A nurse is counseling a client for the management of anxiety.
The client is consistently late for appointments and ignores household chores. The client states, "I'm just too stressed.
I need someone to take care of me." The nurse identifies this behavior as an example of which of the following defense mechanisms?

Rationale:

Choice A: Avoid discussing past behaviors with the client is incorrect. While avoiding dwelling on the past is important, discussing past manipulative behaviors in a safe and therapeutic environment can help the client gain insight into their patterns and triggers. This awareness is crucial for developing future coping mechanisms and preventing further manipulation.

Choice C: Allow manipulation so as to not raise the client's anxiety is incorrect. Allowing manipulation reinforces the behavior and undermines the client's well-being. It also sets a dangerous precedent for interactions with others.

While addressing anxiety is important, it should not be at the cost of condoning manipulation.

Choice D: Bargain with the client to discourage manipulative behavior is incorrect. Bargaining implies making concessions in exchange for the client stopping their manipulation. This approach can be ineffective and even reinforce the manipulative behavior as the client learns to negotiate for desired outcomes. Instead, clear boundaries and consistent consequences are more effective in addressing manipulation.

Rationale for Choice B:

Instituting consequences for manipulative behavior provides a clear and consistent response to the client's actions. This can help to limit the behavior and encourage the client to develop alternative coping mechanisms.

Consequences should be:

Fair and proportional: The consequence should be related to the specific manipulative behavior and not be overly harsh or punitive.

Consistent: The same consequence should be applied each time the manipulative behavior occurs. This predictability helps the client understand the cause-and-effect relationship between their actions and the consequences.

Enforceable: The consequence should be something that can be realistically implemented and followed through on. While implementing consequences, it's important to:

Maintain a therapeutic relationship: Address the behavior in a calm and professional manner, focusing on the behavior itself and not personal attacks.

Communicate clearly: Explain the consequences to the client in advance and ensure they understand the connection between their actions and the outcome.

Provide alternative coping mechanisms: Offer the client support and guidance in developing healthier ways to express their needs and manage their emotions.

By setting clear boundaries and consistently implementing consequences, nurses can help clients with manipulative behaviors learn to interact in a more positive and productive way. This ultimately benefits the client, their relationships, and their overall well-being.

Choice A rationale: Refusal of medication due to paranoia is not typically associated with conversion disorder. Paranoia is more commonly seen in disorders such as schizophrenia or paranoid personality disorder.

Choice B rationale: Preoccupation with manifestations of various illnesses is a characteristic of somatic symptom disorder, not conversion disorder. In somatic symptom disorder, individuals are excessively worried about having a serious illness, despite having no or only mild symptoms.

Choice C rationale: Frequent manic episodes are a hallmark of bipolar disorder, not conversion disorder. Manic episodes involve periods of extreme high energy or mood.

Choice D rationale: Conversion disorder, also known as functional neurological symptom disorder, is characterized by the presence of neurological symptoms, such as the loss of a sensory or motor function, that cannot be explained by medical evaluation. Symptoms can include seizures, weakness or paralysis, or reduced input from one or more senses. Therefore, an involuntary loss of a sensory function or a motor function with no underlying neurologic pathology is an expected finding in a client diagnosed with conversion disorder.