How a healthcare professional can relate to 'difficult' clients in psychiatry
13 February 2023
People who are sombre, anxious or addicted for long periods of time - and who often have complex personalities in the process - often make large and urgent demands on psychiatric services. Care professionals may therefore find them troublesome. Can this be done differently? PhD student Mark van Veen, himself a social psychiatric nurse with extensive experience in acute and long-term care, conducted an experiment with an alternative counselling method in three mental health institutions. With positive effect. On 13 February, he defends his thesis A balancing act: caring for 'difficult' patients in community mental health nursing at the University for Humanistic Studies.
Mark van Veen wondered how care professionals perceive their clients. Some people are perceived as extra 'difficult' by care professionals because they have complex problems, are complicated to deal with or do not 'get better'. That 'difficult' appeared, incidentally, to be less of an issue with people who meet the classic image of the 'psychiatric patient': those who are temporarily 'crazy' (psychotic), 'extremely busy' (manic) or 'extremely gloomy' (severe depressive). Care professionals find it especially difficult when people are sombre, anxious or addicted for a long time - and often have a complicated personality in the process. There are usually all kinds of social problems at play as well, and they make heavy and urgent demands on care services.
Balancing act
Will healthcare professionals find people less 'difficult' if they approach them in a different way? Mark van Veen conducted an experiment in three mental health institutions across the country. Care professionals were randomly assigned and offered either regular counselling or an alternative form - Interpersoonlijke Sociaal Psychiatrische Begeleiding (ISPB - Interpersonal Social Psychiatric Counselling). The professionals who used ISPB indeed found clients less 'difficult'. The method worked positively on the extent to which professional and client agreed on what should happen in the counselling process, and how. This improved the therapeutic relationship between the two. Unfortunately, this had no measurable effect on the client's measured quality of life: it remained the same.
The strength of the ISPB approach lies mainly in reflective working together: there is a constant focus on the relationship between client and professional and where they are heading together - a constant balancing act. This approach provides guidance and direction, both for people with long-term problems and for the people who provide them with professional care and support.
Mark van Veen is a social psychiatric nurse with extensive experience in acute and longer-term care. He is a lecturer at Utrecht University of Applied Sciences, which also co-funded his research. The research came about with support from Stichting tot steun VCVGZ, an SIA RAAK PRO grant and Hogeschool Utrecht.
‘A balancing act: caring for ‘difficult’ patients in community mental health nursing’, Mark van Veen
On 13 February, Mark van Veen defends his thesis 'A balancing act: caring for 'difficult' patients in community mental health nursing' at the University for Humanistic Studies.