Resources and advice for avoiding power struggles with clients
June 3, 2017 9:57 AM   Subscribe

I want to train my social-services staff to better avoid getting into power struggles with our clients, who are all dealing with severe and persistent mental-health challenges. I'm looking for resources or advice that I can present to them.

The clients are objectively difficult to deal with -- many are delusional or paranoid, many have personality disorders that present as extreme contrariness or anger, many are passive in their resistance to advice. Pretty much all of them have trauma histories. Our staff are empathic, compassionate problem-solvers, but many have very little formal training in mental health treatment. They often end up frustrated because they get into bickering power-struggle-y dynamics with clients, which just end up re-creating the dysfunctional dynamics the clients are having in their daily lives, which is not super-healing. I'd like to keep working on changing that.

(We do have psychiatrists and licensed therapists on staff as well; I'm one of them and part of my job is helping train and supervise the rest of the staff.)

I'm having trouble finding resources on avoiding power struggles and on non-defensive communication when dealing with clients (especially social-work clients) rather than co-workers or romantic partners. A big thing I want to emphasize is that staff's feelings really shouldn't matter to clients, so all the stuff about "I language" isn't really appropriate to this work setting.
posted by lazuli to Human Relations (4 answers total) 11 users marked this as a favorite
Best answer: This is similar to the type of power struggle teachers need to avoid with students--the teacher's personal feelings are not relevant, so "I" language is not appropriate.

You may find some helpful strategies for your staff in this article. I like it because it offers concrete suggestions of how to disengage and deescalate. Some won't be relevant because of the classroom setting--and they are not specifically taking into account delusions or paranoia--but many of the strategies would work for adults and are not infantilizing.
posted by hurdy gurdy girl at 10:20 AM on June 3, 2017 [1 favorite]

Best answer: CPI video on Avoiding power struggles.
posted by SyraCarol at 1:42 PM on June 3, 2017 [1 favorite]

Best answer: Motivational Interviewing- I'm pretty sure there's training resources for non-clinical staff for MI principles like rolling with resistance, or MI training for clinical staff could be adapted to just use the principals of working with, not against, the client.

Stages of Change- to give your staff words to put to the idea that some clients will be pre-contemplation regarding whatever it is the worker is trying to get them to do (it doesn't have to just apply to alcohol and other drugs) and no amount of arguing will change that.

Also non-clinical Dialectical Behavioural Training resources for staff. If you can't find anything good, even certain excerpts from Linehan's original book might work in regards to empathetically relating to clients who can be difficult to work with, or as a starting point for deveoping training materials or talking points in supervision.
posted by hotcoroner at 2:23 AM on June 6, 2017

Response by poster: Thank you, all. I had a hubris-deflating incident last week with one of the clients with whom other staff had been struggling, and it helped me recognize that I needed to be coming at this from a humbler perspective, so I shifted the training a bit. I ended up just using the "Human Continuum" exercise from the CPI video that SyraCarol posted, with just a quick intro about how clients pushing our buttons can lead to power struggles, and it led to a really great discussion and staff said they really both enjoyed it and got a lot out of it. They said that just thinking about personal responses to clients would help them in recognizing when they were acting in ways that were more about their own egos than about helping clients, and they said it was really helpful to realize they weren't alone in sometimes reacting to clients that way. So! Highly recommended! (I will caution people about downloading any of the manuals on the CPI site, however -- I got almost immediate phone calls and emails trying to sell me trainings.)

I love the idea of looking at classroom-management resources, hurdy gurdy girl, and will continue with that as I refine my ideas of what skills staff really needs. Thanks!

hotcoroner, we're definitely working on all those skills in particular, too! I've been pushing the larger organization to do another training on MI, because the one they did was years ago, and I don't know enough about it to give much more than a cursory overview. We talk a lot about stages of change, but it might be helpful for me to go more in-depth with it one week. And we're currently running DBT skills groups, and the licensed clinical staff has really picked that up, but I can probably find ways to disseminate that info a bit more to the non-licensed people (some of them have been trained in it, but they don't always think to use it).
posted by lazuli at 6:29 AM on June 15, 2017 [1 favorite]

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