- So there's a couple of techniques that we're gonna
talk about.
How do you diffuse an explosive situation?
So I've given you all this information about what rage
looks like.
And you guys are probably all sitting there going,
"Well what are we supposed to do about it?"
We're gonna actually talk about exactly what you guys
should do about it when it happens.
There's three different parts that you wanna master.
You have to be in control of yourself.
That's really hard to do when your amygdala is turned on
and you're experiencing fight or flight.
How can you stay in control when you are feeling
really afraid?
The other thing is the physical stance.
Do not underestimate the power of body language
and where you physically place yourself in a situation.
It really can make the difference.
Then also the deescalation discussion.
We have a question?
We're absolutely gonna expand on it.
In fact, some of you guys are gonna practice it.
Yeah, we'll get there.
So the first thing is
staying in control of yourself.
You have to appear calm.
That's really hard to do.
How many of you had the experience where you've had
to stay calm in a situation where you were not calm?
Were you able to do it?
Some, maybe?
You probably learned from it if you weren't able to do it.
Yeah.
It's incredibly tricky to do.
Your tone, your volume and your cadence
are really, really important.
Your tone.
You wanna make sure it's not condescending.
You also wanna make sure it's not sarcastic.
Okay?
The reason that we don't use sarcasm is because sarcasm
always has a victim.
You're always kinda makin' fun of somebody
when you're sarcastic.
You're either making fun of the individual
or you're making fun of yourself.
But sarcasm is self-depreciating humor
that some people don't get.
That's the other thing about sarcasm
is that it has to do with that brain development again.
If you don't have your full operations,
then you don't understand sarcasm
because you have to understand two things.
You have to understand that there's information
that's coming in
and the information that's coming in is not actually true.
That's a higher level of thinking.
So I think the hard thing is for those of you
who work with teenagers, especially, or young adults,
they use sarcasm, therefore we think they understand it.
But they don't.
They don't always.
I had an experience one time where I first started.
I worked in a group home.
Group home twelve years ago is very different
than group home now.
Group home back then was more like pre-independent living.
These were very higher-functioning kids.
They went out all the time in community.
They had jobs, curfews, things like that.
I actually was taking a kid to an appointment.
And he said to me, "Sarah, you should let me
"drive your car."
And I was like, "Yeah, okay, why don't you drive my car?"
He was like, "Really?"
And I'm like, no.
So then you're in this awkward moment of having to explain
that, no, that was a joke.
That's sarcasm.
That's an example of a high-functioning kid
not understanding sarcasm.
So, you have to be careful about your tone.
Your tone changes when you're nervous and you're scared.
People can pick up on that.
Your volume is also important.
When you're nervous you might actually start shouting,
especially if the individual that you're with is shouting,
or two people are shouting.
In those situations, you actually want to do the opposite.
You actually want to talk quieter.
And the reason that you wanna talk quieter,
is that they likely, not always, but they likely
will talk softer so that they can hear what you're saying.
It's like this new little trick you can use
to try to help deescalate and bring somebody's level down.
The other thing is your cadence.
This is the rhythm.
How fast are you talking?
I know nobody's noticed how fast I talk.
You wanna be careful of that.
When we're nervous, we talk faster.
The other thing is that when somebody doesn't understand us,
especially in the American culture,
when somebody whose first language is not English,
we talk louder and slower at them,
like that's gonna help them understand us better.
It's like one of the most disrespectful things that we do
in this culture but that's what we do.
So you don't wanna say to a kid like,
"Take out your book."
That doesn't make anybody feel good.
That's cadence and tone.
That's both together.
In my experience, when I figured this stuff out,
working in social work,
my job got so much easier.
I will say that.
I think safety and being able to build rapport
and all of that is really about these things.
It's not the actually words that you're saying.
You don't have to have this brilliant clinical intervention.
You just have to say it the right way.
You have to say it in a way that's respectful.
And I have really found that working with adults
and working with kids,
that when I say things in a way that is respectful,
they often comply.
So that carries far more weight than the actual words
that you're gonna say.
Stop worrying about coming up with the right thing to say
or having this brilliant intervention.
Just pay attention to your body language.
That's so, so critical to your safety.
You wanna watch defensive behavior.
And you're naturally gonna be defensive when somebody's
putting you on the defense.
That's hard.
You've gotta remember to sort of stay disengaged,
avoid the power struggle that they're gonna try
to get you involved in.
Do not be defensive.
Be respectful,
which you guys are social workers.
You already know what that is.
So the physical stance.
Actually, before we get to this, I wanna do an exercise.
And I don't want you to cheat
so I'm not gonna put that up yet.
Can I have ten volunteers?
Every time I do this training, nobody volunteers.
And I do it for a group of social workers in training
and you're all like, "I'll do it."
That's great.
Okay, just come on up.
Ten of you.
We're gonna come over here 'cause this is where we have
the most space.
So I need five of you against this wall
and then five of you right here.
Yep.
Yeah.
Yeah, can this group come back?
Good.
Okay.
All right, can everybody just walk across
and shake your partner's hand
and introduce yourself.
Say hello.
Love social workers.
All right, you can go back.
All right, so a couple of things.
First of all, thank you guys for volunteering.
You're very brave.
Second of all, don't be nervous.
This is just a simple,
can you guys actually move like, yeah,
there we go.
Good, we want good space.
This exercise, I'm sorry for some of you that can't.
You'll get the idea.
A couple of things about this exercise.
One is, you guys have to follow my directions.
It's really important, okay?
So my directions are this.
You're gonna maintain eye contact with your partner
at all times.
And the second rule that I have is no talking.
So you guys can't talk.
All right, so the first thing that we're gonna do
is this group over here,
you guys are actually gonna be clients.
You guys are gonna be social workers.
So when I say go, what we're gonna do is
you're actually gonna walk to your partner slowly.
When they are at a distance that you guys feel like
"I'm good, this is a good comfortable talking distance,"
I want you to just put your hand out like that.
And you guys are gonna respectfully stop.
Okay?
Go ahead.
Whoa, whoa, whoa, whoa, whoa.
Yeah, you're the staff.
Go ahead.
Okay.
That really a comfortable talking distance?
Okay.
Okay, was gonna say.
Maybe.
So the line is no longer linear.
They're a little staggered
and basically that's because everybody has a different
comfort of where they're comfortable and how far
you wanna stand from somebody when you're talking.
Okay, I'm gonna ask you guys to go
all the way back to your original spots.
Okay.
You guys are gonna do the same thing
so you can get an idea of where your comfort level is.
So slowly approach.
Maybe.
(audience laughing)
Okay.
The next part of this exercise is gonna be really awkward
because of that.
Okay, very good.
Thank you, come on back.
All right, so we're gonna try this one more time.
And I just wanna remind you guys of the rules.
Eye contact and no talking.
You guys are gonna approach your group again.
Same thing.
Just hold up your hand again when you are comfortable.
Okay.
So, clients,
I want you to take one giant step towards your partner.
(audience laughs)
I want you to take one small step towards your partner.
I'm serious.
We're just gonna let them hang out like that for a minute.
Okay, you guys can go back.
The hard part is over.
You guys can all breathe.
Okay, what was that like?
Uncomfortable.
In your space.
What else?
Eye contact was really hard.
What was the other thing that they were all doing?
Laughing and talking and looking all around.
Not following my directions, basically, right?
Yeah.
So that's anxiety.
That's what that is.
That what we just did was we created an environment
that produced anxiety.
A response to anxiety is not being able to make eye contact,
being really nervous, laughing,
not being able to talk, looking all around,
just trying to make it a little more comfortable.
That's what they were trying to do to make the situation
a little more comfortable.
Some of them were probably crackin' jokes
under their breath,
all kinds of stuff.
How many of you were uncomfortable watching that?
Yeah.
Me too, every time, but I like it too, so.
You guys can sit down.
Thank you, you've been really great about doing that.
(audience claps)
So the reason that that's important, that exercise,
and why I like to show you
is because everybody has a different level of comfort.
And you need to be aware of what your level of comfort is
and how it may be different than others.
So I'm somebody who will get right in your face.
I'll sit in your lap.
I'll come up to you.
I'm like physical stuff is no big deal for me.
But when it comes to the people that I work with,
I have to remember that not everybody's like that.
When I run up on somebody and I'm just like
talking in your face, people are like, "Whoa, relax."
We've gotta keep that in mind.
So there was that the partner at the end
that got real close to each other,
if that's really how comfortable you guys are,
you're exactly like me.
You've got to be really aware of that
because that's gonna put people off.
The other thing is that the clients and the families
and the people that you're gonna work with,
they don't always have a good sense of boundaries,
so we're gonna have to model that for them,
because they haven't been taught that.
So they're gonna rely on you and your modeling
of good boundaries so that they can learn it as well.
Okay?
So that goes right into the physical stance conversation.
A couple things that you wanna keep in mind.
You're never gonna turn your back on an angry client.
So forget about someone who's enraged.
We're just not even gonna turn our back on an angry client.
Always be at the same eye level.
So basically what that means, obviously,
if there's a height difference, that's a little tricky.
What that really means though is if they're standing up,
so are you.
And if they're sitting down, so are you.
Especially if they're sitting down.
If they're sitting down, that's a good place for them to be,
if they're angry.
Really good place for them to be.
If they're standing and pacing,
you wanna be thinking about that.
I had a situation, I'll go into story number one.
This one was not about me but one that I actually witnessed
where I worked in a school
and it was a specialized high school
for kids that couldn't go to public school
and a lot of really challenging behavioral students.
And we had this one student,
he was incredibly dis-regulated.
We were working on medication for him,
trying to find the right combination of medication
and treatment and we were really having some challenges.
He was very dis-regulated.
And he would come into school in the morning
and he would get there by 8:30.
By 9:00, he was usually in some sort of physical restraint
because he had assaulted somebody or he'd done some sort
of property destruction,
kicked something, punched something.
Just always enraged and sort of heckling
this physical release.
He had a wonderful relationship with his father
and we often would call dad to come and help us
in interventions because it really sometimes would help
deescalate this individual.
So there was one day in particular where
he came into school in the morning.
He had a very hard time.
He sort of destroyed a classroom,
flipped over desks and chairs,
threw books around.
We had all the other students leave the classroom.
I was a behavioral counselor at the time.
This was early on in my career
and I went in with another behavioral counselor
and we just sort of stayed,
if the door was over here,
we just stayed by the door.
That was strategic so that if he started
to throw desks and chairs again we would be able
to get out of the room quickly.
He didn't block us in the room.
The principal of the school had called his dad
and his dad was on the way.
So dad arrives at the school
and we're inside the classroom with this young man,
we'll call him David.
David is really pacing, very agitated,
looking for things to throw.
We're kind of silent at this time,
but every so often we would offer some words
of support to try to see if we could get him
to follow any kind of limit.
So dad comes in and we give dad a rundown
of what's going on.
He says, "All right."
He goes into the classroom and he says, "David."
And David's agitated the dad's there now
because I think he feels like he's gonna get in trouble.
So he starts to get a little more agitated about dad
and dad goes in and says, "David, let's just take a seat
"and talk about this.
"Let's just take a seat and talk about this."
And David's not taking a seat.
David's still pacing.
So dad goes over to where David is and sits down
right in front of him while he's still standing up
and pacing.
What do you think David did?
He kicked him in his face, yeah.
It was awful.
It was absolutely the most horrible thing to see,
to be like standing there watching this son
assault his dad who I know he loved dearly
and had a really wonderful relationship,
but, again, that empathy is temporarily gone.
He was just so enraged and dad was just trying
to be helpful in that moment
and he actually put himself in a really unsafe situation.
So being at the same eye level is about safety.
That's it.
It's really important.
If you say to somebody who's really angry
and they're pacing, if you say,
"Can we sit down and talk about this?"
and they sit down with you, that's a great sign.
That means that they're still in control.
You wanna allow extra physical space.
Yeah, question.
Yes.
Yeah, absolutely.
You don't wanna sit down and then get right back up
when they don't, yeah.
That's a great question.
So you wanna allow extra physical space between you
and the client.
So, going back to the exercise that we just did,
for those of you that don't need a lot of physical space,
your instinct in that moment might be to go over them
to try to be more supportive.
You have to fight against that and you have to keep
your distance,
even if it seems a little unnatural for you to be talking
with somebody across the room.
It's about your safety in that moment.
So that's what needs to be in the forefront,
is our safety.
Question.
Mhmm.
Yeah, do you mean in terms
of how close that they're standing?
So you wanna approach those things.
Yeah, the question is, are there certain interventions
that you can use to talk about boundaries with somebody
that isn't gonna demonstrating good boundaries.
So with regards to physical space,
if somebody is physically too close to you,
the first thing I do is just take a step back.
If they then approach me again,
I go after that directly and assertively.
I say, "This is actually a space
"that I'm not comfortable with.
"Would you mind just taking a step back?"
Or I take a step back.
You wanna be direct in that moment because being direct
in that moment, you assume they're not doing it on purpose.
And so by calling attention to it, they may not be
doing it on purpose.
They may not realize that you're uncomfortable.
So I always go after that stuff directly
but still respectfully.
I don't say things like, "Back up."
Question.
Oh.
I knew somebody was gonna ask that one.
So the question was what if you're in a car with a client.
Yeah.
You guys think I have some magical intervention for this.
So the car is very tricky.
I have actually a couple of unsafe car stories.
The sad thing for all you who've always wanted the answer
to this magical question is there is no magical answer
to what happens when somebody becomes unsafe in the car.
You have to go with basic things.
Pull over.
Get out of the car if you need to
and call for help.
You don't stay in the car.
You do not continue driving.
Even if you're on the highway, you need to pull over.
And if you need to get out the car to make a phone call
for safety, then that's what you need to do.
Putting somebody in your car is more about preparation.
Are they agitated before they get in the car?
You might want to think about that.
You might want to think about, "We're gonna go into the car
"and we're going to an appointment that's gonna be
"particularly difficult for them,"
or if they just blew out of a home visit,
whatever the case may be,
you wanna think about their state prior
to getting in the car with them,
because that's a situation where you really need
to be proactive because it can be very dangerous.
Question in the back?
Yep.
So I'm sorry, I just want to understand you correctly.
You were uncomfortable putting somebody in your car?
Yeah.
Absolutely, absolutely.
If you are uncomfortable in a situation
and you don't feel like you are prepared enough
or you have enough supervision or training,
ask for that.
Don't just get in the car with somebody
if you feel like if something happened
you don't know what to do.
You guys have to be in charge of your own safety
because I'm gonna say this to you as a field instructor
at we walk.
I'm also gonna say it to you as somebody
who supervises interns at Wayside.
We don't often think about that.
So you guys have to be responsible for your own safety.
If you feel like you don't have enough training on something
or you're not prepared to handle a certain situation,
ask and be assertive about it,
because you guys have to make it your own priority.
Yeah, question over here.
To be between them and the door.
No, you're always by the door if you can be, absolutely.
Yes.
Yes, I understand what you're saying.
Yeah, so, so if this is the only door in an office,
if we're in a small office over here,
what you're saying is that you don't stand like this.
Yeah, you don't, because that's intimidating
and they're gonna feel trapped in.
You can kinda stand like this.
Where you don't want to stand is over here
and have the client be here,
because if you need to get out now they're blocking you.
So you wanna be thoughtful about that in a way that
you can both get out safely if you need to.
Now, you're going to think about that.
You guys are gonna walk into your setting the first time
in an office and you're gonna go, "What the hell?
"How am I supposed to do this?"
So it's something that you wanna be aware of
and if somebody's agitated, maybe move the furniture around,
meet with them somewhere else,
be thoughtful about that.
Also when you're going into people's homes.
We're gonna talk about when you go into somebody's home,
so just bear with me on that one.
Is there another question?
Can you just stand up, honey, I'm sorry I can't hear you.
Yep.
Possibly, but your safety comes first.
Okay, so her question was,
and this can be applied to all settings,
"What happens when you put yourself in a position,
"if somebody starts to become agitated and you slowly move
"over towards the door and they notice that?"
And they will because what did I just say earlier,
that they noticed all that body language stuff first, right?
So they're gonna notice when you're scared
and you're feeling unsafe.
That's okay.
Because it's not about the relationship in that moment,
it's about your safety.
Then afterwards, when they're in a better place,
that's when you do the work to repair that relationship.
That's when you process that.
That's when you talk about boundaries.
That's when you say to somebody, "Hey, when you move
"towards me, I felt really unsafe in that situation.
"And that's why I moved towards the door."
Those are really valuable teaching moments
and you wanna be able to take advantage of that.
When you think about the relationship in that moment
you're making yourself less safe.
Do not stand full front to the client.
That's kind of an obvious one.
That's a very, very intimidating posture.
That was intimidating for you guys to stand full front
to each other.
You kinda wanna stand off to the side.
It's like this.
Anybody ever had any kind of restraint training
like CPI or TCI?
So you guys know what this is, right?
The CPI stance type, yeah.
So it's just like a pivot.
Can you actually stand up for me?
So you're an angry client.
Angry.
I'm not gonna stand like this.
This is very intimidating.
I'm gonna stand off to the side like this.
My body is positioned in a certain way.
I'm actually at a pivot,
for two reasons.
One, is I can get to safety quicker this way.
It's respectful of her personal space
and it's less intimidating.
So it's like this weird, unnatural, like
"Who stands like that?"
But with the more practice, you guys actually will realize
that you might start standing.
When I'm arguing with my husband at home,
I'm in my CPI supportive stance.
It's just natural.
When I'm setting limits on my kids
I'm in my CPI stance.
It just becomes second nature for you guys.
So it feels a little awkward at first
but put your ego aside and do it anyway
'cause it's safer.
Question.
Is there a question?
Yeah.
No?
She did?
It will become more natural for you.
And when you're in that moment, you're feeling unsafe,
it won't feel unnatural at all.
It'll feel safer.
Do not maintain constant eye contact.
So not to be confused with number one.
You wanna be looking at them but don't do this
constant eye contact like two dogs that are about to fight.
Yeah, staring at each other.
That's a primal response for a fight.
So be natural about it.
Glance at the clock, look around the room,
head down for a second.
You're not turning your back on them
but you're not just staring at them intently.
Watch your gestures.
And the reason that you need to watch your gestures
is because that's what they're watching.
They're watching your body language.
They're paying really close attention to that,
more so than the words you're saying.
They're probably not even understanding the words,
they're just watching your whole body.
So if you're somebody who talks with the hands
and you're doing a lot of stuff,
that's gonna increase their anxiety.
So watch your gestures.
You're gonna be really calm and in control.
That's a "so not smile."
It should say, "Do not smile,"
which is really hard to do because smiling
is a nervous response.
So is laughter.
But if you're in a situation where somebody's becoming angry
and you're laughing or smiling, yeah.
So if you know that you're somebody who laughs
when you're nervous, be aware of that
and be ready.
And work on being really, really calm and neutral
in that moment,
because they're gonna take that the wrong way.
Nothing in that moment is funny to them
'cause they're angry or enraged.
Do not touch.
I can't state this one enough.
I'm a touch-er, especially in relationships,
I go up to people all the time,
I do that.
You do not do that to an agitated individual.
If you're somebody who's a touch-er,
it's going to be your instinct to do that,
to just kinda go and offer support.
But, one, that's not what they need in that moment.
And, two, you do not want to get close enough
to an agitated individual to be able to touch them.
Yeah, question.
Yep.
Because with TCI and CPI, your goal is to physically manage
the individual.
These are for situations where that's not gonna be
your responsibility.
What your responsibility is to get to safety.
So I'm not sure if any of you are gonna be
in residential placements, settings, things where
they're gonna use physical restraints or schools,
and you're gonna be required to do that.
Often agencies do not want interns doing that.
No? Okay, good.
Yeah, I don't want them doing that either.
But there are some places where it is your job
to physically manage somebody and to keep them safe
and you have to do it with that.
But if that's not your job, then your goal is
to get to safety.
Hands are visible always,
so that they know that you don't have a weapon.
Because, remember, they're not thinking reasonably,
they're not able to use logic.
If you have your hands in your pockets
or behind your back, that's gonna make them very anxious.
So hands visible always.
Just kind of a relaxed, down at your side.
The other reason is that your own safety.
You want to be able to block
if somebody tries to throw something or hit you.
Question.
What if their hands are in their pockets?
Okay.
I have an intervention for that but does anybody else
have an intervention for what they would do for that?
Ask them to take their hands out.
That's exactly what my intervention is.
Say, "I notice that your hands are in your pocket.
"Do you mind taking your hands out?
"Do you have anything?"
They may use that to be provocative in that moment,
like, "Oh, maybe I do.
"Maybe I have a weapon."
Okay.
But you wanna be direct about it because you want them
to know that you're noticing it,
because, again, it's not about
the relationship in that moment.
It's about your own safety.
So, yeah, I ask people directly.
Yeah, question.
Yes.
Absolutely, 'cause if you're standing there like this,
what if I came into the training and just stood in here
like this,
talked to you guys like this?
Do I look interested to be here?
No.
I am, though, I'm really interested to be here.
So thank you.
Yeah, so I can just be cold.
There's a number of reasons why people cross their arms
or do certain things,
but it's gonna be how they perceive
your actual body language.
So you wanna be thoughtful about that.
Do not argue or try to convince.
It's not the time for that.
It's not the time to work all this beautiful critical magic
on them.
They can't even hear it.
So we just don't do it in that moment.
We actually don't do a lot of talking
when we're trying to deescalate somebody.
We're more just making sure that we are physically safe
and we're monitoring and assessing them.
Question.
Could you just stand up so we can hear?
Wanna use the mic?
- In the situation with the father,
did you guys not anticipate that he was gonna do that
because I was just wondering.
Yeah, that's about regulating.
- That's a great question.
Basically, she's asking, "What is wrong with you two
"that stood there while the dad got attacked?"
It's a fair question.
Yeah, we did try to say to dad,
"Listen, he's really agitated right now.
"Please let us intervene."
And what dad said was, "I got this."
It was one of those moments of "This is my kid.
"I know him.
"I can do this."
And so we were like, "Okay."
Lesson learned.
Next time we will be a little more assertive about, like,
"Please don't go in there.
"This is really unsafe right now."
But, yeah, so great question.
Yeah, another question.
You have a great, loud talking voice by the way.
You're welcome.
Right.
Absolutely.
Absolutely, you just get out.
You don't talk.
Yeah, you're just gone.
You can call for help.
Whether it's somebody's house.
Yeah, oh you have to call somebody.
Absolutely.
But you get out of the vicinity
of where you are with the individual
and you get to safety and you call somebody.
So if somebody has a weapon in their house, you leave.
If somebody has a weapon in an office,
you get out of that office.
Yeah.
Yep.
Absolutely.
When we're meeting with an individual in a room,
you have to walk into that room first and think,
"Is there anything in this room that they can use
"as an object?"
And the reality is almost anything in the room
can be used as an object or a weapon somehow.
But the obvious stuff, letter openers, paperweights,
things like that, clear them out of the way.
Make the space safer.
Yeah.
Question in the back?
Yep.
Absolutely.
Yeah, absolutely.
And even when you have that rapport,
there's moments where it doesn't matter.
Yeah, absolutely.
You have to think about that that there's no verbal language
that is gonna be helpful in that moment.
Absolutely.
Yes.
Yep.
Mhmm.
Yes.
I don't with adults.
Yeah, I don't.
Maybe very small things,
like if they move, I might move
in a very natural way.
But typically I don't use that intervention with adults
because I don't want to call attention to it
or seem like I'm mocking them.
Yeah.
She talked about mirroring and how that can be very helpful
especially with younger children and even adolescents.
But how do you do that with an adult who's agitated?
And I said that I don't,
because I don't want them to mis-perceive that as mocking.
Mirroring just means that you're doing
essentially what they're doing.
So if they're moving around,
you're moving around.
If they sit, you sit, which actually you should do.
If they pick up something and play with it,
you pick up something and play with it.
Yeah, so it can be helpful,
it can be this in-the-moment intervention,
to get people to focus more on the moment.
But it's tricky.
Can be tricky.
Yeah, question over here?
Yep.
That's a really great question.
And I don't want my answer to seem like it's flip,
but it doesn't matter in that moment.
You're being a wonderful social worker
and you're a mile down the road thinking about,
"What if I call the police and they act violently
"towards that individual?"
But while you're processing through all of that thinking,
you're not keeping yourself safe.
So you have to think about it really basic in that moment,
"What do I need to do to be safe?"
And if it's just that I've gotta step outside their house
and pick up my cell phone and call for help,
or go outside and ask for my supervisor to come in the room,
whatever setting you're in, whoever is around,
that's where you find out how do you call for help.
And you ask the agency,
"When I need help with a situation,
"what do I do?"
They'll tell you specifically, "Well, we have a panic button
under the desk."
Or, "Pick up the phone and use this code to call
"the reception."
Different agencies have different policies for safety.
If they don't have one and, truthfully, they may not,
ask about that.
What can I do in that situation?
How do I keep myself safe?
But don't ever not call the police,
especially in the case of a weapon or something like that,
because a police may act a certain way.
Does that make sense?
It's a great question and, obviously,
those are real situations that happen.
I work in a residential setting,
and when we've had to call the police,
we don't ever want to because we're residential workers.
We wanna be able to manage the situation.
The police come in and treat our adolescents like criminals.
And that's really hard to see and to witness.
We've had police come in and pull out tasers.
What we have to remember is
that it's a different kind of work.
They're trained differently than we're trained
and the two don't always mesh well together.
So it's great if the agency has a good working relationship
with their local police department.
Some agencies do.
But the reality of the situation is that they're trained
differently.
And they're gonna come in and they're gonna use force
to get control of the situation and that's not what
we're gonna do.
Question in the back?
Could you stand up?
Again, thank you.
Yep.
It depends.
I think it depends on how much time you have.
If it's really unsafe, you just gotta get out.
If you only have time to pick up the phone
and call for help, you do that.
And if they're still angry and you're able
to set limits on it, you can say,
"I wanna sit here and talk with you.
"I don't want my supervisor to come in and talk.
"But if you keep shouting then I'm gonna have to call
"my supervisor to get some help."
So it really is gonna depend on how agitated
and angry they are and how much time you have.
If they're able to follow your limits, that's great.
If they're not, then you wanna get some help.
Yes.
Absolutely.
Absolutely, you ask people to leave.
Yeah, so I'll repeat the question.
She's doing group work with adults
and she was in a situation where she witnessed
two girls start fighting each other in a group setting
and just how awful that was for other people to witness it.
But at the end, what ended up happening is more people
getting involved because it got escalated by the fight.
Absolutely.
There's a contagion effect, absolutely.
There's a contagion effect with that kind of stuff.
When something happens in a group setting
and you can't gain control quickly,
end the group and ask everybody
who's not part of that incident to leave
for that exact reason.
You don't wanna be outnumbered
because it could escalate and you would get a group leader
or you're not safe because you're outnumbered.
And, two, everybody gets out of the room for safety
and if you were to call the police,
you let them come in and intervene.
Now some people are gonna leave and some people aren't
and you can't control that.
But you can ask to see who will.
Yeah.
Can you stand up?
Yep.
Yeah.
Yeah, so she's doing a home visit and she's doing it
more in a remote setting
and is not gonna have a phone and she might be walking.
I think just the basics of safety,
just get out of the immediate situation.
That's really all that you can do.
If you're going in to do a home visit
and something unsafe happens, you're gonna leave
and you're not gonna go back to that home
until you're able to process that situation,
not only with your supervisor, but with the people
in the home as well.
But your goal is always to leave
and if you don't have a cell phone, you don't have a car,
you say to somebody, "I'm sorry.
"This is an unsafe situation.
"I can't stay here.
"My agency requires that I leave."
And leave and repair that relationship later.
Okay?
There really is no magical intervention.
There's every what-if scenario possible out there.
Likelihood is that you guys are not gonna experience them
all anyway.
But the answers are kind of always the same.
It always comes down to that if you're thinking
about your safety first and you're getting out
of an unsafe situation,
that's always the priority.
And the relationship with your agency, with the client,
with the family, with whomever, is always secondary
and can always be processed later.
You can always repair a relationship.
It's a lot easier to repair a relationship
when you've left a situation than to repair a relationship
after you've been assaulted or badly hurt
and you feel like you don't want to continue
to be in the field anymore.
All of those would be a realistic possibility.
So put your safety first and all that other stuff
is secondary.
Can you stand up?
Absolutely.
That is so true, that this is not just about your safety.
This really is about your clients that you're working with,
their safety as well,
because, remember, they lack empathy in that moment.
But that doesn't mean that they're not gonna get it back
and realize what they've done.
We have to remember that they don't want to hurt us.
Nobody wants to be violent.
Nobody wants to hurt us, but in that moment,
whether it's intense guilt
or intense shame that they're feeling,
whatever is causing that rage, they're gonna act on that,
but it's not because they want to.
It's because they don't have control.
So we have to remember that, especially when you go back
to process that situation.
It can be very challenging.
I got hurt by a client.
He was a residential client and I happened to be
his clinician.
I didn't pay attention to anything that I should have.
This kid was very agitated.
We had a treatment meeting that day
and he was very anxious about those kinds of things.
He was very dis-regulated.
And he was incredibly anxious all morning
about the treatment meeting.
Now I should've intervened early on.
I knew that he was anxious.
But I was busy.
I had a million things going on.
I had a ton of stuff I had to do
and I was like, "I'll worry about him in the meeting.
"He'll be fine."
So sure enough, the meeting starts.
I go upstairs to get him
and the residential counselor says to me,
"Sarah, he's a little agitated.
"I don't think he should actually go to the meeting.
"He's not okay.
"He's pacing.
"He's pretty angry."
That right there, that should've been it.
I should've listened to him.
I didn't.
I said, "He'll be fine once we get in the meeting.
"I got it."
And I brought this kid downstairs into the basement
where there's no staff,
to a conference room with his mother,
whom he hated at the time,
his TCF worker, which nobody's really excited to see,
and me, whom he's mad at because he was anxious
all morning and I didn't have time to check in with him.
So we were kinda doomed from the start.
We sit around this big conference table.
He starts making threats.
I set limits on it pretty quickly.
I said, "John, I can't have you threatening.
"We want to get through this meeting.
"We want you to be a part of it.
"But I can't have you making threats.
"So I need you to stop or we're gonna have to end
"the meeting."
That really agitated him.
Reasonably so.
So he continued to make threats.
And at one point, he stood up and came charging
across the table at me and was able to sort of knock me out
of the chair.
The social worker got out of the room,
went and called for staff.
Staff came down and helped.
I wasn't badly injured but he did physically attack me.
That was my fault.
I don't ever like to say that to people when they get hurt,
like, "Oh, well that was your fault."
But in that situation, that was my fault.
And I had to process that and really think about that.
There was a lot of warning signs before that happened
that I ignored.
And I ignored it because I thought I could handle it.
Then I got hurt.
The sad thing about that is that he became
so emotionally upset about what he had done,
he ended up getting psychiatric-ally hospitalized.
He was in a hospital for over a month to repair,
I had been working with this kid for over a year,
to repair back that relationship took forever.
He just felt such guilt for what he had done.
And I had to be like, "This was my fault too."
And we really had to repair that relationship together.
It was very challenging and I took full responsibility
for that.
He did not want to hurt me but he really felt like
I ignored every warning sign he gave me and I did.
So I always remember that, that they don't want to hurt you,
but sometimes they feel like you're ignoring them
and they feel pushed to do that.
Just in the interest of time, I'm gonna move on
and we'll do some more questions at the end.
Just wanna make sure I get through all of this.
So with regards to the deescalation discussion,
you've gotta remember that your only goal is to bring down
their level of arousal to baseline.
And you're gonna know pretty quickly whether or not
you're able to do that.
If they're not able to follow simple limits,
then you're not able to do that,
and you wanna think about another plan for safety.
We do not ever yell over a screaming person.
We're gonna maintain an even tone of voice.
We're gonna respond selectively.
Basically what this means is that we're gonna avoid
the power struggle.
So sometimes when somebody is trying to power struggle you,
they ask certain questions.
They're trying to provoke you.
We respond selectively.
So for example, they may say,
"Why you gotta come into my house?
"And why do I have to fill out all this paperwork?
"I'm sick of all this paperwork."
That's a reasonable question.
That's information seeking so we wanna explain
like, "I know it's a lot of paperwork.
"I'm sorry, these are the agency requirements.
"I wanna be helpful
"and let's try to get through it quickly."
They may also say things like,
"Why are social workers assholes?"
Maybe you have a really good answer for that.
I don't recommend that you answer that question
because they're not really looking for an answer.
They're looking to lead you in provocative behavior,
in a power struggle.
We're gonna respond selectively.
We're gonna explain limits and rules in an authoritative,
firm, but always respectful tone.
Okay?
Empathize with feelings, but not behaviors.
So I can understand why you're angry.
It makes sense to me that you're angry.
But we don't say things like,
"It makes sense that you just threw that chair
"through the window."
Okay.
Do not interpret feelings in any kind of analytic way.
This is not the time to go to John Banahan's
Statistical Analysis of Risk.
Keep it really simple in that moment.
Don't go into the treatment plan and the IEP goals
and the DSM and all.
Don't.
Just save the psychobabble for another time.
Give the consequences of inappropriate behavior
without threat or anger.
So if you continue to shout at me,
I'm not gonna be able to continue this session.
That's the consequence that the session will end.
Not being disrespectful.
I'm just letting them know that that's what it is.
Represent rules or controls as institutional
and not personal.
What that means is throw your agency under the bus.
My agency won't allow me to stay here
when there's weapons that are visible in your home.
So you leave.
It's always about the agency.