Resources for working with difficult patients

[MidWestLass]

Hello! I was wondering if anybody knew of any good resources that would offer tips and suggestions for working with all kinds of difficult patients (i.e., borderline, avoidant, disengaged, low insight, schizoid personality, etc.). Specifically, I'm hoping for some kind of resource/book that would help troubleshoot common challenges working with clients that is all in one place. Thanks for your time!

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[deleted343839]

One suggestion: https://psycnet.apa.org/record/2012-10495-000

Also good supervision or consultation (which is a two-way street).

 

[deleted656923]

My resource is don’t take on difficult patients.

 

[BuckeyeLove]

I often reflect on the fact that I would unequivocally rather work with a. batterers or b. sex offenders in a treatment capacity (2 of IMO the most resistant client basis to work with) than cluster b folks on cluster be folks' things. More focused and streamlined objectives with the former. Compassion fatigue is legit a real thing. The above article is excellent.

 

[cara susanna]

DBT is really helpful and not just with BPD. It teaches you about how to set and observe your limits, as well as principles to remember when working with difficult patients (e.g., they're trying their best).

 

[R. Matey]

I don’t know if there’s one resource I could point to. I’d say for general problems in therapy (e.g.: not doing hw, no-shows, etc...) , I’ve used suggestions from Judith Beck’s Cognitive Therapy for Challenging Problems. It’s an older book, but it checks out



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[R. Matey]

Also, telling them how disappointed you are in their behavior is a surefire way to see rapid change


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[psychlife19]

Dont work harder than your client. I know its frustrating cuz you feel ineffective, like you might be wasting their/your time, like you’re a bad therapist, etc.

For those with low insight, I would suggest more behavioral approaches

 

[MidWestLass]

Thank you all for the tips and suggestions! I am lucky enough to have excellent supervision, but there is a tough client that is hard to crack! (@psychlife19 we've had most movement with behavioral approaches)

This got me thinking about when I finish up training and won't have a supervisor to turn to when working with challenging clients/situations. Hence, my question. I think it would be awesome to create some kind of road map for navigating these challenges. Hmmm...

Great article! And I just purchased Judith's book. So, thank you again for the suggestions!

 

[bcliff]

I agree with Cara's point about DBT. Linehan's CBT for BPD is a great resource for everyone, even those of us who don't typically work with BPD folks. Most of what Linehan describes in DBT is derived from behavioral principles, so I'd especially recommend DBT if you're finding behavioral principles to be effective with this client.

 

[Therapist4Chnge]

I enjoy utilizing primarily Behavioral interventions bc they do not require much if any insight by the patient. DBT skills can also be really helpful, though I only try this approach if the patient has some insight and hopefully some motivation, even if conflicted about it.

 

[cara susanna]

Dont work harder than your client.

This is the best advice I've ever been given as a therapist, and I try to keep it in mind with all of my patients.

 

[Fan_of_Meehl]

Also, telling them how disappointed you are in their behavior is a surefire way to see rapid change

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LOL, depending on their motivational framework, this may be a potent reinforcer for them.

This is the best advice I've ever been given as a therapist, and I try to keep it in mind with all of my patients.

That's a good one (a classic).

Another one I like to use (almost always covertly--that is--I think it to myself rather than say it out loud) is...

"I get paid whether you get better or not."

 

[PsyDr]

I can recommend NOT reading any of the behavioral emergency psychology books, including the handbook from the APA. Hundreds of pages that say nothing useful.

 

[cara susanna]

"I get paid whether you get better or not."

That's a good one, especially for us VA psychologists