Handle 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

Assault Overtly Threatening Behavior Indirectly Threatening Behavior Speech Motor Activity Autonomic Responses

Anger/Fear Precipitous Discharge

PRT LIMIT SETTING SUPPORT

EGO

OUT OF CONTROL BEHAVIOR

Is conscious Experiences the outside world 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.

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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?

Finding Balance…

? Over-reactor ? Under-reactor ? Talker/listener

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

Assault Overtly Threatening Behavior Indirectly Threatening Behavior Speech Motor Activity Automatic Responses

Anger/Fear Precipitous Discharge

PRT LIMIT SETTING SUPPORT

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

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When is the only time we should use restraint?

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Which clients have additions to their behavior plans that allow for earlier hands-on intervention if necessary?

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How do you document for clients with special behavior plans?

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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.”

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Additional thoughts/questions???….

This completes the verbal component of Handle With Care.