ABSTRACT
This chapter focuses on taking care of difficult patients without feeling emotionally depleted or resentful. Keeping the visits brief, setting limits on numbers of problems discussed, understanding the patient’s emotional context, and reframing the situation as a learning opportunity help the practitioner cope. Specific suggestions for treating hypochodriacal patients, chronic complainers, anxious patients, patients with insomnia, and depressed patients, to include grieving patients, are presented. Treatments include cognitive behavioral stress management and relaxation techniques. Homework assignments can include physical activities as well as reading assignments. Pain patients can be treated behaviorally, and John E. Sarno’s books may be recommended. Suicidal thoughts, combined with an action plan, constitute a medical emergency. In the absence of a plan, a show of concern and contract to help may counter negative feelings. Clear documentation and backup are required. To successfully treat substance abusers, strict limits must be set. Patients will only modify their behavior when they are ready to do so, but strategies can be employed that will encourage them to contemplate making changes. Children and teenagers can be BATHE’d during a regular office visit. Although teenagers’ confidentiality must be respected, screening for interpersonal violence and high-risk behaviors is essential.
