Difficult Patients: Their Construction in Group Therapy

Written from the perspective of inter-subjective theory, this article addresses how the leader and group members co-construct the difficult patient. Too often, therapists and patients have tended to attribute difficulties in therapy groups to "the difficult patient" without appreciating how they themselves contribute to the construction, the needs this construction serves, and the potential value of such patients to the group. Mistakes in group leadership, vicissitudes of inter subjectivity, disturbing intra-psychic defenses, and while-group dynamics interact to produce the difficult patient. Also discussed is the group member who is difficult but who no longer meets the criteria for patient-hood. By exploring the factors involved in the co-construction of the difficult patient, the authors hope to guide clinicians in the deconstruction of such impediments, thus allowing the difficult patient to become "just another group patient."