Popular Topic - Challenging Clients & Treatment Populations

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The Psychology of the Sand-Pit

Clinical Lessons from Winnie-the-Pooh

January/February 2003
Despite getting paid to guide them out of their sand pit, we at times succeed only at leading them right back into it. When this happens, it's possible to decide that they somehow "need" their problem, that they're "not ready" to change, or that we lack the skill to help them effectively. Alternatively, we can turn to A. A. Milne for inspiration on how to get unstuck, on how to change the way we're trying to help.

Treating the Self-Harming Client

Therapists Must First Get Past Their Own Anxiety

September/October 2002
My refusal to accept Robin's self-cutting as anything but dysfunctional kept me from hearing what she was trying to tell me. Worse, it was actually causing more destructive behavior.

Deep from the Start

Profound Change in Brief Therapy Is a Real Possibility

January/February 2002
In much long-term therapy, breakthrough experiences seem to come almost randomly, and then only after months or years. In briefer therapies, on the other hand, deeply rooted emotional realities are often ignored altogether in favor of "reframes" and other forms of cognitive or behavioral change.

Revolution on the Horizon

DBT Challenges the Borderline Diagnosis

May/June 2001
Ever since it was coined 60 years ago, the term "borderline" has referred to a category of seemingly intractable clients whom many therapists consider the bane of their existence. Now, psychologist Marsha Linehan has developed a treatment approach, Dialectical Behavior Therapy, that is transforming treatment for them.

My Most Spectacular Failure

Voluntary Simplicity Meets Shop Til You Drop

November/December 2000
I will never forget the Correys, who were referred to me by their family doctor in western Nebraska. Every other week for a year, I saw them, during which time I tried pretty much every trick in my therapeutic arsenal. I spent hours discussing their case with trusted colleagues and read up on their particular problems. I don't know how many nights' sleep I lost worrying about how to get these folks on the right track. And in spite of all my efforts, the Correys were one of my most spectacular failures.

A Matter of Life and Death

When the Therapist Becomes the Survivor

November/December 2000
I've been in full-time private practice for almost 30 years. I've seen maybe 10,000 families. In that time, three patients in my practice killed themselves. Strangely enough, the three suicides were eerily similar. Each suicide has left me shell-shocked and questioning my therapeutic attitudes and methods.

How Involved Is Too Involved?

Twenty-two Years and Still Wondering

November/December 2000
After 22 years, I can still see Amy sitting there, cross-legged, with her arms folded across her chest and her dirty blond hair falling down over her face. She was perched on the hood of my car. It was 9:00 p.m., and I was just leaving my office. Amy glared at me as I approached. Our therapy session had ended five hours earlier.

The Godfather Strategy

Finding the Offer a Client Can't Refuse

November/December 2000
After 20 years of teaching therapy, but not doing it myself, I decided I needed a lesson in humility. What better way to experience humility than to be a therapist? So I started a small practice that basically consisted of taking on the cases that, for a variety of reasons, other therapists couldn't handle: sexual violence, heartbreaking drama, money problems, celebrities. And I was quite successful, to the point that the lesson in humility was escaping me. Until I met Bob.

Been There, Done That

When Clients Resist Your Advice, Hang in There

May/June 1999
What should I do when the response to anything I suggest to a client is, "I've already tried that and it doesn't work"?

The Dog Ate It

When Clients Don't Do Their Homework

May/June 1998
How do you get clients to do homework assignments? For one, please don't call them homework assignments.
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