What makes a difficult patient so difficult? Examining the therapist's experience beyond patient characteristics.

The primary aim of this study is to improve our understanding of therapists' experience of a "difficult patient" and consider the different variables involved in this label. What makes a patient be perceived as difficult by a therapist in public health services? Results of our analysis of 10 qualitative semistructured interviews of therapists working in public health service in Chile indicated that therapists' perceptions of a "difficult patient" depend on variables that go beyond the patient's intrinsic characteristics, including patients' negative attitude toward the therapist and treating team, patients' negative effects on therapists, and a difficult treatment context (e.g., work overload, scarce resources, limited number, and frequency of sessions). We illustrate the interaction of these dimensions and focus on the impact of the treating context on therapists' experience of a "difficult patient" through the case of a therapist working with a patient with complex depression in the public health system of Chile.