2. Handle With Care Verbal Component

3.  Based on a balance of opposing forces SUCH AS: AND OR: AND

4. The Tension/Tension Reduction Cycle… IS NOT TIME DEPENDENT Helps us Understand when to intervene and when to withdraw from an intervention

5. Internal Conflict Responses due to an event not experienced or shared by others. Such as: –Delusions –Hallucinations –Delayed reactions to a real event –Flashbacks

6. External Conflict A direct and clear response to an observable event

7. Inwardly Directed Tension Self-mutilation Self-Neglect Depression Suicidal Ideation

8. Outwardly Directed Tension Destruction Assault Explosive Behavior Instigating others to the above

9. Delayed Style Social Withdrawal marked by a decrease in: »Motor Activity »Speech Production »Avoidance of eye contact Sudden Rage, with violence directed either inward or outward

10. Immediate Style Classic acceleration or motor activity, speech etc… Impulsive acting out

11. Autonomic Responses Motor Activity Speech Indirectly Threatening Behavior Overtly Threatening Behavior Assault SUPPORT LIMIT SETTING PRT Anger/Fear Precipitous Discharge

12. EGO OUT OF CONTROL BEHAVIOR Experiences the outside world Is conscious The Glue that keeps our thinking and behavior in sync

13. Questions: How do we as healthy adults handle tension? What are appropriate ways to handle anger? What disorders might cause impaired ego function? Are there kids in Halleck that can be classified by the disorders we came up with? How do these clients handle conflict/tension?

14. In the absence of internal control we must supply external controls.

15. How Can We Supply External Controls??? ? ? ? ? ? ? ?

16. A Solid Object is: Calm Centered Balanced Makes Direct Eye Contact Verbally Reassuring Firm Non-threatening but not vague or wishy/washy Adheres to Policy

17. The Solid Object Relationship Model (SORM): Presents a solid object that the out-of- control client can attach him/herself to The goal is for you to be the solid object. Your qualities can provide external control. When there is lack of internal control, we must supply external controls.

18. What are your buttons??? Weight Race Complexion Your family Other personality traits Attacks on your values  The out of client that is pushing your buttons is really testing how solid of an object you are!  Are you stable enough for the client to attach to?

19. ? Over-reactor ? Under-reactor ? Talker/listener Finding Balance… To Be A Solid Object.

20. What is transference? The reproduction of positive and negative feelings that were at one time associated with another person or past experience that are now (unconsciously) transferred to a new individual. Examples of transference…

21. Countertransference What is countertransference? A similar experience as transference only in reverse. The client is producing positive or negative feelings in you the residential counselor. Countertransference is normal and happens in any helping relationship. Examples of countertransference…

23. The Rules #1 Always behave as a solid object #2 Appeal to healthy components of the individual #3Avoiding responding emotionally to provoking client behavior #4 Find a positive in all the individual in your care before a crisis #5 What you say is not as important as how you say it #6 The higher the individual falls on the tension/tension reduction cycle, the more external control becomes necessary

24. Automatic Responses Motor Activity Speech Indirectly Threatening Behavior Overtly Threatening Behavior Assault SUPPORT LIMIT SETTING PRT Anger/Fear Precipitous Discharge

25. Support What can we do at this level? »Listen »Accept »Focus »Encourage »Offer »Agree on next steps

26. Limit Setting Limits should be… »Clear »Consistent »Enforceable »Non-punitive

27. PRT (Primary Restraint Technique) PRT should only be used if the client is… »A danger to self »A danger to others »A major group disruption »Engaging in major property destruction

28. (Primary Restraint Technique) PRT should only be used if the client is… »A danger to self »A danger to others »A major group disruption »Engaging in major property destruction

29. When is the only time we should use restraint? Which clients have additions to their behavior plans that allow for earlier hands-on intervention if necessary? How do you document for clients with special behavior plans? Your documentation should be written to justify a hands- on intervention, exactly what did the client do? Do not simply state that the client was “unsafe.” Additional thoughts/questions???….

30. This completes the verbal component of Handle With Care.