Consultation and Treatment Available for the "Difficult" Patient

BorderlineDisorders.com clinicians offer evaluation and treatment of the "difficult" patients encountered in the mental health professional's clinical practice.

Psychiatrists, psychologists and social workers periodically encounter the patient who does not respond to usual treatment approaches. For psychiatrists, this experience is often in the form of patients who do not get better on medication. Patients sometimes describe an initial positive response to medication, but then repeatedly relapse into complaints of depression, anxiety, impulsivity, and, occasionally, thought disorder. Another typical scenario is that of the patient who responds to each new medication trial with complaints of excessive side effects which rule out the possibility of continuing the trial.

In the practices of therapists from all disciplines, certain patients' responses to treatment often include implicit or explicit claims/accusations that the doctor is not helping them or is even making them worse. Alternatively, and sometimes concurrently, the patient becomes more and more dependent on the therapist with increasingly frequent contacts which lead to no apparent therapeutic benefit. In a worst case scenario, the patient's impulsivity and potential for self-destructiveness become of such concern that the therapist extends himself or herself in ways which begin to consume the therapist but do not improve the condition of the patient.

In brief, certain patients become difficult or problem patients. Sometimes only gradually, a patient can begin to overwhelm a clinician's practice and take over an increasingly disproportionate degree of the therapist's time and concern, even to the point of threatening the therapist's peace of mind. Problems in treating these patients often stem from inadequate attention to the personality disorder component of the patient's pathology. Conditions which at first appear to be Axis I depressive or anxiety disorders may reveal an underlying personality disorder as treatment progresses. Borderline personality disorder is the most commonly known among clinicians, but narcissistic, dependent, depressive-masochistic, histrionic, paranoid and schizoid personality disorders may also require a special treatment approach.

The Personality Disorders Institute offers a staff of clinicians (psychiatrists, psychologists, and social workers) trained in the evaluation and treatment of these conditions. Services include consultation and supervision as well as provisions for ongoing treatment at different clinical levels (inpatient, day hospital, and outpatient psychotherapy).

See the description of borderline personality geared for the general public.

For outpatient clinic treatment—The Ambulatory Adult Services at 914-997-5940

For hospital treatment—The Evaluation Center at 914-997-5700

For private referrals—Dr. Frank Yeomans at 212-213-3677

For referrals outside the New York area—At the current time, the PDI is focusing on providing services to people in the metropolitan New York area.  We have colleagues in some other geographical areas, but unfortunately are not able to provide referrals for all areas and, therefore, cannot respond to all inquiries. For such inquiries, please see the Borderline Personality Disorder Resource Center.