The Psychiatrist Player's Handbook

by Guest Tue May 10, 2011 5:01 pm

. The Psychiatrist Player's Handbook .
_________________________________________

This thread is intended for the education and guidance of those who have decided to join the psychiatric team here on STC. Heed ye well the suggestions given here, for they may keep your face off of the end of Bjorgen's shoe.

Before You Apply for a Psychiatrist Position: You should know that it is a lot more work than it appears.

When running a group or individual therapy session, you are expected to know the student characters that are going to be attending. This requires reading applications and even taking notes in some cases. Failure to follow this simple practice most often results in disaster. And disaster results in Bjorgen's foot in your face.

You are expected to know something about the approved issues on the site, and have a loose understanding of what psychiatric practise is, and how to analyse a case. We don't expect you to be a psychiatrist, but we do expect you not to stay in the dark about the issues your psychiatrist is trying to fix in his or her patients. Flying blind is a sure recipe for disaster.

You are expected to be more active than some other staffers might be. You must run individual therapies, and you must make notes on the files of these patients.

You are expected to have good common sense. For example: Don't give DA patients narcotic painkillers. Don't give self-harmers something they can harm themselves with. Don't corner the hysterical, PTSD patient. We'll go more into proper therapist behaviours and protocols later in the handbook.

This job is not for the faint of heart. Psychiatrists are illegally testing drugs on these patients. A professional psychiatrist is a person trained in objectivity, not a subjective and emotional hand-holder, or an easily flustered ball of anger. These people are trained to handle troubled cases and should not be afraid of their patients.

You will be required to roll for new medications for patients. This process involves adding file notes, keeping track of side effects, the rolling itself, and private messaging the player about their side effects.

Something as simple as rolling for medications has a number of steps to it, as you see. As a player, you don't see much of the work that goes on behind the scenes when playing a psychiatrist, but I hope that the above glimpse of some of the things required of the player is enough to give you an idea of how in-depth this character position is. This is not just another staff character. A psychiatrist comes with baggage, and most of it is anal-retentive.

. Things You Should Know .
_________________________________________

Individual Therapy
In recent months it had been the norm to conduct all individual therapies in the individual therapy chat box. This is not the standard practice. All individual therapies should not be conducted in the chat box. For a long time, STC had no therapy chatboxes at all. Individual therapies should be threaded more often. An individual therapy that is threaded boasts a number of advantages over a chatbox session. During a thread, the pause between replies will allow you to consider the character, their issues, and how your psychiatrist reacts to their reactions in more depth. This allows you time to analyse the situation, plan your response, and potentially make more progress with the student than if you have to think up your reply on the spot. Furthermore, with a thread, you have the entire conversation on hand for easy browsing when considering your next course of action. Threading encourages more use of body language in the patient, which can be noted by the psychiatrist. Individual therapy threads also have the advantage of earning you $RP points, and you are not required to reply to the thread instantly, should you be on a time constraint. Certainly they are more time consuming in the long run, but the benefits far outweigh the cons of a half-done job.

File Notes
Notes on the files of any patients that a staff member comes into contact with are mandatory. This is not limited to Psychiatrists, but is especially important in their case. File notes from observant and thoughtful psychiatrists allow players to track the progress -or lack thereof- of any patient. File notes can be long or short, but for a psychiatrist, longer notes are a good way to explore the patient character and think about how to help them. Things to make note of that might otherwise not be obvious include things like body language reactions to subjects and questions. Body language, as mentioned above, is less prevalent in a chatbox environment where a player is not required to reach a word count, but in real life, Psychiatrists rely heavily on these prompts. Other things to note might be alternate analyses of the patient application or their behaviour. If their application suggests they are cripplingly depressed but they do not appear so in a therapy session, a psychiatrist might consider their medication is working, or that another issue is at play. Lines of discussion and reaction should be added to notes, and will give the psychiatrist's player a reference for future sessions and what topics they want to come back to and make more progress in. It is easy to cut corners, but that is not what STC is all about. We're a highly structured game atmosphere with very carefully thought-out rules and construction. What keeps us unique is the player's devotion to upholding that standard in gameplay too.

Common Sense
Everyone knows what common sense is, but not everyone naturally has it. There is no real way to give a clear, step-by-step guide to someone on how to practice common sense when playing a psychiatrist. I can only provide examples and again note that threaded therapy sessions allow much more room for careful consideration before action. Common sense, in our case, is made up of many parts: Knowing the patient, knowing about their issues, learning from experience, and learning from others. Knowing the patient is the largest step to making sure silly mistakes don't happen. This is why reading patient applications before bringing them into a group or individual therapy session is so important. A patient prone to harming his or herself should not be given items which may facilitate this, and a player should know their behavioural tendencies from their application. Likewise, drug seeking patients should be very carefully scrutinised before being given non-psychiatric medications of any kind. Volatile or fragile patients should not be cornered or pressured if they have a history of hysterical outbursts or phobic reactions, etc. Common sense is easy to assume, but when one makes a silly mistake and looks back on it, they will note that it is not always easy to utilise. Be aware. Know your patients.

Research - Fact vs. Assumption
The internet is a wonderful resource for researching psychiatric conditions, and should be utilised if need be. The summaries of our allowed issues on the allowed issues page do not really cover the full scope of many of the diagnoses. It's always advantageous to be ahead of the game and know your stuff before going into a therapy session. This will also give you, as a player, the chance to observe the patient character and gauge whether they are actually playing true to the issues they chose for their character, or whether they are winging it and going on character whims. Unfortunately, the latter scenario does happen often, and it proves a challenge for those playing psychiatrists, particularly if they have taken the time to verse themselves on what they need to know. It can be frustrating when a character does not fit the person laid out during application, but fret not. If you see this behaviour happening in a character, inform a member of staff who will mediate the situation and find a resolution. Outside of this scenario, the more you know, the better prepared you are, and it's really not a chore when you're doing it for a fun game.

The Unfixable Character
Otherwise known as the obstinate player, or the Mary Sue character. From time to time you will most likely come across a character that 'cannot be fixed.' This can be intensely frustrating for you, as a player. Psychiatric tactics that prove effective in real life are ignored by the character's player in favour of maintaining the status quo of their character, or proving their character to be more resilient or indestructible. A character that is unable to be changed or affected by their environment is a Mary Sue character. As with characters that are not played close to the issues they were admitted with, help is available to you through our moderator team. Contact an admin or a moderator and apprise them of the situation. The staff member will then help mediate the situation. Mary Sue characters are against the rules of STC, and you do not have to suffer through pointless individual therapy sessions that will go nowhere. Know the rules and know your rights, and save yourself a heap of aggravation.

Basic Psychiatric Understanding
As mentioned above, we do not expect players to be psychiatrists. Doing your research and reading patient files is a large step on the path to having some basic psychiatric understanding. A psychiatrist staff position is not like playing an orderly or any other position. The psychiatrist's job is not to entertain, enable or otherwise coddle their patients. Keep clear in your mind that a psychiatrist's goal is to fix the patient. Encouraging damaging behaviours for fear of upsetting the patient is poor practice and will undoubtedly earn you scorn from the head of psychiatry. Common sense has a lot to do with this too, and I will go into more depth on this subject in the section below, about psychiatrist conduct during sessions, and the dos and don'ts that are fundamental to most professionals in the mental health fields.

Treatment
On top of medication and psychotherapy, St. Christina's is equipped with specialised treatment rooms, located in the main building. Common psychiatric treatments might include such things as Electro-Convulsive Therapy, Aversion Therapy, Immersion Therapy and more. Before you delve into the realm of treatment, however, research is especially important. There are many myths and horror stories surrounding psychiatric treatments that are simply not true in the modern era. ECT, for example, is not used on troublesome, schizophrenic patients any more, but has been proven an effective temporary treatment for clinical depression that does not respond to medication. Aversion Therapy is the process of of essentially training a patient's mind to associate an undesirable behaviour with an unpleasant result. We use aversion therapy on children every day, from discouraging nail biting with bitters nail painting, to sending them to a time out corner. Immersion therapy is used for such things as phobias and anxiety, and employs the method of gradually introducing a patient to a previously feared situation or object in order to teach them that said object or situation will not harm them or cause negative consequences of any kind. There are many forms of treatment out there, some archaic and barbaric, and some effective. Whatever you choose, do your research.

. Bjorgen's Psychiatry 101 .
_________________________________________
How to Be a Psychiatrist and not a Victim.
The Psychiatrist Player's Handbook Threadse

((It is a commonly held truth that amongst the ranks of the human race, people will try to take advantage of other people. This is especially true in a game, where often-times the point is to win. People get satisfaction from winning in competitive instances, and STC is no exception from the rule. Below is Bjorgen's guide to being a psychiatrist instead of a victim or an agony-aunt. This little guide is relevant in in group therapy, individual therapy and all other instances where you find yourself with a patient.))

The First Rule of Psychiatry: Objectivity
Remember this above all else: Psychiatric patients are psychiatric patients. Yes, some patients are obstinate pains in the backside, and require a heavier hand from time to time. However, they are troubled persons. They are in a psychiatric institution. It is in their nature to be obstinate, or otherwise troubled. A good psychiatrist will keep this in mind and always display a level of objectivity when viewing any of the patient's actions or inactions. A good psychiatrist will understand that personal insults are little more than words, and will slough them off as rain from a duck's back. A good psychiatrist is an adult in all things, and refrains from being flustered by a psychiatric patient, and does not resort to name calling, insults, or defamation of their patients. A good psychiatrist also does not become emotionally invested in their patients. Emotional investment clouds objectivity, reason and logic, and leads to enabling behaviours, coddling, and a lack of progress in the patients under his or her care. Objectivity grants us the ability to see a situation from all possible angles and thus reason what may be right or wrong. So, please be objective. Do not be the victim, do not be the agony aunt. Be what your doctorate claims you to be. Be a professional, rational adult. The patients are not the enemy, and you are paid to do this job.

Avoiding Danger and Chaos
This point pertains mostly to group therapy sessions, though it is equally applicable to individual therapy sessions at times. The most important factor in avoiding a chaotic situation is vigilance. Know your patients well, and pay attention to the whole room and everyone in it. Watch everyone, look for cues that could precede disruptive behaviour, and enforce St. Christina's rules. Intimate physical contact with other patients is not allowed, and can often lead to disruption of an otherwise quiet group. Talking over others, making side comments, or talking out of topic is another common cause for disruption. If a topic starts to veer off course or a person displays attention seeking behaviour by talking over people, try to focus the group's attention back on the subject at hand and do not play into the attention seeking behaviour by engaging in argument with the disruptive individual. Most often, ignoring the behaviour and encouraging others to do so too will derail the potential for chaos, and group stability may be regained.

I caution you all against making life easier for yourself by simply sending troublemakers out of the room. Unless rational and adult reactions to the situation do not rectify it, a patient should never be excluded from these group therapy sessions. These are patients, not an inconveniences to you and your schedule. Often, attention seeking behaviour is just that, and by sending a patient away, we only exacerbate the situation and push them to seek more attention in the future. Keep the group structure, stay on topic, don't allow it to wander, and stay vigilant.

A Good Psychiatrist vs. A Bad Psychiatrist
These are the basic things we should all have learned in schooling, but let's go over a list of dos and don'ts for all sessions and interactions with patients.

A Good psychiatrist:

Is confident
Knows their patients
Is aware of their surroundings
Is objective
Is assertive
Is fair
Can think outside of the box
Is calm
Is professional
Is rational
Is not afraid to ask for a second opinion
Is not afraid to ask for help
Continues their psychiatric research and training
Has a positive outlook for their patients
Treats all of their patients with the same respect and care, regardless of temperament
Listens more than they talk

A Bad Psychiatrist:

Is easily flustered
Takes things personally
Is more interested in making friends with patients than actually helping them
Allows established, damaging behaviours to continue
Is too emotionally invested in their patients
Is easily insulted and upset
Is cruel
Is self serving, and is only attentive to the cases that are convenient to them
Is disorganised
Is narrow-minded
Does not know their patients, or read their files.
Cuts corners
Does not believe their patients can be fixed
Engages in childish back-and-forths
Cannot take constructive criticism
Cannot ask for help
Shows favouritism
Neglects more complicated and difficult cases
Talks more than they listen

From this concise list, we should be able to extrapolate that a good psychiatrist is an individual who is confident in his or herself, is attentive, thoughtful, objective, and professional. This individual is here to do a job and will attempt to do it to the best of his or her ability. The individual does not cut corners to make life easier for his or herself, and does not become emotionally invested to the point of favouritism and resulting neglect of less favourable cases. A Good Psychiatrist is a psychiatrist who belongs at St. Christina's. A Bad Psychiatrist is a psychiatrist who will not stay amidst our ranks for very long. So I bid you all to remember all that has been discussed here, and I extend to you wishes of only the very best of luck in all of your cases here, at the St. Christina Psychiatric Rehabilitation Center.

Sincerely,
Dr. Gunner Bjorgen, MD PsyD

. Patient Protocol .
_________________________________________
Or: "Help! What do I do with This Patient?"

KNOW YOUR PATIENTS. I repeat, KNOW YOUR PATIENTS! It is the sure way to avoid most chaotic situations.

We are not psychiatrists. Many of us have never been anywhere near a psychiatric institution. Some of us can barely stand a screaming kid in a supermarket aisle, let alone know how to handle a hysterical or problem psychiatric patient. This is where that good old Common Sense comes in handy. Failing that, here's a basic guideline of what to do in some situations, in order not to exacerbate them or have the situation dissolve into unbridled chaos. Naturally, these are my own opinions, and yours may differ. It is down to your judgement and knowledge of the characters you're dealing with, as to what you will do in a situation. Here's some suggestions:

The Hysterics:
Some of our patients suffer from Post Traumatic Stress Disorder, from various events in their lives, or from phobias, anxieties, or other afflictions that will cause them to exhibit fearful and hysterical reactions to situations. The basic rule of thumb here is: Remain Calm. Joining the hysterics or panicking will only worsen the situation. Gauge the patient and their history. If you think it is safe to proceed, approach them calmly and try to talk rationally to them about some topic that might distract or calm them. If they are prone to violence when cornered, or are fearful of you or others, Do Not Crowd Them or Manhandle Them. If you do not know the patient and have not read the file, you're on your own here. If your lack of attention to detail causes chaos, there is very high likelihood of In Character repercussions from Bjorgen, and to those of you who have not experienced these, they're not pretty and can result in a loss of your character.

The Attention Seekers:
The very worst thing you can do when dealing with an attention seeker is to give them what they want. Remember, negative attention is still attention. Loud-mouthed patients who disrupt group activities are often looking for a rise out of either the psychiatrist or the other patients. As Bjorgen outlined, the best way to deal with this is to ignore it and entice the group to do so as well. Stay on topic and try to focus the group on someone or something else. Ask someone else a question and ask other members of the group if they have opinions on it. If the group is engaging the attention seeker and arguing with them, address those members directly and ask them questions that are back on topic. Attempt to distract them and put the attention back on the group, not the disruption. Most attention seekers will settle down when they realise they cannot get a rise out of anyone.

The Violent Ones:
Violence comes in many shapes and sizes, psychologically speaking. Outwardly it might be biting, kicking, scratching or threatening. Psychologically, it can have many triggers, from either just obstinate attention seeking behaviour, to defensive reactions and fear. Violence in a group session can be very unsettling for everyone involved, especially the person running the group. It can be easy to run to the hypodermic needle and just sedate them, but remember: This Is Not Standard Protocol. Bjorgen is very hypo-happy, but he was never intended to be the norm. The first course of action should be some attempt at distraction or diffusion. Try to talk them down. Secondly, separation. If the violent patient is attacking another, attempt to remove the patient who is being attacked from the situation. In some cases this can cause the violent reaction to burn out, without directly having to engage the one experiencing it. Thirdly: Physical interception. This does not mean you should punch the violent student in the face. You should attempt to restrain them, or call for orderlies or security to do it for you. In this situation, getting the patient to the floor where they can be more easily restrained is a good course of action. The best scenario would be to pin them on their stomachs with hands restrained until help can arrive. After this, a short spell in isolation and a dedicated therapy session with their primary therapist is necessary.

Only when all else fails should you resort to the use of chemical restraints, otherwise known as sedatives.

The Withdrawn or Silent
I favour a gentle approach in these situations. For the socially withdrawn and quiet, trust is often a very large factor in deciding whether the patient will communicate with the therapist or not. Start out light. If they don't wish to talk, try engaging them in light activities that force you both to spend time together, such as an art project or going for regular walks together. And above all, be patient (no pun intended). Trust can take a long time to earn from those who have been traumatised or scorned. Stick with it and continue to use gentle encouragement.

The Psychiatrist's Enemies
Many students at St. Christina's view therapists as the enemy. They view them as oppressors, and seek to rebel against the system by being obstinate, insulting, or deceptive. A good approach to this is, rather than trying to get therapeutic answers from them while they distrust you, is to address this issue head-on, but gently. Try asking them why they don't wish to talk. Listen to what they have to say and consider it carefully. Often-times, students will say it is because no-one they have talked to before has helped them. From here you can discuss previous experiences with other psychiatrists and try to reach some understanding of where you -both- want to go with these therapy sessions. Then again, sometimes these students will simply remain obstinate and offensive. Try to find some common ground. Remember, talking about nothing is better than not talking at all, and you may find that some banter on a favourite subject of the patient's might bolster some trust. Deep down, most human beings inevitably want someone to understand them, even if they do not express it on the outside. It is the psychiatrists job to have patience and not become discouraged. If at first you don't succeed, try, try again.

. Closing Words .
_________________________________________

In closing, I'd like to remind you, the players of our fine psychiatric team, that you are not alone. Both in character and out of character, you have other players on whom you may rely. If you're not sure what to do with a case or a situation, ask around for some other opinions, or send your character to get a second opinion, or even a third, from the other members of staff. If you're feeling frazzled in a group therapy session, you can call for orderlies or security if you need to, or radio for another doctor to join you if they are available. I know that group therapy sessions can be unnerving for many players as the potential for chaos and disruption is high, and we tend to blame ourselves when a group does not go well. But remember, players, it's all for the fun of it, both in character and out. We all have bad sessions and we all have good sessions. Don't be discouraged, and don't be afraid to ask for help.

For the GT-nervous players amongst us, I'm willing to offer my services as Gunner Bjorgen to co-host some group sessions and ease you into the swing of things, should I be around at the time, and this goes for all staff characters, not just psychiatrists. You are not alone. You're part of a team of staff. Use that team if you have to. Don't sweat the little stuff, don't get discouraged, and if it all feels like too much, just remember this: It's just a game. There are no enemies here.

I hope that this guide will help all of you -not just psychiatrists- to help St. Christina's run more smoothly, and I hope that it has been informative enough to you. If you have any further questions or would like suggestions on some case or topic, you may contact me directly through PM or the chat box, or contact another member of the psychiatric staff.

Sincerely,
Admin Ghost & Dr. Gunner Bjorgen