Why Do Patients and Clients Display Inappropriate Behaviors: 2 Reasons Why

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

“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.”

This is an introduction to Maria and Ken, in our article series, Dealing Effectively with Inappropriate Behaviors. 

In the first article, entitled, Dealing Effectively with Inappropriate Behaviors: The Why, I outlined five reasons why it is crucial for all of us to master the skills of effectively dealing with inappropriate behaviors.

I mentioned,

(1) Promotion of socially acceptable behavior;

(2) Social modeling;

(3) Prevention of trauma;

(4) Prevention of burnout; and

(5) Promotion of safety and decrease of liabilities.

In the second article, entitled, Dealing Effectively with Inappropriate Behaviors: 5 Steps, I outlined,

(1) Naming the behavior;

(2) Pointing out the inappropriateness;

(3) Exploring it;

(4) Addressing it; and

(5) Taking action, as the five steps to follow for effectively dealing with inappropriate behaviors.

In the third article, we then took one step back to identify a root cause analysis approach through the “Rule of 9” and implement this adopted approach to effectively deal with inappropriate behaviors.

In this current, fourth article, we look at why patients and clients display inappropriate behaviors, using a bio-psycho-social and cultural approach; here, we start with two biological contributing factors.

Traumatic Brain Injury

Our frontal lobe allows us to organize our thoughts before executing them and taking action. It allows us to consider consequences, assign judgment and weigh decisions, to think long term, and to wait.

When our frontal lobe is damaged, these functions can dramatically lessen, which then results in several types of behaviors that can be rather inappropriate. Understanding this factor as a possible contributing reason why our patients and clients display inappropriate behaviors will force us to:

(1) Wonder whether a traumatic brain injury may be contributing to the inappropriate behavior;

(2) Ask about head trauma; and

(3) Develop a strategic plan to effectively deal with the inappropriate behavior.

Substance Use

Similar to the related damage of the frontal lobe in patients and clients with a traumatic brain injury, patients and clients who use mind-altering substances can also become impulsive, act without thinking, miscalculate risks and the consequences, and become rather disinhibited. The caveat is that these types of behaviors, ways of thinking and acting, can sometimes become the norm, even when there is no acute intoxication, a phenomenon that can be explained by classical conditioning, operant conditioning, and habit formation. This means that in order to effectively deal with an inappropriate behavior, we need to address both the substance use and the impact and the lingering effects that come with the behavior.

Dealing effectively with inappropriate behaviors entails looking at why our patients and clients display inappropriate behaviors. This involves a root cause analysis, using the “Rule of 9,” as I presented in a previous article, and using the bio-psycho-social and cultural approach. Traumatic brain injury and substance use are two biological-contributing factors.

Using the same model, what other biological or psychosocial and cultural factors may be contributing to inappropriate behaviors in your patients and clients? The answers to this question, in addition to following the principles, steps, and techniques to effectively deal with inappropriate behaviors, will help decrease burnout and dropout rates; help increase career gratification and clinical outcomes, and will help increase productivity and reputation for you as clinicians and for your agency. Everyone will then win, which is what our healthcare system needs.

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

References:

1. Miller BL, Cummings JL, McIntyre H, Ebers G, Grode M. Hypersexuality or altered sexual preference following brain injury. J Neurol Neurosurg Psychiatry. 1986;49(8):867–873

2. Zencius A, Wesolowski MD, Burke WH, Hough S. Managing hypersexual disorders in brain-injured clients. Brain Inj. 1990;4(2):175–181

3. Góscínski I, Kwiatkowski S, Polak J, Orlowiejska M, Partyk A. The Klüver-Bucy syndrome. J Neurosurg Sci. 1997;41(3):269–272.

4. Sebit MB, Acuda W, Chibanda D. A case of the frontal lobe syndrome following head injury in Harare, Zimbabwe. Cent Afr J Med. 1996;42(2):51–53

5. Duffy JD, Campbell JJ. The regional prefrontal syndromes: a theoretical and clinical overview. J Neuropsychiatry Clin Neurosci. 1994;6(4):379–387

6. Holden C. Behavioral addictions debut in proposed DSM-V. Science. 2010;327:935

7. Grant JE, Brewer JA, Potenza MN. The neurobiology of substance and behavioral addictions. CNS Spectr. 2006;11(12):924–930

8. Raymond NC, Coleman E, Miner MH. Psychiatric comorbidity and compulsive/impulsive traits in compulsive sexual behavior. Compr Psychiatry. 2003;44(5):370–380.

9. Di Nicola M, Tedeschi D, Mazza M, Martinotti G, Harnic D, Catalano V, Bruschi A, Pozzi G, Bria P, Janiri L. Behavioural addictions in bipolar disorder patients: Role of impulsivity and personality dimensions. J Affect Disord. 2010 Jan 16

10. Bechara A. Risky business: emotion, decision-making, and addiction. J Gambl Stud. 2003;19(1):23–5