Written by the multidisciplinary staff of the Citywide Case Management Team in San Francisco, Clinical Case Management is a practical guide for case managers and mental health students who are learning to work with seriously mentally ill adults. This volume offers a comprehensive approach to care and describes the integration of a broad array of interventions. Three themes run throughout Clinical Case Management: psychological and practical issues are inextricably intertwined, thus clinical and practical interventions must be delivered concurrently; understanding and utilizing the strengths and resources of the client's culture is critical to the successful implementation of care; and families and natural support systems are essential components of the system of care. Among some of the specific topics discussed are comprehensive assessment and treatment planning, treatment of substance abuse and mental illness, personality disordered clients, and managing problematic behavior. Thought-provoking yet practical, Clinical Case Management provides practitioners and students with information they can use to help solve the day-to-day problems they face in serving their clients. “Case examples are used that really bring the discussion to life and will make this book particularly relevant to students and practicing clinicians. … This is an inspiring and informative book that presumes some clinical sophistication on the part of the reader. I would highly recommend it for administrators of mental health programs and any clinicians who are approaching burn-out and are in need of some encouragement to stay with the work of helping the mentally ill clients.” –Clinical Gerontologist “The evocative case reports in this volume remind us that we are only beginning to learn what happens in case management with different types of clients with different problems in different types of environments. It is my hope that readers of this volume will be inspired by the efforts and ideas of the authors to view their own work as an educational process. In doing so, case managers can learn from both success and failure without succumbing to the despair our clients experience on a daily basis.” –from the preface by Joel S. Kanter “This book is a sensible description of the practice of case management for persons with serious mental illness. … Rich in case study material and realistic in its portrayal of the day-to-day ebb and flow in the life of case managers, … this well-written volume should be appealing to practitioners.” –Psychiatric Services “This is a thoughtful, provocative, and well-organized book that provides an important contribution to our understanding of clinical case management at its best. It should be useful for program planners and administrative supervisors, as well as those who are most directly responsible for providing this essential component of comprehensive mental health care. The richness of detail and the breadth of issues addressed made it a pleasure to read.” –Stephen M. Goldfinger, M.D., Massachusetts Mental Health Center, Boston “This comprehensive work offers a clear definition of case management and describes its implementation with seriously ill psychiatric clients. … Interesting clinical case material is offered to highlight the ideas presented.” –Readings: A Journal of Reviews and Commentary in Mental Health “This book comprises a rich sourcebook of principles and approaches that translate well to the United Kingdom's faltering first steps in case management. The text is laced with many carefully chosen vignettes, demonstrating clearly the contributors' connectedness to their own clients. There is a refreshing absence of rhetoric and constraining ideology. … The book is an excellent read for the reflective practitioner in this field.” –Malcom Firth, Health & Social Care in the Community “Excellent chapters on the management of substance abuse in dual-diagnosis client and the management of problem behaviors are backed up by insightful expositions on the perspective of the psychiatrist, and the role of counter-transference in the work with difficult and distressed long-term clients. I especially enjoyed the chapter on ‘The Power of Dreams,’ a plea to use client aspirations as a starting point to effective therapeutic relationship building. … Overall, an excellent book, well worth browsing by all professionals involved in caring for individuals with enduring and disabling mental health problems, and of interest to psychologists both in its direct application and its insight into the role of care management.” –David Hodgetts, review in Clinical Psychology Forum
Chapter 10: Managing Problematic Behaviors
Managing Problematic Behaviors
Most clinicians in community mental health can provide detailed examples of clients with problematic behaviors. Such behaviors include suicidally, aggressiveness, substance abuse, behaviors resulting from severe character disorders, and noncompliance with medications. These behaviors impair a client's functional ability and may alienate service providers. Clinicians’ and other service providers’ countertransference responses to clients’ problematic behaviors can enhance or impede treatment.
This chapter will describe problematic behaviors, describe characteristics of clients with such behaviors, provide management guidelines, and discuss transference and countertransference issues.
Describing Problematic Behaviors
Frequent Suicidal Ideation, Gestures, or Attempts
This can mean serious suicide attempts, frequent threats of self-harm, reports of an overdose by a client who then presents to the therapist's office or medical emergency room, or more unusual and self-destructive ...