Transference

Many patients attempt to seek attention by hurting themselves to punish a family member. This type of behavior will follow the patient in other relationships. In Freudian Theory the term is used to describe the process by which the patient attributes to the therapist qualities belonging to a significant person in his life, such as a parent, and responds to the therapist accordingly. But the "transference" can pertain to other relationships in the patients life as well. For example, the patient will respond to an employer the way that he or she responded to her father when he or she is asked to do something that he or she didn’t want to do. This applies double for mental health workers.

When a patient is Baker Acted, he comes into the psychiatric facility and he feels powerless. The only way the patient knows how to compensate for this feeling of impotence is to manipulate the staff (particularly the inexperienced ones) in a similar way that the patient had manipulated his parents earlier on in his life. He employs the same attention seeking behaviors that he used in childhood that most people grow out of as they progress into adulthood.

One of these attention seeking behaviors is the threat to hurt herself if she doesn’t receive the attention (or should I say special attention) that she is seeking. Different psychiatric hospitals respond in different ways to the making of "threats" for attention. The hospital that I currently work at is in the habit of rewarding these behaviors. On any given day, there are 2 or more patients receiving 1:1 observation for threatened self harm.

1:1 observation is a term used when a staff is assigned exclusively to one patient. There are differing degrees of observation depending on the degree that the patient is a danger of harming himself or someone else. The two levels that require constant staff attention are, #1 the patient has to be in visual contact or #2 within arms length. Many Borderline Patients thrive on this type of attention and threaten self harm to receive it. To see how Psychiatric Hospitals Reward negative attention seeking behaviors.

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