9 Pages

Treating Difficult Patients in Groups


I am not sure any “difficult” patients exist. I am equally not sure any “easy” patients exist. “Complicated” patients certainly exist. As Groves (1978) noted years ago, patients can evoke powerful negative feelings in therapists and can therefore be difficult to treat. However, in my judgment all the patients are doing their best and are trying to be in relationships rather than trying not to be in them. Usually patients who evoke negative feelings in others are titrating the interpersonal distance to a level they can safely tolerate. Patients are not trying to be difficult, even when they are. Rather, they are establishing a degree and type of intimacy they can tolerate. So, when asked to contribute a chapter on treating the difficult patient, I was immediately confronted with the question, “What constitutes a difficult patient?”