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Re: Personality disorder diagnosis by remote control
Robert E. Feinstein M.D. · 7/5/99 at 9:17 pm ET
Paul, Rob Feinstein M.D.
As in all psychiatry I suggested a "tentative diagnosis" which is a hypothesis that (in a clinical setting) can only be validated by a patient's clinical response to an intervention. Personality disorders are extremely treatable and should not imply either you don't like these patients or can't help them. A preliminary personality disorder diagnosis, made by a treating clinician, certainly does not let anyone off the hook. In fact, if verified, it means you will need to stay with the patient for a very long haul. It also means you need to have all kinds of helpful strategies to manage the countertransferences the patient obviously engendered. It's always wise to assess more throughly the patient beliefs, attitudes, and behaviors. You can't ever lose with that approach. But it is also important to consider the patient using other theories. With a patient who seeks help and then rejects all suggestions, it is not always wise to wait and assess more. In fact, if you don't intervene in a preliminary fashion, these patient often leave the care of their physicians. The wait and evaluate approach is frequently the best way to lose such a patient. Why will the patient keep coming if you haven't showed them you have something to offer? Ultimately, a practical intervention and an evaluation of the patient's clinical response, is the only means of validating an effective strategy in a clinical setting. Let the patient and physician decide together on the next step.
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