Message from the Superintendent (February 23, 2007)

I had a chance this week to listen to some staff struggle with how to get medications to someone who refused and was clearly decompensating, but not meeting the criteria for a “Psychiatric Emergency”. This was visibly concerning to all those working with this client. The concern was, “Do we wait until something bad happens?”

I wanted to share a paradigm that may be helpful. It is an approach I have witnessed staff at Riverview use successfully. It is the focus on relationship. Therapeutic alliance. Trust building. Trust may be the single biggest factor in being able to influence. Think about it. You probably give a high amount of influence to those you trust even if you don’t understand their recommendations. Having a doctor, car mechanic, plumber you trust (unless you are really good at any of these fields) probably leads you to being influenced more then someone who may have high credentials that you don’t know, or have seen act in a less then honorable way.

The same dynamic is at play when you are helping a client. If the client trusts you, even if they do not appreciate the content of your advice, they are more likely to allow you to have influence. Many of you know this already. Many of you have probably worked with someone who “knew” the medicine was “poison”, but would take it because you where reassuring them. The client trusted you. You may be the doctor, psychologist, social worker, nurse, mental health worker, rehabilitation specialist, peer specialist but if you have influence, you are the one with the most to offer the client. Never underestimate the power of a trusting relationship. When you find yourself in the difficult situation of trying to assist someone who, for what ever reason, won’t let you. Won’t take the medication. Won’t go to groups. Won’t address their own hygiene. Remember, you have the power to be consistent, empathetic, respectful, reliable, knowledgeable and helpful. Through the relentless gentle consistency of being engaged with the client, trust can be built. Although not the fastest method, clearly the one most likely to be sustainable.

If you want to treatment plan, “To establish a trusting alliance”, think of some possible steps such as;

Define relationship preference. Most people have a preferred relationship style. I was taught to think of
PIES.
   P = Relating to others through shared physical activity.
   I = Relating to others through intellectual sharing.
   E = relating to others by sharing emotional content and feelings.
   S = relating to others through sharing spiritual ideas, beliefs and experiences.
Engage the client in the preferred relationship style on a consistent predictable basis.
Identify as significant the client seeking you out, asking for your help, or displaying a comfort with you. Now through the therapeutic relationship offer consistent an authentic messages of hope and support.
The above is an approach to treatment of a resistive client through focusing on active intervention of developing therapeutic influence. Never let your self be in a position of “waiting for something bad to happen”.
I hope all you have a great weekend and as always thank you for all your good work.

David S. Proffitt

Agency information

Message from the Superintendent (February 23, 2007)