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Personal safety and self care


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Presentation at the PPA Annual Convention 2011

Molly Cowan has since earned her doctoral degree.

Published in: Health & Medicine
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Personal safety and self care

  1. 1. Personal Safety and Self Care Molly Cowan MA Simone Gorko MS Donald McAleer Psy.D., ABPP PPA Convention 2010
  2. 5. Threats to Personal Safety <ul><li>Assault </li></ul><ul><li>Intimidation </li></ul><ul><li>Verbal Threats </li></ul><ul><li>Stalking </li></ul>
  3. 6. Dr. Calmncool is in solo private practice. Her office suite is in a small building whose other tenants are mostly sales personnel, usually in and out throughout the day and gone by 5PM. Dr. Calmncool is conducting an initial interview with Mr. Narse who is employed in a mid-sized company as a department manager with a small staff he supervises. Because of his work schedule, he requested an evening appointment. The presenting complaint is that he feels undervalued by his superiors, as well as his staff. He believes they disrespect him because he isn’t “higher on the management totem pole” in a position of power. He also complains that his wife doesn’t appreciate him or even try to understand how he feels or what he is going through. Mr. Narse states his treatment objectives as “wanting to learn how to swagger with bravado and command respect and admiration from others.” Dr. Calmncool validates his distress and discomfort, but acknowledges she does not do the kind of work he is requesting. She reframes the situation as one where they could examine his behaviors, attitudes and expectations and how he might be able to build more confidence and positive interpersonal relationships, thereby achieving his goals. Mr. Narse becomes increasingly agitated, asserting that Dr. Calmncool is “just like the others,” his superiors, staff and wife. He indicates she doesn’t understand and is unwilling to help him. He begins to berate her, demanding to know what kind of psychologist she is that she won’t help him in the way that he want, the objectives he wants. Dr. Calmncool maintains her demeanor, tries to defuse the situation and do some psycho education about what therapy and psychology are and are not. Mr. Narse lurches forward into her personal space, stares her in the eyes and bellows at her, “You don’t love me!” What should Dr. Calmncool do? What are the issues of self care here?
  4. 7. Safety/Self Care <ul><li>Almost one in every 5 psychologists reported having been physically attacked by at least one client. </li></ul><ul><li>Over 80% of the psychologists reported having been afraid that a client would attack them.  </li></ul><ul><li>25% to 50% reported having had fantasies that a client would attack. </li></ul>Pope and Tabachnik, 1993
  5. 8. Safety/Self Care <ul><li>Between 10% and 25% had summoned the police or security personnel for protection from a client. </li></ul><ul><li>About 3% reported obtaining a weapon to protect themselves against a client. </li></ul>Pope and Tabachnik, 1993
  6. 9. Frequency of Professional Stressful Events in the Last Twelve Months Never Once Twice Three or More Been stalked by a patient 94% 5% <1% <1% Been robbed by a patient 97% 2.3% <1% <1% Been assaulted by a patient 97% 2% 1% 1% Threatened with assault 88% 8% 3% 2% Had patients assault third party 82% 9% 4% 5% Had patients threaten to assault third party 78% 11% 4% 5% Had patient commit suicide 86% 10% 2% 2% Had patients attempt suicide 68% 16% 8% 8% Had patient make suicidal gesture 46% 17% 15% 23% Had patient threaten suicide 46% 18% 12% 25% Been sexually harassed by a patient 94% 3% 2% 1% Knapp and Keller, 2004
  7. 10. Safety/Self Care <ul><li>1999 Survey of marriage and family therapists residing in Georgia </li></ul><ul><ul><li>44% experienced a physical or psychological assault from a client </li></ul></ul><ul><ul><li>30% reported fearing that their lives might be in danger </li></ul></ul>Arthur, 1999
  8. 11. Guy, Brown and Poelstra, 1992
  9. 12. Attacks <ul><li>Generally younger psychologists or those in training </li></ul><ul><li>Inpatient / Public > Private / Outpatient </li></ul><ul><li>Most attacks result in minor injuries </li></ul><ul><li>Most frequently male attackers and male victims </li></ul><ul><li>Threats of attack more common </li></ul>Guy, Brown and Poelstra, 1990
  10. 13. Ethical and Role Conflict <ul><li>Role as helper / doing good for others </li></ul><ul><li>Role as individual / doing good for oneself </li></ul>
  11. 14. Stalking <ul><li>6-12% reported being stalked by current or former patients </li></ul><ul><li>Stalking often occurs in conjunction with harassment which is a pattern of following, annoying, or alarming another person with the intent to cause substantial emotional distress. </li></ul><ul><li>The duration of stalking or harassment episodes varies considerably although most stalking episodes last less than one year </li></ul>
  12. 15. Questions <ul><li>How many of you have been threatened by a current of former patient? </li></ul><ul><li>How many of you have been assaulted by a current or former patient? </li></ul>
  13. 16. Consequences <ul><li>Increase in personal vulnerability </li></ul><ul><li>Decrease in emotional well being </li></ul><ul><li>Decrease in sense of competence </li></ul><ul><li>Increase in marital / family tensions </li></ul>Guy, Brown, Poelstra and Paul, 1991
  14. 17. Consequences <ul><li>Anxiety </li></ul><ul><li>Anger </li></ul><ul><li>Fear </li></ul><ul><li>Physiological responses </li></ul><ul><ul><li>Sleep disturbance </li></ul></ul><ul><ul><li>GI distress </li></ul></ul><ul><ul><li>Pain </li></ul></ul>Gentile, 2002
  15. 18. How does the Ethics Code help to guide us?
  16. 19. <ul><li>What are our obligations to clients </li></ul><ul><ul><li>4.05 Disclosures (a) Psychologists may disclose confidential information with the appropriate consent of the organizational client, the individual client/patient, or another legally authorized person on behalf of the client/patient unless prohibited by law. </li></ul></ul><ul><ul><li>(b) Psychologists disclose confidential information without the consent of the individual only as mandated by law, or where permitted by law for a valid purpose such as to (1) provide needed professional services; (2) obtain appropriate professional consultations; (3) protect the client/patient, psychologist, or others from harm; or (4) obtain payment for services from a client/patient, in which instance disclosure is limited to the minimum that is necessary to achieve the purpose. </li></ul></ul>
  17. 20. <ul><li>What are our obligations to ourselves? </li></ul><ul><li>2.06 Personal Problems and Conflicts (a) Psychologists refrain from initiating an activity when they know or should know that there is a substantial likelihood that their personal problems will prevent them from performing their work-related activities in a competent manner. </li></ul><ul><li>(b) When psychologists become aware of personal problems that may interfere with their performing work-related duties adequately, they take appropriate measures, such as obtaining professional consultation or assistance, and determine whether they should limit, suspend, or terminate their work-related duties. </li></ul>
  18. 21. <ul><li>Psychologists do not automatically give up their personal rights when treating another </li></ul><ul><ul><li>10.10b Psychologists may terminate therapy when threatened or otherwise endangered by the client/patient or another person with whom the client/patient has a relationship </li></ul></ul>
  19. 22. Issues for Early Career Psychologists <ul><li>Lack of knowledge </li></ul><ul><li>Where to go for help? </li></ul><ul><li>False expectations </li></ul><ul><li>“ It won’t happen to me.” </li></ul>
  20. 23. The Pregnant Therapist <ul><li>Physical limitations </li></ul><ul><li>General increased risk of violence </li></ul><ul><li>Special challenges with client population </li></ul>
  21. 25. Questions <ul><li>How do we raise issues of safety and self care with ourselves, our colleagues, our students / trainees? </li></ul><ul><li>How do we address personal safety in a realistic fashion without alarming ourselves, our colleagues, our students / trainees? </li></ul>
  22. 26. What is to be done <ul><li>Research on stalking is in its infancy, and no set of rules can be applied to all situations. We urge all psychologists who are being stalked to seek professional guidance on the optimal manner in which to respond. However, here are few general comments: </li></ul><ul><ul><li>Confronting the stalker is not advised, as it may act as an intermittent reinforcer. </li></ul></ul><ul><ul><li>Document the harassment by keeping tapes of home calls, notes, letters, copies of e-mail messages, and detailed information on each incident. Such actions help document the stalking needed in the event that the psychologist decides to institute criminal proceedings. </li></ul></ul><ul><ul><li>Preventive actions, such as changing phone numbers or varying routes to work, often thwart or discourage stalkers. </li></ul></ul><ul><ul><li>Decisions to use restraining orders or criminal charges should be made carefully because their effectiveness varies considerably depending on the manner in which the police implement them and the manner in which stalkers respond to them. </li></ul></ul>Knapp, Baturin and Tepper
  23. 27. What is to be done <ul><li>1. do not see new patients alone at night, unless you have screened them over the phone and feel comfortable seeing them alone </li></ul><ul><li>2. obtain a history of violence and involvement with law enforcement agencies as part of your initial assessment; </li></ul><ul><li>3. screen or refer out patients with serious problems in controlling violent behavior if you do not feel capable to helping them; </li></ul><ul><li>4. structure your physical office in such a way that it increases your sense of protection. For example, remove objects that could be used as weapons (e.g., letter openers), seat yourself (not your patients) closer to the door);. </li></ul><ul><li>5. deal with hostile behavior therapeutically; use clinical skills to de-escalate the situation; </li></ul><ul><li>6. maintain professional boundaries; do not let patients know where you live, etc. </li></ul><ul><li>7. if you share offices with others or have office staff, be certain that everyone knows how to alert others when there are threats of violence and </li></ul><ul><li>8. Learn basic techniques for self-defense. </li></ul>Knapp 2008
  24. 28. Guy, Brown and Poelstra, 1992
  25. 30. What is to be done <ul><li>Self Protection </li></ul><ul><ul><li>Prevention / screening </li></ul></ul><ul><ul><li>Controlling the environment </li></ul></ul><ul><ul><li>Record keeping </li></ul></ul><ul><li>Consultation / Supervision </li></ul><ul><ul><li>Ongoing support </li></ul></ul><ul><ul><li>Dealing with specific situations </li></ul></ul><ul><li>Networking </li></ul><ul><li>Continuing Education </li></ul>Brems & Johnson, 2009
  26. 31. Self Care <ul><li>Getting enough sleep. </li></ul><ul><li>Balancing work and leisure time. </li></ul><ul><li>Keeping realistic expectations about work. </li></ul><ul><li>Maintaining professional contacts. </li></ul><ul><li>Seeking consultation for personal or professional difficulties before there’s a problem. </li></ul>
  27. 33. Questions Discussion