At the same time, it is not permissible to abandon the patient. Thoughtful, successful, and possibly even therapeutic management of the treatment nonresponder is part of the art of the expert clinician. I offer some guidelines to aid clinicians in managing treatment failure. Here are the steps I suggest. Sometimes the patient, the therapist, or both can have distorted views about whether progress is occurring.
Distortions can occur in both directions.
And some patients who are not making progress may feel impelled to tell you how well they are doing for fear you will get discouraged and give up on them. To obtain some objective information about whether the patient is making progress, collect some data. Agree with the patient on an objective measure or two that can be used to monitor progress in treatment, and then use it to monitor the therapy. Investigate, collaboratively, with the patient, the reasons for the failure to progress, and do some brainstorming about changes in the treatment plan that might break the logjam. This discussion might last for weeks, and might include several experiments with new approaches to treatment.