“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.”

Similar to Maria and Gaelle’s experience, your patients or clients may have displayed inappropriate behaviors with which you have had to deal.  And, too, your experience or the way you have dealt with such behaviors may have led to burnout, trauma, limited clinical effectiveness, and limited career gratification.  But there is good news: it does not have to be this way.  There is a method (the How) for effectively dealing with inappropriateness.  But, before delving into the How, let us first start with the Why.

Here is an outline of the five reasons why you and your co-workers will benefit from learning how to effectively deal with inappropriate behaviors, and how you, your patient or client, your agency and the entire health system will benefit from this much needed skill.

From the Client Perspective:

• Promotion of socially acceptable behavior

Ken’s family subculture, religious beliefs, and upbringing have all reinforced his thinking pattern about relationships.  These have all taken precedence over considerably socially appropriate behaviors, the impact of his statements on others, and the practical boundaries of different types of relationship contexts.  Had Maria known how to deal with inappropriate behaviors, including Ken’s behavior, she would have taken the opportunity to work with him, promoting socially acceptable behavior, explaining and emphasizing the nature of the client-clinician relationship and how it differs from other types of relationships.  She also would have been able to explain to Ken how the ability to function within these boundaries would have served him well.  Further, Maria would have also taken the opportunity to help Ken better express his thoughts and feelings, appropriately verbalizing them during sessions, without the need to act them out and create an inappropriate level of discomfort.

Since you strive to make a difference in the lives of others, every event or instance can be seen as an opportunity for positive change.  Learning to deal effectively with inappropriate behaviors will allow you to promote socially acceptable behaviors from which your patients or clients may highly benefit.

• Social Modeling

“Now I dread meeting with him…” Maria said concerning Ken, who had been inappropriate in his behavior, but she also responded by “acting out,” instead of addressing her emotions.  “Acting out,” a term often misused, is related to a defense mechanism whereby one carries out an action instead of managing the urge to perform it.  This can often be to the detriment of our patients or clients.  “Acting out” prevents the development of more positive responses to the respective feelings, emotions, or thoughts.  Ken was “acting out” and so was Maria, who was doing her best to contain herself, not knowing how to best deal with Ken’s inappropriate behavior.  Had Maria known a better behavior management approach, she would have expressed her own feelings and emotions in a way more helpful to Ken.

For example, Maria could have set the tone with Ken, telling him candidly and with containment, how his “advances,” his “assumptions,” and his “flirtations,” were making her uncomfortable, as I mentioned above.  This is a simple yet powerful intervention, because Ken might not have been aware that he was doing something wrong; and he might have needed to hear this, maybe for a ninth time, from someone else before he finally understood his behavior was inappropriate and needed to stop.  Maria’s intervention would have been a form of modeling for Ken, showing him there are more positive and constructive ways of expressing his emotions and feelings.  Ken saying, “Maria, I think I have been developing some feelings for you.” would be different from, “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 to see you.”  Ken was “acting out,” and he was making Maria uncomfortable.  Maria responded also by “acting out” and missed the opportunity to model for Ken.

From the Clinician Perspective:

• Prevention of Trauma

Working with patients and clients can increase the likelihood of both direct and indirect trauma, also known as vicarious trauma.  A retired mental health practitioner once said, “We ought to disclose the high probability of trauma in the workplace before we hire our clinicians and advocates.”  He was alluding to the fact that dealing with patients and clients can, in fact, lead to trauma, and clinicians and other professional staff need to be prepared and properly supervised or, at least, given the tools in order to do the most effective and efficient job, while also preventing their own trauma.  Learning how to effectively deal with inappropriate behaviors can be a powerful tool and can help clinicians and advocates prevent trauma in the workplace.  “I am having similar issues with one of my clients. I am also unsure what to do, and one week ago, I had a bad dream about him. I have been scared ever since.”  This was Gaelle’s response to Maria.  She was scared and, indeed, traumatized.

• Prevention of burnout

Preventing trauma by knowing how to effectively deal with inappropriate behaviors is an essential component and powerful tool for preventing burnout.  (I describe another powerful burnout prevention tool in a previous article, De-escalation Skills: 6 Reasons Why).  “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 avoiding the situation; she was resentful, feeling helpless, and experiencing burnt out.  These feelings started to spill over into her therapeutic relationship with other patients and clients, and she had to take some days off, because of fatigue and exhaustion and generally feeling drained.

From the Client, Clinician, Agency, and System Perspective:

• Promotion of safety and decrease of liabilities

In a previous article entitled, De-escalation Skills: 6 Reasons Why, I mentioned the necessity for creating a safe environment for our clients, our clinicians, and all staff, which in turn decreases liabilities, helps prevent burnout, and increases career gratification for all.  When patients and clients escalate, it is often heard and seen, and 911 will usually be called.  When a patient or client displays inappropriate behaviors, it is rarely seen or heard, and a third party rarely intervenes.  This “unseen” behavior can be a type of “cancerous” component that may lead to more consequences for our client and staff, our agency, and the system as a whole, unless we take steps to provide the proper tools to effectively deal with inappropriate behaviors.

Modeling for our patients and clients and supporting them in promoting socially appropriate behaviors are powerful ways to help them.  Several times opportunities present themselves, but they are often missed because of inexperience in effectively dealing with them.  Since major parts of the current situation of our patients or clients have been influenced by their relationships, one best way to help facilitate change will also be through their current relationships, including relationships with clinicians and advocates.

For example, Maria telling Ken that he was making her uncomfortable not only would help Ken see a different way of expressing his emotions but would also help him understand that he does have a right to tell others they are making him uncomfortable, when it is the case.  Ken was, at one time, the victim of an abusive relationship.  He was going to school and working, while his girlfriend, with a substance use disorder, was home all day, using drugs and drinking alcohol.  She was verbally abusing him, if he did not have enough money to give to her for wine and other substances.  Ken resented Monique, his girlfriend and thought he deserved better, but did not feel confident in saying and expressing, “enough of this abusive treatment” to Monique.  Instead, he “acted out” with Maria, who in turn acted out as well.

“I have been giving him the benefit of the doubt, but things have been worsening…” Maria was indeed giving Ken the benefit of the doubt but not in an effective way. Whether you are meeting with a patient or client for a one-time evaluation or working with him or her on a short-term basis, you can impact his or her life in a deep, real way, if you learn how to effectively manage any inappropriate behaviors that may emerge.  This will also allow you to help minimize the likelihood of vicarious trauma that might otherwise lead to burnout.  It will also help decrease liabilities, in addition to promoting safety for all.

References:

1. Bandura, Albert (1963). Social learning and personality development. New York: Holt, Rinehart, and Winston.

2. Jump up Renzetti, Claire; Curran, Daniel; Maier, Shana (2012). Women, Men, and Society. Pearson. pp. 78–79

3. Rotter, Julian (1954). Social learning and clinical psychology. Englewood Cliffs, New Jersey: Prentice-Hall.

4. Bandura, A. (1972). “Modeling theory: Some traditions, trends, and disputes”. In Parke, R.D. Recent trends in social learning theory. New York: Academic Press, Inc.