ABSTRACT
This chapter discusses a number of common clinical scenarios that are particularly challenging when engaged in combined treatment. It includes managing suicidal patients, repeated symptom recurrence, treatment-resistant cases, chronically non-compliant patients, and substance abuse. Rather than focusing on technical aspects of pharmacological treatment of the cases, the chapter describes how a combined approach provides additional tools for helping such patients. Nondynamic psychotherapies have proven efficacy in the treatment of specific disorders associated with suicide, and modest evidence exists for the role of psychodynamic treatment in borderline personality disorder in diminishing self-injurious behavior. Chronic noncompliance with medication creates a vicious cycle that, left uninterrupted, can result in treatment failure or chronic sadomasochistic transferences. Given the large number of patients suffering with major psychiatric illness, personality pathology, and substance abuse who seek treatment, it is not surprising that many of the patients they treat fall into the category of the complex case.
