Glen Gabbard: “The Difficult Patient”

Outline of Lecture

I. Introduction

  • Dr. Glen Gabbard is the 2018 recipient of the American Psychoanalytic Association’s Master Teacher Award [1].
    • Quote: “I am very grateful for this award. Teaching is something that I have always found very important. It’s a way of passing on knowledge from generation to generation” [1].
  • Dr. Gabbard finds teaching to be very important because knowledge can be passed on and benefit future generations [1].
  • He credits his deceased mentors for helping him through difficult times [2].

II. Defining the Difficult Patient

  • A psychoanalyst is someone who pretends not to know everything [2].
    • Quote: “A psychoanalyst is someone who pretends not to know everything. We are constantly learning from our patients and our own experience” [2].
  • There is no single definition of a difficult patient [2].
  • Dr. Gabbard shares his experience working with difficult patients at the Menninger Clinic [2].
  • He warns against the “kiss of death” in psychoanalysis, which is being known for working well with difficult patients [3].
    • Quote: “There is a kiss of death in psychoanalysis. If you get known as someone who is good with difficult patients, you will get all the difficult patients” [3].

III. Characteristics of Difficult Patients

  • One sign of a difficult patient is that they may not say much in therapy [3].
  • Dr. Gabbard gives an example of a patient who would not come to therapy sessions [3].
    • Quote: “I had a patient who would come to therapy sessions and just sit there in silence. He wouldn’t say anything. That was a difficult patient for me” [3].

IV. The “Usual” Patient (a Myth)

  • Dr. Gabbard describes the “usual” patient as highly motivated, insightful, and grateful [4].
  • He argues that the “usual” patient is a myth [4].
    • Quote: “We all have this idea of the usual patient who is highly motivated, insightful, and grateful. But that’s a myth. Most patients are not like that” [4].

V. The Difficult Patient May Be Subjectively Created

  • Dr. Gabbard argues that therapists may contribute to making patients difficult [4].
  • He suggests that therapists may project their own issues onto patients [4].
    • Quote: “Sometimes we make patients difficult. We project our own countertransference onto them and then we get frustrated when they don’t behave the way we want them to” [4].

VI. The Importance of Consultation

  • Consulting with colleagues is helpful because it can help therapists identify their blind spots [5].
  • Dr. Gabbard suggests that consultation should be an ongoing part of analytic work [5].
    • Quote: “Consultation is essential. It can help us to see our blind spots and to work more effectively with difficult patients” [5].

VII. Audience Questions

  • A question is raised about how to avoid blaming oneself for patient difficulty [6].
  • Dr. Gabbard suggests writing about difficult patients as a way to understand them better [6].
    • Quote: “If you are struggling with a difficult patient, try writing about them. It can help you to understand them better and to develop a more effective treatment plan” [6].
  • Another audience member asks about avoiding the focus on symptom cure [7].
  • Dr. Gabbard advises against promising symptom removal and emphasizes the importance of managing expectations [7].
    • Quote: “We should not promise our patients that we can cure their symptoms. Our focus should be on helping them to understand their underlying conflicts and to develop healthier coping mechanisms” [7].
  • A third audience member brings up a situation where a therapist tends to avoid patients with difficult personalities [8].
  • Dr. Gabbard emphasizes the importance of understanding the therapist’s countertransference [8].
    • Quote: “If you find yourself avoiding patients with difficult personalities, it is important to explore your own countertransference. What is it about these patients that makes you feel uncomfortable?” [8].

VIII. Conclusion

  • Dr. Gabbard is awarded the Master Teacher Award in recognition of his exceptional teaching skills [9].