Thanks for reading. I'm a new grad working my first job in a short term psychiatric and rehab facility, and I'm finding myself completely clueless on how to respond to aggressive or irrational patients. I'm hoping to find a book to help me with this.
I typically do alright with more rational patients by applying active listening and by putting myself in the patients shoes. However, with delusional and combative patients I frequently find myself at a total loss for words. I just don't know what the therapeutic response to "You need to empty everyone's food but mine out of the refrigerator. God told me so." especially when my rational response is met with screaming and combative behavior.
I'm wondering if there's a good book on communicating with combative and irrational patients. I'm looking into Verbal Judo, which is a book frequently used to teach police officers how to deal with conflict, but other suggestions would be greatly appreciated. Thanks
Nov 13, '11
by Davey Do, ASN, RN
I know of no books on communicating with aggressive Patients.
But I do know that there are some gudelines to adhere to in dealing with such Patients. Let's apply one of these guidelines to your example:
Quote from fizz872
I just don't know what the therapeutic response to "You need to empty everyone's food but mine out of the refrigerator. God told me so." especially when my rational response is met with screaming and combative behavior.
The definition of a delusion is "a false fixed belief in spite of evidence to the contrary". Actively delusional Patients cannot be logiced out their delusions. Delusions can only be resolved through medications, therapy, and time. Since the delusional Patient has a very loose grip on reality, confronting them with reality can often have dire results.
If this Patient made this sort of comment to me, I may have just said, "Okay" and went about my business. To give credence to a delusion takes the focus off of what is important. If the Patient was open to discussion, I might tie in something they said and give it back to them: "Yeah-your food is really important, isn't it? But you know what else is important? You are important. And your therapy is important. And that's why you're here- to get better" and so on and so forth.
I think the technique is called "Verbal Aikido". Basically, something which is said that can be used therapeutically is given credence and directed toward a therapeutic ends.
That's enough for now, fizz. I wish not to ramble on. If you would like to discuss certain specific instances, I'm game.
There are a lot of techniques I've learned over the past 36 years of working with Developmentally Delayed, Behavior Disordered, and Mentally Ill Individuals which I would be glad to share with you. The majority of these techniques have been learned through emulation and/or trial and error.
Good luck to you, fizz.
Last edit by Davey Do on Nov 13, '11