A View From Riggs: Treatment Resistance and Patient Authority—Introduction to Paper V

This series of articles is intended as an opportunity to share some of what we are learning at the Austen Riggs Center about work with treatment resistant or treatment refractory patients. Our hope is that readers will be able to apply in their own clinical practices some of what we are learning. Previous articles in the series speak to the kind of clinical work an individual therapist does with a patient. In this fifth article in the series, Donna Elmendorf and Margaret Parish begin to take us in a different direction as they cast treatment resistance as a social phenomenon, explicating the theoretical underpinnings of the unusual therapeutic community program that evolved at Riggs during the 20th century.

Since relatively few clinicians work in therapeutic community settings, application of what Elmendorf and Parish describe to the work settings of many readers may not be apparent at first glance. However, all those who work with treatment resistant patients can benefit from an increased awareness of the contextual factors that contribute to disturbance. Additionally, whenever patients receive care in a clinic setting or group practice, interface with an “administrative milieu” of some sort(e.g., a secretary or receptionist), or when we deal with a patient's family, issues of patient authority and our own authority may well arise and be worth viewing through the lens Elmendorf and Parish offer us. Further, their article illustrates part of what a program such as that at Riggs offers. This includes an opportunity for an experience of immersion in treatment that deepens learning beyond the individual psychotherapy, and is part of what has made Riggs a national referral center for treatment refractory patients.

For Leslie and Alice, the patients Elmendorf and Parish offer as case illustrations, engagement in the therapeutic community offers a crucial opportunity to learn about themselves, about roles they repeatedly carry on behalf of others, about their relationship t