De-escalating the
Acting-out individual
What do you do?
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1) You ask a individual if they need help, He pushes a chair,
swears, walks to the other side of the room and yells, “Leave me
alone.
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2) An individual is complaining about not seeing the Doctor, The
more he talks the more angry he is getting. Seeing the Doctor is
not an option, since the Doctor is not in.
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3) You ask an individual to leave the room. He does, but on his
way out he turns off your lights and states,”I’ll make sure you all
go to hell.”
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4) A individual becomes increasingly upset in session with his
wife, now he is becoming more argumentative and starting to yell.
Sources of individual Stress
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Social life, dating, friendships, harassment
Self Image issues
Life circumstances - divorce, unemployment,
D&A abuse, legal issues
Work stress
Physical health
Life circumstances,
Mental functioning
Emotional health
Possible causes of acting out
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Frustration or Anger Reaction (over desires or
needs not being met)
Retribution (directed towards individual, staff or
institution)
Loss of Control ( medical issue, insufficient coping
skills, social conditioning)
Displaced Aggression
Low tolerance for boredom, no patience
Stressed, rushed, confusion,
Full Moon (if you are in the field long enough, you
just might believe it)
Bio-physiological reasons- meds, hormonal
changes, physical conditions, pain
Precipitating factors
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Being aware of precipitating factors can
strongly influence the successful interaction
with an escalated individual.
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Although you don’t have control over anothers
precipitating factors, you can become one
yourself.
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Issues like, hunger, lack of sleep, weather, staff
changes, holidays, attitude,
What are the ways a person can
act out.
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Verbally - refusing, defiance, anger, verbal
assault/aggression,
Physically- striking, destroying property,
biting,choking,etc.
Many of the problems that end up with a
physical outcome, could have been
maintained to the verbal realm.
Two types of aggressive person
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Intentional deliberate, motivated,
goal directed, for
status, revenge,
disruption, etc.
CD,ODD, Some Axis II
Dx.
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Reactionary- not
deliberate, not
controllable (yet),
escape, avoid, fight or
flight condition.
PDD, ADHD,Intermittent
Explosive Disorder
Most situations will progress from one step to
another, it’s possible that you can manage a
crisis by addressing the level appropriately.
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a noticeable change in
mood, behavior
Verbal defiance,
beligerant, yelling
Physical acting outslamming, shoving,
Reduction in physical and
emotional energy calming
down
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Be supportive, nonjudgemental talk
Be directive, control by
setting limits
Insure safety of all,
physical restraint if trained.
Re-establish
communication, become
the individual’s “nurse”get water, tissue, etc.
Examples of the Intentional
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The individual who becomes argumentative as a way
of getting people to give in
individual who acts out due to being disrespected,
“brushed off”,
individual who feels their “rights” have been violated in
some way.
Individual who has a rational or irrational reason for
retribution, revenge, settle the score.
How to handle the intentional
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Verbal de-escalation, the person usually retains the
ability to think, reason, weigh consequences at least to
some degree.
Remain in control, but assertive, it may be necessary
to slightly “heighten” your emotional state- not to
argue, but to “join” with the individual’s state of being.
Forced choices, to allow a conversation, the first
choice positive, the second with a consequence.
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“We can sit down and see what we can do, or if you
choose to continue to (yell, swear, disrupt others) we will
be forced to (have you leave, call security, etc.)
How to handle the intentional
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Often times the “acting out” individual simply wants to
be heard. Other times, they require some kind of action
to be satisfied.
Don’t operate on a “must win the battle” or you will
likely lose
Finding some accommodation or middle ground will
help defuse the situation quicker than, “sorry that’s
against policy” attitude.
Examples of reactionary.
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Autistic individual who is unable to engage in
their ritualistic behaviors, due to (schedule
change, new staff, )
Knee jerk reaction to physical contact- read by
the individual as aggressive in nature
“Melt down”- emotional outburst with no
apparent cause or triggering event.
How to handle the reactionary
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Remove stimulus and audience if possible
allow for it to play out, insure individuals safety, limit
maneuverability if necessary
Once venting has started, need to let it happen
Wait for tension reduction, offer water, wet wash cloth,
tissue, etc.
delay verbal processing of incident
Look to antecedents for future prevention.
When confronted with non-compliant behavior
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Don’t lose sight of your goal.
Remember that the only behavior you can
directly control is your own.
Stop thinking in terms of “giving in” or
showing who is boss
Look for ways around the hurtle that the
individuals behavior is causing.
Don’t get trapped in a power struggle with
the individual
Be Aware of Body language
(individuals and yours)
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Posture, arms crossed, stance, swaying,eye
contact, hand gestures, facial expressions,
speed of approach- all carry a message
Reading body language is a two way street,
make sure your body is conveying the
information( tone, mood) that you want it to.
Supportive stance, sideways, hands at side,
When approaching a conflict situation, think
about…
What is happening - What am I walking into, what is
the danger level
Who is involved?- Is the individual angry with
someone or something? Have I worked with them
before, what is the status of the relationship?
What do I know about them? Triggers, issues, if past
history, types of behavior, spits, swears, bites.
Supportive Stance
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Remain a bit more than “one leg length” (of
theirs) away
Stand sideways, don’t square off shoulders,
Tilt head slightly to the left or right, signifies
concern and attempt at understanding
Arms at side, waist level, palms up, as if they
were going to hand you something.
Keys to Setting Limits
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Simple directives 2 choices
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1 positive, 1 less positive
Reasonable within individual’s ability
Enforceable, don’t use a consequence that
you can’t follow through with.
Managing a Fight scene
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Make a quick assessment, consider disputants,
weapons, likely level of assistance
Call for help/back up, use phone, radio, individual or
yell, (organization should have a code word)
Attempt to defuse situation- model calmness, talk
assertively and slow, use individuals names if known,
Cause a distraction-kick trashcan, pound locker, toss
water on them, you are trying to get their attention off
each other an onto you.
Controlling a fight scene
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Control crowd, block doorway, tell individuals to leave
area, “anyone watching will receive a consequence”
Avoid empty threats, ridicule, screaming
Only attempt to separate individuals if you have been
trained to do so, and have the help and support you
need. If you do it is usually more effective to assess
who is the one losing the fight and drag them
backwards, if you chose correctly, the winner will often
be satisfied and the loser will be given an “out” of a
losing situation.
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Allow the combatants to de-escalate, keep them out of
sight and preferably out of ear shot.
Interview separately, or have them write down what
they feel happened.
Debrief any bystanders, coworkers often can be
shocked by the physical nature of the conflict, let them
talk about their reactions.
Summary- Ask yourself
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What was my original goal?
What might be the individual’s motivation for the
behavior?
Will traditional interventions (warnings, punishments,
exclusion and orders) work now or do they make the
situation worse?
What can I do to adjust my behavior right now to meet
my original goal? (offer help, planned ignore, involve
the individual)
What type of follow up is needed to teach the
individual new skills so he/she can learn socially
acceptable ways to express themselves?
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Establish Rapprt- when in a crisis, the individual tends
to feel no one understands his concerns.
Don’t say “I understand”, or “you need to calm down, You
shouldn’t let this get you so upset”
Remember they are likely upset because as of yet, they don’t
feel understood, the other two responses are telling them
something they should or need to do, taking control away,
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Say things that help you join with them,
I’d certainly be upset too.,I can see why this is frustrating, I
can see this is big concern.
and then add, “How about if we…
“Why don’t we see if…
Let’s see about…
You have very quickly joined with them, validated their present
mood, and are working on it together.
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Give them a reasonable amount of time and space.
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Invite them to tell you more, let’s find a place where we
can talk. Let’s sit down and see what we can do.
Listen to their concerns, don’t allow phone calls or
interruptions if you can help it, convey to them that they
are important, and you are willing to listen.
Active listening, clarification questions, mirroring back
what you hear are their concerns.
Jot down notes, helps convey that you are taking their
concerns seriously.
Summarize their concerns back, and when possible tell
them what’s going to happen from there.
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Explore possibilities and options,
“Next time you feel that…, I’d like you to get a
hold of me.”
 “While we can’t go back and undo it, we can try
to insure that… doesn’t happen again.”
 “What can we do, to help prevent such
frustration again?”
 Don’t say “ If you would have only …” this tells
them that it was all their fault, it won’t help the
current situation.
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Don’t take things personal, it is likely the individual is
venting to you as a representative of what they are
frustrated with.
Don’t hold grudges, or you will be ineffective with that
individual
Disapprove of their behavior not the actual person.
At a future time, ask how a potential concern could be
handled differently by them and you.
Intimidation, Threats
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Most attempts at intimidation are designed to get at a
“goal”
Threats need to be taken seriously, no matter what the
mental state, (manic, psychotic)
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Get witness ASAP, keep any email, phone, written
threats
Inform supervisor, co-worker, determine if follow up with
police is warranted.
Remember, most threats occur in the “heat of conflict”
and once it’s over, you will usually “mend fences”,
however if the threat is threatening to you, make sure
your supervisor follows up with a reaction that you can
live with.