the client and to develop strategies to be able to continue to work therapeutically with them.
Communication with a Disturbed Individual
General Attitude and Approaches:
A.Attitude or feeling state
•Control your own behaviour. Remain calm (“mirror calm”).
•Be non-judgmental.
•Avoid threatening words or actions.
•Don’t take insults personally.
•Do not enter a power struggle.
•Use “soft focus” eye contact and an expression that says “I’m your friend, not your enemy”.
•Show concern without anger.
•Be in firm but kindly control.
•Be empathetic. (Remember “Hurt People, Hurt People”). Show that you have listened and understood how the individual feels. “I heard you say ...”; “As I understand it ...” ; “I know it is difficult for you, how can I make it easier?”
•Show respect, if only because he/she is a human being and all human beings are entitled to respect. Show the person that you are for him/her, not neutral and not against him/her.
•Be genuine. Don’t respond in an institutionalized or stereotyped professional manner. Try to affect an open, spontaneous interaction style. Use your own language and avoid buzz words that might anger the person e.g. “It is our policy ...”
•Be concrete. Deal with the individual in and with specific, concrete feelings, behaviours and directions. Do not be vague. Do not lie.
•Recognize and reinforce steps to regain control. Use positive gestures and language.
•Trust your intuition and feelings. Ask the person if you are correct. For example, “I have the feeling you are upset because your daughter couldn’t visit today. Am I right or wrong about that?”
•Be aware of personal responses to aggressive behaviour. Caregivers who project their own feelings of rage and fear onto the impaired will overestimate the potential for violence and resort to excessive use of restraints, physical or chemical.
•Heed inner dialogue (awareness of counter-transference reactions).
•Avoid the “saviors” or “macho” attitude in an effort to live up to expectations of on-lookers or to compensate for personal fears.
B.Speech
•Use simple, concrete, positive statements. Say what you want them to do not what you don’t want them to do. For example, “Please sit over here” instead of “Don’t pace in the dining room.”
•State instructions or questions one at a time. When they can respond appropriately, they are regaining control.
•Keep voice volume appropriate for distance and the person’s ability to hear. Raising the voice raises the pitch. This is the hardest range for the elderly to hear.
•Use a smooth supportive tone.
•Use normal speech rhythm. Speaking too fast, too slowly or in a jumpy excited manner can irritate the person and escalate the problem. Address persons by name, e.g. “John”...
•Pay attention to the response. Do not assume your message is understood.
•Do not use jargon.
•Avoid giving advice.
•Listen and learn, open and active listening (nod and “yes, yes”). What does the client see as the problem and what do they expect of you?
•Use silence and restatement to clarify message.
•Ask questions to seek information, a favour or to distract the person.
•Avoid sarcastic or insulting remarks. Be careful of using humour. When in doubt, don’t try to be funny. Humour is a high risk, high gain technique.
•Reassure acting-out and frightened individuals that you, the care-giver, did not intend to be a threat.
•Telling aggressive people their behaviour frightens, worries or upsets you can be appropriate. They may not see their behaviour this way and may attempt to change it.
•Asking individuals who are aware of their aggressive urges to tell you when something you do or say makes them angry may defuse a touchy situation.
•Verbal abuse is not always a safety valve and may aggravate assault.
C.Non-verbal messages
•Be aware of non-verbal communication. A person cannot “not communicate.”
•Avoid exaggerated gestures which may startle or threaten.
•Reduce nervous mannerisms and avoid over-activity. You will appear in control even though you may not feel that way.
•Portray a confident non-anxious manner.
•Keep your hands in view and not behind the back or in the pockets. The person may believe you are hiding something.
•Approach with the palms open. This is the handshake or welcoming position.
•Honour “personal space”. Remember the variables involved include the sex, size, familiarity and the speed of the approaching helper.
•Remember this distance may double or triple when a person is in a crisis state.
•Use the “tactical interview stance”. Standing at least one leg length distance from the client (about 3 feet), and turned approximately 45 degrees to the side with the hands in plain sight is less threatening and offers individuals a “perceived” route of escape. Keep hands open and above waist line. Standing squarely face to face is issuing a challenge and is also unsafe.
•Avoid standing over people who are upset. Use eye level. Use increased distance to approach eye level.
•Isolate the situation.
D.Empathic Listening (an active process to discern what a person is saying)
•Don’t be judgmental.
•Don’t ignore or fake attention.
•Carefully listen to what a person is really saying.
•Use silence and restatement to clarify messages.
•Reflection can be used to clarify.
Listening Versus Really Hearing
