025: Ask David — How do you handle a patient you don’t like (or who bores you)?

In this Podcast, David answers two intriguing questions posed by listeners, and one question posed by his host and colleague Dr. Fabrice Nye.

1. How do you deal with a patient (or friend) who is boring? David describes a technique he learned from a mentor, Dr. Myles Weber, during his second year of psychiatric residency at Highland Hospital in Oakland. The technique works instantly 100% of the time, and is guaranteed to make any boring interaction with any patient instantly exciting! David and Fabrice emphasize that the same technique can be used with a friend, colleague, or loved one who seems boring, including someone you are dating and can’t seem to connect with at anything other than a superficial level.David also describes powerful, shocking and illuminating experiences he had when attending psychodrama marathons sponsored by the Human Institute in Palo Alto during his medical school years, and what he learned about the differences between the off-putting “outer” selves we display to others and the more genuine “inner” selves we often try to hide.
2. How do you deal with a patient (or friend) you don’t like? David describes a method he always used with patients he didn’t like, including one who he found intensely offensive—even disgusting. He explains that the patients he disliked the most almost always became the ones he liked the most, and ended up feeling the closest to, once he used this radical technique. The technique can also be effective with friends or colleagues you’re at odds with.Fabrice reminds us that the approaches David describes in this podcast involve several of the Five Secrets of Effective Communication discussed in previous podcasts. He warns us that they require considerable training, skill and practice, and are likely to backfire if done crudely.
3. How do you get patients to do their psychotherapy homework? Every therapist who assigns psychotherapy homework is keenly aware that many patients, perhaps most, “forget” or simply refuse to do the homework. And these are the patients who don’t improve much, if at all. Dr. Burns explains how he tried dozens of techniques that didn’t work early in his career, and finally discovered an approach that was almost always effective.