Additional Factors

• Shame and Dependence by Dorothy Chance, 8/6/97
  • Difficult Families and Caregiving: Attack-Other? by Sue Deppe, MD, Burlington, VT, 8/7/97
    
    

I would like to add some additional factors to my original post for your consideration, and the consideration of any others who would be so kind as to share insight!

By law, there is no way these patients/families can be forced to leave the centers. When they are given that choice, they are always "shocked" and further enraged, percieving (perhaps correctly) the offer of such an option as rejection and abuse.

In my experience, there is a cluster of behaviors that could be described as a "syndrome." Once these behaviors are identified, management strategies must be directed toward the understanding/response behaviors of the staff as opposed to the "usual" staff support of the pained individual. This approach has proven effective, tho quite difficult to teach/learn.

The presence of even one of these family members in a center constitutes a definite danger to the patient and to all the other patients in the center. 1. Staff will of necessity protect themselves from "abuse" from the family member and may avoid the situation if at all possible, leaving the patient without the necessary support. 2. The staff can very easily become caught up in the ensuing power/control struggles and lose sight not only of this patient's care, but other patients as well. 3. The hours of required to "handle" these situations is awesome, thus depriving the entire community of focus.

The strategies useful in standard dealing with "difficult" people do not seem to apply. Conflict resolution strategies also do not clearly address the situation. With each of these concepts, the option of removal seems to lie at the core, and for us that is not an option.

Is there anyone out there dealing with the effects of shame on the institutional care of the chronically ill?

• Syndrome in difficult family members in institutional settings? by Sue Deppe, MD, Burlington, VT, 8/11/97
  • More Later by Dorothy Chance, 8/11/97
• Shame in Institutional Settings by Don Nathanson, 8/11/97
  • Taking Issue by Dorothy Chance, 8/11/97
    • Better name needed by Don Nathanson, 8/12/97
      • A Rose by any other name by Dorothy Chance, 8/12/97
  • And we wonder why they come back for more by Mell Williams, Jr., 8/18/97
    • Understanding the relevance of shame for rehabilitation by Don Nathanson, 8/20/97
      • Shame in corrections by Mell Williams, Jr., 8/20/97
        • See if this works by Jim Duffy, 8/20/97
          • positive regard by Mell Williams, Jr., 8/23/97