Tenets of Play Therapy for Difficult Patients – Hughes

Emotionally activated patients:  unmet childhood needs, pts will repeat themselves and their behaviors, result of trauma in childhood that resulted in failed development of coping skills in certain situations.

Key skills:

Structuring Skill:

  • Setting the tone for the visit.  “I’ve got about 10 minutes, but I want to address your concerns…” Guides pts to understand constraints of meeting.  Non-disciplinary way, not aggressive or angry boundary imposition.

Empathetic Listening:

  • Demonstrates interest and acceptance.  Allows patients to clarify misunderstandings when you repeat what you’ve heard.  Helps to label feelings – validates and increases the patient’s own emotional intelligence.  Increases patient self-acceptance.

Following the Patient’s Lead:

  • Non-directive questioning and talking method.  Allows the patient to lead the conversation.  Helps you understand what role the patient wants you to fill. Important to reflect what you’re hearing to clarify.

Limit Setting Skill:

  • Protects patient and others.
  • Limits must be stated and enforced – inadequate follow-through creates boundary pushing.
  • Keeps limits to a minimum.
  • How to set limits:
    • State the limit clearly (e.g., you won’t speak to me that way, pull out IVs, etc.)
    • Define an appropriate alternative (e.g., get a nicotine patch, walk around the floor, etc.)
    • Give a warning.
    • Enforce the consequence (e.g., calling security, etc.)

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