Potential Clinical Presentations Presentation What it May Look Like Possible Reasons Initial Approaches Angry Behavioral Anger may be a Set limits and boundaries, including time limits to problems/’acting out’ secondary and more sessions comfortable emotion Threatens verbally: Threats Maintain consistent response to limit setting. of violence, threats of Pain (physical or Be transparent threats of complaints emotional) Consider a task oriented approach focusing on about clinician Trauma concrete tasks and deliverable outcomes Difficulty tolerating distress Psychiatric or SUD Allow the Veteran to guide the pace of which impacts ability to disorders, including Axis II assessment, explore gently and don’t push too complete tasks disorders hard for answers if Veteran is presenting as May present as Past negative experiences guarded Defense mechanisms Maintain consistency such as projection or Maintain good self-care and don’t personalize the displacement anger Engage in consultation as needed for support Disorganized Literal disorganization: lots Medical issues like Assess for immediate safety or medical needs of papers, difficulty dehydration, low blood Create simple and structured plans for achieving remembering sugar, or UTI goals: break things down appointments, “spinning Psychiatric conditions: These clients may require shorter, more frequent their wheels” Psychosis, depression, visits to accomplish tasks mania Psychological Focus on one task at a time disorganization: Substance abuse/Acute Help clients keep a calendar, or even just one disoriented, rambling, intoxication consistent appointment each week to check in unable to have linear Dementia or other Consistency and simplicity are key conversations cognitive disorder (could Consider formal mental health and/or be related to SUD, age, or neuropsychology evaluations whenever possible other organic cause) Monitor changes in presentation: do they sometimes present at more or less organized? What’s different during these encounters?
Potential Clinical Presentations Presentation What it May Look Like Possible Reasons Initial Approaches Angry Behavioral problems/’acting out’ Threatens verbally: Threats of violence, threats of threats of complaints about clinician Difficulty tolerating distress which impacts ability to complete tasks May present as Anger may be a secondary and more comfortable emotion Pain (physical or emotional) Trauma Psychiatric or SUD disorders, including Axis II disorders Past negative experiences Defense mechanisms such as projection or displacement Set limits and boundaries, including time limits to sessions Maintain consistent response to limit setting. Be transparent Consider a task oriented approach focusing on concrete tasks and deliverable outcomes Allow the Veteran to guide the pace of assessment, explore gently and don’t push too hard for answers if Veteran is presenting as guarded Maintain consistency Maintain good self-care and don’t personalize the anger Engage in consultation as needed for support Disorganized Literal disorganization: lots of papers, difficulty remembering appointments, “spinning their wheels” Psychological disorganization: disoriented, rambling, unable to have linear conversations Medical issues like dehydration, low blood sugar, or UTI Psychiatric conditions: Psychosis, depression, mania Substance abuse/Acute intoxication Dementia or other cognitive disorder (could be related to SUD, age, or other organic cause) Assess for immediate safety or medical needs Create simple and structured plans for achieving goals: break things down These clients may require shorter, more frequent visits to accomplish tasks Focus on one task at a time Help clients keep a calendar, or even just one consistent appointment each week to check in Consistency and simplicity are key Consider formal mental health and/or neuropsychology evaluations whenever possible Monitor changes in presentation: do they sometimes present at more or less organized? What’s different during these encounters?