, Volume 8, Issue 1, pp 101-102
Date: 21 Dec 2010


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The case history by Parker describes a patient treated in long-term psychodynamic psychotherapy who has precluded certain treatments, such as medication, from the outset. The patient is chronically unwell, often fails to make progress and is very demanding of the treating health professional, such that the treating therapist comes to question what are the limits to their care and responsibility for this patient.

This case reminds me of a dilemma I sometimes got myself into in the earlier stages of my career as a psychiatrist and psychotherapist—hanging on year after year with a patient who is only very partially co-operative, in the hope that the patient will improve with time. My rationale for continuing with a patient of such limited capacity for co-operation was that at least I would be benefitting them by stopping them suiciding, or saving the need for the patient to use other expensive medical services, such as psychiatric inpatient units. These days, I very much try to avoid enter ...