Patients and clients bear witness to the dangers and adverse effects of K2. How can we capitalize on the principle of social currency and that of peership, to help our patients and clients, like Raj, who uses K2, a dangerous drug with significant adverse effects? After all, this is in line with the principle of harm reduction.
New strategies for substance use assessment will help us master the needed skills, so we can continue to do the best work possible for our patients and clients, helping with relapse prevention, promoting full recovery, paying attention to integrated care, lessening fragmented care, and feeling gratified, as we continue to do this challenging though noble work.
Split treatment remains a challenge and has been shown to be detrimental to our patients and clients. This becomes more significant when it involves a patient population with several comorbidities. Patients with both mental health and substance use treatment needs are particularly vulnerable to split treatment, and integrating substance use treatment and mental health services is not only advised but also essential if we are to make meaningful changes.
The system has its role to play. It needs to empower clinicians and advocates, patients and clients, if there are interests in decreasing staff turnover and restoring trust. If burnout is to be addressed and prevented and self-care promoted, we all have to work together. And, these efforts must be supported by the system, if we are to reach our goals and continue working effectively and with the passion with which we came into this field.
After experiencing a phenomenon for so long, it becomes the new normal, the new culture, which is then very challenging to change or undo. It is going to be a slow process, which requires a collective effort from all of us—clinicians, advocates, agency leaders and decision makers—and from the system, as a whole. It will be a process, but it indeed starts with understanding “The Why” of preventing burnout and promoting self-care.
Cynicism, depression, and lethargy are some of the manifestations of burnout. Burnout is present in about 21-67% of mental health professionals. The ramifications can be devastating for our patients and clients, our clinicians and advocates, and for our agencies and the healthcare system, as a whole. Burnout can and must be prevented. Self-care can and must be promoted. Here are four reasons why.
A lack of purpose and direction in treatment has been one of the factors contributing to feeling drained when working with patients and clients suffering from Borderline Personality Disorder. This draining propensity is rather common; it adds to negative countertransference and leads to clinician resistance to working with these patients and clients.
Prior to learning the skills, exploring the reasons why of the skills helps put things into context and helps prepare the terrain for a successful implementation. Strong Countertransference, Draining Propensity, and Splitting Ability are the three reasons why it is crucial for us as clinicians to learn and master the skills for working with patients and clients suffering from Borderline Personality Disorder.
“I have been talking with Peter about diabetes, and we were working on starting an exercise regimen. He recently started to talk about his migraine medication.” Kate eagerly articulated these words to Roger, who then responded, “We will get to talk about medications. But before we do so, let us discuss the remaining 7 of the 12 most common physical health conditions.”
In this current article, like Roger promised Kate, I am going to delve into how to best talk to your patients and clients about 5 of the 12 most common physical health conditions.
Peter received home health care resident visits from multiple providers, including, nursing care, the care coordinator, and the diabetic educator, in addition to visits from Kate, the social worker. He began sharing medical concerns and complaints with Kate that he was not sharing with the rest of the staff. However Kate was limited in her understanding and ability to best support Peter.
“What are you laughing about; why are you laughing at me?” Castro asked these questions during his visit with Jack in the ER. He started to raise his voice, then he got up, made a fist, and as the situation escalated, he ended up in restraints.
James is a patient and client at the HOPE Clinic. He is working, attending college, and planning his wedding. Two-years ago, when he first came to the clinic, through open access, things were totally different: “I am going to kill all of you. You are not here to help. All you care about is a pay check.” James yelled these words to Kellie, in the waiting area. JoAnn, Kellie’s supervisor, who was close by, heard the yelling, saw the situation, and quickly intervened.
“How dare you tell me I can’t leave; who do you think you are? How dare you?” Harry spoke these words loudly and in anger to Nate, a forensic social worker, who was meeting with him for the first time, for an evaluation.
“I went to look for help, and now I am going to jail. What do I need to live for?” Matthew said in anger to the medical student conducting the initial interview. Two days later, he was found tying the bed sheet around his neck. His roommate arrived soon enough, and he was placed on “one-to-one” monitoring for suicide watch. After discharge, Matthew found himself in jail, waiting for trial. Three days later, he was found once again, with his bed sheet around his neck, this time, unconscious.
Patient and client engagement is a challenge across all aspects of clinical care and more so in mental health, especially for those who feel forced into treatment. There is no single best definition for patient or client engagement, but I usually describe it as the active patient and client involvement in his or her care for best outcomes.
“I want to make a difference in the world and in people’s lives. I am a social worker; I am an advocate.” Jackie articulated these words in response to the question: “What motivates you?”
“I used to just equate hearing voices with schizophrenia,” said Clara, a clinician employed at the Hope Center. “Now, I know how naive of me that was. I walked in the room expecting it to be psychosis related to schizophrenia, not realizing that it could have been a physical or a different mental health issue. I feel embarrassed and wonder how often I have misdiagnosed clients who have been under my care,” Clara added.
Arianna’s dream was to become a researcher. “My older brother has been sick and suffering a lot, and I want to help him and also help stop suffering in the world.” She often said these words to herself, as a way to remember that keeping her promise alive meant hard work, keeping up with great grades, and maintaining her extracurricular activities. Arianna wanted to be sure she was doing all the right things to get ready for college and in preparation for graduate school. At age 15; however, Arianna suddenly developed some unusual and disturbing symptoms…
“Talking about these cognitive distortions has been helpful. What are some of the other ones?" Vladimir, a colleague who previously did not think much about CBT, has now become a believer.
After providing the background on CBT and an overview of cognitive restructuring and automatic thoughts, I then started to talk with him about cognitive distortions. Here we discuss 3 more...