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Behavioral Health Challenges...

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Understanding the Relational Character of Behavior Problems

As crucial as they are, knowing that someone may have a treatable mental health condition; involving mental, and physical, health professionals; and knowing the rudiments about medication are not enough. Home care workers also need to have some skill in engaging and helping clients whom they find difficult to serve. Fundamental to developing these skills is understanding that

Mr. F. believed that he had been prescribed too many pills and that they couldn’t be good for him. He also thought that they cost too much money, not just to him but to Medicare. It offended him that the price was so high. As a result, he took his pills selectively, often cutting them in half to make them go further. He thought that this had nothing to do with his being out of breath much of the time and not having enough energy to take a walk. His worker tried to insist that he take the pills. He became even more stubborn over time.

behavior problems are not “in” the person. Behavior problems are in the relationship between the troubled person and the caregiver. Behavior that is a problem for a caregiver who may, by nature, be impatient or is highly reactive to stressful situations may very well not be a problem for a person who has

greater equanimity, patience, and tolerance for a bit of disorder. Helping home care workers understand that their reactions may be part of the problem and helping them learn how to control their own reactions is very important.

Understanding Inner Experience

One of the ways that those who work with people with mental and behavioral problems can develop more helpful reactions related to trying behavior is learning to understand the inner experience of people whose behavior is difficult to tolerate or manage. For example, a person who accuses a home care worker of wanting to rob them is clearly living in a state of fear and distrust. They are also probably feeling powerless and alone. They may be miserable that they need care, that they’ve lost their independence, or that it is humiliating to wear diapers and be wiped clean after an episode of incontinence. Angry outbursts may be more an expression of inner despair than of the disdain, disrespect, and dislike that they seem to reflect.

Engaging One’s Client as a Person

There is a tendency to blame trying behavior on a disease. He or she is difficult, we often think, because s/he has dementia or is depressed or has an anxiety disorder or is psychotic. That can be an important insight, but when it comes to engaging a client in ways that help to quell their trying behavior, it is not very helpful to blame it on a disease. The inner experience of each person is different. Knowing that a person is depressed does not help too much with understanding that individual’s unique experience. And thinking that the

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