Story Corner
1987-12-01 00:00:00
The Example of Maria Maria is now 27. Her mother had been a patient in the hospital for the past 24 years, while her father deserted them both early in Maria's life. Maria was first admitted to the Psychiatric Clinic at 20 and had had 25 subsequent admissions, including one to a psychiatric institution. Her admissions were usually through the casualty department on weekends. She customarily acted childishly, demandingly, irresponsibly and destructively. Not surprisingly she was unpopular with the staff and there were frequent clashes. When living away from the clinic, she lives under the care of the social services in an old people's home, where she worked as a staff aide. Soon after every admission, the staff would recommend transfer to an !n~titution in order to prevent her from further exploiting our clinic, The admission/re-admission pattern was becoming clear. We held a case d.iscussion in order to explore the relationship of Maria and the nursmg staff and to understand better the role of our clinic in maintaining the homeostasis of the Maria/Psychiatric Clinic system. It soon became apparent in our discussion how difficult survival w~s. for Maria given her life circumstances and how important our clinic was for her. On the other hand, it was confirmed that Maria could not be seen to be suffering from a 'psychiatric illness' that we could treat or label 'chronic'. These conclusions accounted for our helplessness and feelings of uselessness. We then decided to reframe her admissions as understandable, useful and necessary, but not for reasons of therapy. With everyone present, we invited Maria in and informed her of the following: "We studied the difficulties you have and thought how we could help you. We understand that you are in a continuous struggle to organize your life but it is hard due to the special difficulties you h~ve ~ad. We were impr~ssed by your fighting spirit and your deterrmnanon to succeed. It IS natural and understandable that in such a struggle, you should grow tired and need to rest. Although, unfortunately, our Clinic has no treatment to offer you and cannot help you m your struggle, we suggest that you join us for a fortnight's holiday twice a year. Whether you are well or not, you have an open mvitation and we want you to consider it your right. You will always be welcome!" Following this intervention, Maria was discharged. She returned six months later presenting her usual behaviour. The staff accepted her and her behaviour because she had honoured her side of the bargain. She was told that she could stay for exactly a fortnight. The staff accepted her behaviour and made no attempt to intervene. The stay was uneventful and at the end of her holiday, she packed up her belongings, said goodbye to staff in a most friendly manner, and left. She was invited back in six months' time. The relationship between the staff and Maria had changed. We hope that such a change will be helpful to Maria. It does look like a new Maria/Psychiatric Clinic system is evolving. We wonder if other colleagues have similar experiences. VASSOS PYRGOS Consultant Psychiatrist, Nicosia, Cyprus INTERVENTION IN THE CONTEXT OF A PSYCHIATRIC CLINIC WITH A REGULAR CUSTOMER The Psychiatric Clinic of the Nicosia General Hospital is a small 24 bed unit. It accepts voluntary patients whose behaviour is not dangerous. The customary length of stay is 2 to 4 weeks. In our clinic - and I imagine in every other clinic - there are a number of 'regular' customers, who are frequently admitted either through the 'fr~nt doo( or the 'back door'. Back door entry involves contactmg ACCident and Emergency following a suicidal gesture. Such customers frequently have a demoralising effect on the staff as they are evidence of failure of their therapeutic endeavour. Negativity and hostility towards these people breeds within the therapeutic team, leading at times to an inability to co-operate
http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.pngAustralian and New Zealand Journal of Family TherapyWileyhttp://www.deepdyve.com/lp/wiley/story-corner-Dacg4KzfHs
The Example of Maria Maria is now 27. Her mother had been a patient in the hospital for the past 24 years, while her father deserted them both early in Maria's life. Maria was first admitted to the Psychiatric Clinic at 20 and had had 25 subsequent admissions, including one to a psychiatric institution. Her admissions were usually through the casualty department on weekends. She customarily acted childishly, demandingly, irresponsibly and destructively. Not surprisingly she was unpopular with the staff and there were frequent clashes. When living away from the clinic, she lives under the care of the social services in an old people's home, where she worked as a staff aide. Soon after every admission, the staff would recommend transfer to an !n~titution in order to prevent her from further exploiting our clinic, The admission/re-admission pattern was becoming clear. We held a case d.iscussion in order to explore the relationship of Maria and the nursmg staff and to understand better the role of our clinic in maintaining the homeostasis of the Maria/Psychiatric Clinic system. It soon became apparent in our discussion how difficult survival w~s. for Maria given her life circumstances and how important our clinic was for her. On the other hand, it was confirmed that Maria could not be seen to be suffering from a 'psychiatric illness' that we could treat or label 'chronic'. These conclusions accounted for our helplessness and feelings of uselessness. We then decided to reframe her admissions as understandable, useful and necessary, but not for reasons of therapy. With everyone present, we invited Maria in and informed her of the following: "We studied the difficulties you have and thought how we could help you. We understand that you are in a continuous struggle to organize your life but it is hard due to the special difficulties you h~ve ~ad. We were impr~ssed by your fighting spirit and your deterrmnanon to succeed. It IS natural and understandable that in such a struggle, you should grow tired and need to rest. Although, unfortunately, our Clinic has no treatment to offer you and cannot help you m your struggle, we suggest that you join us for a fortnight's holiday twice a year. Whether you are well or not, you have an open mvitation and we want you to consider it your right. You will always be welcome!" Following this intervention, Maria was discharged. She returned six months later presenting her usual behaviour. The staff accepted her and her behaviour because she had honoured her side of the bargain. She was told that she could stay for exactly a fortnight. The staff accepted her behaviour and made no attempt to intervene. The stay was uneventful and at the end of her holiday, she packed up her belongings, said goodbye to staff in a most friendly manner, and left. She was invited back in six months' time. The relationship between the staff and Maria had changed. We hope that such a change will be helpful to Maria. It does look like a new Maria/Psychiatric Clinic system is evolving. We wonder if other colleagues have similar experiences. VASSOS PYRGOS Consultant Psychiatrist, Nicosia, Cyprus INTERVENTION IN THE CONTEXT OF A PSYCHIATRIC CLINIC WITH A REGULAR CUSTOMER The Psychiatric Clinic of the Nicosia General Hospital is a small 24 bed unit. It accepts voluntary patients whose behaviour is not dangerous. The customary length of stay is 2 to 4 weeks. In our clinic - and I imagine in every other clinic - there are a number of 'regular' customers, who are frequently admitted either through the 'fr~nt doo( or the 'back door'. Back door entry involves contactmg ACCident and Emergency following a suicidal gesture. Such customers frequently have a demoralising effect on the staff as they are evidence of failure of their therapeutic endeavour. Negativity and hostility towards these people breeds within the therapeutic team, leading at times to an inability to co-operate
Journal
Australian and New Zealand Journal of Family Therapy
– Wiley
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