Treatment Resistance and Patient Authority: The Austen Riggs Reader


Therapeutic hope for “treatment resistant” patients.The Austen Riggs Center is nationally recognized as the leading psychiatric hospital for treatment-resistant patients, who willingly seek help but just cannot respond to treatment. Here, leaders in treating such challenging patients offer a comprehensive psychodynamic approach for treatment and offer hope for recovery.
In this book, readers are given an in-depth view into the psychodynamics systems perspective of treatment ...

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Therapeutic hope for “treatment resistant” patients.The Austen Riggs Center is nationally recognized as the leading psychiatric hospital for treatment-resistant patients, who willingly seek help but just cannot respond to treatment. Here, leaders in treating such challenging patients offer a comprehensive psychodynamic approach for treatment and offer hope for recovery.
In this book, readers are given an in-depth view into the psychodynamics systems perspective of treatment resistant disorders, with illustrations of the value of including family therapy, and developing and using a psychodynamic treatment team. Also offered is the first description published in book form of the newly-defined area of psychodynamic psychopharmacology—an approach to the use of medications that attends to the meaning of medications to the patient and clinician, as well as to their pharmacologic effects.
Important clinical problems such as trauma, psychosis, suicide, family resistant, integrated treatment, and psychopharmacologic failures are covered in detail. Throughout, practical principles are reported in text boxes to help the reader apply learning from Riggs to other outpatient, residential, day treatment, and inpatient settings.
The Austen Riggs Center is on the forefront of dealing with difficult-to-treat patients, and this book provides an invaluable resource for both understanding treatment resistance and implementing effective techniques to treat it in clinical practice.

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Editorial Reviews

Journal of Psychiatric Practice
“In an era when extended hospital treatment is diminishing rapidly in the face of an increasing cohort of difficult-to-treat patients who often have treatment-resistant illness, this is an excellent and important contribution to the literature…. [W]ell written and seamlessly edited…. [A]n important resource of its own in this very challenging work.”
The American Journal of Psychiatry
“This is a wonderful book about the healing benefits of psychodynamic psychotherapy…. [A]n invaluable book for academic, public sector, hospital-based, and private practice psychiatrists. By emphasizing the importance of a psychodynamic approach, this book may even nudge the field of psychiatry toward an acceptance of the efficacy of an intensive dynamic psychotherapy, in conjunction with the psychodynamically informed use of medications, and help improve the general state of in- and out-patient psychiatric practice for patients with severe mental illness.”
New England Psychologist
“[A]n excellent hands-on guide to working with difficult-to-treat patients.”
Psychiatric Times
“The book is worth reading by all mental health professionals. . . . The text is well organized with take-home messages set apart in boxes. . . . A variety of issues are addressed . . . .”
Journal of the American Psychoanalytic Association
“[S]uperb volume . . . .[P]sychoanalytically informed approach at Riggs aims to restore the patient’s sense of agency…Each author impressively and persuasively demonstrates how difficult, how emotionally and intellectually demanding a process this is, and how effectively Riggs is able to do it…enormously gifted group of like-minded staff members who have worked together for a long time and have painstakingly hammered out a coherent view of the treatment process through painful trial and error. . . .[A] veritable tour de force, a brilliant exposition of the concept and a persuasive demonstration of its need for wider applicability in a hospital setting. . . . [O]ught to be required reading for all psychiatrists and insurance carriers. It is one of the most thoughtful treatments of the psychological complexities of psychopharmacoloy I have ever read, at once both exhaustive and concise. . . . [S]ufficient variability in the authors’ vantage points that the book never becomes tiresome. . . each chapter abounds with rich, insightful clinical cases. . . . [O]ffers clinical writing at its best; psychoanalysts who aspire to write clinically should study these cases and learn from their simple, vivid, and jargon-free language.”
Psychodynamic Psychotherapy
“[A]n amazing book, a light of hope in the present depressive, unproductive climate of psychiatric education and treatment . . . . [A]bout more than treatment-resistant patients. It is about the dignity of man. . . .The various well coordinated chapters of the book focus on different aspects of this complex therapeutic culture. . . .Detailed clinical vignettes help the reader appreciate the dramatic impact of different therapeutic encounters. . . .This book is a treasure trove, to be recommended to all psychotherapists and certainly to all therapists working in a institution, clinic, outpatient or group setting.”
Daniel Carlat
“We live in an age when psychiatrists respond to treatment 'failure' by ever more elaborate tweaking of the drugs we prescribe our patients. We end up with elegant drug regimens, but increasingly find that our patients are getting worse, not better. This wonderful book, replete with clinical case examples, reminds us to take a deeper look into the minds of our patients. Sometimes a 'treatment failure' reflects our own failure to listen to how patients are interpreting the medications, or how they are viewing us as human beings. This book is long overdue and will enhance the reader's clinical practice.”
Vamik D. Volkan
“I have spent several months of each of the past seven years at the Austen Riggs Center as the Senior Erik Erikson scholar, where I have been witness to Riggs' impressive clinical work with previously treatment resistant patients, including those with histories of abuse, trauma, and major losses. I have come to the conclusion that Riggs provides a uniquely caring therapeutic environment that respects patients' autonomy in the service of their growth, which neither humiliating them nor shrinking from engaging their aggression. This book illustrates the technical aspects of Riggs treatment and makes them accessible to clinicians working in other settings. It is a most significant contribution to the mental health field.”
Steven S. Sharfstein
“In this managed care era of psychiatric treatment driven by economics, Austen Riggs stands alone in its individualized, psychodynamically-informed but multimodal approach to hospital care for treatment of individuals who have failed multiple efforts. Treatment Resistance and Patient Authority is an outstanding contribution and a must-read for all of us, regardless of the treatment setting, engaged in trying to understand and care for these severely ill individuals.”
Journal of Nervous and Mental Disease
“[W]onderful . . . well written . . . comprehensive and engaging . . . . Special kudos to Eric Plakun for the superb job of editing this invaluable volume – a must-read for all clinicians treating a growing population of patients who find themselves drifting from one treatment to another and slowly spiraling down into personal and professional chaos.”
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Product Details

  • ISBN-13: 9780393706611
  • Publisher: Norton, W. W. & Company, Inc.
  • Publication date: 6/20/2011
  • Pages: 320
  • Product dimensions: 6.40 (w) x 9.40 (h) x 1.30 (d)

Meet the Author

Plakun, MD, is a senior psychiatrist at Austen Riggs Center in Stockbridge, Massachusetts, an award-winning clinician, researcher, author, and leader in organized psychiatry, and an advocate for the value of psychotherapy and psychosocial treatments.

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