������

Abstract

Individuals troubled by addictive illness present clinicians with serious challenges regarding the experience, understanding and management of dual diagnosis disorders. Among them, the difficult-to-reach patient features prominently. Such individuals can pull clinicians into intense and endless cycles of relapses, impasses and stalemates and thwarted progress. Not only are clinicians and families left exhausted and frustrated, patients often earn the distinction of being deemed â�?�?treatment resistant.â�? Outside the extremes, there are many subtle but no less powerful risks for the patient and professional engaged in psychotherapyâ�?�?where enactments around addiction (dishonesty/hiding, enabling, etc.) can wind their way throughout a treatment and create havoc of their own. Using clinical examples and research findings from work with difficult-to-treat patients, this presentation will discuss multiple issues involving the vagaries of working with such patients within the framework of psychodynamic treatment. The presenter will lead a discussion with the audience encouraging dialogue from everyoneâ�?�?s clinical experience.

Biography

Michael Groat is the Director of the Division of Adult Services at the Menninger Clinic and is an Associate Professor of Psychiatry & Behavioral Sciences at the Baylor College of Medicine. He received his Master’s degree at Miami University, Ohio and his Doctorate in Psychology from the State University of New York, Albany. He completed a four-year clinical psychology fellowship in psychodynamic psychotherapy and dynamic family work at the Austen Riggs Center. He is a past fellow of the American Psychoanalytic Association and Anna Freud/Yale Child Study Center research fellowship. He is currently a candidate in adult psychoanalysis at the Houston Center for Psychoanalytic Studies.

Email: mgroat@menninger.edu