Conflict management – How to deal with volatile patients

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Conflict Management
Managing potentially violent
situations
by K Sammut Henwood
Registered Forensic Psychologist
The problem of violence
in our society is
misunderstood,
mishandled, and
increasingly problematic
(Karon, 1969).
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Most studies in forensic psychology
suggest that violence is a learnt behaviour
(through reinforcement schedules,
conditioning and modelling) where the act
of being violent has proved to work in
helping the aggressor deal with life
circumstances.
Violence cannot solely be equated with angry
explosiveness. There is a shape and form to
violence. Even patterns of destructiveness show
consistency, and they vary reliably from person
to person. It seems to reflect a purpose, and it
implies the presence of hidden (if perverted)
meanings.
The paradox of anger
 Anger leads to empowerment and is used as an
attempt of establishing control
 However paradoxically – it could lead to an
outburst and puts one in a mode of dyscontrol
due to eruption of turbulence and chaos – in
turn being out of control is inherently anxiety
arousing.
General characteristics of
violent people
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Poor coping skills
Inability to correctly identify sources of
stress - poor cognitive appraisals
Low frustration tolerance
Past reinforcement for violent behaviour
Intoxication
This is worsened if
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Overcrowded environments - hot and high
client turnover
Lack of physical restrictions to movements
Lack of structured activity for clients
High pay-offs for violence (NB depends on
client’s perception) lack of sanctions
Victims of assault
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Tend to older and smaller in size
Uniformed staff at a greater risk
Authoritarian behaviour
Staff demanding activity or imposing
sanctions
Conflict management
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Context – employer responsibilities and it s
consequences to the staff.
Avoiding conflict – the John Wayne Syndrome
Controlling conflict – recognising the cycle of
violence and de-escalation techniques
Escaping conflict – break away techniques
Context of violence
When dealing with people coming from certain populations
it is important to be:
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Aware of the environment and potentially
difficult situations
Learn what upsets people in general and those
that are specific to the client.
Learn skills of reading verbal and non-verbal
behaviour that in most cases would be
idiosyncratic to the particular individual thus
identifying baseline states.
Monitor one’s own verbal and non-verbal
behaviour
Consequences of conflict and
violence
To a member of staff
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Serious physical injury
PTSD
Fear of further assaults
Unemployment or early retirement
To colleagues
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Anxiety
Stress related illness
Low morale
Lack of job satisfaction
To the organisation
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Absenteeism/need for cover
High staff turnover
Low productivity
Poor industrial relations
Framework for conflict
management
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AVOID
CONTROL
ESCAPE
AVOID
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Avoid potential conflict by assessing risks
Be prepared
If necessary take action before meeting
the client
CONTROL
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Control the potential for conflict in what
you say
Read non-verbal cues
Recognise the cycle of violence
Use de-escalation techniques
ESCAPE
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Escape from violence by terminating the
task at hand (e.g. The interview) when
you judge it to be unsafe
Raise the alarm
Use break-away techniques
John Wayne Syndrome – Problem
Attitudes (Davies, 1992)
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I know how his mind works he will always back down in
the end
Give people an inch and they will take a yard – they
must not get away with anything
I’ll lose face if I run away
I can’t tell my supervisor I am afraid of this person, she’ll
think I can’t do my job
I know it’s nearly Friday tea time but its my job to tell
him he is high risk
NB its not events that trigger violence but the
interpretation and belief systems of the actors
Cycle of escalation of violence
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Angry thought
e.g. he won’t give
me parole
Feeling/emotion e.g.
fear, grievance,
suspicion, hate
Aggressive behaviour
e.g. questions the point of
the interview
Swearing, non-verbal
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Event Reaction
e.g. I’m assessing you,
Anxious arousal
There are great similarities
between anger and anxiety
arousals both would lead to
the release of adrenaline,
hyper-vigilance, aggressive
staring/forced attentiveness,
rigid posture/frozen posture,
hostility/lacking animation,
A
unreasonable/unable
to reason,
n
disjointed speech/faltering
g
speech.
r
It is important toy keep yourself
t of the
calm and be aware
h like
potential to conflict
threatening bodyolanguage.
u
g
h
t
Davies (1992) 3-step model of
de-escalation
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Calming – displaying empathy, show concern,
interest and involvement. Paraphrase the client’s
grievances. Legitimise his feelings.
Problem-solving – clarify the nature of the problem,
depersonalise the issue and your own part in it,
generate potential solutions, evaluate the best course
of action.
Summarising – praise the client for finding options,
describe what has been decided, be clear about the
division of responsibilities between yourself and the
client.
Other miscellaneous de-escalation
techniques
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Signal non-aggression e.g. sit back, move
slowly and appear interested
Firmly request the behaviour to stop
Remove any sense of urgency
Show you are considering both sides of
the argument
State how you would feel in their position
Use self-calming techniques
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Tell yourself to stop and relax
Concentrate on breathing more deeply
and exhaling more slowly
Continue at a consciously slower pace and
relax your face, mouth and jaw
Controlling the potential for conflict
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Threatening body language
Invasion of personal space – if there is
room move back from them
Touch – avoid giving or receiving touch as
it is easily misinterpreted
Direct body positioning – always turn so
that you are more sideways (easier to
defend and is viewed as less threatening)
Controlling the potential for conflict
part II
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Eye contact – avoid a staring match however it is
important that some eye contact is established
Facial expressions – be aware of these as they are a
very good indicators of person’s moods regardless of the
verbal expression
Smiling and nodding are useful tools since they build
rapport but need to be used carefully as they might be
interepreted as mocking or nervousness
Mirroring – often this is used in order to increases the
feeling of empathy however aggressive gestures should
not be mirrored as they escalate conflict
Controlling the potential for conflict
the potential aggressor
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Signs of imminent assault
Raised voice, rapid speech erratic
movements and changes in the voice tone
Flushing, dilated pupils, pacing around
Verbal threats, increased swearing or
threatening gestures
Controlling the potential for conflict
the potential aggressor Part ii
Beware of less obvious signs ;
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Refusal to speak/withdrawal
Delusions/hallucinations with a violent or
persecutory content
Disjointed reasoning, poor concentration
Escaping conflict
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If de-escalation techniques don’t work terminate
the task at hand (e.g. Interview)
If necessary, don’t be frightened to walk straight
out of the room
If they block your exit be assertive and tell them
to move out of the way loudly enough to draw
the attention of other staff
If they grab you use breakaway techniques
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