Therapy Tough Clients

CHAPTER ONEInitial sessions with Maggie and CharlesThe Case of Maggie: a referral for individual therapyPerusing Maggie’s V.A. medical record before the first session, Iglimpsed a 33-year-old Mexican-American woman who had becomediscouraged and hardened after 12 years of treatment in the U.S.Veterans Affairs system. In the past two years she had had threebrief, voluntary psychiatric hospitalizations for suicidal thought,had been tried on various SSRIs, mood stabilizers and other agents,and had been in and out of individual therapy with a series of psychologyinterns. She continued to decline offers to participate in thePTSD women’s therapy group. Diagnostically, she was classified earlyon with depression and chronic PTSD, and the recent assignment ofborderline personality disorder seemed to reflect staff frustration.Medically, she was followed in a primary care clinic as well as the GIClinic for irritable bowel syndrome.First session with MaggieMaggie had someone with her, a short, rathershriveled up Mexican woman.Maggie: This is my mother. I didn’t have anybodyto watch her. She’s pretty deaf and doesn’t speakmuch English.Therapist: Buenos días, señora.The woman smiled politely, sat down in a chair inthe corner of the office and folded her hands onher lap.13