Low Expectations

Before me lie the records of yet another forensic case (this one disability) in which a patient apparently suffering greatly from a very treatable mental disorder has continued treatment that appears to have failed to yield significant improvement. We accept that some conditions often respond only partially to aggressive treatment, but for most, given all the therapeutic tools at our disposal, many enjoy complete remission of symptoms.

When all my efforts fail after a reasonable amount of time, I encourage the patient to start looking for another physician. What keeps others from doing the same? Do they need so badly to keep a full practice? Do they blame the patient? 

And what about the patients? Do they fear jumping out of the frying pan and into the fire? Do they form too much of an attachment? Do they take pleasure in suffering? Or do they just want a free ride?

How much does the popular notion that “long term” therapy works best, or that any good therapy takes a long time, affect our expectations?

If your condition has failed to remit at least a little, ask your treater how much longer it should take and when they might want you to seek someone else, possibly with a different approach, or maybe who might just offer a different fit with your personality.

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