Environmental Signals of Danger

The environmental context has a number of signals that may indicate a potentially violent situation. Certain situations are more potentially violent than others, such as the following. A protective service worker decided to remove a child from a home in which one, or both, of his parents are abusing him. A social worker at a battered women’s shelter takes one of the residents to her home (where the batterer may be present) to pick up some of her belongings. A social worker at a police department goes with a police officer to a home in which domestic violence is reportedly occurring. A social worker at a neighborhood center is working with juvenile gang members to curb criminal activity.

Client Signals of Danger

The best predictor of violent outbursts is a history of violent expressions. Persons with a history of violent reactions have a greater chance of becoming violent again. Therefore, if at all possible, an intern should read a client’s records prior to meeting with him or her. Diagnoses of antisocial personality disorder, borderline personality, and schizophrenia have been associated with proneness to violence.

Another indicator is a history of substance abuse. Alcohol intoxication lowers inhibitions towards violence, and it interferes with a client’s judgment. Use of such drugs as cocaine, PCP and amphetamines increase the risk of violence as they increase the potential for agitation, suspicion, grandiosity, and delusional beliefs.

Signals of Danger

In assessing the risk of potential violence, it is crucial that interns also attend to their internal responses (“gut-feelings”). Interns who know themselves well will be better able to identify their feelings and thoughts. They then can utilize these gut feelings to assess the risk of potential violence. However, it should be noted that intuitive feelings can be erroneously affected by the intern’s personal biases, cultural biases, and by misinformation. For example, facial gestures, body language, and verbal expressions may communicate different meanings across cultures (Native Americans, for example, generally find direct eye contact to be rude, and a sign of aggressiveness). In general, however, gut feelings are an important source of information for assessing the risks of violence, and interns need to access and attend to them.

Assault Cycle:

Most assault occurrences follow a predictable pattern of five phases:

1. Triggering phase: All persons have a baseline of their normative behaviors. In this triggering phase, an event occurs that serves to ignite the first deviation from these baseline demeanors. The event can be of infinite variety—such as receiving criticism, or receiving a speeding ticket.
2. Escalation phase: The client becomes increasingly emotionally aroused. His speech, behavior, and emotions move further away from his normative expressions. The best time to intervene is early in this cycle. The intervention, for example, may involve active listening, nonjudgmental listening, and problem solving, so as to divert the client’s agitation from escalating further.
3. Crisis phase: At this stage the client is so aroused physiologically and psychologically that he is unable (or at least not inclined) to control his angry and hostile feelings. Instead, he becomes verbally or physically aggressive. At this point in time interventions of active listening and problem solving are no longer apt to be effective. Instead, the intern needs to seek to attend to: his or her own safety, the safety of others, and the safety of the aggressive client.
4. Recovery phase: The client begins to return to baseline behaviors; yet, the client is still in a precarious state. If further events occur that are upsetting to him, he may rapidly return to being verbally and physically abusive. To support the recovery, the intern needs to pace interventions in response to the client’s cues, and perhaps reassure the client that he will be safe. The intern in this phase should avoid disapproving comments, and should not as yet seek to explore the reasons for, and consequences of, the behavior.
5. Post-crisis depression phase: At this point the client has calmed down and returned to baseline behaviors. He may even be more subdued than his normal baseline behaviors. He may be mentally and physically exhausted. He is apt to have feelings of remorse and shame, which then make him more receptive to social work interventions.

These five phases provide suggestions of when and how to intervene with communication skills to de-escalate the situation. For example, during the crisis phase, and during the recovery phase, this paradigm suggests that active listening and problem solving should not be used; yet, these techniques should usually be used during the other three phases.

Preventing Violence

The best way to deal with violence is to prevent it from happening in the first place. Usually the most constructive way of doing this is to lessen the perceived threat and the feelings of helplessness. There are a variety of options for preventing violence (fortunately) that an intern can pick and chose from.

De-escalating verbal communication: One way of de-escalating verbal communication is for the intern to facilitate the client in expressing his feelings and thoughts. Such expression may have a ventilating effect for the client. Ventilation can be facilitated by the intern using the skills of active listening and reflecting the client’s feelings. Reflecting feelings helps the client to be validated as a worthy person. The intern may also use the technique of disarming where the intern finds some truth in what the client is saying, and then expresses this “agreement.” Disarming results in the client feeling understood and validated, and thereby he is more apt to be open to examining the intern’s point of view.

Also useful in helping the client to express thoughts and feelings is for the intern to use empathy by paraphrasing the content of what the client says. Restating the meaning of this thoughts and feelings may help him to reflect about the issue, and problem solve the issue.

Encouraging the client to problem solve, and assisting him in problem solving is another strategy to de-escalate verbal communication. Violent prone clients have greater difficulty in generating nonviolent solutions to problems. Sometimes suggesting nonviolent options to clients facilitates them in choosing nonviolent courses of action.

Sometimes redirecting the client’s attention to a less emotionally charged subject can de-escalate the verbal communication. For example saying, “It’s really getting warm in here. I think both of us need a little time to cool down. Let’s take a short walk and talk about something else for awhile. Once we’re more relaxed, we may be better able to come up with some creative ideas to resolve this.”

It is also important for the intern to avoid using aggressive, confrontational or macho responses when a potentially violent client is emotionally upset. Such responses increase the likelihood of violence.

De-Escalating Nonverbal Communication: The intern should maintain some distance from the client, so that the client does not feel his personal space is being violated. Individuals with a history of violence tend to want a wider territorial space around themselves for personal comfort than do less violent individuals. The intern should avoid touching the client (other than shaking hands), as touching may be perceived by the client as a challenge, or it may psychologically arouse the client if he connects such touching with being physically abused in the past.

Some eye contact with a potentially violent client may be useful as it conveys interest, and it also enables the intern to be watchful. However, sustained eye contact and glaring should be avoided as it may be perceived as hostile, and heighten aggressive arousal.

Setting Limits: Many angry clients actually fear losing control. For such clients it is useful for the intern to say something like, “It’s OK to be angry, but it’s not OK to strike out. What can I do to help you feel more in control right now?” Such a statement helps clarify to some potentially violent clients that physical aggression is not acceptable. The tone and wording involved in setting limits should be supportive of the client’s worth, and should not increase feelings of powerlessness.

In setting limits, it is important not to come across in a parental tone, or in a nonassertive tone. Both may serve to trigger additional arousal. The intern should set limits in a confident, assertive tone, rather than in an aggressive tone.

Staying Calm and Generating Options: As much as possible, the intern should seek to remain calm. In addition, even if aroused (and frightened) the intern should seek to communicate calmness, both verbally and nonverbally. An even, slow, soft-toned voice and a confident, nonjudgmental, nonauthoritarian approach will somewhat facilitate the client feeling reassured rather than pressured. An intern who becomes agitated, and conveys this agitation, may subtly provoke the client’s aggression. (Interestingly, the same advice is often given when seeking to “stare down” a grizzly bear or some other threatening creature.)

Remaining calm also facilitates the intern being creative in generating constructive options (including escape strategies). In contrast, fear and high anxiety will interfere with generating and assessing appropriate options. Remaining calm is facilitated by the intern using relaxation techniques.

Home Visits

Specific safety precautions need to be tailored to the individual situation. However, the following are some guidelines for planning for safety when conducting home visits.

If possible, the client should come to the office, where the safety of the intern is more easily achieved. If the meeting cannot be held in the office, perhaps it can be held in some other public place, such as a library or restaurant.

If the visit needs to be held in the home, the situation may warrant that the visit be made by two persons. If the potential for violence is heightened (as in helping a woman at a battered woman’s shelter retrieve some of her belongings from her home when the batterer may be present), perhaps the woman and the intern should be accompanied by a police officer.

The intern should seek to obtain as much information as possible on the client, prior to the home visit. The file, for example, should be reviewed for any evidence of a history of violence, and for risk factors related to violence (such as alcohol or other drug abuse). It is also important to seek to determine if there are others in the household who might present a risk of violence. Also, the intern should seek to determine if there is an aggressive dog in the home or in the yard.

As an intern enters a home, she or he should seek to determine the entrances and exits, in case a quick exit is needed. Interns should wear the kinds of shoes that facilitate a rapid exit. Wearing expensive jewelry and expensive clothes should be avoided in deteriorating neighborhoods, as such articles may be perceived by the client as indicating the intern is a member of a different socio-economic class and therefore is unlikely to relate to him or his circumstances. Interns should wear professional attire that presents them as a non-threatening person. Interns should make certain the agency knows their itinerary when making a home visit. Other staff should know the location and approximate arrival and departure times. Interns should carry a cell phone and have it on. The cellular phone should be programmed with agency and emergency numbers for quick dialing.

It is useful to present oneself as a confident, assertive person. Being timid, or aggressive, is more apt to elicit an aggressive response. If other people are present near the destination, and appear threatening, the intern may choose to return another time or day—perhaps taking another staff member along.

The intern should park his or her vehicle in a place that allows for a quick escape. If a noisy argument is occurring at the destination, it may be best to return at another time.

When entering the house, the intern should do a quick visual scan looking for signs of danger, such as weapons or drugs. The intern should be watchful of all persons. The intern should ask who else besides the client is at home. If there are signs of danger, the intern should promptly and politely postpone the visit, saying something like “I’m sorry, you’re going to have to excuse me. I just remembered I’m supposed to be at another meeting. I’ll call you this afternoon to arrange another time when we can meet.” It’s best, at least at first, to say near the entrance door, in case a quick exit is needed. The bottom line when conducting a home visit is to seek to remain calm, so the intern can creatively generate and assess options in regards to safety. Furthermore, the intern needs to trust his or her “gut feelings” in relation to signs of danger.