Tuesday, July 21, 2009

Client Validation

I had the opportunity to sit in on a presentation by a director of nursing home. The nursing home houses both elderly folks and people experiencing mental illness. During one section the director discussed orienting new workers and interacting with the mentally ill residents. Her discussion of validation made me think a lot about one specific client of mine. She gave the example of a worker being approached by an upset resident. If the resident starts engaging the worker in conversation but the worker isn’t able to converse at that moment, the worker needs to validate the resident. Makes a lot of sense. Validation shows the resident that the worker is listening to what he’s feeling, that what he’s feeling is important and that the matter will be addressed later.

I agreed with this. At the same time I also thought, what happens when that validation needs to take place constantly?

During the discussion that followed the presentation I brought up my question concerning my client, Dina. Dina catches me 2-3 times a week in the lobby and with as little as a “hello” will launch into a tirade about a particular difficulty she’s facing. These topics are usually repetitive and ones we’ve discussed many times over the past year, mainly concerning relationship problems she’s having with her friends, boyfriend, and family. For a couple of reasons I prefer not to have these talks in the lobby. Confidentiality being one reason. Also, I don’t always have 10-15 minutes each of those mornings – and even this amount of time won’t be enough.

So I asked for advice as to the best way to deal with a situation like that. The advice I got was to validate the client and keep it brief. Say that I understand client wants to discuss something that’s bothering her, that I think it’s important to discuss, and set up an appointment to follow up. In the past I did try to explain to Dina that I’m not able to discuss her personal concerns in the lobby and she seems to understand me, but while she’s in the middle of a rant it’s very difficult to stop the flow of her words. And worse, sometimes when I try to say something she responds that I don’t care about what she thinks, even though later on she says that she didn’t mean it. Which I understand because I can see that when she’s ranting to me that she’s in a different state of mind.

To make matters a bit more difficult my client is developmentally disabled and even though we’ve talked about her concerns and ways of addressing them it’s very hard for her to change the way she responds to conflict. I feel my limit at these times. I know I’m not a clinician and I know that my agency can’t be this person’s sole support. I see where her anger is coming from – isolation and feeling like she doesn’t have a real source of support. I also see how she’s so focused on her feelings of loneliness that it’s nearly impossible for her to step out of them, and I appreciate just how difficult this is for anyone. Recently, after months of discussion, my client and I came to a decision that it would be helpful for her to meet with a psychologist. It’s hard to see her in such pain and I hope that it’ll be a valuable resource for her.

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