Students' perception of a difficult case in psychotherapy

Area of Science:

• Psychology
• Social Work Education

Background:

• The definition of a "difficult" psychotherapy case is complex, involving patient, case, and therapist variables.
• Paniagua et al. (1993) proposed a relational definition for difficult psychotherapy cases.

Purpose of the Study:

• To investigate the hypothesis that "difficult" psychotherapy cases are defined relationally.
• To compare the perceptions of graduate social work students with those of mental health professionals regarding the defining characteristics of difficult cases.

Main Methods:

• A sample of 44 graduate social work students completed the Difficult Case Questionnaire.
• The questionnaire assessed variables related to client motivation, disorder, generic factors, and therapist orientation.
• Results were compared to Paniagua et al.'s (1993) findings from mental health professionals.

Main Results:

• Both groups agreed that patient, case, and therapist characteristics are important but unequally weighted in defining difficult cases.
• Mental health professionals ranked the domains as: patient's, case's, and therapist's characteristics.
• Social work students ranked the domains as: therapist's, patient's, and case's characteristics.

Conclusions:

• The perceived importance of specific domains in defining difficult psychotherapy cases varies between novice (students) and experienced (professionals) practitioners.
• Therapist characteristics may play a more significant role in the definition of difficult cases for social work students compared to established professionals.