Working With Mentally Ill Clients

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Working with clients who have mental health concerns is probably one of the challenges you didn’t anticipate when choosing a career as a veterinary health professional.

It can often feel like a daunting, even overwhelming, task to deal with people who have issues ranging from situational distress to long-term mental health diagnoses. Successful communication and boundary setting is a continuous process with all clients and will be unique to your career, practice, and setting. In addition, each interaction you have with clients creates, reinforces, or readjusts boundaries. The crux of successful communication, regardless of where someone falls on the spectrum of mental health, is within the relationship.

Response = Intuition + Awareness + Skills
It is important to recognize that stress and anxiety (such as when clients are concerned about their pet or there is a crisis situation) can bring out the worst in all of us. Remembering this can help you find a place of empathy when working with clients who seem to be struggling emotionally or mentally. Being able to respond compassionately is key to establishing and maintaining professional relationships and boundaries with all clients, particularly those with mental health concerns.

Unlike reacting, which refers to an intuitive and instinctual response to a situation, response reflects intuition, awareness, and skills. For the purposes of this article, intuition refers to that which you know without knowing how you know; awareness refers to a deeper understanding of why/what something means through integration of further data; and skill refers to intentional application of knowledge and techniques for a particular purpose. An effective response when working with clients with mental health concerns requires an integrated engagement of all 3 domains.

Responding to Clients with Mental Health Concerns
Table 1  explains how to engage intuition, awareness, and skill before, during, and after a potentially distressful or critical client interaction to improve your ability to respond in a compassionate and constructive manner while maintaining positive boundaries. While there may be a tendency to focus solely on the actual event, attending to preparation and follow up will facilitate successful communication strategies for all involved.

See Table 1

First, determine whether this is a situation you can handle on your own. If not, arrange for a colleague to join you or, if you are concerned for the safety of others or the client (see Suicidality in Table 1 above)  immediately follow your practice’s protocol for emergency situations. If the situation is manageable without outside intervention:

• Remember that you are a trained observer of animal behavior; those skills are transferable and applicable to working with people.
• Recognize that your emotions and behavior will be read and interpreted by the client. Be calm, compassionate, and confident.
• Speak clearly and directly; try to remember that maintaining strict boundaries may feel patronizing in some instances but may provide a much-needed gift of structure to a client experiencing emotional or mental distress. Compassionate and caring directness may help a client stabilize her/himself, allowing both of you to provide the best care for the animal.

Before
Several considerations regarding working with clients with mental health issues necessitate systematic and individual preparation. You may identify clients to whom you have an intuitive “gut” response to based on previous interactions that may help you and your team identify and prepare for potentially challenging situations. Your awareness may increase as you review a client’s history, understand your own personal triggers, and gather information on the presenting concerns. In addition, establishing clear policies and procedures on how to address critical client interactions will allow your entire team to manage situations as they arise. These procedures can include steps for contacting local emergency services, compiling a list of mental health referral sources, and using role-play techniques to practice interactions.

During
In the midst of a difficult interaction with a client who is distressed and/or has mental health concerns, you are likely to experience myriad responses. It can be difficult to engage with clients who you perceive as responding with more emotion than the particular situation warrants. Managing the patient, your client relationship, and your own professional persona is uniquely stressful in challenging situations.

Your first sense that something is “off” is likely to be an intuitive process. Pay attention to the autonomic body responses of yourself and your client. Are you experiencing (or do you notice your client experiencing) increased respiration, sweating, or arousal? This instinctual response is likely to trigger a flight, fight, or freeze response for both you and your client. As your awareness increases while you engage in the interaction, pay attention to your intuitive responses and try to understand why you feel compelled to act in a specific way.

When experiencing a “fight” response, you may find yourself raising your voice, becoming angry, or posturing aggressively. It is essential, therefore, to pay attention to unusual affect, nonverbal behavior, and verbal expressions so you can emotionally step back from the situation, understand your instinct, think about how you want to engage differently, and implement further skills. Notice how you and your client may each be feeling, taking note of unusual nonverbal behaviors (body movements, eye contact, aggressive posturing). Pay attention to changes in speech pattern, volume, and rate or changes in the way your client is interacting with his or her pet. Unusual verbal expressions, such as excessively repeating statements, direct or veiled threats, and extreme language may indicate increased distress. Understanding these intuitive responses and being aware of yourself, your client, and the situation will allow you to employ skills to engage the client compassionately and effectively.

After
Once the client situation has been handled, it is important to discuss the experience with your colleagues. First, express your feelings, release physical tension, and let yourself simply react to the situation. Once you have had the opportunity to express your intuitive responses, continue to increase your awareness through dialogue and thoughts about how you handled the situation, how you responded to the client, and what was effective or ineffective in your handling of the situation. Elicit feedback and address your strengths and limitations so you can continue to improve your skills in this area. Finally, identify further resources for the client and continue to firmly maintain the boundaries of what you are able to provide to the client in regard to personal support, patient care, and a future working relationship.

Summary
A comprehensive and intentional response when working with a client in distress requires preparation, an ability to integrate intuition, awareness, skill, and thoughtful follow-up. Remember that the relationship is central to your work with all clients—whether or not they have mental health concerns—and that positive boundaries are established and maintained throughout every client contact. Through compassionate use of skills in responding to clients, you can most effectively serve the health and well-being of both clients and their pets. | EVT 

For related articles, please see the following:
Delivering Bad News: A Crucial Conversation
How To Handle Crucial Conversations