How to Coach Yourself and Others Coaching and Counseling in Difficult Circumstances | Page 72
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Hallucinations
Tolerating and making allowance for auditory hallucinations (3/28)
Even when just trying to have a normal chat with the hallucinating patient, nurses recognised that
they had to make allowance for the reality of the patient’s experience. This could be about
acknowledging the potential for the patient to be distracted, as the voices might be like ‘a radio that
can’t be switched off’ and ‘lucid answers’ to questions should not necessarily be expected. Thus
‘patience’ and ‘pragmatism’ around expectations, coupled with open acknowledgement of the
hallucinations as something potentially impacting on communication were all requirements for a
reasonably successful conversation.
Not too much too fast (5/28)
Too much stimulation, either through trying to convey ‘excessive amounts of information’ or trying
to communicate with the patient in a very noisy place with lots of people around, were seen as
things that hallucinating patients would not be able to cope with. This was perhaps another way in
which conversations had to ‘accommodate their needs’. Failure to attend to these needs might have
negative consequences for the patient, resulting in more ‘bizarre behaviour’ or even aggression.
Say their name (2/28)
Given the distraction of hallucinations, nurses recommended using the patient’s name more than
usual in order to get their attention back: ‘just saying their name, just to get them back in the
conversation again’.
Be creative (1/28)
“I remember once … we had a young girl who was incredibly suspicious and she locked herself in a
room for ages and every time we went in to see her, she’d become incredibly hostile because she
was so paranoid and we wouldn’t give up really. So it was a case of I’d go in to see her maybe once
every half an hour. She wasn’t on observations but, and just pop my head through the door and just
say, did she want a drink and constantly try and play it down and it took a long time and then
eventually we put some music on and we just went in her room and danced with her and it seemed
ridiculous but it was something that she was able to respond to. So I think it’s a, it’s difficult, it’s
about being creative. It’s about trying different things, if something doesn’t work then it’s not just
saying, well that, that person is really disturbed and you can’t get through to them. It’s about trying
different things and that’s what we do. It was, it worked for her and every time she became
extremely distressed, she’d put music on and she’d dance.”
Thought disorder
Acceptance and listening (15/28)
Going along, being patient, waiting for sense to emerge over the longer time period, without
‘straightaway feeling you have to say something’. In using this technique the patient is kept going
by responses such as ‘oh yeah’ and nods of the head. Some nurses said they ‘enjoyed that aspect of
the mind’, ‘had some affinity with it’ and found the process ‘creative’. Listening over the longer
term enabled nurses to identify ‘themes giving you an insight into who that person is, and what’s
most important for them as well’. Further understanding could then develop as to how the thought
disorder was affecting them and interfering with what they might want to do. Nurses could also then
‘tune in to how they were feeling’, enabling the identification and treatment of distress, and/or
better risk assessment. Being prepared to listen for some time also made possible a social
connection for the patient that might be ‘quite rare for them’. Such opportunities also allowed the
patient to ventilate and let off steam. The difficulty in attending and listening to a thought
disordered patient was also commented on, as
‘”while there is no connection between their ideas … you need to be completely the opposite,
maintain your brain in gear and listen to what they say’.
“I follow people's tangents that they go on, I'll just go with them on the ride essentially. And often I
think people on the surface are not making much sense, but even in thought disorder I think
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