, the other just is not interested in improving himself, psychotherapy, and only wants medications - in fact, he just got out of a 24 day rehab stint for going on a bender for ETOH and Cocaine.

Okay time for a more serious reply to this thread. Bearing in mind I'm basing this on my own observations/knowledge of experiences I think in some ways the need to cling to the 'sick role' is the person's attempt at communicating their own needs when they haven't been given or allowed to have a voice and therefore they don't know how to actually communicate except through attention seeking type behaviour. I suppose the trick then is to show/teach them better communication skills when they've relied on maladaptive ones for so long and may not be willing to give them up for fear of being 'silenced' again.

 

[Armadillos]

I apologize in advance as you all are often asked questions as this, but is there a term to explain the following.

Let us say that you have a patient with a medical complaint. They are desperate for help, demand to be seen ASAP because they can no longer live with said condition, it is utterly ruining their life and you must help them now. That being stated, they find a problem with every treatment that you offer and suddenly minimize the once prior urgent life altering condition once you start to recommend treatment.

In other words," please help me, but I won't accept the help that you offer to me, but help me!"

Any good terms for this type of scenario?

Seems more like plain old denial than anything. Patient has X symptoms they know are associated with Y condition. They seek a doctor and subconsciously are thinking that if they can tell X symptoms to a doctor and then convince the doctor not to do anything about it then means they are safe/normal/whatever because the doctor said its ok.

We have all done it, have some slightly dysplastic looking nevus, point it out during a annual physical and then convince them not to cut it off you

 

[smalltownpsych]

How about going with Winnicott and rejecting the nurturing breast? I am only being half-funny. This conceptualization works for a significant number of patients. Try giving them a piece of candy or even a compliment and watch how they react. This is deep characterological psychopathology. I am sick, lonely, sad, hurt, and I will keep you away so that you can't give me what I need. It is really important to not feed into the trap of trying to help them and being rejected. For cases like this, the mirroring needs are where the work has to be for quite some time. Resist the urge to help, instead reflect and empathize with their pain. It sounds like the patients are coming to your for physiological complaints only so that makes your situation more challenging, of course. I imagine they do complain about depression, too, so rule out and treat any physical issues and refer to a good psychotherapist. I would usually say to this type of patient, "I know it probably won't help much with the whole depression thing and I know it won't help all of the other problems (😉 one of the few times I'm not totally honest), but it could be worth giving it a try." You then just have to hope the psychotherapist knows that they shouldn't try to fix this patient or they'll get sucked right in. 😎

 

[Ceke2002]

How about going with Winnicott and rejecting the nurturing breast? I am only being half-funny. This conceptualization works for a significant number of patients. Try giving them a piece of candy or even a compliment and watch how they react. This is deep characterological psychopathology. I am sick, lonely, sad, hurt, and I will keep you away so that you can't give me what I need. It is really important to not feed into the trap of trying to help them and being rejected. For cases like this, the mirroring needs are where the work has to be for quite some time. Resist the urge to help, instead reflect and empathize with their pain. It sounds like the patients are coming to your for physiological complaints only so that makes your situation more challenging, of course. I imagine they do complain about depression, too, so rule out and treat any physical issues and refer to a good psychotherapist. I would usually say to this type of patient, "I know it probably won't help much with the whole depression thing and I know it won't help all of the other problems (😉 one of the few times I'm not totally honest), but it could be worth giving it a try." You then just have to hope the psychotherapist knows that they shouldn't try to fix this patient or they'll get sucked right in. 😎

Yes, Winnicott is awesome! I believe a lot of the object relations work I'm doing in therapy now is more of a Winnicott style combined with an Interpersonal Neurobiological approach. All very fascinating and I must say a lot more helpful, for me at least, when it comes to dealing with some of the deeper more 'characterological psychopathology' (as you put it) than other approaches such as CBT, or ACT (which both definitely have their place and have provided me with a lot of forward momentum as well, but the Psychodynamic/Psychoanalytical object relations type stuff is just wonderful). 😀

 

[smalltownpsych]

Yes, Winnicott is awesome! I believe a lot of the object relations work I'm doing in therapy now is more of a Winnicott style combined with an Interpersonal Neurobiological approach. All very fascinating and I must say a lot more helpful, for me at least, when it comes to dealing with some of the deeper more 'characterological psychopathology' (as you put it) than other approaches such as CBT, or ACT (which both definitely have their place and have provided me with a lot of forward momentum as well, but the Psychodynamic/Psychoanalytical object relations type stuff is just wonderful). 😀

The CBT people hate this, but it is mainly aimed at symptom relief. Sometimes that is all you need becuas the person can function pretty well. Those cases bore me to be quite frank. I prefer working with the tortured souls. As long as they are willing to show up, I am totally game for it. It is actually kind of fun when you begin to change the interpersonal patterns of relating. I love watching the self unfold. I can think of one case in particular when a young patient was literally withering away, had lost about 40 pounds, and was the only teen at this place who wouldn't take any candy from my jar. I noticed that she wouldn't take in any emotional care either, huge defenses against any type of typical empathic, caring response. My intervention was to spend ten minutes finding out what her most ideal candy would be. At first she was reluctant to identify anything, but I persisted. The next week I brought the candy and after that the wall started to crumble and we were able to develop a trusting and therapeutic relationship. She wa able to take in the nurturance. Failure to thrive doesn't really stop after infancy, we just call it a lot of other names.

 

[Ceke2002]

The CBT people hate this, but it is mainly aimed at symptom relief. Sometimes that is all you need becuas the person can function pretty well. Those cases bore me to be quite frank. I prefer working with the tortured souls. As long as they are willing to show up, I am totally game for it. It is actually kind of fun when you begin to change the interpersonal patterns of relating. I love watching the self unfold. I can think of one case in particular when a young patient was literally withering away, had lost about 40 pounds, and was the only teen at this place who wouldn't take any candy from my jar. I noticed that she wouldn't take in any emotional care either, huge defenses against any type of typical empathic, caring response. My intervention was to spend ten minutes finding out what her most ideal candy would be. At first she was reluctant to identify anything, but I persisted. The next week I brought the candy and after that the wall started to crumble and we were able to develop a trusting and therapeutic relationship. She wa able to take in the nurturance. Failure to thrive doesn't really stop after infancy, we just call it a lot of other names.

That is an awesome story, and well done! 🙂 And yes, absolutely, patterns that are laid down in even the earliest moments of childhood can go on to distort and cloud a person's true 'self', unravelling the threads that keep those distortions in place, and learning where everything fits in the tapestry of the autonomous self, and being able to start shifting and rearranging different thought patterns and old ways of being to work on creating something newer and better - from the patient's side of the table, it's pretty damn exciting. 😀

Obviously I'm still a work in progress, but I think I'm probably a bit similar to the patient you described (actually I'm a lot similar). My Psychiatrist picked up pretty quickly that apart from the glaringly obvious trust issues there was some past trauma processes at work that were blocking me from accepting or asking for help (I'm the sort of person that would probably hop into the Emergency Department with my leg hanging off and then point to the guy next to me and say 'Oh no, please take care of him first, I'm fine, really" and proceed to apologise for bleeding all over the floor). It's taken a while, but having a safe, stable and empathetic environment to talk freely in, and also having someone mirror and demonstrate, through interpersonal interactions, both empathy for others and empathy/compassion for self when it's needed, I've gradually been able to open up a lot more and now that we're actually getting into the deep stuff (we had a really cool discussion on Nietsche and the Three Metamorphosis last session, building on a previous session where we discussed the Buddha Vairocana, with the last stage of Metamorphosis being the Dragon of familial and societal expectations representing the caves and beasts of the inner world of the psyche that was built in childhood, that now needs to be traversed and conquered for there to be growth and empowerment)...sorry got off track there for a moment, any way now that we're starting to tackle the deeper stuff it's exhausting and kind of mind blowing at times, but it's also so damn rewarding and hope giving - for me at least. 🙂