Vocational Implications of Psychiatric Disabilities: Introduction by NllWeY

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									 Vocational Implications of
  Psychiatric Disabilities:
Introduction to Personality
        Disorders
    David R. Strauser, Ph.D., CRC
         University of Illinois
         strauser@uiuc.edu
           Work Foundations
• Changing nature of work
  – Macro level factors
    • How work is performed
    • Increased cognitive and interpersonal factors


  – Impact on individuals with psychiatric
    disabilities
    • Hard to meet the changing demands of work
Problems with work behavior
–   Conflicts with authority
–   Problems with co-workers
–   Poor work quality
–   Inability to modify behavior to meet
    standards and increase productivity
–   Inability to create effective boundaries
    between work and non-work issues
Conceptualizing Problems at Work
• Occupational Adjustments

• Performance Adjustments

• Personal and Social Adjustments

• Work Adjustment
      Occupational Adjustments
• Following work rules   • Interacting with
• Relating with co-        Supervisor
  workers                • Dealing with work
• Dealing with public      stress
• Using Judgment         • Functioning
                           independently
                         • Maintaining attention
                           and concentration
      Performance Adjustments

• Complex Job Instructions

• Detailed Job Instructions

• Simple Job Instructions
 Personal and Social Adjustments
• Maintaining Personal Appearance

• Emotional Stability

• Predictable in Social Situations.

• Demonstrate reliability
           Work Adjustment
• Work 8 hours per day

• Work 5 days per week

• Work without excessive breaks

• Maintain regular attendance
         Personality Disorders
• Definition- an enduring pattern of inner
  experience and behavior that deviates
  markedly from the expectations of an
  individual’s culture, (that) is pervasive and
  inflexible, has an onset in adolescence or
  early childhood, and is stable over time,
  and leads to distress or impairment.
    Four areas of problematic
functioning (Personality Disorders)
 –       Typically, individuals with personality disorders
         have problems in the following areas:
     •     Expressive acts


     •     Interpersonal conduct


     •     Cognitive style


     •     Regulatory mechanisms
     Cluster A- The Odd Cluster
• Paranoid

• Schizoid

• Schizotypal
    Paranoid Personality Disorder
• What is like-
   – Misinterpretation of interpersonal situations

   – Hostile and aloof

   – Blaming and vindictive

   – Overtly rationale

   – Litigious
   Paranoid Personality Disorder
• Effect on Work
  – Profound interpersonal tensions

  – Difficult to supervise

  – Difficult to work with

  – Workplace danger
        Vocational Strategies
• To optimize success
  – Work alone
  – Interactions conducted in a direct,
    straightforward manner
  – Include in decisions that impact them directly
  – To have an emphasis placed on specific tasks
  – Emphasis on strengths, abilities, and work
    well done
  – Good relationship with the supervisor from the
    rehabilitation professional
  Cluster B-The Dramatic Cluster
• Anti-Social

• Borderline

• Histrionic

• Narcissistic
         Borderline Personality
• What is it like-
  – Instability in relationships, sense of self-and
    mood
  – Lack of empathy and remorse
  – Impulsivity, irresponsibility, unreliability
  – Inappropriate expression of anger
  – Self-Destructive
  – Fear of abandonment, hypersensitivity to
    rejection
        Borderline Personality
• Effect on Work
  – Tense, unstable relationships

  – Frequent changes in career and training plans

  – Poor stress tolerance

  – Workplace danger
        Borderline Personality
• Workplace strategies
  – Strong support for vocational strengths
  – Flexible scheduling
  – Clearly spelled out behavioral expectations
  – Firm supervision
  – Direct and straightforward approach
  – Social support within and outside
  – Good communication from provider
         Anti-Social Personality
• What is it like?
  – Disregard for rules, norms and laws
  – Frequent alcohol and drug use
  – Lack of empathy and remorse
  – Impulsivity, irresponsibility, and unreliability
  – Physical and verbal aggression
  – Poor relationships with authority figures
   Antisocial Personality Disorder
• Effect on Work
  – Superficial, troubled relationships with
    supervisors and co-workers
  – Easily bored, poor judgment
  – Danger in the workplace
  – Can be charming and persuasive
   Antisocial Personality Disorder
• Vocational Strategies
  – Close supervision
  – Frequent reminders about limits
  – Very little flexibility
  – Extended periods of monitoring
  – Monitor drug and alcohol use
  – Outdoor and fast paced work
  Cluster C- The Anxious Cluster
• Avoidant

• Dependent

• Obsessive-Compulsive
  Passive Aggressive Personality
• What is it like?
  – Negative attitudes

  – Passive resistance to reasonable demands by
    others

  – Excessive complaining about and criticism of
    authority figures
  Passive-Aggressive Personality
            Disorder
• What is it like at work
  – Obstructs efforts of others

  – Impedes work completion

  – Argumentative with supervisors

  – Chronic Complaining
  Passive-Aggressive Personality
            Disorder
• Vocational Strategies
  – Flexible scheduling
  – Opportunity to work mostly alone
  – If possible, tie compensation to work
    performance
  – Close supervision
  – Clear work objectives
  – Immediate and consistent consequences
        Intervention Approach


• Working Alliance
  – Goals

  – Bonds

  – Tasks
                   Bonds
• 1st step- develop a good structured
  relationship with the consumer
  – Value
  – Listen
  – Respect
  – Expectations
                    Goals
• Three level of goals
    – Immediate
    – Short-term
    – Long-term
•   Must have all three
•   Clear to both parties
•   Easily measurable
•   Easy to understand
                   Tasks
• Action steps-brings goals to life
  – What is going to be done
  – Who is going to do what
  – Clear expectations of consumer
  – Clear expectations of counselor
  – Constant evaluation
  – Expect results
              Conclusions
• Summary

• Questions

								
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