handle with care verbal component based on a balance of opposing forces such as: and or: and
TRANSCRIPT
Handle With CareHandle With Care
Verbal Component
Based on a balance of opposing forces
SUCH AS:
AND
OR: AND
The Tension/Tension Reduction Cycle…
• IS NOT TIME DEPENDENT
• Helps us Understand when to intervene and when to withdraw from an intervention
Internal Conflict
• Responses due to an event not experienced or shared by others.
•Such as:–Delusions–Hallucinations–Delayed reactions to a real event–Flashbacks
External Conflict
• A direct and clear response to an observable event
Inwardly Directed Tension
• Self-mutilation
• Self-Neglect
• Depression
• Suicidal Ideation
Outwardly Directed Tension
• Destruction
• Assault
• Explosive Behavior
• Instigating others to the above
Delayed Style
• Social Withdrawal marked by a decrease in: » Motor Activity
» Speech Production
» Avoidance of eye contact
• Sudden Rage, with violence directed either inward or outward
Immediate Style
• Classic acceleration or motor activity, speech etc…
• Impulsive acting out
Autonomic Responses
Motor Activity
Speech
Indirectly Threatening
Behavior
Overtly Threatening
Behavior
Assault
SUPPORT
LIMIT SETTING
PRT
Anger/Fear
Precipitous Discharge
EGOOUT OF
CONTROL BEHAVIOR
Experiences the outside
world
Is conscious
The Glue that keeps our
thinking and behavior in sync
Questions:
• How do we as healthy adults handle tension?• What are appropriate ways to handle anger?• What disorders might cause impaired ego
function?• Are there kids in Halleck that can be classified by
the disorders we came up with?• How do these clients handle conflict/tension?
In the absence of internal control we
must supply external controls.
How Can We Supply External Controls???
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A Solid Object is:• Calm• Centered• Balanced• Makes Direct Eye Contact• Verbally Reassuring• Firm• Non-threatening but not vague or wishy/washy• Adheres to Policy
The Solid Object Relationship Model (SORM):
• Presents a solid object that the out-of-control client can attach him/herself to
• The goal is for you to be the solid object. Your qualities can provide external control.
When there is lack of internal control, we must supply external
controls.
What are your buttons???• Weight• Race• Complexion• Your family• Other personality traits• Attacks on your values
The out of client that is pushing your buttons is really testing how solid of an object you are!
Are you stable enough for the client to attach to?
? Over-reactor
? Under-reactor
? Talker/listener
Finding Balance…
To Be A Solid Object.
What is transference?
The reproduction of positive and negative feelings that were at one time associated with another person or past experience that are now (unconsciously) transferred to a new individual.
Examples of transference…
Countertransference
What is countertransference?A similar experience as transference only in
reverse. The client is producing positive or negative feelings in you the residential counselor.
Countertransference is normal and happens in any helping relationship.
Examples of countertransference…
The Rules
#1 Always behave as a solid object#2 Appeal to healthy components of the individual#3Avoiding responding emotionally to provoking client
behavior#4 Find a positive in all the individual in your care
before a crisis#5 What you say is not as important as how you say it#6 The higher the individual falls on the tension/tension
reduction cycle, the more external control becomes necessary
Automatic Responses
Motor Activity
Speech
Indirectly Threatening
Behavior
Overtly Threatening
Behavior
Assault
SUPPORT
LIMIT SETTING
PRT
Anger/Fear
Precipitous Discharge
Support• What can we do at this level?
»Listen
»Accept
»Focus
»Encourage
»Offer
»Agree on next steps
Limit Setting• Limits should be…
»Clear
»Consistent
»Enforceable
»Non-punitive
PRT (Primary Restraint Technique)
• PRT should only be used if the client is…
»A danger to self
»A danger to others
»A major group disruption
»Engaging in major property destruction
(Primary Restraint Technique)
• PRT should only be used if the client is…
»A danger to self
»A danger to others
»A major group disruption
»Engaging in major property destruction
•When is the only time we should use restraint?
•Which clients have additions to their behavior plans that allow for earlier hands-on intervention if necessary?
•How do you document for clients with special behavior plans?
•Your documentation should be written to justify a hands-on intervention, exactly what did the client do? Do not simply state that the client was “unsafe.”
•Additional thoughts/questions???….
This completes the verbal component of Handle With Care.