Chapter 6 Therapeutic Response Fearful Angry Aggressive Abused

Chapter 6 Therapeutic Response: Fearful, Angry, Aggressive, Abused, Abusive Clients

Objectives • Describe the behavior & discuss therapeutic responses for the fearful client. • Describe the behavior & discuss therapeutic responses for the angry/aggressive client. • Recall 4 types of abuse • Define the 3 types of abuse/violence toward others • Discuss therapeutic responses to both the abuser and the abused • Examine personal attitudes/biases toward fear, anger, aggression, and abuse

Fearful Clients & Responses • Fear is real or imagined • Distrust, worry, dread, paranoia (past exp) • Physiological, somatic responses • Degrees of fear • Panic attack • Types of phobia • Recognize & accept client’s fears • Use problem-solving approaches • Encourage clients’ control as much as poss of the situation • If panic stricken, act for the client

Angry Clients & Responses • • Temporary versus chronic Unmanaged client anger Hatred, hostility Negative or positive energy • Observation of angry client • Reactions of health professionals • Do not take personally • De-escalate client anger • Listen to & observe client’s body language • Try to resolve client’s problems • Document • When professional Loses control

Aggressive Clients & Response • Unresolved anger, aggression • Conflict intensifies = loss of control • Abuse: verbal, physical • Nonreciprocal • Due to physical and/or emotional stressors & trigger statements • Try to resolve the conflict • Unacceptable to respond as client does • Listen, respect, and be assertive • Set personal limits • Protect self • Call for assistance

Abusive and Abused Clients • Types of abuse/violence – – Intimate Partner Violence (IPV) Child Abuse Elder Abuse Rape • Violent behavior with intent to harm • Biological, psychological, social, and cultural factors

Characteristics of Abusers • • • Low self-esteem Feel powerless Blame others for their actions Want to control others Manipulators

Types of IPV Violence • Physical violence • Sexual violence • Psychological or emotional violence

Types of Child Abuse • Definition of child abuse • Types of child abuse – – Negligence Physical injury Mental injury Sexual abuse

Types of Elder Abuse • • • Physical abuse Psychological or emotional violence Neglect or abandonment Sexual abuse Financial exploitation Violation of rights

Rape • Forcible sexual intercourse with unwilling partner • Sexual act versus violence • Age of those raped • Person versus person • Gang rape

Abuse Indicators & Treatment Reporting and Documenting • Indicators of abuse • Legal requirement in all 50 states, except IPV & elder abuse • Who reports & how reported • Medical record – Physical – Psychological or emotional • Treatment of abuse – Focus on the survivor’s & abusers emotions and coping skills – Create a safe environment – Therapy for both the abused and abuser – History of the event, using facts, observations, and client’s words – Evidence such as photos, labs, and physical exam

Therapeutic Response • Focus on the person seeking treatment, not the event • Allow them to express feelings (appropriately) • Do not shame or ridicule • Be gentle, calm, patient, supportive, and do not rush your interaction • Assure a safe and private environment • Establish trust to ensure a therapeutic relationship • Know how to access resources to help

Professional: Understanding Self • Examine own feelings toward fearful, angry, aggressive, abused, abusive clients • Seek treatment accordingly • May seek treatment if survivor • Do not stereotype • It is difficult work with clients