Tuesday, December 11, 2007


By Carol A. Butler, MS Ed., RNC, for Wellness Reproductions and Publishing, LLC

Do you clench your teeth, tighten your muscles, and bristle when people complain, criticize, or condemn? Join the club! Angry clients and their families, going through the worst of times, often lash out at professionals who choose to help. Enable them to vent feelings, cool down, comply with requests, or resolve conflicts while you remain calm, compassionate, but unwavering when necessary.

Empower versus overpower them with these tips:

Overdose With Agreement

You need not agree with their views. Just validate their feelings. For example, you could say...

"It sure is an upsetting situation for you."
"Yes, it is very difficult for you."
"It does it seem terrible."
Don't try to reason with irate persons. Your goal is to calm, not persuade.


Ask Questions
Listening allows them to vent feelings. Have you ever fumed to your friends or family and received well-meant advice? Were you receptive? Initially, angry people want to be heard, not helped.

Empathizing conveys that you understand their concerns. Don't try to change their minds or impose your opinion.

Asking questions elicits their perspective. Avoid "Why...?" which fosters defensiveness. Ask "How...?" to determine their thoughts and feelings. Don't impersonate a detective or a judge!

Paraphrasing proves you've heard and understand. Repeat their concerns in your own words.

Summarizing provides a "snapshot" of the situation, laying the groundwork for later problem-solving.

Behavior Begets Behavior

Be calm, compassionate and respectful and your clients may model your behavior. Apologize for their inconvenience. Explain what you can do to help. Don't verbally attack the people or defend the institution, staff, laws, or yourself. Defensiveness appears argumentative and adds fuel to the fire. Ignore sarcasm or questions challenging your position or policies and redirect attention to the issues.

Spatial Relationships


Provide them extra personal space. Be approximately their leg's length away versus "toe to toe" or "in their face." Position yourself near a door, but allow them access to exit. Don't corner yourself or anyone else.

Body Language

Don't literally look down at them. Be at their eye level, stooping near the bed, sitting across from or standing at an angle, facing slightly sideways, palms up. Avoid authoritative stances with hands on hips or arms crossed.

Break Barriers

Unless you fear physical violence, do not sit behind a desk or stand behind a counter. Move to their side of the obstacle and, ideally, seek an area within earshot of help but away from an audience.

Paraverbal Communication

Tone, volume and cadence matter more than content as people escalate. Although we would not be making the following (defensive) remark, it illustrates how accentuating one word changes the message. Read the following statement aloud, emphasizing only the word in bold:

"I didn't call you stupid." (implies someone else called you stupid)
"I didn't call you stupid." (denies the accusation)
"I didn't call you stupid." (implies you really are stupid versus being called stupid)
"I didn't call you stupid." (implies I called someone else stupid)
"I didn't call you stupid." (implies I called you something worse)

Avoid Escalation Enhancers

Don't command, criticize, threaten, preach, placate, analyze, advise, debate, degrade, blame, lecture, label, stereotype, minimize, interrupt, use sarcasm, misuse humor, half-listen, tune out or try to be right. Don't "should" on them!

Expect Anger

Avoid taking it personally! Don't be unnerved by their crying or offended by profanity. Denial, anger, bargaining, depression and acceptance relate to the grief and loss associated with mental illness and/or substance abuse. Remember the person who is mad at the boss and kicks the cat? To clients and families upset with the disease, the doctor, law enforcement, the system, or whatever, you're the cat!

Tip Of The Iceberg

Angry words represent the tip of the iceberg...understand the underlying layers: fears of abandonment, loss of face, loss of control over a situation, sadness, guilt, and other factors. The current stressor may be the last straw on the overburdened camel's back.

Ignorance Is Not Bliss

Fear of the unknown generates anger. A lack of education, cultural or language barriers, and illiteracy can compound a client's frustration. Even highly educated people experience cognitive deficits during crises. Concisely communicate only what they need to know now.

Conflict Resolution

Here are some techniques to resolve your conflicts with clients:

Clear the air: "We need to talk."
Take time out: "Lets calm down for ten minutes, then meet."
Set ground rules: "No threats or violence...only mutual respect."
Listen first: "Please tell me your view."
Summarize their perspective: "You feel...you think...you're upset about..."
Share your information: "The policy states...the procedure is..."
Provide options: "You may resolve it at this level or talk with the supervisor or file a grievance report..."
Brainstorm solutions: "Let's think of all the possibilities."
Compromise: "Let's meet halfway."
If all else fails, agree to disagree!

Assertion As Needed

If there is no room for compromise and your client must comply for safety's sake, use these techniques:

Make simple requests
Just say "no"
Be a broken record -- calmly, in one or two brief sentences, repeat your request or response each time they argue
Speak in positives
Repeat alternatives
Hot Versus Cold Threats

Hot threats are made in the heat of anger and pose immediate danger: "If you come closer I'll punch you out!" Cold threats are cunning, calculated efforts to control: "I'll get you fired!" or "When I get out of this program you better watch your back!" or "Don't take your eyes off your kids!" They pose future danger.

When dealing with hot threats, talk "down" escalating situations by calming the client down with the methods previously addressed.

When facing cold threats, talking them "up" is imperative for safety. People making cold threats use your traits or personal information against you. They comment about your appearance, sexual preference, age, family, or other sensitive issues or convey knowledge about the kind of car you drive, your children's school or your address. They often threaten via notes or phones. They thrive on secrecy. You must talk "up" to colleagues about the threats, despite embarrassment or fear. You and at least one coworker must confront the manipulation and discuss better ways to solve the problem. When necessary, report threats to the police, Child Protective Services or other agencies, and utilize restraining orders (and stalking laws if available).

Safety First

Intervene early at the first signs of escalation. Don't think that if you ignore them they'll go away!
Keep others away from angry people.
Alert staff members and security guards to be close by.
Avoid appearing to gang up on someone, but if necessary, a show of numbers usually fosters compliance.

Only one person should verbally direct the agitated person. However, additional staff provide support by their presence.
Allow angry people time and space.

Remember "fight or flight," and allow them a graceful way out.

Train staff members how to manage assaults for times when physical containment is required.

Realize that people with frightening hallucinations, paranoid delusions, and/or who are under the influence of substances, usually are not receptive to verbal de-escalation. Medication and special interventions may be required.

Daybreak Counseling Service

1 comment:

Anonymous said...

good information you

write it very clean. I am very lucky to get this tips from you.