Social Work Programs

September 10, 2009

Dealing With Difficult Patients

The movie “What about Bob” is a classic about a borderline patient in psychotherapy that cannot accept his therapist taking a vacation. Mr. Bean goes to the dentist is a comical look at this problem in the context of seeing a dentist.

In the Mr. Bean dentist visit video he sabotages his appointment in a number of ways. I won't spoil it! In "What about Bob", Bob is able to get the phone number of his therapist on vacation in New England. That wasn't enough: He later went down to the answering service office to get the location of his vacation home. Of course, he shows up and we get to watch Richard Dreyfus lose his control numerous times while the rest of the family finds Bob endearing and child-like. Dreyfus knows he is passive-agressive and doesn't understand why no one else sees the manipulations.

It is useful to look at our reactions to patients we find difficult. What are the aspects that are challenging? Can you draw lines with people. Is that what may be the underlying issue with a number of difficult patients? Do clients pick up the reactions from the professional and find ways to stop the distancing acts of the professionals?

In the dental video clip we see Mr. Bean playing with various dental instruments and ways he sabotages the authority of the dentist. Seinfeld has also made jokes about how the patient feels powerless in the waiting room of a doctor's office. The patient-doctor relationship has a complexity to it and it's good to be honest and see when you fall into a power trip or other forms of ego.

One of my first psychotherapy clients talked about how he'd see two different women at the same time. After a few months of therapy, he started seeing a second therapist. I was able to use this as a context for him to see his own mind. Why does he always need to have two set up in his life?

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