Work with, not around, chaotic clients

Therapists can either work on, or work around, the chaos in client’s lives. Identifying clients, rather than their circumstances, as chaotic risks disempowering the client.

“Chaotic” seems to be one of the mildest “unofficial diagnoses” a therapist can apply to a client: it seems more descriptive than derogatory. “Chaotic” is defined as being “in a state of complete confusion or disorder”. This would be an accurate description of the circumstances of a large number of mental health clients, especially those who come to the attention of psychiatric services.

The stereotypical “chaotic” client would be someone who misses appointments, over- or under-uses prescription medication, has disrupted and disorganised home and work routines and struggles to achieve any consistency or reliability in their interactions. This state of affairs would usually have been at least part of their reason for seeking therapy.

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Use your casenotes as a Foley file

Making notes of information incidental to the case enhances interactions. The more personal details you retain, the more intimate the interaction and the greater the sense of personal attention.

Compare & contrast the following:

Last time you said you were going on holiday with your husband and daughter but you were worried about the journey: how well did it go?

Two weeks ago you said you were going to Greece with David & Sally but you were worried about the flight: how well did it go?

Item one says: I was listening. Item two says: I was really paying attention.

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