How to Coach Yourself and Others Coaching and Counseling in Difficult Circumstances | Page 84

This book is in B&W, not color - Print page in Grayscale for Correct view! “Right this is what I see at the moment, we feel as a team that this might help you and this is what we’re going to do. So it’s being very directive … taking control of the situation because they are not able to do that for themselves.” Delusions Semi-collusion for greater good (3/28) Where tasks were really important, such as delivering the food/fluids/medication trio, some nurses were willing to lean a little bit towards colluding with patients delusions, by not challenging them, not taking a position on them, or expressing neutral comments that were ambiguous as to whether they expressed understanding or agreement. In other words bordering on allowing the patient to believe that their delusional system was accepted to some degree. This was recommended with extreme reluctance: ‘it may not be a, the intervention that people would recommend, but sometimes you have to go down that route, I think, just to get the person, who is pretty deluded to work with you’. One example given was of a patient who believed he was a member of the royal family, but who hadn’t washed for some time. The nurse concerned said he did not believe royalty would allow themselves to get so dirty that they smelled, instigating the patient to have a shower. “If you’re trying to achieve a task and the task is important, so if it’s something to, for instance, trying to get them to, let’s say, take their medication for one thing. Then if whatever their delusion is, and how they’re express ing it, if it doesn’t pose any danger then, in a way, not acknowledging it but going along with them, just nodding and saying, OK, just for the short term, for them to achieve that task.” Thought disorder More gestures (5/28) Instead of using language, which these patients can find difficult to understand and process, nurses suggested that desired tasks could be modelled, indicated, or described through gestures in order to enhancer successful communication: ‘being more visual and demonstrative about it’. Talking about symptoms This section includes everything the interviewees had to say in relation to talking with patients about their symptoms, or interacting with them in ways to reduce their symptoms. Although there was some overlap between domains, we present this material separately by symptoms, as there were specific nuances to these approaches that required careful description. Every one of the interviewees mentioned the value of medication, either regular prescriptions, as required doses, or in some cases coerced rapid tranquillisation. This is not explored in detail below. They also mentioned a number of formal psychotherapeutic approaches as applicable, including: cognitive behavioural therapy, solution focussed therapy, hearing voices groups, relaxation training, anxiety management training, anger management training, motivational interviewing, systemic family therapy. As these are all well described in textbooks, and the interviewees did not add any detail about their specific application to acute psychosis or inpatient work, these have not been further described. However there were a number of techniques the nurses did describe which would be claimed by one or other of these therapeutic approaches. As these were described in detail and repeatedly by nurses, with specific applications to acute psychosis or inpatient work, these are described below. Apathy/withdrawal Hearing and respecting the experience (9/28) The emphasis for apathetic and withdrawn patients was not so much the endeavour to get them to describe it, but instead to observe, recognise, acknowledge, respect and try to understand it. This meant not pushing too hard, tolerating silence whilst still spending time with the patient. Patients For [email protected] Property of Bookemon, do NOT distribute 86