Managing Distressed and Disruptive Clients in Mental Health Practice

1. Distressed, Disruptive and Unmotivated Clients: What to do when they walk through your door Distressed, Disruptive and Unmotivated Clients: What to do when they walk through your door Presented by Dr. Debbie Samsom, Presented by Dr. Debbie Samsom, Registered Psychologist Registered Psychologist November, 2013 November, 2013

2. Back in Motion Rehab Inc. Distressed Clients: Do they have a mental health diagnosis? Distressed Clients: Do they have a mental health diagnosis? Symptoms of MH disabilities are multiple and varied depending on the diagnosis Focus on observations Crying spells Irritability Limited interpersonal skills Agitation Withdrawal from others Poor/inconsistent follow through Poor personal grooming Lack of participation in daily activities Ask the Client about what you observe

3. Back in Motion Rehab Inc. Employment Planning Principles Employment Planning Principles Strengths Vocational Interests Limitations/Barriers strategies to address Workplace Supports and Accommodations *Level of employability is linked to what you discover here (not to a specific diagnosis)

4. Back in Motion Rehab Inc. Where do we get information? Where do we get information? Historical Information Available New Information Gathered Community Agencies Family Members Referral for assessments (Medical, Vocational- Psychological, Work Simulation Assessment) The Client

5. Back in Motion Rehab Inc. The Client as a Source of Information The Client as a Source of Information Dont be afraid to ask Insight (individual and diagnosis dependent) Duration of Mental Health Diagnosis Desire to Disclose

6. Back in Motion Rehab Inc. Distressed Clients - Strategies Distressed Clients - Strategies Talk about the behaviours you see (or dont see) Problem-solve with Client (What will help?) Medication review Increased self-care Change of schedule Disability Management workshop participation Referral to community services Program interrupt (with plan)

7. Disruptive/Demanding Clients - Examples Disruptive/Demanding Clients - Examples People who project a negative and rude attitude. Within a workshop, Clients who are demanding and wont let others talk Lack of self-control being emotionally charged easily when not getting yes for answers Back in Motion Rehab Inc.

8. Back in Motion Rehab Inc. Disruptive/Demanding Clients - Strategies Disruptive/Demanding Clients - Strategies Be calm, empathic and respectful Have difficult conversations (tell the truth) Set boundaries and expectations People with mental health issues dont want or need a pass Never say youre too busy or dont have time Document ethically and effectively Learn de-escalation skills

9. Back in Motion Rehab Inc. Unmotivated Clients - Examples Unmotivated Clients - Examples Mental health clients who wont access the help they require Clients who dont follow instructions Clients who avoid contacting employers for informational interviews Clients who are lethargic about their job search In other words, Clients who wont do something that we think they should do.

10. Motivational Interviewing References: OConnell, D. (2013). Helping Clients to Change Behavior, presented at the 9 th Annual Health Care Professional Conference. Vancouver BC. Miller, W & Rollnick, S. (2012). Motivational Interviewing, 3 rd Edition: Helping People Change . New York: Guilford Press. Motivational Interviewing References: OConnell, D. (2013). Helping Clients to Change Behavior, presented at the 9 th Annual Health Care Professional Conference. Vancouver BC. Miller, W & Rollnick, S. (2012). Motivational Interviewing, 3 rd Edition: Helping People Change . New York: Guilford Press.

11. Back in Motion Rehab Inc. What is MI? What is MI? MI is a collaborative goal-oriented style of communication, with particular attention to the language of change . MI is designed to strengthen personal commitment to a specific goal by eliciting and exploring the persons own reasons for change within an atmosphere of acceptance and compassion .

12. Back in Motion Rehab Inc. Elements of MI? Elements of MI? Focus is on your interaction with client Communication style is one of guiding (rather than directing or following) Collaboration (done with)

13. Back in Motion Rehab Inc. Motivational Strategies: The Building Blocks Motivational Strategies: The Building Blocks Providing information Removing practical barriers Providing Choice Identifying the benefits of change Practicing empathy Providing feedback Clarifying goals Active helping

14. Back in Motion Rehab Inc. 4 Processes of MI 4 Processes of MI 1. Engaging: establishing a working relationship 2. Focusing: establishing an agenda 3. Evoking: eliciting clients own motivation to change 4. Planning: committing to a specific course of action

15. Back in Motion Rehab Inc. Ambivalence is Normal Ambivalence is Normal Explore ambivalence, rather than think resistance Develop a discrepancy between present behaviour and goals and values When a behaviour is seen as conflicting with goals, change is more likely to occur Client rather than the practitioner should present the argument for change

16. Back in Motion Rehab Inc. Ambivalence is Normal Ambivalence is Normal The Client is not an opponent Its not about winning and losing Its not about convincing Its not about telling someone what to do If asked for advise, give a set of options Remind yourself and the Client of their autonomy *The Client is the primary resource for finding answers and solutions

17. Back in Motion Rehab Inc. Change Talk vs. Sustain Talk Change Talk vs. Sustain Talk Change talk are statements that indicate some movement in the direction of change I need to do something about this I suppose I could at least update my resume Sustain talk are statements that indicate support for the status quo I dont think Im ready to get a job I dont see how that would help

18. Back in Motion Rehab Inc. Dont Encourage Sustain Talk Dont Encourage Sustain Talk Questions that elicit sustain talk What gets in the way of ? What prevents you from ? Why havent you ? Even empathic statements can encourage sustain talk so watch how you use them

19. Back in Motion Rehab Inc. Evoking Change Talk Evoking Change Talk D esire (I wish, I want, Wouldnt it be great if) A bility (I could, I would be able to, I have done that in the past) R easons (I would have more money, I would have something to talk about, I wouldnt be bored) N eed (Must, should, ought to, have to)

20. Back in Motion Rehab Inc. Ready to Start Planning Ready to Start Planning Look for signs of readiness Increased change talk Diminished sustain talk Increased resolve Envisioning Transition from Evoking to Planning So where does all of this leave you? What do you think you might do?

21. Back in Motion Rehab Inc. Checking For and Strengthening Commitment Checking For and Strengthening Commitment C ommitment Is that what you intend to do? So, in order to get this going, what would you have to do first? A ctivating How would you get ready? Are you willing to give that a try? T aking Action So you checked out that website I sent you. I see that you are looking over the workshops we offer.

22. Back in Motion Rehab Inc. Motivational Interviewing Motivational Interviewing Empowers people to make positive changes Fosters pleasant relationships with our Clients Makes our job easier! Thank you