A view from Riggs: treatment resistance and patient authority--VIII. Standards of care and patient autonomy.

The therapeutic community at the Austen Riggs Center relies on patient authority to preserve the open setting. Patients' willingness to take on the challenges and responsibilities of citizenship makes it possible to work without bars or locks. Most patients arrive having been labeled "treatment resistant," a label that can connote noncompliance but can also mark the complexity of the trouble and a resistance to being objectified in ways that are dehumanizing. Respect for this complexity can at times counter standards of care that define and prescribe ways of viewing patients and attending to their distress that may be simplistic and undermine development. This paper will explore how current ideas about standards of care may insufficiently take into account the importance of the patient's authority--and the therapist's standards--in helping an individual to make sense of life and experience, and how facing this dilemma head on can reduce resistance.