This is a side road, but i think germane to the discussion and some may find it interesting.
i'm a critical care nurse and part of my job is to assess/examine my patients 2x a shift. It's a very detailed and intimate exam that i have written about in other threads. For me, it's all part of my profession, i'm a total bottom with some sub thrown in, so i don't have to flip a switch or draw lines when it comes to dominance or med fet, since i'd be a receiver in those scenarios. But it does not keep me from experiencing and observing behavior in response to my professional position.
i had a patient recently who had advanced dementia. That's not an all or nothing disease process, and though lots of dementia patients have things in common, it's a very individual disease in my experience. i had this patient two days, he had a 1:1 nurses aide in the room at all times because he would flip at any point into a confused state that would put him at risk for injury (i.e., trying to get out of bed on legs that would not support him).The first day he was a lamb, completely cooperative and compliant with a very sweet attitude. The second day, he had 'flipped' at night and was refusing all of his meds, was incontinent and fighting getting cleaned up, refusing meals, eating. He was confused, angry and scared.
i went in and sat down with him. my intent with a patient is about as opposite to dominance as one can get, i guess my sub nature comes through a bit? my primary goal is to advance them on the health spectrum, i.e., to help get them to a healthier place with a holistic approach ("health" is a very complex and in many ways an individually defined state). i have found with dementia patients, there's often a part of the person still there, someone to connect to in a real way. i want to connect with all of my patients as part of giving care, it's how i can care for them as individuals vs just generic care. It can be a very delicate dance, but it's not manipulative. i eschew manipulation, but i also find most people are unconsciously on guard against being manipulated. my honest approach was transparent, that i did not want to make him do anything. What impressed me was how once he saw my honest care, the walls and resistance came down and he returned to a state of cooperation and compliance.
It doesn't always work that way. We get lots of patients with altered mental status (AMS) from a variety of causes, but i have found in my practice that compliance and cooperation seem to be a response connection to honesty, openness.