De-Escalation and
Pro-active Communication
Skills
How to manage aggression and
hostility and move the client
forward when they are acting out.
A. Christine Furman MMHS
Director of Acute Care Services
What we are going to talk about:
 Recognizing aggression and hostility
 Communication Skills
 Non-verbal Communication Skills
 Diffusion Strategies
 De-escalation techniques and skill
Why do people escalate and become
aggressive or hostile?
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Frustration
Feel that they have been treated unfairly
Feel that they have been humiliated
They are immature
There is a level of excitement they are reacting to
It works – it is a means to an end
It is part of their reputation
Aggression and Hostility may be symptoms of their
mental illness
How do you know when someone is
feeling hostile or aggressive?
 They may stand taller
 Their face may redden
 Their voice may raise
 They may breath faster
 They may make prolonged, direct eye contact with you – stare you
down
 They may make exaggerated gestures
 They may become very tense
 They may begin to pace
 They may clench their fists
 They may clench their jaw and tighten their facial muscles
 Behavior is different than normal
Communication
This is a two way process that includes:
 Listening
 Speaking, and
 Hearing
As a staff member you will also need to:
 Observe, and
 Interpret
Some things that get in the way of
effective communication are:
 Background noise, and having to
speak loudly (are you having to yell?)
 Inappropriate setting
 Language barriers
 Perception and Prejudice
 Intrusion of personal space
 Time constrains
 Lack of encouragement
Twelve Roadblocks to Listening –
Thomas Gordon, Ph.D.
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Ordering, directing, or commanding
Warning or threatening
Giving advice, making suggestions, or providing solutions
Persuading with logic, arguing, or lecturing
Moralizing, preaching, or telling clients what they ‘should’ do
Disagreeing, judging, criticizing, or blaming
Agreeing, approving, or praising
Shaming, ridiculing, or labeling
Interpreting or analyzing
Reassuring, sympathizing, or consoling
Questioning or probing
Withdrawing, distracting, humoring, or changing the subject
Escalation Prevention Steps:
Prevention Step #1
Staff need to be able to recognize early warning
signals such as:
• Behavior changes
• Quiet people become agitated
• Loud people become quiet
Commenting on the changes may open up
conversation and minimize frustration or anger
build up – giving the client an opportunity to
diffuse the situation.
Prevention Step #2
Recognize that Anger is a normal emotion – we don’t always
need to fix it or be afraid of it – unless the person becomes a
danger.
Anger is not ‘normal’ when:
 Anger is often used to get ones way
 Anger is often used to get
 attention
 to escape a situation
 to gain control of a situation
 Anger is used to pump one’s self up when feeling small or
insecure
Prevention Step #3
Staff need to remain in touch with their
emotions when dealing with an angry client. If
you become angry or defensive you will not be
able to help the client. If you cannot manage
your emotions and remain calm and objective,
you will need to get help.
Prevention Step #4
Take a deep breath, and attempt to remind yourself of the following:
• Avoid criticizing and finding fault with the aggressive person.
• Avoid being judgmental with the aggressive person.
• Use a calm, steady voice without and edge or sing song.
• Do not become involved in the conflict.
• Be able to try to see the situation from the angry person’s point
of view.
• Remember that your job is the health and safety of your client.
• Have a plan.
What should staff do once
a client has Escalated?
 Take deeper breath
 Appear confident – but not cocky
 Remain calm
 Show that you are listening
 Speak slowly, gently and clearly
 Avoid arguing and confrontation
 Create space between you and the agitated person
 Know how you are going to get out of the area
Adopt a non-threatening
body posture
 Use a calm, open posture – either sitting or
standing
 Reduce direct eye contact – do not stare
 Allow the person adequate personal space
 Keep both hands relaxed and visible
 Avoid any sudden movements
 Avoid and discourage an audience
De-Escalation Techniques
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Explain your purpose or intention
Give clear, brief, assertive instruction
Negotiate options
Ensure that your non-verbal communication is
non-threatening
De-Escalation Technique #1
Just Listen
Sometimes all it takes to de-escalate
someone is a good ear and the time to allow
the client to vent. Just listen to what they
have to say and give them encouragement.
Technique #2
Acknowledgement
This is when you really listen and are able to
relay back to them that you understand
what they are feeling.
“I understand that you are angry”
“I see that you are frustrated”
“You feel that you have been wronged”
Technique #3
Allow Silence
You don’t need to be the problem solver.
It’s not your job to have all the answers.
Give the client time to reflect, don’t fill the
time with your thoughts and questions. Just
be with them, calmly.
Technique #4
Apologize
If the situation was unjust or unfair – a sincere
apology is powerful. It does not mean that
you are accepting blame, it means you are
acknowledging that something that occurred
wasn’t right or fair.
Technique #5
Invite Criticism
Ask what you/we/the program could do better,
be sincere. Don’t tell them why it won’t work or
why it’s not a good idea, just listen and thank
them for their input.
This may intensify
someone’s anger temporarily – but if you
encourage them to continue and let them be
heard the conversation tends to end on a more
positive note.
Technique #6
Develop a Plan
You should have a plan at the ready, for
example… a place for a time out, a meeting
with a supervisor or case manager; however
you will want to work out the options with
the client.
Never Threaten
Once you have threatened or given an
ultimatum all negotiations will cease and you
will be in a win/lose situation. Try to keep
options as open as possible.
Ultimate Plan for Safety
• Do you have a plan if you can’t de-escalate a
client?
• Does your agency?
• Does your agency have P&P regarding safety?
• Do you have a way to summons others for help?