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Working with Complex and Difficult-to-Treat Patients: A VIRTUAL Conference for Psychiatrists in Training

Austen Riggs Center

25 Main St
StockbridgeMassachusetts 01262
April 23, 2021 at 10:30 AM to April 24, 2021 at 3:30 PM

Note: this virtual conference is specifically for psychiatric residents

Please note: Registration is currently full. We have experienced an unexpected level of interest and are currently working to expand the capacity of the conference. 

To be placed on a waiting list, please click here: https://forms.gle/xv1oGxBqkYHkUbpD7 

If space opens up, we will email you to let you know. 

Abstract:   

In a treatment environment in which most patients bring psychiatric complaints to primary care clinicians, psychiatrists increasingly treat patients who have not responded to initial treatment strategies. Hence, such patients make up a substantial proportion of the caseloads of psychiatrists. The dilemmas these patients pose often test the limits of our knowledge and our skills. Equally important, they test our emotional capacities, whether we are offering pharmacotherapy or psychotherapy or leading treatment systems. When characterologic difficulties contribute to treatment resistance, distressed patients may transmit to physicians the same distressing feelings that they are trying to escape. In treatment systems, the patient’s internal tumult may be projected into the larger system, so that psychiatrists are managing both the evoked irrationality in the system and the intense distress of the patient.  

Integrating a psychodynamic perspective into treatment offers a way, first of all, to make sense of treatment-resistance, preserving the treater’s capacity for empathy while also allowing the treater to better adapt to the unique demands of the individual patient. Understanding the underlying dynamics of complex patients also gives the psychiatrist tools to address irrational system dynamics that are potentially countertherapeutic if unidentified and unchecked. Thoughtful attention to the meanings of countertransference is one valuable tool not only for managing unhelpful reactions, but also understanding the patient’s experience. A psychodynamic perspective also provides tools for developing and using a therapeutic alliance, with patients for whom the alliance is often fragile. Understanding the patient’s and therapist’s contribution to impasses in psychotherapy can help such treatments become unstuck, and is an important aspect of the skillset of competent psychiatrist-psychotherapists. Those same skills can also be useful for addressing treatment resistance in relation to psychopharmacotherapy, given how meaning effects often shape pharmacotherapy treatment outcomes. 

This conference, designed for psychiatric residents, is intended to enhance participants’ capacities to work effectively with difficult-to-treat patients through the integration of psychodynamically-informed and patient-centered perspectives into diverse aspects of the patient’s care. The knowledge, skills, and attitudes of psychodynamic psychiatry are not only useful in the psychotherapy of patients, but also foster leadership skills for addressing systems enactments in relation to challenging patients, and can markedly enhance effectiveness of pharmacotherapy. 

Objectives: 

At the Conclusion of this 2-day conference, residents should be able to: 

  1. Empathically describe the human struggles and common dynamics underlying treatment-refractoriness, encompassing both the patient’s and the treatment’s contribution to impasse 
  2. ​Ameliorate treatment-interfering dynamics in psychotherapy 
  3. ​Apply practical psychodynamics to enhance pharmacotherapy outcomes 
  4. ​Improve medical leadership skills through the ability to address systems dynamics evoked by complex patients.  

Agenda: 

Friday, April 23 

10:30-11:00 a.m              Introduction 
                                         David Mintz, MD

11:00-11:50 a.m.             A Psychodynamic Perspective on the Difficult Patient
                                         Eric Plakun, MD

11:50 a.m. -12:00 p.m     Discussion 

12:00-12:50 p.m.             Setting the Frame in Psychotherapy: Roles, Tasks, Boundaries 
                                         Jane Tillman, PhD

12:50-1:00 p.m.               Discussion 

1:00-2:00 p.m.                 Lunch 

2:00 -2:50 p.m.                Impasse in Psychotherapy
                                         
Jennifer Stevens, PhD 

2:50-3:00 p.m.                Discussion 

3:00-3:15 p.m.                Break 

3:15-4:00 p.m.                Small Groups – applying our learning 

4:00 - 4:15 p.m.              Reflections on the day: Common themes, common challenges, common learning

 

Saturday, April 24 

10:30-11:20 a.m.             The Disturbing Patient in the Disturbed Treatment System 
                                         
Samar Habl, MD; Cathleen Morey, PhD, LICSW 

11:20-11:30 a.m.             Discussion 

11:30 a.m.-12:20 p.m     The Uses of Countertransference 
                                        
Elizabeth Weinberg, MD 

12:20-12:30 p.m.            Discussion 

12:30-01:15 p.m.            Lunch 

1:15-2:15 p.m.                Psychodynamic Psychopharmacology 
                                       
David Mintz, MD

2:15-3:00 p.m.                Small Groups – applying our learning 

3:00-3:30 p.m.                Lessons Learned, Concluding Remarks, and Feedback 

For more information, please contact Erikson Institute Education Coordinator Kathleen Young at kathleen.young@austenriggs.net or 413.931.5230  

Please note: Registration is currently full. We have experienced an unexpected level of interest and are currently working to expand the capacity of the conference. 

To be placed on a waiting list, please click here: https://forms.gle/xv1oGxBqkYHkUbpD7 

If space opens up, we will email you to let you know. 

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