Personality and Mood Disorders Q 38
A client with avoidant personality disorder says occupational therapy is boring and doesn’t want to go. Which action would be best?
A. State firmly that you’ll escort him to OT.
B. Arrange with OT for the client to do a project on the unit.
C. Ask the client to talk about why OT is boring.
D. Arrange for the client not to attend OT until he is feeling better.
Correct Answer: A. State firmly that you’ll escort him to OT.
If given the chance, a client with avoidant personality disorder typically elects to remain immobilized. The nurse should insist that the client participates in OT. Expand limits by clarifying expectations for clients in a number of settings. When time is taken in initial meetings to clarify expectations, confrontations, and power struggles with clients can be minimized and even avoided.
Option B: In a respectful, neutral manner, explain expected client behaviors, limits, and responsibilities during sessions with nurse clinician. Clearly state the rules and regulations of the institution, and the consequences when these rules are not adhered to. From the beginning, clients need to have explicit guidelines and boundaries for expected behaviors on their part, as well as what the client can expect from the nurse. Clients need to be fully aware that they will be held responsible for their behaviors.
Option C: Addressing an invalid issue such as the client’s perceived boredom avoids the real issue: the client’s need for therapy. Understand that PD clients, in particular, will be resistant to change and that this is symptomatic of PDs. This is particularly true in the beginning phases of therapy.
Option D: Arranging for the client to do a project on the unit validates and reinforces the client’s desire to avoid getting to OT. Responding to client’s resistance and seeming lack of change in a neutral manner is part of the foundation for trust. In other words, the nurse does not have a vested interest in the client “getting better.”. The nurse remains focused on the client’s needs and issues in any event.