Trusting vs Guarded

When I have talked about trauma patients, I have often started with an explanation loosely based on Shawn Shea's “Psychiatric Interviewing: The Art of Understanding” 1988 “differentiating 'trusting' vs 'guarded' clients that seems to make sense to most people.

Realistically, many trauma patients are 'guarded'.

I thought I'd share a brief blurb on how I explain this.

 Two types of clients, and of course all variations in between

1. Trusting

2. Guarded

 Trusting

Accept ground rules that clinician has:

1) Client's best interest is priority; another 'agenda' doesn't have priority

2) Clinician is sufficiently competent, to not lead them to 'well-intentioned harm'

 Guarded

Not uncritically accept above ground rules

Iatrogenic harm (harm from seeking and receiving medical treatment) is likely when client is perceived as difficult or non-compliant, when in reality they are appropriately guarded.

 Appropriately guarded from experience of having someone(s) in position of authority/privilege having previously failed or betrayed them.

 T Hugie MD, FRCP(C), Psychiatry, updated January 13, 2019