During years of working in crisis services in a community mental health center, I've heard lots of stories from both clinicians and clients about how frustrated they get with each other. Usually, both parties are well meaning but they persist in repeating a dysfunctional behavior pattern: the worker who gets frustrated by seeing problems continue for the person acts out their frustration by withdrawing somewhat. The client sense this and becomes more desperate in her attempt to get needs met and ups the ante by calling more often, being louder, saying "the S word," or acting out against self, others, or property. The worker becomes frightened or angry and either withdraws further or, if the right button has been pushed, over-reacts. The worker's ability to control her feelings and emotions is key to changing the pattern to a more functional design. Or, I have found Marsha Linehan's material on Dialectical Behavioral Therapy to be effective working with those with borderline personality disorder (the population it was formulated for) and effective in working with my "self" in any interaction I intend to be therapeutic. Dialecticism refers to embracing dualities; recognizing that life is not a matter of "either-or" but of "both-and." In a therapeutic relationship this means finding the balances between caring and limits, acceptance and change. Before I knew of Linehan, I tried to express this balance by saying to myself a phrase Dinkemeyer and McKay (in Parent Effectiveness Training materials) recommended parents to use as self-talk in disciplining teens: "I"ll remain firm and kind." Linehan teaches and I follow the teaching of the following assumptions as central:
Clients are doing the best they can.
It is important to maintain a present focus, dealing with the most immediate precipitator even though the frequent presenter often has a long history of woes that truly have added to the present problem. However, a present focus and a short-term plan begin to make problems feel more manageable for both the client and the therapist. Tomorrow night, next week, next month it will be important for the repeater to hear many of the same things with the addition over time of "cheerleading" about effort and reinforcing positive behaviors even if outcomes are not what the client had hoped. Effort is important.
Clients and staff need to recognize the value of their frequent interactions. People who may in some settings be labeled "attention seeking" probably are indeed hoping for attention; they seek the connectedness and meaning in life all people need. Not getting it can be a matter of life and death literally.