TRAINING AND AWARENESS PREPARES US FOR THE UNKNOWN OF TOMORROW
Concepts to Keep in Mind:
• Learn ways to try to keep situations from becoming dangerous
• Know how to control yourself in dangerous situations
• Know when and how to de-escalate highly charged situations
• Learning safe options when managing agitated clients.
Ways to help the situation from escalating:
• Take a deep breath…It will help you calm down.
• Appear calm, centered and self-assured even though you don’t feel it. Anxiety can make the client feel
anxious and unsafe which can escalate aggression.
• Use a calm, low monotonous tone of voice (normal tendency is to have a high-pitched, tight voice when
• If you have time, remove necktie, scarf, hanging jewelry, religious or political symbols before you see the
client (not in front of him or her).
• Move the situation outside or to another room, if possible. It makes it less likely other clients will get
involved or become an audience for the agitated client to play to.
• This also creates a quieter environment and may help in de-escalating the client, especially mentally ill.
Control of Self
• Take a deep breath…this will calm you
• Do not be defensive…even if the comments or insults are directed at you.
• Be aware of any resources available for backup.
• Be very respectful even when firmly setting limits or calling for help.
• Give the client plenty of room to move and significant space between you and him.
• Do not see client when alone.
• Be sure co-worker’s know if you are seeing someone with history of violence.
• Do not allow the client to get between you and the door.
• If the client comes to the office already agitated do not take them into your office. See them in a neutral,
larger space, if possible.
• Be aware of items in your office that can be used as a weapon. If possible, keep them out of the reach
of the client.
• Review the safety protocols for your office.
• Never turn your back for any reason.
• Always be at the same eye level.
• Allow extra physical space between you…about four times your usual distance and on nondominant
side of client.
• Do not maintain constant eye contact. Allow client to break his/her gaze and look away.
• Do not point or shake your finger at the client.
• Do not touch…even if some touching is generally culturally appropriate and usual in your setting.
• Keep your hands OUT of your pockets, up and available to protect yourself.
• Stand with one foot slightly in front of the other with your weight evenly distributed.
The De-Escalation Discussion
• Remember there is no content except trying to calmly bring the level of arousal down to a safer place.
• Use simple, clear language.
• Do not get loud or try to yell over a screaming person. Wait until he/she takes a breath…then talk.
• Address the client by name, it helps to ground them.
• Respond selectively: Answer only informational questions, no matter how rudely asked (e.g. “Why do I
have to fill out these g-d forms?”). DO NOT answer abusive questions (e.g. “Why are all the staff
• Explain limits and rules in an authoritative, firm, but always respectful tone.
• Give choices where possible in which both alternatives are safe ones (e.g. “Would you like to continue
our meeting calmly or would you prefer to stop now and talk later or come back tomorrow when things
can be more relaxed.”)
• Empathize with feelings but not with the behavior (e.g. “I understand that you have every right to feel
angry, but it is not okay for you to threaten me or others.”).
• Do not solicit how a person is feeling or interpret feelings in an analytic way. Instead talk about how you
know the client wants to be in control; ask how you can help the client do this.
• Do not argue or try to convince.
• Wherever possible, tap into the client’s cognitive mode: DO NOT ask, “Tell me how you feel.” INSTEAD
ask, “Help me to understand what you are saying to me.” People are not attacking you or themselves
while they are teaching you what they want you to know.
• Suggest alternative behaviors where appropriate (e.g. “Would you like to take a break and have a cup of
coffee [tepid and in a paper cup] or some water?”)
• Give the consequences of inappropriate behavior without threats or anger.
• Represent external controls (rules) as institutional rather than personal.
• Trust your instincts! If you assess or feel that de-escalation is not working…STOP! Tell the person to
leave, escort him/her to the door, call for help or leave yourself and call police.
There is nothing magical about talking someone down. You are transferring your sense of calm,
respectfulness, clear limit setting to the agitated person in the hope that he/she actually wishes to
respond positively to your respectful attention.
DO NOT TRY TO BE A HERO!!!
Do not try de-escalation when a person has a gun or other serious weapon. In that case, simply
Effective Options for safe care of violent clients
• Emergency Petition of the client to the hospital.
• Crisis Center/Mobile Crisis Team (MCT)
• Current treatment provider
• Family member
• Clinical follow-up