DEALING WITH PSYCHIATRIC PATIENTS

through therapeutic communications

CONS C. PAUBSANON JR.

Clinical Psychologist
National Center for Mental Health

The Aggressive Patient

 Aggression can be verbal or physical
 Can be inward or outward
Characteristics of Aggressive Behavior
 Aggressive behavior is communicated verbally or non verbally
 Aggressive people may invade the personal space of others
 They may speak loudly and with greater emphasis
 They usually maintain eye contact over a prolonged period of time so that the other
person experiences it as an intrusive
 Gestures may be emphatic and often seem threatening. (For example they may point
their figure, shake their fists, stamp their feet or make slashing motion with their
hands)
 Posture is erect and often aggressive people lean forward slightly towards the other
person. The overall impression is one of power and dominance.
Types of Aggression
 Instrumental aggression
 Hostile aggression
 Relational aggression
 Instrumental aggression -- aggression aimed at obtaining an object, privilege or space
with no deliberate intent to harm another person
 Hostile aggression -- Aggression intended to harm another person, such as hitting,
kicking, or threatening to beat up someone.
 Relational aggression -- A form of hostile aggression that does damage to another's
peer relationships, as in social exclusion or rumor spreading
Strategies
No Demand Attitude
• present a calm appearance
• speak softly
• speak in a non proactive and non judgemental manner
• speak in a neutral and concrete way put space between yourself and patient
• show respect to the patient
• avoid intense direct eye contact
• Demonstrate control over the situation without assuming an overly authoritarian
stance.
• speak in a neutral and concrete way put space between yourself and patient
• show respect to the patient
• avoid intense direct eye contact
• Facilitate the patient’s stance.
• Listen to the patient
• Avoid early interpretations
• Do not make promises that cannot keep.
• Demonstrate control over the situation without assuming an overly authoritarian
stance.
Depressed Patient
Depression – feelings of extreme sadness
Characteristics:
 Hopelessness
 Worthlessness
 Loss/increased appetite
 Impaired sleep/excessive sleeping
 Loss of energy
 Loss of interest to pleasurable activities
 irritability
 Presence of suicidal ideations
Strategies
 Kind Firmness
 Supportive and non-confrontational
 To externalize their hostility
 Aggression is usually turns toward to self
 ex. Repetitive counting and non-gratifying which may provoke the patient’s anger

Withdrawn Patient
 Social withdrawal is a form of defense mechanism that is generally common to all
psychiatric patients.
 They are usually isolated and do not like to mingle with people.
 Non-responsive/non-communicative.
 Has difficult ty in expressing himself
Strategy
 Active-Friendliness Attitude
 TLC
 Supportive gestures, should be non-threatening
 Assurance of safety
 Attend to basic needs if possible

The Paranoid Patient

 Exaggerated distrust to others
 Extremely suspicious
 Often jealous of others
 Most common feature is persecutory delusion
 They don’t like to have an eye-contact
 Usually evasive

Strategy
 Passive-friendliness
 Maintain your distance
 Do not stare
 He/she must be part of decision-making
 Do not laugh/smile unless he started to
 Do not whisper with others in front of the patient
 Do not make unnecessary movements/gestures
 The Manipulative Patient
 Often demanding
 Persistent complain of bodily pain and other discomfort feelings
 Often lie and make their own stories
 Appears to be initially friendly.
 Would do anything to befriend you and when he/she is not successful, he’ll find ways
to get even with you in a subtle way.

Strategy
 Matter-of-Fact Approach
 Stick to the rules
 No negotiations/bargaining
 Do not react to his/her manipulations
 Do not give in to his/her request at once
 Rule implementation must be consistently followed by all staff