DIFFICULT PATIENTS - THEIR CONSTRUCTION IN GROUP-THERAPY

Written from the perspective of intersubjective theory, this article a ddresses how the leader and group members co-construct the difficult p atient. Too often therapists and patients have tended to attribute dif ficulties in therapy groups to ''the difficult patient'' without appre ciating how they themselves contribute to the construction, the needs tills construction serves, and the potential value of such patients to the group. Mistakes in group leadership vicissitudes of intersubjecti vity, disturbing intrapsychic defenses, and whole-group dynamics inter act to produce the difficult patient. Also discussed is the group memb er who is difficult but who no longer meets the criteria for patientho od. By exploring the factors involved in the co-construction of the di fficult patient, the authors hope to guide clinicians ill the deconstr uction of such impediments, thus allowing the difficult patient to bec ome ''just another group patient.''.