I've read an interesting article called "Sleight of Mouth patterns and Communication Patterns in Psychiatric Settings". You can read it here:
The following text in italics is from the article. The normal blue text are my own comments on the article:
Now, let's look at the patterns from the reverse perspective. A patient who is asked to carry out a task X,Y or Z denies responsibility/capability by stating, "I haven't got a head." I have experienced a patient that maintained this line for several years. The standard response from the staff was a simpering effort of, "Well, that is just how you feel, why don't you go and sit down."
Because she was labeled as "ill", this statement was permitted as a statement of feeling and thus supported and inadvertently legitimized by the staff. Through experience, the staff had soon learned on arriving in the department that for themselves, this was the line of least resistance. Questioning this patient too closely could prove to be a very frustrating affair where invariably the patient would still get her own way.
Statement: "[I cannot do X,Y,Z because] I haven't got a head."
Pattern #2 - Consequence: "And what happens when you haven't got a head?"
Pattern #4 - Chunk Down: "So how can you talk without a head?" I think this is a good comment, as it clarifies and gently challenges what the client is saying
Pattern #6 - Counter-Example: "How is it that you are able to talk then?" This also gently challenges what the client is saying, which is appropriate.
Pattern #9 - Apply To Self: "So the head that you haven't got thinks that?"
Pattern #11 - Change Frame Size: "Oh right, so if we all used that excuse, nothing would ever get done." This sentence shouldn't be used, as it could aggravate clients. I've worked as a student social worker in a psychiatric hospital, and some clients could get physically or verbally abusive (and very distressed) if staff made rude comments like this. Many clients at the hospital I worked at were also less likely to obey instructions from staff who talked rudely like this. I've seen clients who refused to talk to staff who they thought were rude.
Pattern #12 - Meta-Frame: "You only say that because you like to confuse the staff about how you feel." How could Austin have known if the client is trying to confuse the staff? Not an appropriate question, IMHO. Plus it makes assumptions about the clients that may not be true. And plenty of psychiatric clients say bizarre things because of their mental illness, anyway!
Pattern #13 - Model of The World: "In my opinion, you are saying that as a metaphor for something else, are you not?" This question seems fine, except for the words "are you not". Using the words "are you not" assumes something that may not be true, and it is a leading question. Plus I've seen some psychiatric clients become easily offended (and refuse to talk/give vaguer answers) if someone uses leading questions (even when the leading questions are inoffensive).
Pattern #14 - Reality Strategy: "How do you know that not having a head stops you from doing X,Y,Z?" This is good, as it's a clarifying question (it gets the client to explain their views).( Read more... )