thank you for your suggestions. this is certainly proving to be a difficult situation. the patient has "hopped" around in therapy for years. Her refusal to talk about what is bothering her is the reason for the many changes. she's been on a variety of different combinations of anti-anxiety, anti-depression and sleep medications for quite a few years, but to no avail- if anything, she improves for a brief period of time, but falls right back deeper then before. Her psychiatrist is shrugging his shoulders at this point, medication wise. Obviously I cannot force her to talk to me, but I am certainly willing to give it all I can. But the break for myself will be helpful, especially after trying to build up some sense of trust by carrying on a one sided conversation interrupted by silences while she stares blankly at the floor. But thank you again.
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