So how do we react to the difficult inpatient client in our caseload? That person who acts defiantly, does not comply, seems that does not want to be there, but is. Other peers in treatment are not too keen of this client and neither is staff. Does the client follow programming? Not quite.

This scenario presents a challenge to clinicians, staff, and others participating in treatment. The client behaves in such a way that gets under everyone’s skin but is not doing enough to have their treatment terminated. Every morning the news on how clients are doing revolves around this specific person. Whaaaat now? What did the client do (or didn’t do) this time?

How is the psychic and morale of the clinician affected? Do we wish this client wasn’t here anymore? Can insurance please deny further coverage? Can we just kick this person out?

Helping the client engage in treatment can be a work in progress while meeting the client where they are at can also be challenging without the support of other staff who want you, the primary clinician, to “fix the client”. Wishing this client not be in treatment can seem like the best out, but many dynamics must be addressed if we are to remain true to the importance of patient care and ethical practice.

In an individual sense, the clinician must be aware of feelings arising from the situation, be it transference related or due to pressures from others involved. In group settings where staff is present discussing the case, the clinician must be aware of how others’ comments affect their own perspective of the situation and of the individual. Are we buying into the groupthink or are we able to maintain our individual opinions?

They all deserve the best from us, always and unconditionally, whether we like them or not, independent of our opinion, and independent of our professional prognosis.

The need for supervision seems paramount in cases as such. Easy answers should not be expected as there are many factors to consider. But if we are to speak about client care and ethical practice as a priority, the following points are of relevance:

While the client is still in treatment and under our care, this person deserves nothing but the best from us and our team. That is the warranted client care. The possibility of assessing whether the client should be in this treatment episode, or not, becomes a different conversation. Until, and if, a decision as such is made, the client is still a client, no matter anything else.

Am I as a clinician aware of the power of my expectations of the client, on the client’s outcome? There is a chance of closing down possibilities to be helpful if my expectations of this client are minimal or non-existent; if I am not as present as I can be for this person; if “I know this client will fail, so why try”. They all deserve the best from us, always and unconditionally, whether we like them or not, independent of our opinion, and independent of our professional prognosis.

Picture this scenario: I take my car for a tune-up, but I am not one of those to really take good care of the car nor to follow all preventive care suggestions. It is also a bit dirty and filled with fast food reminders. How would I feel if I found out I was not given “the usual tune up” they give everyone else because the mechanics thought I did not deserve it for not taking good care of my car? I did pay the same amount as the “worthy ones”. I don’t know about you guys, but I would not be a happy camper.