Working With A Patient With Antisocial Personality Disorder

[Lady Rebel]

I'm a CNA currently working in home health. I was recently assigned a new client & had my first visit with the client. The client was very blunt about their life, accomplishments, and shared intimate details about their sexuality & sex life. They practically bragged about sleeping with another aide & the tender way they treated the aide. Then later on in the visit this client was flirtatious & acted as if I needed protection on the street & asked if I was bad with stairs & needed help going down (because I go down steep stairs cautiously). Otherwise they were nice & all but after the visit, I just felt something was off & so I shared my disbelief with my supervisor that he was bragging about his sexuality, flirtatious, & told my supervisor that of course I took everything out of their mouth with a grain of salt, & that I'll need to keep my boundaries up with this one, to which my supervisor agreed. So there's that. But then tonight it hit me just why someone felt wrong, I realized that I'm probably dealing with a person with an antisocial personality.disorder. They sure had all the red flags. So my question is how can I protect myself from manipulation while working with this individual. I know I struggle with maintaining boundaries & I set safety guidelines for myself, but am concerned this person may try to charm & manipulate me

[Lady Rebel]

*Something felt wrong (not someone), it won't let me go back & edit again

[Lady Rebel]

Update:

I shared my concerns about my patient with the office & they reassured me this person was mostly talk, probably to boost their ego (which makes sense) & harmless. Still this person told me they don't like going by the rules, but has strict expectations for their aides (including the aides texting them on their personal cell phone if they're going to be late, which is a no-no for our agency)

This person bucked at the idea of following company policy because they should have the say since their insurance is paying for their services. I need the hours (& am scheduled 5 days a week and every other weekend with this client), so I'm just going to keep my guard up, although I'm not sure if things are going to work out or not with this client, time will tell :

[Ddestiny, BSN, RN]

With situations like this it's important to decide what boundaries are important in advance (don't let him catch you off guard if possible) and keep them. No, you will not text him with your privacy cell phone number under any circumstances. No, you will not go against company policy. The fact that his insurance pays for the services does not dictate company policy. Don't walk on eggshells around him, he will pick up on it and he will feed off of it. Try to act casual and comfortable even if you don't feel that way. If he asks you to do something that is outside of a boundary, say "no". You do not owe him any justification and if you don't offer it initially, don't let him pull it out of you. That will show him that he can keep pushing buttons and that you'll bend to his will. It's hard finding the right balance when you know you have to keep your boundaries up -- you don't want to appear anxious or concerned, but you also don't want to go in with guns a'blazing and looking like you're trying to pick a fight. Practice makes perfect and even if this particular person is just a short-lived stepping stone to learning that skill, you'll come out more prepared and better educated for having to deal with him.

It's always nicer when the clients are complaint and non-manipulative but it's inevitable that you'll get someone that's more of a chore. Reading up on how to establish and maintain healthy boundaries might be helpful. There might even be some YouTube videos to visually show some skills.

Good luck!

[Missingyou, CNA]

Be very clear with him, just as he's been very clear with you. You WILL follow company policy.

Walk with confidence (I'm thinking of the stairs you mentioned). Walk and act as if YOU have control of the situation. If he flirts, ignore it and walk away from him. If he touches you inappropriately (I bet he will if he hasn't already) tell him firmly that it's not acceptable, you do not want to be touched.

It may be his home, his insurance but, you are in control of the situation and your comfort zone. Trust that "woman's instinct". Put space between you and him whenever possible.