Helpful patients are not hateful patients

Therapists should encourage and support, not dread, “helpful patients”. Internet or other research by the client can indicate active involvement in treatment.

In 1978 JE Groves described four categories of “hateful” patient, ie: the patients most physicians dread:

  • dependent clingers
  • entitled demanders
  • manipulative help-rejecters
  • self destructive deniers

To this list a fifth category appears to have been added: “helpful” patients, who search the internet for details of their condition and treatment and provide these to their therapist. Comments from colleagues (in person and via blogs), as well as cartoons and the popular press, suggest that these folks inspire almost as much dread (or, at least, derision) as the other four stereotypes.

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Leave contracts out of the first session

Many therapists set explicit goals and use treatment contracts with their clients. Goal setting provides a focus for therapy: contracts indicate that both parties have agreed to the terms of the therapy (or should: the contract you use does bind the therapist as well as the client, doesn’t it?)

Some therapists aim to conclude this business by the end of the first session. While this gives a nice structure to therapy (1st session: agree goals, 2nd session: work toward goals), this may not be the best way forward.

Setting goals and signing a treatment contract is a big step for a client. Although clients may have been awaiting their first appointment for weeks, months, even years, the assessment process may bring to light new information and perspectives which could alter their aims significantly…given time to think things through.

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