Medical Director: Max Baker M.D.

Rational Detachment

One of the challenges of life is to cope with the negative and threatening behaviors and attitudes that arise when we human beings attempt to deal with each other; whether at play, at church, in grocery stores, with neighbors and friends, or with strangers on the street. In the mental health field, our challenges are heightened by the illness and attitudes and past and present experiences that those we deal with interact and react to us. The experience disturbances in thinking, feelings, and behaviors – off of which magnify the problem and makes special stresses us in the mental health helping professions.

When we are provoked and react in negative, threatening and provocative ways, it is destructive to our IWS’. We therefore need to maintain our cool and not let our own unresolved issues or sensitivities or experiences prompt us into reactive defensive reactions. The ability to not do this is termed “rational detachment”, which allows us to be more able to not make situations worse and to not let our own behaviors or attitudes deteriorate into non-professional actions.

In our clinical work, we focus a lot of attention on understanding how a given IWS may react to perceived threats. We can often identify that the source of their reaction is, at least in part, a combination of their symptoms and their previous experiences (where somebody unnecessarily hurt or attacked them), past baggage (unresolved issues), negative attitudes (personal bias, prejudices) and ego-defense mechanism (projection, denial, repression, etc.). We also identify and empathize with some of their current stressors that increase reactivity and vulnerability (relationship issues, finances, family stresses, losses or threatened losses, etc.) However, despite having this professional knowledge to guide us, once we ourselves are “under attack”, we bring to the table all of these same issues from our own past and sometimes these issues – if we have not identified them and mastered these through our personal and professional development experiences – simple overwhelm our better judgment and we react right back with our own pathological behaviors. When this unfortunate situation occurs, the intervention in the current clinical situation does not work. In the worst of situations, our behavior may result in such negative reaction on our part that disciplinary action or job termination might occur.

The bottom line: when two people both get their buttons get pushed (one an IWS; one a staff member), nothing therapeutic usually results.

So what are some common button that get pushed:

a) Fear of our professional identity, training or experience being adequate

Sometimes an IWS who is threatening us, pushes our buttons and we, as a result, feel threatened and out of control. We then retaliate by trying to find their weaknesses to attack back. The button-pushing war is on – and both parties are typically the losers; despite the fact that, after the battle, both parties may leave the war zone feeling that they were actually the victors.

Although the incident usually becomes grist for the therapy mill for the IWS, the professional has to watch that this attitude is not a fatal flaw. As the professional they must understand the incident and learn from it. They do so by debriefing and working with their supervisors to understand what went wrong and how to replace their defensive reactions with adaptive, therapeutic behaviors. They must be very sensitive to the role that their own boundary violations might have played in the incident. They must look at behaviors with the IWS prior to the critical incident, to see if there were subtle issues building up that were not identified.

Each significant incident of failed “rational detachment” must be seen as an opportunity for learning; both for the involved professionals and the other team members. Sometimes, there are circumstances and attitudes which have made a more general situation become focused on a particular employee. We must understand the professional relationship: we have the training, this is our chosen job, we are expected to react appropriately, and we get paid for doing what we do. None of those expectations are present in our IWS.. Part of being a member of a professional team is to support each other. Finger-pointing and blaming are not professional team actions. Identifying areas of improvement and providing support and training certainly are.

So what are the guidelines for being able to react in a detached fashion:

Max Baker MD
Medical Director