De-escalation Tips, Skills and Strategies

Introduction

The goal of this de-escalation presentation is a map from feeling anxious and overwhelmed to having a mindset, strategy and skills for a calm and contained non-physical and non-violent intervention and resolutions when someone appears out of control and agitated. 

•             Mindset
•             Concepts
•             Strategies
•             Techniques
•             Debriefing
•             Other Notes

There is a lot of focus on and to learn about how to deal with irate, violent, disorganized, psychotic and drug influenced folks. Whether you are a business owner, line staff, office receptionist, waiter/waitress, hospital employee, law-enforcement, in the service sector, teacher or parent. This presentation is based on my training, education and experiences of a 37-year MH career; much which was on the crisis end of the scale. I’ve only been mildly assaulted twice (early in my career) kicked and shoved because I was not paying attention to the client. I’ve been involved in countless physical take-downs and restraints. But countless more verbal de-escalations. There have been many out-reaches with law-enforcement. Years in ER departments and frequent requested from other community professionals. Each community, agency and organization have their protocols, resources and system. The intent of this presentation is to provide thoughts and concepts for your consideration in dealing with folks who are having a difficult time.   

Mindset

It begins with you. It’s not about you. It’s about how you handle the interaction. 

The goal is for you to remain calm in control of yourself and purposeful.

• What is your role? 
• What is your purpose?
• Do you need to get some support?

Roles

• Are you the leader, director or support?
• The leader focuses on and interacts with the person.
• The director directs traffic, task and other supports.
• And the supporters attend to the other environmental/situational things that need attention.

Of the Minds:

• Be able to attend to the crisis that is in your face. 
• Be mindful of the larger contextual situation of risk, liabilities, agendas, pressures and the other parties involved.
• Be mindful of your behaviors.
• Be mindful of how to position for leverage.
• Be respectful and mindful.
• Breathing, non-judgmental, non-attached and being an open to notice opportunities. This is mindfulness.

Concepts

The Cycle

• The beginning, middle and closing phases of the interaction. 
• Break down, break open, to break through.
• It starts as the problem behavior, releasing the energy, holding space, discovering options and empowerment.
• The build-up > expression (outburst or release) > the middle/breaking open is about you abiding with the person in crisis and holding space for them, > resolution. If not resolved, it becomes recovery > build-up… repeating behavior.
• Control versus containment. Containment offers wiggle room that can allow for breaking down and breaking open. It’s the opportunity to “abide” or hang in the space with the client. And this is where empathic leverage is developed.
• Push pull: Herding versus Leading. Herding is making it uncomfortable where you don’t want them to go and making it comfortable where you want them to go. But it is essentially chasing.
• OTOH Leading is getting them to follow you. Often you must allow them to wear themselves out or conclude it’s easier to follow you. But you must be patient, show them you are there for them and already there. It’s like fly-fishing, the fish wears itself out, and you gently reel them in when they swim towards the shore. And let them run when they fight. This is the process of developing empathic leverage. Which subsequently encourages them to follow your “leading.”

Situational Awareness

• Stop, look and listen. 
• What is exactly happening, what can be done and what can you do?
• What support is needed and available? How, when, where and a code.
• Why is it happening? Pain, anger, frustration, loss of hope, fear, anxiety, disorganization, under the influence, etc.
• What is your assessment of why this behavior is happening? What is the underlying driving or dynamic? Why is there pain, anger, frustration et cetera? This is your working hypothesis, which is open to change.
• By making space for the client, they will tell you why. Their why is more telling than your why. Because their subjective reason/interpretation gives you insight into what they will accept as a solution/resolution. Be patient, open, non-judgmental and empathic. Their why will guide you toward the resolution or remedy. If you do not do this, you will likely be chasing your own tail on a wild goose chase. That will have little to nothing to do with the client and will probably lead to an increased frustration, desperation and escalate their behavior… because they don’t know what else to do or have learned that it has worked in the past.

Techniques of interaction and communication

Nonverbal which is the majority of communication.

• Relaxed and Confident or Domineering and hyper-vigilant.
  • Positioning
  • Posture
  • Eye contact
  • Breathing
  • ***Respect personal space and no touching***

Verbal communication can punctuate the non-verbal, but it has to be aligned or congruent. If it is incongruent, then the nonverbal takes precedent.

• Tone is the feeling
  • Rate and volume
  • Cadence or rhythm
  • Pause, silence and use of space.

Feelings .(i.e., your feelings are how you set your tone for interaction)

• Calm
  • Competence is seen > Confidence is quiet
  • Open
  • Compassionate
  • Graceful
  • Empathic

Content

• Ask open-ended questions!
  • Ask them what’s up?
  • Ask them why?
  • Ask them what they would like?
  • Ask them what they can do… THEN,
  • Suggest options as questions… I wonder, have you ever thought, how would you feel, have you ever tried, etc.

Time, where do you want to spend your time?

• Slow it down.
  • Use your breath. 
  • Be mindful. 
  • Position for leverage.
  • Use the space to listen deeply.

It’s a process, use your time and space. It’s not a crisis event. It’s the process of de-escalation.

Do you want to do paperwork detailing the events of the crisis? Or do you want to resolve the crisis, make a quick summary note and go home?

Debriefing: (For ongoing learning and improvement)

• Why do a debriefing? Learning, improvement and teamwork.
  • What went well?
  • What did not go well?
  • What can we improve and how can we do better next time?
  • Positive team and a learning opportunity.
  • The recovery time or phase. Releasing energy, stressors, anxiety and team relationships.

Other Notes:

The push-pull. Tension release -> build up or resolution. It’s easier, more effective and efficient for you to move instead of trying to get the client to move. Creating the vacuum to help the client move. Similar to aikido martial arts… they over-extend and expect “oh crap” but you react in mindful support. This is unfamiliar to them and they don’t know how to respond… or they may test you for a bit but come to conclude you are not their enemy. The enemy is themselves.

• Start with “What’s up?” An invitation to tell their story. 
• Confidence is quiet. Competence is seen. Anxiety/fear is a disorganized shit show.
• Empathic space… Abide with them.
• Visualizing your compassion and gracefulness.
• Circle Positioning for leverage and relationship. Open, Inviting and Leading!
• Breathing for synching and leading.
• Collaboratively work towards them finding solutions that work for them.
• Empower… I knew you could do this! Give them the credit for their work.
• Thank them for their effort and participation!

Summary

Realize you must establish a relationship in which you have some empathic leverage. And then you can lead them. If this type of relationship is not established, then at best, you are left trying to contain them. It’s not about control of the client. It’s about you maintaining control and being mindful of how to interact with purpose.

Blessings,

Tim