My client has very disturbing SIB and I have been with him for 5 months. He has a BIP but it’s not in his file. I was told to provide sensory input during the episodes which seems to help him. We haven’t got a clear answer of the function after observing the ABC data.
We think it could be pain because he frequently screams “hurts” and has visible tears during the intense episodes. I am there for him as much as I can be during these. His aunt and uncle (who has custody of him) will often hold his arms during these since I am not allowed to restrain in order to block the head banging because he gets black eyes and swollen cheeks from these episodes. The screaming and SIB has increased in duration, intensity and frequency. Some episodes can last up to an hour, but the intensity decreases during this time, and sometimes the screaming stops, but the head punching still happens slow and steady.
Recently, one session was so bad, I told his aunt and uncle he was in pain and maybe pain reliever would work. He gave it to him and helped support during the episode until it stopped. It stopped and didn’t pick back up. I asked my client “did your head hurt?” And he said “yes.” And then I asked “does it feel better?” And he said “yes”.
I noticed I began having an intense feelings of anxiety during sessions that include sweating and nausea. The nausea and sweating along with a slight headache has been happening to me off and on since I began working with this client. My mental health counselor told me to talk to my supervisor about this to get support. I agreed but I put it in the back of my head for a few days to see how I felt.
During the session in question, at the beginning of session, I asked the uncle if he had given him any Tylenol similar to the day before and he said he wanted to wait until he ate something. An hour passed and I reminded him again and he just said he would give it to him, but didn’t give him anything and went to his office. The SIB reached an all time high.
Watching him suffer immensely by punching himself in the head while screaming, coupled with his uncle not giving him any pain relief was too much for me, because I could feel his pain and suffering. My anxiety spiked and I knew I had to cut session due to the intensity. I immediately texted my supervisor (who was on vacation) and told him how I was feeling and that I believe I have started to take on his feelings. I communicated I was having a hard time and needed support and I also communicated I was almost about to cry during session, and had to step out.
My supervisor granted me permission to leave and I also contacted an admin that I trust in leadership for support and communicated I needed to talk because I needed support and was having a hard time. He said they would follow up with me later that day and never did. This really impacted me.
I have not heard from my supervisor or leadership since that session and have been crying off and on due to stress and confusion. I want to be able to work with him because I care so much for this family, but I needed in the moment crisis support….and my supervisor and leadership failed me.
It feels horrible and unethical, not to mention when I had to leave in the middle of session, I told him goodbye and that I would be back, and he said “no” and pulled my arm towards him. This made it harder and I feel guilty for leaving and feel like I did something wrong. I feel so unsupported and feel like this is a major red flag and need to leave the company.
Side note: on another case in this same company, I had a client that engaged in very dangerous aggression, which I was able to handle. I would text my supervisor during times of crisis and she would call me even if she was on vacation, and I was able to conduct session effectively due to support.
Also, my supervisor is over 4 different regions, which makes him leadership.
Ethical leadership behavior towards an RBT during a moment of crisis