Series Epilogue: A View From Riggs: Treatment Resistance and Patient Authority

This series began as a result of two unrelated conversations. In the first, Otto Kernberg, who was visiting Riggs at the time, suggested that Riggs had not yet developed a coherent voice within the field, articulating how we work and what we are learning. The response of Riggs staff was to begin to publish more about the work we do, speaking as individuals with multiple voices in a range of journals rather than with a recognizable and distinct (or even formally negotiated) voice of the institution. The second conversation was a few years later with Journal editor Douglas Ingram, who was familiar with the work emerging from Riggs. He asked if there was interest in publishing more about what we were learning. After speaking to colleagues at Riggs and negotiating the articulation of a theme about the ways we work, I accepted the offer to edit such a series, and set out to select six papers. As the papers began to emerge and interest in them and in Riggs' work grew, I realized we had more to say, and negotiated with Doug a total series length of twelve papers. Editing the series has proven rewarding, if sometimes daunting, but I am pleased that it has helped shape a voice of Riggs within the field.

Riggs is an unusual institution that treats a small number of treatment refractory patients with enough financial resources of their own or from third parties to support a mobilization of intensive and extensive treatment resources including individual, group, and milieu treatments. Few will work in an institution like Riggs or have our clinical resources. Some might argue that such intensive work cannot be relevant