Personality and Mood Disorders Q 15
A client with a diagnosis of narcissistic personality disorder has been given a day pass from the psychiatric hospital. The client is due to return at 6 pm. At 5 pm the client telephones the nurse in charge of the unit and says “6 o’clock is too early. I feel like coming back at 7:30.” The nurse would be most therapeutic by telling the client to:
A. Return immediately, to demonstrate control.
B. Return on time or restrictions will be imposed.
C. Come back at 6:45, as a compromise to set limits.
D. Come back as soon as possible or the police will be sent.
Correct Answer: B. Return on time or restrictions will be imposed.
This sets limits, points out reality, and places responsibility for behavior on the client. Be clear with the client as to the unit/hospital/clinic policies. Give brief concrete reasons for the rules, if asked, and then move on. Institutional policies provide structure and safety. Be very clear about the consequences if policies/limits are not adhered to. Client needs to understand the consequences of breaking the rules.
Option A: When limits or policies are not followed, enforce the consequences in a matter-of-fact, nonjudgmental manner. Enforces that the client is responsible for his or her own actions.
Option C: If the client becomes seductive, reiterate the therapeutic goals and boundaries of treatment. The client is in the hospital/clinic for a reason. Being taken in by seductive behavior undermines the effectiveness of the treatment.
Option D: Approach the client in a consistent manner in all interactions. Enhances feelings of security and provides structure. Exceptions encourage manipulative behavior. If the client becomes hostile or projects blame onto you or staff, project a neutral, calm demeanor, and avoid power struggles. Focus on the client’s underlying feelings.