I’m going to try really hard to keep this from being a post about how seriously bad ass I am.
Really hard.
Being a therapist is difficult work. It’s not only emotionally draining most days, but occasionally physically demanding. Especially in Psych.
Today I had the honor of being ‘blooded’ in my first fight. Thankfully, I was not actually blooded.
For those of us who work at institutions, we all receive defense training. We’re all educated about the steps of escalation and de-escalation. For a lot of the line staff who are not a part of nursing, it’s not too frequently we’re involved in altercations.
A lot of the time, it’s Patient on Patient (who’s peers don’t occasionally piss them off?), Patient on nursing staff (they are always there), or Patient on Case Manager or Doctor (source of frustration).
Today, we had patient on patient, but while I was closing group. I was playing a game that I do once a week with my kids, and all enjoy it. Minus this one patient who has refused to do anything whatsoever, has very inappropriate affect, and is a really scary kind of version of conduct disorder, with perhaps some psychosis (he may just be laughing because he’s twisted, I’m really not sure).
We also have a morbidly obese patient on our unit who has already attacked one staff member with (supposedly) absolutely no provocation. This patient is, to put it unpleasantly, a beast. She goes into rages, is over 350 lbs, and just wow. Don’t want to tussle with that.
In my situation today, psycho-boy was walking up and down the halls during group flipping the girls a bird and cursing out of no where. He was redirected by staff to sit in the day area (oh nice, where I am having group), and he complied. He then continued to sit and curse at me, the males, and the females.
I told him in my most awesomest of therapy voices, that while I am very glad he is participating, his cursing at his peers is not tolerable. He then went down this lane of weird questions to me as to why it’s not tolerable, and who says it’s not tolerable, but I did not engage him. He then turned to Amazon, and called her… guess what?
A Bitch
She told him, showing remarkable restraint, “You don’t call me a bitch”
His response?
Biotch.
To channel my sisters and brothers of another color, that girl got up so fast and went and choked that boy it was just cuhrazy.
Now, to make a story short, I intervened, assisted in pulling them apart, and was really proud of myself for the actions I performed without hesitation.
To stop talking about myself now, I want to bring back attention to how this can be part of the therapists repertoire.
We occasionally have to be intermediaries in conflict. Even as Music Therapists (although there was nothing musical about this conflict). I really believe that this is an important skill that we posses, and often times, don’t even know that we possess it. It’s a gut reaction to protect those that we care for.
I ironically, had my update to my defense training yesterday. As I mentioned, there was a woman there who refused to give mouth to mouth to a patient without adequate protection (i.e. mouth guard). That to me, is appalling. Not only is there the litigiousness of the situation, there’s also the fact that this person is working multiple hours a day in a position where she is supposed to care for these individuals– yet she wouldn’t touch one with her mouth if it would save their life.
We, as therapists, are first responders. We are those that care about the people in need. We are those that shake after an incident, think of what we could have done better, and actively work to make changes so that the next time can be better.
I did the best I could today in the situation I was presented with. No staff was hurt (unfortunately, most of us focused on pulling Amazon off of Psycho, so he was able to get some good hits in). There was no major injury to patients.
I was, however, almost pinned against a wall and I actively worked during the situation to extract myself. I had another staff person tell me later that I was “pulling out of the fight”.
I was very offended. I removed myself from the dangerous spot I was in, then went right back to restraining the patients as much as I could. This person apparently expected me to hold that position at risk of my own safety.
Really? This is where boundaries enter in. I am here at this job, working to provide care for these patients. If I am injured, my ability to provide care is minimized. I had to get out of that situation asap. This person thought I should have stayed to help protect him.
I’m working myself into a rant. I shouldn’t do that.
The main point is that we, as therapists, even music therapists, have to know ourselves well enough to know what we can handle. If two patients start fighting, will we be okay? If a verbal altercation begins, can you diffuse it? the list goes on.
Safety is so important. I’m really proud to have learned today that I am a reactor, and not a freezer.
Related posts:
Well, first of all, I’m glad you and your clients are safe. As the, er, saying goes, “This ain’t no disco! This ain’t no foolin’ around!”
I’ve been there, with regard to being assaulted and having to intervene when clients got out of hand. It’s very not fun (which is one of the many reasons why I really find it frustrating when people tell us, “oh, you get to do the FUN therapy.” Um. Therapy is not “fun.” It’s hard work. For both the therapist and the client. But I digress.).
And, yes, it’s hard to know how you’ll react in a scary/crisis situation until you’re actually in it. I’ve been told the reason we’re all trained in CPR year after year (after year after year- can you tell I’ve worked at my job for 22 years?) is that eventually, if/when something should happen, instinct will take over, and we’ll have some neuron in the back of our head reminding us of what we’re supposed to do.
Anyway, all of this was a roundabout way of saying: I’m glad you survived, and I hope you don’t have to go through this again. At least, if you do, you’ll remember your survived.
P.S. It occurs to me (belatedly) that I’ve also written about this topic over at my blog: http://mindfulmusictherapist.blogspot.com/2009/09/when-we-are-injured-by-our-clients.html
And the comments left by other music therapists seem to indicate this is a fairly common issue.