Working with psychopaths/sociopaths, please advices!

leslie :-D · Jul 20, 2009

zuzi, you may want to consider posting your question in the psychiatric nursing forum (under nursing specialties).

hopefully you will get the help you need, whether it is here or there.

have you talked to your nurse manager for guidance?

leslie

Editorial Team / Admin · Jul 20, 2009

Already moved there, Les.

Someone will come along and help you, zuzi.

rn/writer, RN · Jul 20, 2009

Are so many years from when i didn't look over any psychology or psychiatry books... or just flying couple of pages. In this time I was around with A LOT of kukuness people, like patients and not only, but ever was so many psychopaths like now....... From couple of days I started again to study... again...because I need to figure out how to act with them.
Psychopathology is an amazing field... and belive me or not I never wanted to work in this field like now, lol, , or may be not in this style of work, lol
Trying to setup the limits of behavior with these type of people, I was going to beginning to PCL-R Factor 1, versus PCL-R Factor 2, for Dx and I try to uderstand where is happen and what is happen with them but was wortless.
I need help from you, now. I don't have a soo deep training in, and I feel just overhelmed to work with them and tired to verify my back all the time or to untwist them twisted actions.
I know that setup the limits of the behaviors with these type of personalities, could help some how...but they broke the rules all the time, they don't obey to any, and mess all around, they try to setup them own rules instead of social ones, offer rationalisations for each and every action....
I am just tired with them...did you ever worked with psychopaths/sociopaths... please help me with a professional attitude that you need to have with them.
How you could set-up limits, what you need to say to them, to do, to work with them, to interact with them, how you document all, where you need to adress your issues related them...... IS MY WORK, i love nursing and could not resign now...but I am not prepared for that .... here....
Is somewhere a traing course for nurses who work with psychopats, sociopaths? Please help me! Thanks!

Zuzi, it's understandable that you are feeling a little off balance right now. Many people find psych uncomfortable. I always liked it because I enjoyed the challenge and could connect with many different kinds of people.

Can you tell me something about this job? What kind of unit are you working on? What other staff members are there, and what are your responsibilities?

Let me offer a little reassurance. Very few psych patients are psychopaths/sociopaths. Sociopaths are folks who lack any kind of connection/empathy with others and function without a conscience. They don't end up in psych units often because they can be quite charming and persuasive and act normal most of the time. If they end up confined anywhere, it's usually in a jail or a prison.

What you are most likely to find in a psych unit are people with bipolar disorder, borderline personality disorder, depression, and other mood disorders. They may also have substance abuse/alcohol issues. Many are in for med changes that need to be monitored. Some will be in because they are a threat to themselves or others. Just about all of them will be looking for some kind of safety and boundaries even as they fight against those things.

The "psychopath" behavior you're referring to is most likely garden variety manipulation. That is a part of almost every mental illness because the person sees it as a way to get what they need and also protect themselves. You will fall for the manipulation at the beginning. It goes with the territory. Don't feel bad about it. Just learn for next time. Patients will tell you sad stories and give you reasons why they should be able to bend or break the rules. Just remember, manipulation is a backdoor way to try to get along in a world you don't trust. You'll learn, probably from watching other staff members, how to handle the trickery without getting angry or taking it personally.

That's a big thing. Taking things personally. Most of the negative behavior is nothing against you. You'll just be an easier target for a little while. Then you'll learn and they'll sense that you aren't such a pushover anymore and back off.

You're right that you need to develop an awareness that keeps you safe. Things like not turning your back on patients, not letting a patient get between you and the door, and keeping track of sharps. This will come with practice, and, before you know it, will be second nature to you.

It's smart to be wary, but you can overdo the fear and become paralyzed. First and foremost, these are people. Granted, they are people with problems, but you'll learn how to deal with that, and then you'll become better at seing the person behind the behavior.

If you tell me more about the job and what you are supposed to be doing, I'll try to give you some ideas and pointers.

You can do this.

Aydia1 · Jul 21, 2009

Hi there. I am a psych nurse working in a clinic setting. One of my doctors let me borrow a book of his called "Without Conscience" by Robert Hare. It describes in depth the challenges of working with psychopaths/sociopaths. While it may not give you direct answers in how to work with these people, it will teach you the principles behind their behavior. Once you know why they act the way they do, maybe you can better work with them. I am about halfway through the book and I just started reading it 3 days ago. Just an idea if you want some reading material.

zuzi · Jul 21, 2009

Is very hard to explain in english why I truly belive that are psychopaths... i will search my terms ....to be sure that You will understand me right....

- a psychopath dosen't have sense of guilt.... but many other disease had the same s/s. I asked her/him? Why did you that? Do you don't think that is bad think? She/him responded to me NOT! I belive in that, and I will do the same and the next time! I am enough "experienced" to do that! And I explain them and why.....At that moment I start to be afraid! Are people who one is what they tell to you and one they do really...... because they belive their actions, for them are trues, perfect logical! They don't fell guilty at all. So how I could deal with that? When I know that whatever I will do.... they will do the same, but in another tricky way!

look here how an article describe that "A psychopath will use people for excitement, entertainment, to build their self-esteem and they invariably value people in terms of their material value (e.g. money, property, comfort, etc..). They can involve and get other people into trouble quickly and they seem to have no regret for their actions"

Look the article here...

http://www.crisiscounseling.com/Articles/Psychopath.htm

I try some how to set up limits with these type of personalities, because as foreign I am and non english native speaking I am, I am the perfect target.

And I became afraid even to go to work just thinking what a mess will be in their minds again, lol

I will go to buy or borrow the book.... I had just couple of cases in all my life of them, and never more than one to be around, now is different... and because is not psychiatric facility any breaking rules could be worst.... I am a RN there, with regular RN duties, nothing more nothing less, we have RN, LVN, the regular staff from a facilty...is a public forum I could not tell you much more...

Yes I am scare, because they are how they are, I am the one who need to act professional and I don't know how.....I even start to ask myself where is the limit between normal behaviors and patologic behaviors, what is normal and what pathologic, because they look soo normal special when they talk and they try to explain you somenthing........

rn/writer, RN · Jul 21, 2009

How did you get this job? Do you have a preceptor? Are you being given any education about the unit and the patients? What kind of unit/facility is this?

I am concerned that you are vulnerable without being specifically trained to handle this population. And the fact that you are scared makes you even more of a target.

zuzi · Jul 21, 2009

Is a long story...one by one, a single one, I could handle...but when I have more than one to deal with is hard....this categ don't have dx of mental diseases, so nothing legal to worry, so we don't need special training for it...but ....I belive that nurses who work with this type of patients need to be them self balanced FIRST and special trained what to say to patients how to react with them and special what and how to DOCUMENT the behaviors in a professional way to be helpful for patient first. I really don't know what to do....

A dynamite combination is an unbalanced nurse untrained in clinical psychiatry with a psycho-patient, and me a foreign one (with few months of experience with psychopaths ) coming after, trying to deal with this crap...if you can...

zuzi · Jul 21, 2009

We had long discussions about work management. I work and we work with very difficile patients, very difficile families and why not we have very difficile coworkers to handle with. Is not aboyt demanding ones....is much more, is about psychopathy. Is hard to say that but is just true!

A psychpath plan his/her actions, he/she dosen't have any regrets, about what she/he did. Is not a confused one, is a very well oriented dirty mind one! You explain one time, second time, third time, at the 4th time she/he find anoher tricky way to do the same think. Is very hard to work with, and I don't know any p[rofessional way to handle these type of personalities. I acted just after common sense till now, but when you are in conyact with many is hard...

And yes a lot of them are on the psychopatic part of personality. I am not intersted, I am VERY intersted how I can hande them. I spend my time, my energy trying to undertand and adjut me and medical nursing act to them psychopatic behavior. Is hard and scary in the same time...and belive me you don't want to be there....and be nurse beetwen them when they start to act like that

Thunderwolf, MSN, RN · Jul 25, 2009

I am concerned that you are vulnerable without being specifically trained to handle this population. And the fact that you are scared makes you even more of a target.

Totally agree. Being scared may be the honest "gut tingle" alerting that one is not prepared. One should listen to one's gut with this population. Otherwise, if untrained and unprepared, one literally becomes the proverbial lamb thrown to the wolves.

Listen to your gut.

It is your friend.

mikayla0813 · Jul 28, 2009

I understand your frustration! Patients with personality d/o are some of the most frustrating to deal with. It is difficult at times to remain therapeutic. My advice to you is if you ever start to feel that you can no longer be therapeutic, take a break! Chances are at times that you may be "triggering" the behavior if you are not being therapeutic.

I have found that it is useful to do Empathy Training with these individuals. Any time they become aggressive ask them how they would feel if that were done to them. If they give inappropriate responses, tell them how YOU would feel if it was done to YOU. This is an example of the old adage, "fake it till you make it"! In time, they will know the right responses, even if they don't mean it. Eventually, maybe, some of them might start to at least consider how their behaviors affects others adversely. People with antisocial behavior have a "messed up" brain. Their limbic system is all out of whack. Their transmitters are firing every which way, and making inappropriate connections. It is with overlearning that the "holes" in the limbic system can be "fixed" again. Make yourself a "broken record" about empathy training and setting limits. A good limit-setter is "Nothing else happens until...(insert phrase). Keep repeating this phrase until you get the desired result. Worth a try, anyway.

Be sure to understand the history of the patient with personality disorder. Usually there is a background of severe abuse or neglect. Make sure you know what their triggers are. Is it loud noises? Delay of requests? Women with long black hair? Find out...and try to keep these triggers away. Find out what their early warning signs for aggression are. Do they pace? Do they grind their teeth? Find out and intervene EARLY, before the aggression can begin.

wonderbee, BSN, RN · Jul 29, 2009

Pathological states are fascinating in the abstract. In reality, dealing with the real thing in multiple patients tries your very last nerve. You need to develop a therapeutic style that exudes self-confidence while being supportive to the patient. Head knowledge and actual application are two different things. I suggest you may want to take steps toward independent practice by taking a step back into the safety of more precepting if it is available to you. There aren't adequate words to describe the many feelings encountered by staff in the delivery of care on the psych unit. It is crazy making and exhausting. Then we go home and take very long hot showers and try to let all the tension go down the drain.