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

As I suggested in the first article in this series, much of what we are learning about work with treatment resistant patients on behalf of the field is about the importance and difficulty of engaging and working with negative transference and countertransference (Plakun, 2006). A treatment center like Riggs offers a resource rich environment to support treatment when negative transferences and negative countertransferences are prominent. One manifestation of this support is the numerous clinicians among whom a patient may disperse transferences that might be too much for any one treater to bear—or for a patient to bear in work with just one transference object. When all goes well, these split and dispersed transferences are integrated through the work of the treatment team, where all involved clinicians meet to share their piece of the elephant to create a comprehensible picture of the whole—and have the occasional opportunity to speak directly with the patient about what they are learning.

This process may sound easier than it is. Team members often find themselves caught up in difficult and passionate struggles. It is not easy to maintain a perspective on the way this is not simply personal conflict between team members or even reasonable (or unreasonable, as it may sometimes seem) people disagreeing, but also a manifestation of dispersed and split, perhaps even dissociated, elements of transference and countertransference. As such, team conflicts are an extremely valuable lens for seeing, understanding, and integrating split off bits of the patient's experience that may be intimately related to their status as treatment resistant patients. The task of integration and interpretation of these conflicts is the responsibility of the team leader, who needs to be not only a good manager of time and other resources, but a sophisticated psychodynamic clinician. Of course, team leaders are as human as other team members, and may become caught up in team conflict, too, so t