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Dealing with Problem Work Behaviors in Long-Term Care

Published May 13, 2008 12:17 PM by Brian Garavaglia
In the previous article, Problem Personalities can Lead to Workplace Turmoil, a few major personalities and their resultant issues were examined. This paper looks at personality problems, their behaviors, and how to address these issues in long-term care environments. However, before moving forth with this discussion, it must be stated that there are no full-proof ways that always work in addressing individuals with these problems. Yet, there are some major approaches or rules of thumb that can be used to deal with individuals that present these problems in the workplace environment.   

In the previous article the passive-aggressive personality was mentioned as individuals that often engage in passive activities such as tardiness, lateness, procrastination, and obstructive efforts that are very disruptive to the workplace. What is interesting is that these individuals often enjoy the frustrating reactions that they provoke in others.  These individuals will frequently manifest these types of negative and obstructive aggressive activities very early after being hired. However, because of the insidious nature of their aggressive behavior, failing to demonstrate the overt features of many forms of aggression, many individuals fail to pick up on the destructive nature of this type of behavior until it is too late.       

Essentially, being aware of how aggression can manifest itself on a passive-aggressive level can be instrumental in ridding the workplace of individuals with these types of traits before they become part of the entrenched working environment. Since many long-term care environments are unionized and membership often is solidified after 90 days, picking up on these individuals early and weeding them out of the environment is imperative.

Furthermore, as was stated, these individuals often thrive on the response that they provoke in others. The reactivity from others that they achieve from their passive and obstructive aggressive activities feeds their personality needs. Although it is easier said then done, failing to be reactive, and failing to be taken into their manipulative web of passive aggressive tendencies often thwarts what they lust for most, the frustrating and over-reactive response from those that they aggress towards in a passive manner.  Therefore, being firm yet non-reactive, will often help to address the concerns that this type of personality poses.                 

The narcissistic personality, often coming off with an over-inflated sense of self-importance, has a very fragile ego that often attempts to avoid any type of issue or event that may challenge their sense of self-worth. Their grandiose sense of self and exalted since of entitlement makes them an utterly individualized entity of pomposity. Here again, they are destructive to the larger team environment. They need to be reigned in quickly and their behavior addressed. 

However, in addressing these individuals, it becomes imperative to not become overly confrontational. When this happens their delicate sense of self becomes insulted to the point that they lead a counter-attack against the person that is confronting them.  They fail to listen to anything that is constructive and react to the apparent threat that is posed to their fragile sense of self. Therefore, addressing their behavior aggressively and confrontationally will only lead to a lose-lose conflict, leading to nothing productive for either party.     

The paranoid personality is the third personality type that was mentioned in the previous paper and will again be addressed here. Their widespread suspicion of others, and their lack of trust make them a formidable challenge. Their maladaptive suspicious nature makes them feel that they are always needing to be on the defensive for fear that someone may unduly threaten them in a myriad of ways. Their lack of trust in their environment makes them react with accusations against others that may range from racism or sexism, to harassment or imputed violent accusations. Please do not mistake or misconstrue these statements.

I am not saying that all individuals that make these accusations as such have a paranoid personality. However, those with a paranoid personality will often assert these accusations when no firm reality basis for their existence. They engage in an autoplastic adaptation, which means that to deal with these perceived psychical threats they alter their perceptions to fit their ill-conceived mental constructs.

In dealing with the paranoid personality, one has to avoid engaging in a confrontational battle of trust. Since lack of trust and suspicion are the catalyst for their worldview, it becomes difficult, if not impossible, to make them the trusting team player that you need for success in your long-term care environment. It is often a terrible reality, but these individuals are often a highly litigious threat.  They are just a slight push or pull away from filing suit over some issue. They need to be closely monitored and all your "i"s need to be dotted and your "t"s crossed in dealing with them. This is not to say that all individuals that present themselves in your organization with this type of personality will inevitably lead your facility to court. However, depending upon the level of their personality issues, the probability for such behavior does deserve watching and may even entail the need for frequent legal counsel to help address many situations that they will bring to your attention.         

It becomes apparent that there are some very interesting, yet challenging, personalities that can wreak havoc on the long-term care environment. This paper reexamined three personalities from the pervious paper, but it looked at some further consequences as well as brief strategies of intervention that can be used to address these personality issues.  However, this brief article far and away fails to provide a voluminous array of interventions that can be used. The topic and its complexity fails to lend itself to a complete discussion in the limited space available for this article. That being said, the reader should still be able to come away with a general knowledge and some rudimentary skills that can better enhance their ability to deal with these problem individuals as they arise in their long-term care environments. It is my hope that the reader will come away with a better understanding of individuals with passive-aggressive, narcissistic, and paranoid personality traits, as well as how to address these individuals and the many challenges they may present in long-term care settings.      

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About this Blog


    Brian Garavaglia, PhD
    Occupation: Long-term care administrator
    Setting: Sterling Heights, Mich.
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