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Samenvatting handvaten voor de klinische praktijk
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aan de slag gaan vanuit een klinisch referentiekader waarbij er gebruik wordt gemaakt van gerichte weloverwogen interventie + 6 vraagstukken
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Handvaten klinische praktijk: Introductie...............................................................................................5Vraagstuk 1: omgaan met ‘moeilijk/lastig/weerstandig’ gedrag............................................................6
Wat is moeilijk gedrag?......................................................................................................................6
Hoe kunnen we moeilijk gedrag beter begrijpen?..............................................................................7
BOKS-BANT metafoor.....................................................................................................................7
BOKS:..........................................................................................................................................8
BANT.........................................................................................................................................10
Vraagstuk 2: omgaan met moeilijke mensen........................................................................................11
Moeilijke mensen.............................................................................................................................11
a) Mensen met kenmerken van een Persoonlijkheidsstoornis.........................................................12
Behandelingsmogelijkheden.........................................................................................................12
Verloop behandeling................................................................................................................13
Doel behandeling......................................................................................................................13
DSM-clusters.................................................................................................................................14
Cluster A: Paranoïde pslh..........................................................................................................14
Cluster B: Antisociale pslh.........................................................................................................16
Cluster B: Theatrale pslh...........................................................................................................17
Cluster B: Narcistische pslh.......................................................................................................19
Cluster B: Borderline pslh.........................................................................................................20
Vraagstuk 3: omgaan met suïcidaliteit in de klinische praktijk.............................................................27
Centrum ter preventie van zelfdoding..............................................................................................27
1. Zelfmoordlijn 1813 (hulpverlening)..........................................................................................27
2. Vormingsdienst.........................................................................................................................27
3. Studiedienst..............................................................................................................................27
Zelfdoding.........................................................................................................................................28
Definitie en woordgebruik............................................................................................................28
Epidemiologie: algemeen.............................................................................................................28
Zelfdoding.................................................................................................................................28
Zelfdodingspoging....................................................................................................................29
Zelfdodingsgedachte.................................................................................................................29
Een verklarend model...................................................................................................................29
Verklaringen- risicofactoren.....................................................................................................30
Beschermende factoren...........................................................................................................30
Verklaringen.............................................................................................................................31
1
, Met andere woorden................................................................................................................31
Anders gezegd..........................................................................................................................31
Het suïcidaal proces..................................................................................................................32
Altijd proberen het onzichtbare zichtbaar te krijgen................................................................32
Signalen van zelfdodings(gedachten)...............................................................................................33
Hoe omgaan met signalen................................................................................................................34
Hoe bespreekbaar maken?.......................................................................................................34
Inschatting ernst en acuutheid.................................................................................................34
Gespreksfasen..........................................................................................................................35
Tips...........................................................................................................................................35
Doorverwijzen: inleiding...........................................................................................................36
Doorverwijzen: hoe?.................................................................................................................36
Doorverwijsinstanties...............................................................................................................36
Vraagstuk 4: hoe omgaan met rouw en verlieservaringen in de klinische praktijk...............................37
Wat is rouw?.....................................................................................................................................37
Rouw is universeel............................................................................................................................37
Rouwmythes.................................................................................................................................38
Soorten verlies..............................................................................................................................38
Theorieën rond rouw....................................................................................................................39
Fasenmodel kubler-ross............................................................................................................39
Takenmodel (William worden) manu keirse............................................................................39
Duale procesmodel (stroebe en schut).....................................................................................40
Maar rouw is ook uniek....................................................................................................................42
Verliesdriekhoek...........................................................................................................................42
Het belang van hechting bij verlies...............................................................................................43
Rouw integratief traject................................................................................................................45
Winsten en verlies........................................................................................................................45
Wanneer is rouw niet meer normaal................................................................................................46
Rouw bij verschillende doelgroepen.................................................................................................48
Rouw bij kinderen en jongeren.....................................................................................................48
Rouw bij ouderen.........................................................................................................................48
Rouw bij mensen met een beperking...........................................................................................48
Wat doet een rouwconsulent?.........................................................................................................49
Vraagstuk 5: omgaan met KOPP...........................................................................................................50
2
, Inleiding............................................................................................................................................50
Uitgangspunt en realiteit..................................................................................................................50
Invloed: negatief...............................................................................................................................50
Invloed: positief................................................................................................................................52
Definitie KOPP..................................................................................................................................52
Wat kan je als ouder nog wel doen?.................................................................................................53
Praten met je kind over je ziekte..................................................................................................53
Zoveel mogelijk je ouderrol opnemen..........................................................................................54
De inzet van je kind erkennen......................................................................................................54
Informatie geven over de behandeling die je krijgt......................................................................55
Indien nodig, je kind onschuldigen...............................................................................................55
Het werkmodel.................................................................................................................................55
Doelstellingen...............................................................................................................................55
Concept........................................................................................................................................56
Het kind informatie krijgt over problemen van de ouder (cfr leeftijd/niveau).........................56
Kind ruimte krijgt om eigen gevoelens te uiten........................................................................56
Kind kind-gerichte activiteiten mag doen/ voldoende ontspanning/ “eigen leven” kan leiden 57
Kind steun heeft van volwassen vertrouwenspersoon.............................................................57
Vraagstuk 6: hoe omgaan met mensen die lijden NAH/neurocognieiteve aandoen, psychose............58
NAH = niet aangaboren hersenletsel................................................................................................58
Het therapeutisch milieu..............................................................................................................58
Ruimte......................................................................................................................................58
Tijd............................................................................................................................................59
Handelen..................................................................................................................................59
Benaderingswijzen tav van zorgvragers met NAH en/of mentale beperking................................59
Waarop letten als hulpverlener................................................................................................60
Hoe dialogeren als hulpverlener...............................................................................................60
Neuropsychologische revalidatie..................................................................................................60
Oplossingsgericht werken.............................................................................................................61
Tip: ga samen met de zorgvrager na.........................................................................................61
Boks-bant (Martin Appelo)...........................................................................................................61
Ondersteuningsmethodiek: hooi op je vork.................................................................................62
2 fase model bij hooi op je vork................................................................................................62
Aanpak bij mensen die een mentale/cognitieve beperking hebben.................................................63
3
, Beschrijving emotionele ontwikkeling 5 fasen.............................................................................63
1. Adaptiefase (0-6 maand).......................................................................................................63
2. Eerste socialisatie (6-18 maanden).......................................................................................64
3. Eerste individuatie (18 maanden – 3 jaar)............................................................................65
4. Identificiatiefase (3-7 jaar)....................................................................................................66
5. Realiteitsbewustwording......................................................................................................67
Aanpak bij iemand die psychotisch is...............................................................................................68
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