Make the Mental Health Triangle Work for You while you Rejuvenate, Innovate, and Collaborate

1. Make the Mental Health Triangle Work for You(while you Rejuvenate, Innovate, and Collaborate) Dan Baker, Ph.D. Department of Pediatrics Boggs Center on Developmental Disabilities Robert Wood Johnson Medical School � UMDNJ dan.baker@umdnj.edu

2. An Introduction I lived in Oregon from 1992-2003, and worked at the Oregon Rehabilitation Association from 2000-2003 What helps us to rejuvenate? Let�s start with a trivia contest!

3. How is this relevant? Supporting the employment for people is not easy. Our society still discriminates against people with disabilities. Arranging the right constellation of resources is not easy � sometimes we can not provide what people want Some of the people we support can be difficult

4. How do you think Oprah felt?

5. The Mental Health Triangle Sometimes called the Karpman Triangle It was developed from work with people with mental health disorders, but I see it as being useful with a huge variety of people who have immature patterns of interaction It is a helpful management tool as well

6. Is it always right? No, but it helps us understand why people act the way they do You may see it as having more than 3 sides � I see a few other patterns, but these happen over and over again

7. The Triangle Victim

8. What Might You See? A person with an immature pattern will treat you as one of those three �actors, � almost as if you are a cardboard cutout. The person can roll between those three at any pace Sometimes if one does not work, the person will try the next

9. An Example You won�t pay for that service? Aw c�mon Dan � you are the only one who likes me here. You know that you always help me out (rescuer). No, well then I hate you too! I�m gonna get you. I�m going to fine a grievance with the CAP (victim) No, why do you hate me so much. Everyone wants me to die (persecutor)

10. How to tell an Unhealthy Interaction 1. I�m being worked. Something smells rotten. 2. Rapid changes in patterns of interaction. What�s going on here? He was just being nice a few minutes ago� 3. Feeling confused. Why is she doing that? 4. Story changes. But I thought that you wanted me to�

11. Common Mistakes Provide inappropriate reassurance. Don�t worry, of course we can� Get sucked into the drama. So the job coach said what? My feelings are hurt. I thought we connected. I feel special. No other VR Counselor has the rapport that I do or can work with you.

12. Basic Rules in Healthy Interactions 1. Be an individual. I�m Dan and here are some things about me.� 2. Be positive and fun 3. Model healthy responses to things. I�m mad, so I will� This morning I was stressed, so I� 4. Follow the rules of your role.

13. Basic Rules in Unhealthy Interactions 1. No emotion 2. Know your role and follow your rules. The DVRS Policy is to� 3. Use the �higher powers.� The Rehab Act says� 4. Use only natural consequences and explain them

14. The Rescuer Don�t let yourself be the rescuer, even if it feels good in the short run. It will only cause more and more problems over time, and eventually, you will not be the rescuer. Step back into your role. We like to be the rescuer. Sometimes it is ok�

15. An Example You are the only one who understands me. No, I am just a DVRS counselor (or other). My job is to assist you in finding employment, and there are plenty of other people who work with you, too Everyone else hates me here. No, everyone else is concerned about you. You can let me do what I want. It is ok. No, if I do, I�ll be fired.

16. Oh come on, please� Don�t you want to see a montage about New Jersey? I know you do! Aww � just say yes, ok. It will just take a minute. Hard to resist huh?

17. The Victim Don�t get into struggles and don�t let yourself be picked on, but don�t bully either. Place reasonable and firm limits without being the �Persecutor.� Clarify roles. If a person poses a threat, rely on DVRS�s safety plans

18. Some cultures fit into the triangle

19. An Example I�ll get you fired. You have been told how to file a grievance. I�ll get you! I hate you! You are a $&#*% Refer to DVRS�s safety plan Any threat of violence Refer to DVRS�s plan

20. The Persecutor Be clear to follow the same rules as everyone else. Remind people of natural consequences and be clear that if the person makes a choice that results in some form of consequence, it is the person�s choice and the person�s actions, and not yours.

21. And some jobs shape you�

22. Not to be partisan

23. An Example You hate me! No, I�m following the rules. Then you want me to die. The rule here in regards to paying for services is� You are doing that to get me! The world is out to get me. No, the employer did not give you the job because you discussed %&#$* in the interview. Why didn�t my former employer say I was good? I don�t know. What happened at the end of your employment there.

24. Let�s watch a video to illustrate this Look for how the two different characters use all three roles.

25. How to Get Past This� Be patient This will teach maturity Know your weak points with this. I have trouble with people seeing me as the persecutor�

26. More Resources Getting to Yes: Negotiating Agreement without Giving In. Fischer & Ury, 1981 Gandhi�s Way: A Handbook of Conflict Resolution. Juergensmeyer, 2005 http://www.mental-health-today.com/articles/drama.htm http://www.coachingsupervisionacademy.com/our_approach/karpman_drama_triangle.phtml