How to Effectively Deal with Inappropriate Behaviors: “The Rule of 9”


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“DEALING EFFECTIVELY WITH INAPPROPRIATE BEHAVIORS,”

ON FRIDAY, MARCH 9, 2018, 12PM - 4:00PM


How to Effectively Deal with Inappropriate Behaviors: “The Rule of 9”.jpg

“I have been giving him the benefit of the doubt, but things have been worsening. Now I dread meeting with him, and I drag myself to work on the days I know he is scheduled to see me.”

 

Maria was teary when she articulated these words to Gaelle, one of her co-workers, who then responded: “I have been having similar issues with one of my clients. I am also unsure of what to do, and one week ago I had a bad dream about him. I have been scared ever since.”

 

Maria’s client, Ken, had started seeing her in the midst of a tumultuous relationship with his girlfriend. “I see you don’t have a ring, and you are very well dressed. Sometimes I wonder if you are as well dressed on the days I don’t come here to see you,” Ken asked Maria, on several occasions. He then added, “You are the type of woman I want and deserve, and I know you want me desperately.”

 

In a previous article entitled, Dealing Effectively with Inappropriate Behaviors: The Why, I explained that similar to Maria and Gaelle’s experience, our patients and clients may have displayed inappropriate behaviors towards us, and we may have dealt with them in such a way that may have either led to burnout or negative clinical outcomes or both.  I added that there is a method for effectively dealing with these situations, and in a subsequent article entitled, Dealing Effectively with Inappropriate Behaviors: 5 Steps, I outlined the steps to follow for effective management, while ensuring that everyone, clinicians, advocates and staff, our patients and clients, our agencies and system win, in the process.

Dealing Effectively with Inappropriate Behaviors

In the first article, referenced above, we looked at why we all need to learn how to effectively deal with inappropriate behaviors, and in the second article, also referenced, we looked at the five steps to follow, in order to effectively deal with inappropriate behaviors.  In this third article, let us take one step back and look at the “Rule of 9” and how we can use it to effectively deal with inappropriate behaviors.

 

In my articles and during SWEET seminars, I often talk about the problem-solving process, and I remind clinicians that part of the process is to first formulate and agree upon the exact defining problem.  I also explain that the next step is to seek to understand what is causing the problem in the first place.  No, I am not talking about the immediate cause.  I am talking about the root cause, and for that we need to go through the process of a root cause analysis.  

 

A root cause analysis may come across as a daunting task.  While it is, indeed, far from a quick fix, we can adopt the “Rule of 9” to help simplify it.  I borrow this concept from the principle that we often need to hear something 9 times before we finally really hear it.  This 9-times principle can also be adopted to mean that we need to ask, “why,” 9 times, in order to get to the root of any issue, when conducting a root cause analysis.  When I explain this to clinicians that I supervise, and others during consultation, they have an “aha!” moment, and this is then when I know that learning has taken place.

 

“I see you don’t have a ring, and you are very well dressed. Sometimes I wonder if you are as well dressed on the days I don’t come here to see you,” Ken asked Maria, on several occasions. He then added, “You are the type of woman I want and deserve, and I know you want me desperately.”


 

The “Rule of 9” Applied (with possible answers):

 
Dealing with Inappropriate Behavior
 

1.     Why was Ken acting this way towards Maria? 

There seems to be several contributing factors, including his family subculture, his religious beliefs, and his upbringing.

 

2.     Why is this contributing to his current inappropriate

        behavior?  

His family subculture, religious beliefs, and upbringing seem to have taken precedence over considerably socially appropriate behaviors.

 

3.     Why did that (precedence) take place?  

There has been a lack of social modeling.

 

4.     Why did a lack of social modeling lead to this? 

He may not have learned any better.

 

5.     Why may he have not learned any better? 

The people whom he looks up to may not have told or taught him otherwise, or not told him enough times.

 

6.     Why have people not told him before?

(We know from our first article that he may have done this before).  Similar to Maria, they may have chosen to act out, or ignore him, or not tell him in the most effective way possible.

 

7.     Why have they been responding to him like this? 

They may not know how to effectively deal with his behavior.

 

8.     Why would they not know how to effectively deal with this  

        behavior? 

Dealing with such inappropriate behaviors requires a specific set of skills, and most clinicians may not have learned such skills, since this is rarely taught in school, during supervision, or elsewhere.

 

9.     Why have we not learned this before? 

Many supervisors or teachers may not have learned these skills themselves, which makes it difficult for them to properly guide their supervisees, and the ripple effect never ceases.

 
SWEET Institute-Dealing Effectively with Inappropriate Behaviors
 

As you have seen, the first question starts with trying to understand why Ken has been behaving the way he has been with Maria, and yet by the question 8, we have come to understand that Ken’s behavior, per se, may not have been the root of the issue after all.  Rather, the main issue seems to be how these behaviors that have been learned throughout his life have never been appropriately and effectively addressed.  This lends itself to the question of how prepared have we been in effectively dealing with inappropriate behaviors.  Continuing education, training, consultation, and proper supervision are some of the answers to this, but it does start with knowing what we do not know, knowing how to find the answer, and knowing how we learn best.

 

Meanwhile, kindly share your stories, experiences, and feel free to share these resources with your colleagues.  Helping to empower your colleagues also helps empower you in the process.  Until later.

 

Your friend and colleague,

Mardoche


LEARN MORE, PRACTICE DIFFERENTLY, AND FEEL CONFIDENT

IN ADDRESING MALADAPTIVE PATTERNS 

BY JOINING US FOR A SEMINAR ON,

“DEALING EFFECTIVELY WITH INAPPROPRIATE BEHAVIORS,”

ON FRIDAY, MARCH 9, 2018, 12PM - 4:00PM


For more in this series of articles, check below!


SWEET Institute- Mardoche Sidor, MD

Dr. Sidor is quadruple board certified in psychiatry, with board certification in General adult, Child and adolescent, Addiction, and Forensic, psychiatry. He also has additional training in public psychiatry, in several treatment modalities, in addition to his teaching, supervision, mentorship, and management, experience. Some of his passions are public speaking, leadership, business, and research, in addition to program development and project management. His overall goal is to empower all health care professionals throughout the United States and globally, towards ensuring the continuity of excellent patient care, while balancing the need to take care of themselves. Dr. Sidor is the main instructor for the SWEET Institute, and he is currently an Assistant Professor of Psychiatry at Columbia University. He is also the Medical Director and Chief Medical Officer for CASES (Center for Alternative Sentencing and employment Services), and he speaks and writes fluently in six (4) languages—French, English, Spanish, Creole, and has intermediate proficiency in Portuguese and Italian.


References:

  1. Wilson, Paul F.; Dell, Larry D.; Anderson, Gaylord F. (1993). Root Cause Analysis: A Tool for Total Quality Management. Milwaukee, Wisconsin: ASQ Quality Press. pp. 8–17.
  2. Taisha Ohno (1988). Toyota Production System: Beyond Large-Scale Production. Portland, Oregon: Productivity Press. p. 17.
  3. Ferry, Ted S., Modern Accident Investigation and Analysis, sec- ond edition, John Wiley and Sons, 1988.
  4. Occupational Safety and Health Administration Accident Investigation Course, Office of Training and Education, 1993.
  5. Quality Basics-Root Cause Analysis for Beginners, James L. Rooney and Lee N. Vanden Heuvel, Quality Progress, July 2004, pp. 45–53.
  6. Incident [Accident] Investigations, A Guide for Employers, A Systems Approach to Help Prevent Injuries and Illnesses, U.S. Department of Labor, Occupational Health and Safety Administration (OSHA), December 2015.