Part Two:Dealing with Difficult People

When problems come up

Everyone needs to walk the talk by developing new skills!

Once you recognize a boundary violation it is important to develop a plan for dealing with it.

The first step in developing a plan of action is to identify how you typical handle critical conversations with difficult people.

Strategies for setting appropriate boundaries with difficult people

1. Self-esteem Self-Check You cannot survive a relationship with a

personality disorder if your self-esteem is damaged or weak. You need to learn to take care of yourself by setting good professional boundaries.

Suggestions for avoiding Ethical Situations

2. The Four Don'tsThere are four things you should not do or say to a

Borderline individual. The first is don't defend yourself. The second is don't explain. The third is don't justify. The fourth is don't counter attack. The individual

with a personality disorder may misconstrue the above-mentioned statements and actions.

Suggestions for avoiding Ethical Situations

S stands for Support. It is very important to have a support network of others around you. When in doubt, always consult with another person.

E stands for Empathy and hands the problem when a patient needs to own the problem.

T stands for time. This technique allows you time to think about how you are going to handle situation after emotional outbursts or accusations.

3. Practice SET Communication Method (Support, Empathy, Time)

1. Help them to make sure you have the correct understanding of what is being said, (e.g. Is your first impression of what you heard correct?).

2. Try to interpret what that person is really saying.

3. Do not respond and defend. (Remember: You will only end up looking foolish. Doing this will actually be “fuel” for the bully to continue the teasing.)

4. Use strategies that will empower and make you a poor target.

4. Learn to be appropriately assertive and avoid becoming a victim.

Rule #1: Sets firm behavioral limits in a caring way. They model taking good care of themselves, and setting good boundaries. This means that staff will avoid:

getting angry lecturing/reasoning  making threats that can not be followed through giving repeated warnings 

Rule #2: Hand problems back to individuals that they should be responsible for.

5. Setting and Maintaining Boundaries

Rule #1: Sets firm behavioral limits in a caring way. They model taking good care of themselves, and setting good boundaries. This means that staff will avoid:

getting angry lecturing/reasoning  making threats that can not be followed through giving repeated warnings 

Key to consider: To accomplish these two rules it will be first important to neutralize arguing and their non-compliance to what you have asked them to do.

Step One: Go Brain Dead

Never attempt to reason with a person that wants to argue. Reasoning and logic will not work in these situations because the patient is playing by a different set of rules than you are. He/she is not interested in facts and logic. He/she is interested in getting their way and seeing you give into them.

Neutralizing Arguing

Step Two: Choose a “Detachment State” Consider using:   “I bet if feels that way sometimes.” “This sounds like an argument.” “Let’s talk about this at a later time.”

Neutralizing Arguing

Step Three: Do Not Attempt To Think

Become a broken record, saying the same antidote for each new argument that comes up with. Keep your voice soft. Allow any frustration to be that of the individual, not of you.

Neutralizing Arguing

Step Four: If the person continues to argue consider using “Enforceable Statements” For some very strong-willed or manipulative individuals, it is effective to say, “I’ll talk when your voice is as calm as mine.” Or “Let’s talk about this later when you have had more time to think about this.”

Neutralizing Arguing

• Rule #2: Hand problems back to individuals that they should be responsible for.

• People who’re successful with this skill make it easier by using just one empathetic statement that fits their personality, their culture, etc. 

Quick Empathy Statements: • “How sad”• “What a bummer”• “Uffda”• “Oh, wow”

5b. Using the Power of Empathy To Hand Problems Back

 How much time could you save each day if some people would own and solve problems that they have created for themselves?1. Provide empathy, (e.g. “Oh that’s not good.”).2. Send an empowerment message, (e.g.“What are you going to do?”).3. Offer a menu of suggestions,(e.g. “Would you like to hear what others have done?”).

Five Step Process

4. Ask the patient to process after each suggestions, (e.g.“How will that work for you?”).

5. Give the person permission to solve or not solve the problem they created, (e.g. Send the “Good Luck” message.).

Five Step Problem Solving Technique:

Please note: There is copyright materials in this handout from Love and Logic. As a result, I would ask that you not reproduce any of the information for distribution.

Thank you in advance!

Let’s Dance: A high-spirited patient enters the unit, pulls a small

recorder out of her purse, turns on samba music, and announces that she just won a dance contest. She bounces over, puts her arms around you and squeals, “Let’s dance.”

What would you do?

So, what are you going to do? What will you say to her? Her arms are already around you, so what do you do with them? Might she be seductive? Or is she only in a very good mood today? Can you tell the difference?

What would you do?

Scary Guy:Your new patient always looks brooding and is difficult

to engage. He is new to this country and is hard to understand him. He mostly sits sullenly, answering your questions using the fewest possible words, often looking down at his feet. You find his enormous size, flashing eyes, and foreign accent intimidating.

What would you do?

A patient shows up early for her appointment, and goes out of her way to express her appreciation for your assistance. She is becoming very dependent upon you and often asks you to help her make decisions regarding non-medical issues (e.g. the spending of money, dealing with her adult children. problems in her marriage.)

What would you do?

Do you give her advice on how to deal with the problems in her marriage? Her parenting issues? Spending her money?

What would you do?

Angry and Demand:This patient has a problem keeping his appointments on

time. You have indicated to him that you will have to move his dialysis time to the end of the day. When he learns that he will have to come back later in day he becomes angry and demands that he should be treated immediately.

What would you do?

Would you argue with him? Should he be allowed to be treated now , or have his appointment moved?

What would you do?

This patient is cognitively limited. She doesn’t always eat correctly and often has medically related issues as a result. She tells you that she is going to file a complaint that you aren’t helping her.

Would you argue with her? Would you discharge her care due to patient non-compliance?

What would you do?

• Justin Tyme, MSW is often late for appointments. When a single mother of four young children complained to you that she didn’t like waiting for up to a half hour because it throws her schedule off, he responded, “You don’t have a job, so what difference does it make?”

• What would you do about her complaint? Would you say something to your co-worker?

What would you do?

End of Part Two