A patient with personality disorder seemed intelligent to the nurse. He said all the right things to please the nurse but often failed to follow through. One evening he was brought back late from a pass, acutely intoxicated
The nurse seemed dismayed and remarked, "I thought he was making such good progress.". Which phenomena are likely illustrated in the nurse's response? Select all that apply. a. Successful manipulation by the patient
b. Naiveté on the part of the nurse herself
c. Guilt for having supported the patient's pass
d. Failure by the nurse to remain objective
e. An incompletely formed therapeutic relationship
f. Honest disappointment that the patient regressed
A, B, D, F
This patient may have successfully convinced the nurse that he had made more progress than was actually the case. Patients may manipulate staff in this way to get increased privileges or achieve discharge. Inexperienced nurses often have high expectations for the progress of personality disorder patients and fail to appreciate how enduring the patient's behavior patterns have become, and as a result, how likely it is that progress can be incomplete or subject to regression. The nurse may have allowed positive but superficial behaviors or traits in the patient to lead her to overestimate his progress (i.e., she lost objectivity). The nurse might also have been genuinely disappointed; the initial reaction to relapse or continuing acting-out behaviors is often disappointment. The scenario does not provide data supporting a role for guilt or a defective relationship in the nurse's response.
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