1. Chapter 6 Therapeutic Response: Fearful, Angry, Aggressive, Abused, Abusive Clients

2. Objectives Describe the behavior & discuss therapeutic responses for the fearful client. Describe the behavior & discuss therapeutic responses for the angry/aggressive client. Recall 4 types of abuse Define the 3 types of abuse/violence toward others Discuss therapeutic responses to both the abuser and the abused Examine personal attitudes/biases toward fear, anger, aggression, and abuse

3. Fearful Clients & Responses Fear is real or imagined Distrust, worry, dread, paranoia (past exp) Physiological, somatic responses Degrees of fear Panic attack Types of phobia Recognize & accept client’s fears Use problem-solving approaches Encourage clients’ control as much as poss of the situation If panic stricken, act for the client

4. Angry Clients & Responses Temporary versus chronic Unmanaged client anger Hatred, hostility Negative or positive energy Observation of angry client Reactions of health professionals Do not take personally De-escalate client anger Listen to & observe client’s body language Try to resolve client’s problems Document When professional Loses control

5. Aggressive Clients & Response Unresolved anger, aggression Conflict intensifies = loss of control Abuse: verbal, physical Nonreciprocal Due to physical and/or emotional stressors & trigger statements Try to resolve the conflict Unacceptable to respond as client does Listen, respect, and be assertive Set personal limits Protect self Call for assistance

6. Abusive and Abused Clients Types of abuse/violence –Intimate Partner Violence (IPV) –Child Abuse –Elder Abuse –Rape Violent behavior with intent to harm Biological, psychological, social, and cultural factors

7. Characteristics of Abusers Low self-esteem Feel powerless Blame others for their actions Want to control others Manipulators

8. Types of IPV Violence Physical violence Sexual violence Psychological or emotional violence

9. Types of Child Abuse Definition of child abuse Types of child abuse –Negligence –Physical injury –Mental injury –Sexual abuse

10. Types of Elder Abuse Physical abuse Psychological or emotional violence Neglect or abandonment Sexual abuse Financial exploitation Violation of rights

11. Rape Forcible sexual intercourse with unwilling partner Sexual act versus violence Age of those raped Person versus person Gang rape

12. Abuse Indicators & Treatment Indicators of abuse –Physical –Psychological or emotional Treatment of abuse –Focus on the survivor’s & abusers emotions and coping skills –Create a safe environment –Therapy for both the abused and abuser Reporting and Documenting Legal requirement in all 50 states, except IPV & elder abuse Who reports & how reported Medical record –History of the event, using facts, observations, and client’s words –Evidence such as photos, labs, and physical exam

13. Therapeutic Response Focus on the person seeking treatment, not the event Allow them to express feelings (appropriately) Do not shame or ridicule Be gentle, calm, patient, supportive, and do not rush your interaction Assure a safe and private environment Establish trust to ensure a therapeutic relationship Know how to access resources to help

14. Professional: Understanding Self Examine own feelings toward fearful, angry, aggressive, abused, abusive clients Seek treatment accordingly May seek treatment if survivor Do not stereotype It is difficult work with clients