When a patient or client isn’t doing better in psychotherapy, sometimes a therapist may fall back onto that old familiar refrain, “Well, the patient just isn’t doing the work. He’s to blame for his lack of progress in getting better.”
Dr. Richard Friedman describes this strategy in a thoughtful article in yesterday’s New York Times. It’s not uncommon for a psychotherapist, when faced with a client who doesn’t seem to be improving after months (or even years) of therapy, to blame the patient.
- They aren’t trying.
They’re not doing their homework.
They don’t really want to get better.
There’s a dozen different reasons a therapist will come up with depending upon the specific client.
More often than not, though, as Dr. Friedman points out, perhaps the client just hasn’t found the right combination of the right diagnosis, psychotherapist, and medications to help them:
Another patient, a young woman with unstable moods, was recently hospitalized with a diagnosis of bipolar disorder. When she failed to respond to two mood stabilizers, the staff began to entertain a diagnosis of borderline personality disorder, which involves emotionally chaotic relationships and impaired ability to function in the world.
“She’s pretty aggressive and demeaning, and we think she has some serious character pathology,” one of the residents told me.
But partly treated bipolar disorder can mimic borderline personality disorder, and after she received a third mood stabilizer, her “personality disorder” melted away, along with her provocative behavior.
In this case, the diagnosis was right from the onset, but the mental health treatment team just hadn’t hit upon the right medication that works best for her. Sometimes it takes 2, 3, or even 4 or more tries to find a medication that is the “right” one for the person.
The same is true for type of psychotherapy or psychotherapist tried. While some may believe that such things don’t matter (since research has long shown that any psychotherapy seems to work better than nothing), they do.
Finding the right therapist can be as frustrating and as challenging as finding the right medication. But at this time, we have no sure-fire way to identify what those “right” treatments are for any given individual. You must do it yourself (or with the help of your therapist or psychiatrist) through trial and error.
At the end of the day, the patient’s not to blame. What’s to blame is our inability to adequately or reliably predict treatment response to any given treatment that is prescribed. Psychotherapists and doctors should always question what’s really going on when they find themselves “blaming the patient.”
Read the full article: When All Else Fails, Blaming the Patient Often Comes Next