Are your client’s constant crises, big or small, stopping you from moving on with the treatment goals you’ve set together?
Do they keep presenting in an agitated state?
Are you spending all your time helping them to put out spot fires while the bigger issues keep burning away unable to be reached by your treatment?
Sadly, this pattern of recurring and distracting “crises” is common amongst those who have chaotic lives and complex histories. Often, service provision is on a time limit, driven by a budget or by a fixed set of available sessions. If you don’t address these sorts of treatment interfering presentations (or TIPs), it can appear as though your client is not motivated to get the most out of your service and they could leave your service without having managed to achieve any change. Also, letting these interfering presentations go unaddressed can leave you feeling ineffective or useless.
When you notice an ongoing pattern of treatment interfering presentations, it’s crucial to get on top of them before they erode hope, energy and workplace resources.
Here are three practice steps to deal with TIPs.
1. Analyse the common themes or threads of the interfering presentations.
What are the interruptions telling you? Common themes with complex young people are usually around independence, autonomy, or any perceived threat to their identity, relationships or sense of safety. It is not unusual for those who have experienced multiple traumas to deal with the world and everything in it as though it is an attack. As a result of seeing things as a threat, clients usually respond in attack mode – even if you are on “their side”. Watch for the collective themes in their narrative and behaviours.
2. Feedback what you’ve noticed about the interferences.
Talk about the patterns that you’ve noticed during their times with you. At the risk of seeming one sided (because this is a blog and not an actual conversation), a useful dialogue could go something like – I’ve noticed the last few times we’ve talked that you’ve seemed really upset by other people interfering or putting their nose in your business. There was that time with your landlord, then the time with your mum and then this time with your worker. What do you think is going on with that?
3. Invite them to address the apparent themes in more effective ways.
Again, a useful dialogue could go something like this – Would you like to talk more about other things you can do to manage when other interfere that might stop you from getting so upset? It seems really important to you that other people don’t interfere. We can’t change other people, but imagine what it might be like if you could handle these times differently.
Looking for the themes of the TIPs and opening up conversations about the common threads can lead to more effective time spent with your complex client. More time getting to the burning heart of the matter and less time on the spot fires.
Let me know how you go!
While Shona is regularly engaged to develop formulation and treatment plans for troubled children and young people, she is also available for peer supervision, consulting, speaking and workshops. Call Shona Innes Psychology on 0400 150 106 or email firstname.lastname@example.org