I have yet to encounter the unproblematic patient, the one whose course of therapy resembles a newly christened ship gliding smoothly down the slip into the water. Each patient must be a problem: the success of therapy depends on each individual's encountering and mastering basic life problems in the here-and-now of the group. Each problem is complex and unique: the intent of this book is not to provide a compendium of problems but to describe the strategy and set of techniques that will enable a therapist to adapt to any problem arising in the group.
Some common recurring behavioral constellations, however, prove taxing to the therapist and merit particular attention. An American Group Psychotherapy Association questionnaire sent to practicing group therapists inquired about the critical issues necessary for group therapists to master. Over 50 percent responded, "Working with difficult patients." 1 Accordingly, in this chapter, we shall turn our attention to difficult patients and specifically discuss eight problematic clinical types: the monopolist, the silent patient, the boring patient, the help-rejecting complainer, the psychotic patient, the schizoid patient, the narcissistic patient, and the borderline patient.
The bête noire of many group therapists is the habitual monopolist, a person who seems compelled to chatter on incessantly. These patients are anxious if they are silent; if others get the floor, they reinsert themselves with a variety of