Jim, These are always difficult patients. This patient is revealing a personality disorder likely in the self defeating or borderline personality spectrum. When ever you suggest something she has a way of deafeating all of your attempts. In patients like this, I recommend the following: Let us know if anything works, Robert E Feinstein M.D.
1) Empathize with this patient's suffering, for a very long time before suggesting any new interventions. Suggestions will just be defeated.
2) Emphasize that change will be slow and hard and take a very long time.
3)Openly express your doubts that change is possible considering her history but offer your continued support for the long haul
4) Since nothing professionals suggest helps her, ask her to search the web and present you with some options (which she discovered) that might be worth a trial.
5) She could also purchase two self help manuals. a) Mind over Mood Padesky & Greenberg (Guilford) b)Skills Training Manual for patients with Borderline Personality Disorder Marsha Linehan ( Norton)
6) If all this fails, over the next few months, gradually introduce the idea that the help she needs is from a psychiatric specialist in personality disorders.
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