Treatment Strategies for “Difficult” Patients In Health Care

Dr. Jeff Riggenbach

From confrontation to connection: Transform your therapeutic approach.


Download an outline

  • 3h of continuing education
  • 31 lessons that last from 5 to 15 minutes each
  • 1 certificate of achievement
  • 1 PowerPoint
  • 1 bibliography
  • 1 course evaluation
  • 4 months unlimited access
  • 7-day money back guarantee
  • 97% of participants who completed the satisfaction survey declare they would recommend this course to a colleague


We all have them. Those clients that make us want to pull our hair out! They discount their progress and the progress of others. They know more than you do. They don’t trust anyone. They make threats, have emotional outbursts, and play coy when you are only trying to get information to help them. Psychotherapy research has made unthinkable gains in recent decades. We now have evidence-based protocol for dozens of clinical conditions, and clinicians also have a plethora of new tools at their disposal. However, practitioners still run into those clients that don’t respond to standard protocols. Some even seem to have aversive reactions to the tools that we have become used to using regularly that so many clients find helpful. These clients can leave clinicians feeling frustrated, stressed out, and sometimes even defeated. Leave this virtual training equipped with evidence-based strategies from an integrated model that Incorporates, dialectical behavior therapy (DBT) cognitive behavioral therapy (CBT), and schema modification interventions to help individuals struggling paranoia, aggression, lack of empathy and other dysregulated emotions not only get better in the short term but stay well in the long term.

About the expert

Picture of Jeff Riggenbach

Jeff Riggenbach, Ph.D. is a three-time best-selling and award winning author, speaker, and trainer who uses his 20 years of clinical experience to inform his workshops on assessment and treatment of “challenging” cases. As part of his training with The Beck Institute of Cognitive Therapy and Research in Philadelphia, Jeff developed and directed personality disorder treatment programs in two different psychiatric hospitals. Over the course of 15 years, he and his staff treated over 500 patients with personality disorders. Additionally, he has run cognitive-behavioural based treatment programs for depression, anxiety, OCD and IOP programs for behavioural health as well as addictive behaviour disorders.

Dr. Riggenbach has trained audiences in all 50 United States, the UK, Canada, Mexico, Australia, and South Africa. He is known for bridging the gap between academia, research findings and day-to-day application of practical strategies with everyday clients, and his sessions routinely receive the highest evaluations in terms of quality of information as well as entertainment value from conference participants.

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Learning objectives

  1. Integrate CBT, DBT, & Schema Therapy into a cohesive treatment approach
  2. Address maladaptive coping styles & their risks for relapse
  3. Apply treatment strategies for multiple DSM 5 personality traits
  4. Deploy effective intervention strategies for paranoia, narcissism & self-injury

Learning material

A theoretical course illustrated with clinical examples. This course is composed of videos of 5 to 15 minutes each. The PowerPoint of the course to download.


  • PowerPoint
  • Identifying and Understanding Challenging Patient Characteristics

  • 1. Introduction
  • 2. What is a difficult patient
  • 3. The 5 characteristics that make a patient difficult
  • Cognitive Insights

  • 4. Belief development
  • 5. The 3 levels of cognition
  • 6. Schemas-Beliefs
  • 7. Beck's beliefs - 3 areas
  • 8. Schema therapy- domain 1
  • 9. Schema therapy- domain 2-3-4-5
  • 10. Characteristics of schemas
  • 11. Schema reinforcement
  • 12. Role of beliefs in communication
  • 13. Self-respect effectiveness
  • 14. CBT strategies - self-care
  • 15. CBT Strategies - Behavioral experiments
  • 16. CBT Strategies- building support and relational work
  • 17. 3 types of cognitive interventions
  • 18. Cognitive distortions
  • 19. Cognitive restructuring
  • 20. Schema modification interventions
  • Navigating Personality Challenges

  • 21. Types of difficult personalities
  • 22. Paranoid personalities
  • 23. Paranoid personalities- case study
  • 24. Perfectionistic personalities
  • 25. Perfectionistic personalities- case study
  • 26. Dependent personality
  • 27. The histrionic personality
  • 28. The antisocial personality
  • 29. The narcissistic personality
  • 30. The land mine and the victim
  • 31. Conclusion
  • Bibliography

CE Credits

Download a certificate of successful completion.


This training is intended for mental health professionals.


  • 3h of continuing education
  • 31 lessons that last from 5 to 15 minutes each
  • 1 certificate of achievement
  • 1 PowerPoint
  • 1 bibliography
  • 1 course evaluation
  • 4 months unlimited access
  • 7-day money back guarantee

Legal notice

The courses offered by ASADIS are accredited by different professional organisations. In addition, ASADIS is approved by the Canadian Psychological Association to offer continuing education for psychologists. ASADIS maintains responsibility for the program.

The CPA’s approval of an individual, group, or organization as a CE Sponsor or Provider is restricted to the activities described in the approved application or annual report form. The CPA’s approval does not extend to any other CE activity the Sponsor or Provider might offer. In granting its approval, the CPA assumes no legal or financial obligations to Sponsors, Providers, or to those individuals who might participate in a Sponsor or Provider’s CE activities or programs. Further, responsibility for the content, provision, and delivery of any CE activity approved by the CPA remains that of the CE Sponsor or Provider. The CPA disclaims all legal liability associated with the content, provision, and delivery of the approved CE activity.

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