Rivalries among case-aides are not overt rivalries. Nobody hates anybody in the groups. What does sometimes happen is that the roles of the day leader and the professional advisor have to be clarified between them. They have to work together so that the advisor doesn't feel usurped by the day leader and the day leader doesn't feel put down or put himself down to the supervisor. If not, the group will split and form loyalties. This is where professionalism comes in--here, and in answering questions like "What is the effect of electroshock?" or "What does this drug do?" or "I want to get my patient out; who should I contact?"
If the day leader and the supervisor get together frequently enough, the group will cohere. If there is any competition among group members, it spurs them to try different ways of helping their patients. Problems do come up when one member tries to dominate the group by endlessly bringing up his patient.
Other problems come up when one member unknowingly tries to turn the session into group therapy by saying that the supervisor is lousy or that the day leader isn't doing his job or that the whole philosophy of the group is wrong--raising the anxiety of the group in order to get attention for himself. At that point, rather delicate handling of the situation is needed to keep it from becoming group therapy, or to keep the one from being clobbered by the rest of the group.
Brute Honesty
No formal ethic evolves, but of course you do not lie to patients, you do keep your problems, you do keep your appointments. Furthermore, since patients are very sensitive to their own feelings--not so much to yours--they do not necessarily respond to your wishes but they do sense immediately whether you are telling the truth and whether you are afraid. If they feel this, they immediately withdraw.
On the other hand, brute honesty is not particularly indicated; this is not an Ibsen's Wild Duck situation. You listen to something and you try to respond more or less the way you feel, within the bounds of judgment. You don't tell the patient, "We won't talk about that because I'm scared." What you might say is, "That's kind of a frightening idea." He may be frightened of it too.
One girl we had finally learned to say no. She couldn't stand to hurt anybody's feelings, but the patient kept asking to kiss her and she spent almost a whole year just learning to say no. For her to learn that was a very important part of her growing up.
Sex has not been any problem in any of the groups I've had, because it's very simple--you handle it matter-of-factly. The patients are not that intersted in sex, anyway. It's not the issue. The issue is fear, and terror, and sickness, and trembling unto death, a la Kierkegaard.
Patients are very much like children sometimes. They sense things without understanding them. They are sometimes frightened of what they sense, so it is occasionally appropriate for the case-aide to be aware of what he is feeling so he can explain something about the topic or problem in a way that the patient can understand too.
"WHEN AM I going to get out of here?" Possible answers: "Ask your doctor." "Do you want to get out of here?" "When do you think you're going to get out?" "You'll get out of here just as soon as you show them that you aren't going to go around hitting people." "You get off the bottle." "You can get out of here any time you want to, but you have to have a job first."
Honesty is basic, but you can only be honest about what you know about yourself. You cannot equate honesty with brutality. In Hannah Green's book, the doctor was not brutal with the child. She did finally say, "I never promised you a rose garden." But it was only whenthe patient was ready to hear it, and had discovered that the world wasn't going to be a rose garden.
I discourage the reading of any records until after they've known the patient for at least six months. When finally they see the records, inevitably they say the record doesn't help one bit. Actually, the record is very useful to a professional, but for accomplishing what you're trying to accomplish as a case-aide, the record may be useful for finding out that the patient doesn't really have a sister, or didn't really kill his child, or has in fact held good jobs, but what is the good of knowing about the truth of a sibling when the patient was a year old? To a professional it may be helpful, but for working with the patient or getting him out of the hospital, it isn't very helpful.
I THINK the voyeurism you originally asked me about comes in in wanting to see the record, but it is also the child of insecurity in the role: there must be some answer to this case, and it must be hidden in the record. Father must have the answer. This leads to a whole series of unspoken assumptions that something has been denied. The doctors are deliberately not curing this person. The answer is somewhere in the record. They won't let me see the record. Therefore they don't want to cure this person.
"The nurses and attendants are nasty, vicious people." This is not true! And when case-aides see a nurse say to a patient, "Damn it, get up! Get out of here!" they protest, but it may be exactly what that patient needs, and they may find themselves saying the same thing four months later