The role of emotion regulation, coping, self-reflection and insight in staff interaction with patients with a diagnosis of personality disorder in forensic settings.

WHAT IS KNOWN ON THE SUBJECT?: Interaction between staff and patients with a diagnosis of personality disorder in forensic settings is important for quality of care, but research is lacking on what determines this interaction. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Insight, emotion-focused coping and emotion regulation of staff influence the interaction between staff and these patients. Staff who understand their own thoughts, feelings and behaviour better (more insight) needed less support, encouragement or back-up from their patients. Staff who cope by getting upset, blaming themselves or fantasizing about solutions (emotion-focused coping) on the contrary needed more support from their patients. Emotion regulation had an impact on the relation between coping and hostile staff behaviour. When staff get upset (emotion-focused coping) and try to think differently about the situation (reappraisal), this makes them behave in a more hostile manner towards their patients. When staff suppress their emotions and also distract themselves or engage in social activities (avoidance-focused coping), they behave in a less hostile manner towards their patients. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: In order to provide compassionate care for their patients, staff ought to be trained in self-compassion. This may help them not to get upset, blame themselves or fantasize about solutions and to understand their own thoughts, feelings and behaviour better. As a result, staff may need less support, encouragement or back-up from their patients. Context is important: Staff ought to suppress their emotions when emotions run high, but only when they also care for themselves by distracting themselves or engaging in social activities. Facing and regulating their emotions by changing what they think about the situation (reappraisal) may be more appropriate once emotions have settled down. This may help staff to remain compassionate towards their patients in the long run and avoid burn-out or compassion fatigue due to ignoring their own needs and boundaries. ABSTRACT: Introduction Research is lacking on what determines interaction between staff and patients with a diagnosis of personality disorder in forensic settings. Aim To test whether coping, self-reflection, insight and emotion regulation are related to the behaviour of staff towards these patients, and to test the possible moderating and mediating effect of emotion regulation. Method Using a cross-sectional design, 76 direct care staff of a forensic clinic completed questionnaires on all variables. Relations were tested using simple linear regression, mediation and moderation analyses. Results Insight and emotion-focused coping of staff were related to seeking less and more support from patients, respectively. Emotion regulation by reappraisal combined with emotion-focused coping was associated with more hostile behaviour by staff, and suppression combined with avoidance-focused coping with less hostile behaviour. Conclusion Insight, emotion-focused coping and emotion regulation of staff influence the quality of care of patients with a diagnosis of personality disorder in forensic settings. Future research ought to include contextual factors. Implications for practice Enhancing self-compassion may improve insight and reduce emotion-focused coping. Context is important: Taking the needs of staff into account may involve suppressing emotions combined with avoidance in a highly emotional situation while facing and reappraising the situation when emotions are low.

Dynamic Patterns of Three Staff Members Interacting with a Client with an Intellectual Disability and Challenging Behavior: Suggestions for Coaching.

In relationships between staff members and clients with intellectual disabilities (ID) and challenging behavior (CB) it is important to study their bidirectional dynamic interactions. In the present study three staff members were recorded on video during a daily bathing session with the same client with ID and CB. The video codings were analyzed using Cross Recurrence Quantification Analysis (CRQA) and based on the categories of Leary and Banjamin's interpersonal models. CRQA analyses demonstrated different synchronization levels of the three dyads with respect to affiliation and control. The dyads also differed in who (staff or client) was leading or following regarding affiliation and control. Furthermore, the nature of the staff-client interaction on a short time scale looked different from that on a longer time scale. We recommend that when coaching staff members regarding dynamic interactions with a client, the emphasis should be on the balance between staff interpersonal active and reactive behavior, applying principles of similarity and complementarity, and changing the amount and timing of taking the lead or following during interactions.

The relationship among attributions, emotions, and interpersonal styles of staff working with clients with intellectual disabilities and challenging behavior.

Several studies have tested Weiner's model, which suggests a relationship among causal attributions regarding challenging behavior (CB), emotions, and helping behavior of staff. No studies have focused on interpersonal styles. The goals of this study were to investigate the influence of type of CB on attributions, emotions and interpersonal style of staff, the relationships among staff attributions, emotions, and interpersonal style, and the mediating function of emotions in the relation between attributions and interpersonal style. Participants were 99 staff members. CB aimed at the environment was related to higher levels of negative emotions, attributions and certain interpersonal styles such as controlling behavior. In addition, a relationship between emotions, attributions, and interpersonal style was found. However, there was no mediating function of emotions in the relationships between attributions and interpersonal style. Future research should take a more dynamic view of staff behavior and staff-client interaction into account.

Measuring staff behavior towards clients with ID and challenging behavior: further psychometric evaluation of the Staff-Client Interactive Behavior Inventory (SCIBI).

Recently, the Staff-Client Interactive Behavior Inventory (SCIBI) was developed, measuring both interpersonal and intrapersonal staff behavior in response to challenging behavior in clients with ID. The aim of the two studies presented here was first to confirm the factor structure and internal consistency of the SCIBI and second to demonstrate its convergent validity. In the first study, a total of 265 support staff members, employed in residential and community services, completed the SCIBI for 62 clients with ID and challenging behavior. In the second study, 158 staff members completed the SCIBI for 158 clients, as well as the SASB-Intrex, the NIAS and the Bar-On Emotional Quotient Inventory (EQI). Replication of a confirmatory factor analysis resulted in a consistent seven-factor solution of the SCIBI with high levels of internal consistency. Also, mostly good convergent validity with the SASB-Intrex and sufficient to good convergent validity with the NIAS and EQI were found, except for the self-reflective intrapersonal staff behavior scale. By replicating and extending earlier results on the SCIBI, it proves to be a reliable and sufficient valid measure of interpersonal and intrapersonal behavior of staff working with people with intellectual disabilities.