agression/violence towards CP's especially when training

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raglangirl
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agression/violence towards CP's especially when training

Post by raglangirl » Fri Jun 10, 2016 8:07 pm

Not sure where to post this but I'm currently reading Tanya Byron's book about her days training as a CP. It's fascinating but if I'm honest her experiences of being punched/pinned down/bitten really scared me as someone considering becoming a CP one day.

I know she trained in the 80's but I'd like to know what life as a trainee and CP really is like today? What kind of settings and people do you work with? How at risk are you? I would love to know your experiences are and what a typical placement could be like - I appreciate that everyone's experience is unique!

I'm sorry if this sounds very naive but the reason I am concerned is that I have had 3 corneal transplants and so my eyes especially are very precious to me. The thought of being punched in the eyes makes me feel sick so in all seriousness I need to consider whether being a CP is right for me.

Thank you for reading my post x

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ChipChip
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Re: agression/violence towards CP's especially when training

Post by ChipChip » Fri Jun 10, 2016 10:33 pm

Hi,

I'm not qualified - I think it completely depends on the setting but technically you could be at some sort of risk from any service-user. Settings such as LD, Autism, Brain Injury and Mental Health might carry more of a risk of physical aggresion and violence. It's probably worth pointing out that you have to work across a variety of settings when training including placements such as these.

In the company I currently work for (LD) we have staff who have had eye surgery/detatched retinas who are unable to work with individuals who are known to poke eyes/scratch eyes and also punch people in the face because the risk of damage to that person's health is too great.

It's hard to say because even working in challenging settings you can't predict what will happen to you, I've never been punched but I've been bitten many times (not fun), ended up with a broken finger and had multiple scratches. But that was when I was a support worker working 10 hour shifts.

One of our newer qualified CPs got punched by a service-user and found it really hard to cope with and anxiety provoking. I think he came into the setting not realising how challenging the behaviours that the people we support engage in can be. There are no guarantees but you'd be trained to de-escalate situations before they get to physical aggression within these settings so it would probably be few and far between. In this instance the individual didn't know the new CP too well and had a demand placed on him during a stressful time causing him to lash out.

Someone who's on training/qualified will give you a better idea :)

Chip x

ChipChip
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Re: agression/violence towards CP's especially when training

Post by ChipChip » Fri Jun 10, 2016 10:41 pm

Also just wanted to say that I didn't particularly enjoy Tanya's book. Obviously it's based on her work but it's also fictionalised/dramatised. There were a couple of scenarios in the book where I thought she was not very risk aware herself (I think the pinned down situation) whether this genuinely happened and was naivety or not I don't know but there were things where I thought you just would not put yourself in that situation. Whether that's me being risk averse and paranoid or not I don't know. I'm pretty sure I never finished reading it.

Reducing risk is a big priority for all services now but that does not mean you will never be at risk from being punched in the face.

Chip x

raglangirl
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Re: agression/violence towards CP's especially when training

Post by raglangirl » Sun Jun 12, 2016 11:13 am

Hi Chip,

Thank you so much for your reply, thank you for being honest. I am sorry you've have experienced some aggression before, I guess that can be an expected part of the job especially working with certain client groups. That must have shaken your CP's confidence but like you said it's a job where you have to be aware of the client\s needs and try to preempt the situation and deescalate what is going to happen - although that is never easy!

I know what you mean about the book, I think though (even if it is dramatised) it has made me think about this side of things and whether I could put myself at risk (although it could happen in the street!). I might phone some uni's and ask what would happen with a student in my situation and whether any adjustments could be made.

Thanks again for your reply it's really helped :)
x

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workingmama
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Re: agression/violence towards CP's especially when training

Post by workingmama » Sun Jun 12, 2016 1:21 pm

Whilst we all face potentially risky situations, and more so in some settings, my own opinion is that psychologists are proportionally less likely to face physical violence than many other staff groups (I'm thinking nursing, especially). That's little comfort, thinking that you might only have one punch compared to the nurse having seven (bad example), but it's worth remembering how much good risk aware practice reduces bad outcomes for psychologists. It's not always forseeable/avoidable, by on the whole I have generally seen situations escalate, and had the opportunity to think about what I can do to make myself safer (good reading of pre-assessment referral letters, phoning other staff/services to ask their own views on risk with my new client, only having first appointments with someone else or in the hospital where possible, good lone working procedures, attending de-escalation training, having a very low threshold for ending appointments or agreeing to reschedule if feeling threatened, etc).

It sounds like a good idea to phone ahead to universities if you are feeling anxious, and I can't guarantee that you wouldn't ever face violence, but I'd put the small statistical likelihood of physical violence in the context of a much greater likelihood of verbal aggression, and think about good techniques to de-escalate where possible.

Hope this helps x
Fail, fail again, fail better.

raglangirl
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Re: agression/violence towards CP's especially when training

Post by raglangirl » Sun Jun 12, 2016 6:11 pm

Thanks workingmama that does help a lot. Like you said there are a lot of things you can do prior to seeing someone that can greatly reduce the risk.
It will be interesting to see what the uni's say....i'm probably 3 -4 years off applying but I want to know more before I start working towards a career in CP. I am trying to get work exp at the moment so fingers crossed I will have a better insight into the profession too.

Thanks again for all your help it is much appreciated x

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maven
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Re: agression/violence towards CP's especially when training

Post by maven » Thu Jun 16, 2016 7:54 pm

I've been working in the field since 1995, never had any experience of aggression towards me. Two verbal threats, nothing physical, ever.
Maven.

Wise men talk because they have something to say, fools because they have to say something - Plato
The fool thinks himself to be wise, but the wise man knows himself to be a fool - Shakespeare

lakeland
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Re: agression/violence towards CP's especially when training

Post by lakeland » Thu Jun 16, 2016 10:47 pm

I'd echo what workingmama said. In my experience you're more likely to be exposed to threats / violence as you work your way up the ladder. Nursing Assistants and nurses definitely get the brunt of it.

I also think it depends on the setting you work in. If you've always had a breezy CAMHS or paeds / physical health job, you're unlikely to get particularly challenging clients (with regards to aggression). No one can make any promises unfortunately. I'd also wildly speculate that the chances of assault are more likely now than 10-20 years ago because of increasing service pressures, but this is just based on my experience and anecdotal reflections.

raglangirl
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Re: agression/violence towards CP's especially when training

Post by raglangirl » Fri Jun 17, 2016 12:59 pm

Thank you Maven - that's reassuring to know!

Lakeland - I agree, you never know what's going to happen and that is just life!

Thank you both for your advice x

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Re: agression/violence towards CP's especially when training

Post by lingua_franca » Fri Jun 17, 2016 8:43 pm

lakeland wrote:I'd echo what workingmama said. In my experience you're more likely to be exposed to threats / violence as you work your way up the ladder. Nursing Assistants and nurses definitely get the brunt of it.
A clinical psychologist at my workplace (CAMHS inpatient, with a high proportion of young people with attachment and emerging personality difficulties) made an observation on this that was quite interesting. She said that in her experience, psychologists and therapists tend to be viewed extremely positively and are often idealised by our patients. If anyone is going to get hit, it will be a nurse or a HCA. She said it makes her feel almost guilty that she can spend three or four hours a week in the ward and be showered with appreciation, while the nursing and support staff work with these young people 24/7 and often bear the brunt of so much hostility and anger. I think this is probably specific to our client group - the young people like 1:1 support and attention and the sense of someone listening to them, which they get from the psychologist; and they don't like being told that they can't have the TV on past ten on a week night, which they hear from nurses and HCAs. They can see the psychologist's work as caring and supportive, but they have a harder time recognising that the nursing team is also being caring and supportive, even when we're enforcing rules they don't want.

But even outside this setting, I would agree that the likelihood of being physically assaulted by a patient as a psychologist is very low.
"Suppose a tree fell down, Pooh, when we were underneath it?"
"Suppose it didn't," said Pooh, after careful thought.
Piglet was comforted by this.
- A.A. Milne.

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maven
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Re: agression/violence towards CP's especially when training

Post by maven » Fri Jun 17, 2016 10:19 pm

Agreed. But I would note Lakeland has written more when the context suggests she means less! Unless she means whilst you work your way up from the bottom of the ladder, as opposed to when a bit higher up.
Maven.

Wise men talk because they have something to say, fools because they have to say something - Plato
The fool thinks himself to be wise, but the wise man knows himself to be a fool - Shakespeare

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persephone56
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Re: agression/violence towards CP's especially when training

Post by persephone56 » Sat Jun 18, 2016 12:15 am

I work in CAMHS with a high-risk population who are often prone to aggression. There are a *lot* of basic safety tips you can implement to keep yourself safe (from the very basic, like sitting close to the door, to more behavioural things like learning beforehand what triggers are likely, and minimising/avoiding them). Naturally, you have to exhibit common sense too - try to avoid being isolated as much as possible, for example, and workingmama has a lot of good strategies in her post.

I used to be very nervous about the risk of violence and aggression, particularly after reading a fictional book where a CP was brutally attacked (I do not recommend it!!). But as time has gone on, I have relaxed more. The risks are low and the supports in place are plentiful, usually. When you think about it, any job where you deal with others has an element of risk, or even just walking down the street. Psychologists benefit by being very well trained in observing someone's affect and behaviour, and you can generally begin to de-escalate a situation very early on by aware of any changes that signal frustration or anger.

lakeland
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Re: agression/violence towards CP's especially when training

Post by lakeland » Sat Jun 18, 2016 7:37 am

Oops - I've been badly wording things all week, judging by my performance in LiveChat last night! Yes I meant more likely as you're working your way up (in lower paid, higher patient contact jobs) and less likely when you're a CP. What I do get more now that I'm qualified (and it's related to the service I'm in) are more sexual comments and advances, which I think comes from the client group having generally poor relationship boundaries and misinterpreting professional care for something else. I find those pretty tough to manage, but that's probably a reflection for another post.

lingua_franca
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Re: agression/violence towards CP's especially when training

Post by lingua_franca » Sat Jun 18, 2016 11:33 am

lakeland wrote:Oops - I've been badly wording things all week, judging by my performance in LiveChat last night! Yes I meant more likely as you're working your way up (in lower paid, higher patient contact jobs) and less likely when you're a CP. What I do get more now that I'm qualified (and it's related to the service I'm in) are more sexual comments and advances, which I think comes from the client group having generally poor relationship boundaries and misinterpreting professional care for something else. I find those pretty tough to manage, but that's probably a reflection for another post.
Would you make that thread? :P I've encountered this a few times and I feel really ill-equipped to manage it. It's not so bad in CAMHS. When two of our charming and politically conscious boys noticed that I don't shave my legs, they wanted to know if I'm a lesbian and whether I have a sex life, and I dealt with this OK - it was easy enough to reinforce boundaries with a bit of humour combined with a firm manner. When one of the girls wanted to ask me about my intimate relationships, I just told her, "I am not your big sister, I am your boring staff and boundaries get drawn long before the conversation goes near my pants." But this manner obviously doesn't work when it's adult men hitting on you. It has happened to me in the men's PICU before and I'm at a loss for how to deal with it effectively. I usually just say, "Don't talk to me like that, it's making me uncomfortable and it's not OK," but they take this as an invitation to prolong the conversation. It's hard for me not to get snappish and curt, because I find this so offensive coming from a grown man, and my instinct is not to give them a pass - after all, plenty of men have adverse life experiences but don't then turn round and harass women, and having mental health or social and behavioural problems doesn't take away your moral agency. I think I interpret the harassment I've encountered in mental health settings in the same light as harassment I get in the street, which may not be helpful.
"Suppose a tree fell down, Pooh, when we were underneath it?"
"Suppose it didn't," said Pooh, after careful thought.
Piglet was comforted by this.
- A.A. Milne.

alexh
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Re: agression/violence towards CP's especially when training

Post by alexh » Sat Jun 18, 2016 4:27 pm

Making you uncomfortable may well be the aim, or a major part of it. I would highly recommend omitting "it's making me uncomfortable" part and stick to "that's not OK".

I think you must determine what response is appropriate in the PICU setting for the level of inappropriate comment and that may well be different to the response in a different work setting or when you are not at work. Very helpful if staff share a sense of what is not OK and help each other to enforce it.

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