The Short Answer:

Share your power.

The “can you say more, Elizabeth?” answer:

Challenging clients or patients are ones who make your life difficult in one way or another...or several. The patient who:

...doesn't show up for the appointment or follow the agreed upon care plan.

...won't give you any answers to the questions you ask.

...ignores offers of support, education or resources.

...acts dramatic or high maintenance or just the opposite: complacent, resigned and unengaged.

...uses their diagnosis as an excuse for poor or unhealthy behavior.

And you likely have even more examples.

We can all agree that these people are challenging! On top of the behavior issues, challenging patients take extra time, require kid-glove handling and are often unpredictable. Right?

Maybe not.

Challenging clients are actually easy, if you know how to read them and what to look for.

Here's what you need to know:

Challenging clients don't trust you.

It may not be not be personal. Your clients may not trust the system that you represent. (Because you do represent a system or institution, whether you like it or not.) It may be the "healthcare system", for example, that they distrust or any another large, powerful institution. Whatever it is, people act out in challenging ways because they don't feel safe in the "care" that their institution offers.

Trauma survivors are doubly challenged. They are more likely to be seen as challenging patients and more likely to feel unsafe and non-trusting of systems and institutions...for many reasons. One of which is that trauma survivors may have experienced betrayal by the very systems that were supposed to protect them. But intergenerational trauma may also be a factor in their lack of trust.

Large systems are often unable or unwilling to make the large scale changes needed to trauma-sensitize their practices, unfortunately.

But, you can choose to trauma-inform your own behavior. And in doing so, influence greater trust in you as their provider.

And one way to do that is to share your power. How?

Offer choices.

Give clients a choice in how they are addressed.
A) “Hi, I’m Elizabeth your IBCLC. Do you like to be called Ms Johnson, Paulette, Mrs. Johnson or something else?”
Give patients a choice when it comes to touch:
A) "Would you like me to show you ______?”
B. “Could I move your arm over so I can ______?"
Very basics:
A) “I noticed the light off when I came in. Would you like it to remain off?"
(If "yes", you can offer another choice: "Could I come back later?”
B) “May I sit down?” before assuming you can sit down. And if they say “yes”, sit in a chair, not their bed.
C) "Are you interested in hearing more about rooming-in/kangaroo care/weekly support group?"

Choices build trust because they allow the patient more power and control in their own care. People who feel as if they have choices with their provider are more likely to be engaged, compliant, trusting. They may your life easier, not more challenging.

You can't change someone's past. And you might not ever be in a position to change your institution's practices. But you can always choose to trauma-inform your own behavior as a way to build trust with people who need it most, including your challenging patients!

I’m talking at GOLD Lactation 2019 about this very subject! Click here for all the details.