The Difficult Patient: Deconstructing Challenging Interactions using Principles of Dynamic Deconstructive Psychotherapy with Robert J. Gregory, MD

Video Transcription

Video Summary

The webinar, led by Dr. David Stifler and featuring Dr. Robert J. Gregory, focused on advanced addiction psychotherapy. Hosted by the American Academy of Addiction Psychiatry, it was part of a series aimed at addiction psychiatry fellows and faculty. Dr. Gregory introduced Dynamic Deconstructive Psychotherapy (DDP), a treatment for borderline personality and substance use disorders, and discussed the concepts of patient interactions and challenging behaviors. His approach highlighted the importance of acknowledging the emotional responses and needs of patients, as well as the therapeutic relationship between patient and clinician.<br /><br />Dr. Gregory emphasized the significance of understanding a patient's embedded badness, which refers to a deep-seated sense of self-worthlessness or defectiveness, and the role it plays in patient behaviors like rejection sensitivity and defensive avoidance. He talked about specific states of being patients might exhibit, such as angry victim or helpless victim states, often pushing the clinician to react in counter-therapeutic ways. By transforming these interactions, clinicians can help shift the patient's self-perception and promote better outcomes.<br /><br />The discussion also covered strategies for responding to difficult patient behaviors from a therapeutic standpoint, emphasizing the importance of boundary setting, maintaining a judgment-free zone, and fostering a strong doctor-patient alliance. Dr. Gregory utilized video examples to illustrate how mirroring and non-confrontational communication can help deconstruct persistent negative schemas in patients, facilitating more authentic interactions and progress in therapy. The session concluded with a Q&A, addressing specific practitioner dilemmas related to patient interactions.

Keywords

Addiction Psychotherapy

Dynamic Deconstructive Psychotherapy

Borderline Personality Disorder

Substance Use Disorders

Patient Interactions

Therapeutic Relationship

Embedded Badness

Rejection Sensitivity

Defensive Avoidance

Boundary Setting

Doctor-Patient Alliance

Non-Confrontational Communication

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