During a group therapy session, a nurse observes several clients using multiple defense mechanisms.
Which of the following client statements demonstrates the use of maladaptive coping mechanisms?

Choice A rationale:

Providing strategies for redirecting violent behavior is a relevant intervention for individuals with borderline personality disorder, as they may exhibit impulsive and aggressive behaviors. However, it is not the priority in this situation. The immediate focus should be on ensuring the client's safety and preventing self-harm.

Strategies for redirecting violent behavior can be implemented once the client's safety is stabilized. These strategies might include:

De-escalation techniques

Distraction techniques

Time-outs

Setting clear boundaries and expectations

Teaching coping skills for managing anger and frustration Choice B rationale:

Exploring reasons for her behavior is important for understanding the underlying issues that contribute to the client's selfharming behaviors. However, it is not the priority in the initial phase of treatment. The focus should be on ensuring the client's immediate safety and preventing harm.

Once the client is stabilized, exploring the reasons for her behavior can be done through individual therapy, group therapy, or other therapeutic modalities. This exploration can help the client gain insight into her patterns of thinking, feeling, and behaving, and develop healthier coping mechanisms.

Choice C rationale:

Encouraging the client to talk about her feelings is a valuable therapeutic intervention, as it can help the client express and process emotions in a healthy way. However, it is not the priority in the context of borderline personality disorder, where the risk of self-harm is high.

Encouraging emotional expression can be beneficial once the client's safety is ensured and appropriate coping skills are in place. This can be done through individual therapy, journaling, or other expressive arts therapies.

Choice D rationale:

Protecting the client from self-harm behavior is the nurse's priority when working with a client who has borderline personality disorder. This is because individuals with this disorder have a high risk of engaging in self-injurious behaviors, such as cutting, burning, or overdosing on medication.

It is important to implement various safety measures to protect the client, including:

Close observation and monitoring

Removal of potentially harmful objects from the environment

Clear communication of expectations and boundaries

Collaboration with the healthcare team to develop a comprehensive safety plan

Regular assessment of suicide risk

Choice A rationale:

Asking "Why do you believe you are hearing voices?" is not a suitable response because it challenges the client's reality and can make them feel defensive or invalidated. It's important to validate the client's experience and avoid questioning the reality of their hallucinations.

It can also imply that the client is somehow responsible for their hallucinations, which can be stigmatizing and distressing.

It's more helpful to focus on the content of the hallucinations and how they are affecting the client, rather than on the cause of the hallucinations.

Choice B rationale:

Asking "What are the voices instructing you to do?" is a suitable response because it allows the nurse to assess the content of the hallucinations and the potential for harm.

This information can be used to develop a safety plan and to help the client manage their symptoms.

It also demonstrates to the client that the nurse is taking their concerns seriously and is interested in understanding their experience.

Choice C rationale:

Telling the client "You need to comprehend that there are no voices" is not a suitable response because it is dismissive of the client's experience and can make them feel like they are not being heard or understood.

It's important to remember that hallucinations are very real to the person experiencing them, and telling them that they are not real is not helpful.

It can also damage the therapeutic relationship between the nurse and the client.

Choice D rationale:

Asking "Are the voices familiar to you?" is not a suitable initial response because it is not directly relevant to the client's safety or to the assessment of their symptoms.

While it may be helpful to gather information about the nature of the voices at some point, the priority is to assess the potential for harm and to develop a safety plan.