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That Difficult Family?

SARAH JONES sjjones @ melbpc.org.au. That Difficult Family?. o r… Those difficult conversations? Those difficult relationships?. Overview . Explore problems for staff when working with ‘difficult’ people Hospitals ARE DIFFICULT places How to think compassionately under pressure

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That Difficult Family?

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  1. SARAH JONES sjjones@melbpc.org.au That Difficult Family? or… Those difficult conversations? Those difficult relationships?

  2. Overview • Explore problems for staff when working with ‘difficult’ people • Hospitals ARE DIFFICULT places • How to think compassionately under pressure • To ensure clinicians do not bear the brunt alone

  3. Difficulties? For Staff members: Abuse/violence in the Workplace Difficult conversations and relationships • Verbally challenged • Emotionally laden • Feelings of intense dislike or judgement • Wanting to and actively avoiding family members • Feeling helpless • Being shouted at • Being threatened • Threatening body language • Being belittled • Being fearful of physical attack

  4. This presentation will not cover: • Violence in the Workplace • Finding a ‘magic formula’ (eg. Harry’s Invisibility Cloak or Nimbus 2000)

  5. Remember: hospitals are Difficult places Children’s hospitals are places where: • Children are cut open • Put to sleep with chemicals • People take blood from them • Left in beds without their parents • Other people make decisions on a child’s life Interventions that, anywhere else in the world, would be considered criminal

  6. What are the problems staff may encounter? • Frightened, fragile parents? • Parents keeping a child alive at all costs? • Parents at war with each other? Or with us? • Parents encountering terrifying situations? • Parents in a literally unbearable place? • Do we underestimate hospitals being place of panic, fear, cruelty for some parents/children? • Do we defended ourselves against “emotionally knowing” what we do to children

  7. Rupture and Repair – UNIVERSAL in Relationships • RUPTURE: conflict, anger, refusal, protest • REPAIR: Lets talk about that anger today.. Can I hear how wrong we got that yesterday? How can we do it better? Our team want to know.

  8. ASK THYSELF Turn to the person next to you…

  9. Under pressure: what are YOU most likely to do? Clinician: • You are under enormous stress • You are frustrated, exasperated with the family • What do you do when someone blames you? • Attacks you? • 2 minutes each: GO!

  10. How to think compassionately under pressure • Managing your own affect means you can help them with theirs better… • Know your self when faced with CONFLICT • If you get overwhelmed quickly • If you get angry quickly • If you get anxious and apologetic too quickly • Notice you own emotional responses first

  11. 1. Not helpful • Getting angry • Getting emotionally aroused to the extent that you can no longer offer your best thinking • Giving ultimatums • Giving orders • Acquiescing to all demands • Participating in abusive conversations

  12. 2. not helpful • Notseeingour part in the problem or our part in the relationship dynamic • Projecting our distress or contempt • Labellingthem and reinforcing the label • “Splitting”(a defensemechanism) of course it’s the family who are “the difficult ones”not us

  13. Helpful? • Attending to the “complaint” or distress seriously • Attending acutely to the emotional distress in the parent/guardian etc in order to process, feel, think and consider your response (consider RISK) • Noticing your own affect AND helping them to manage theirs • Working at repairing the relationship once conflict managed

  14. Affect regulation • AFFECT what? • In a nutshell, this is the capacity to regulate one’s own emotions by capturing and processing them thoughtfully so that one may manage another’s emotional distress… • We “naturally” do this when someone is crying, much harder to do this when someone is shouting

  15. Reflections, not rapid reactions • “I want to offer you my best help, but I can not do that if you are intimidating me and my staff.” • “You’re shouting at me, and that affects how to work out the problem. It seems as if you are very upset. Let’s sit down together and see if we can work this out.” • “Let’s see if we can get a hold of the whole situation, because I feel it is probably more than the late blood results.” • “I wonder if you’re angry because we haven’t yet found a way to talk with you about what you’re most frightened of?”

  16. Highly expressed emotions:need a reflective mind, not an impulsive reaction or solution • Recognise emotional consequences of working in close relationships with sick children/adolescents • Sometimes even closer relationships with parents • Listening quietly, taking the upset very seriously • Enabling the story be told • Not defending yourself allows some of the emotional distress to be relieved. • Set firm limits • Asking for help to talk through this, formally/informally!

  17. Relationships are created and occasionally destroyed within the context of caring The losses can be of tragic proportions for everyone. And yet more often enormously rewarding. However, remember… If threatened, head for the hills… Call in the cavalry!

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