20:  Working With Resistant Families

Chapter Overview

This chapter will examine those skills needed to effectively work with clients who may be resistance to treatment and to prevent the potential for violence.

Introduction

Children’s Service Workers need to know some techniques to effectively work with threatened or hostile clients.  It is important to gain some knowledge of the ways to reduce resistance to treatment and to prevent the potential for violence in the casework interview.

It is basic to the humanitarian value of social work practice that services be available to all who are in need.  Traditionally, the treatment process is set in motion when someone decides he/she has a social or psychological problem for which he/she desires help and he/she acts on the feeling by contacting a social agency.

Most clients who see Children’s Service Workers because of child welfare problems have been referred or in some way are required to obtain services.  They are involuntary clients in that someone else has determined that the client is in need of intervention by a social agency.

Client self determination is the practical recognition of the right and need of clients to make their own choices and decisions in the child welfare process.  This right is limited by clients' capacity for constructive decision making, by the law and by the agency functions.  In actual practice, the Children’s Service Worker assesses a family's situation and sets intervention goals based on that assessment.  It is urgent that the worker be aware of the problems involved in working with a client who did not consciously choose to be "helped" and in establishing goals that may go beyond the client's wishes.  We need to be directive and purposeful.  Care must be taken not to threaten, devalue or apologize.

Interviewing Techniques

Prior to the first contact, the Children’s Service Worker may need to review his/her repertoire of skills and select the approach to use with a new client with which he/she is most comfortable.  More specifically, the worker should review interviewing techniques which are essential in establishing the relationship.  Many times the worker is judged by the client on the basis of the initial interview and subsequent contact reflects the positive or negative reaction of the client and the worker.  Interviewing techniques can be non-directive or directive.

Non-directive techniques include:

• Head nods, smiles, frowns;
• Eye contact and body posture/gestures indicating that the listener is responsive to what the speaker is saying;
• Minimal verbal exchanges such as "yes," "I understand," "I see," "um hum," etc.;
• "Verbal follows."  In using "verbal follows" the listener simply repeats a key word that the speaker has used in a statement to demonstrate attentiveness.  Verbal follows may be used to get the speaker back on track.  They may steer the speaker in the direction the listener wants him/her to go.  (Verbal follows may also be directive if the word is repeated in questioning tone, indicating that the listener wants clarification in that particular area.)
• Non-directive techniques can be powerful means of expressing empathy.  They tell the speaker that the listener is tuned into the speaker's feelings and concerns.  The skilled use of non-directive techniques, combined with the more directive, assertive interviewing techniques convey positive regard even when facing a client with unpleasant truths.

Directive/Assertive Techniques:

• Clients in the child welfare system often enter the agency on an involuntary basis.  Either they come to the agency as a last resort or enter due to legal and/or community requests.  Often the client would prefer not to talk about the reasons they have become involved with the agency.  This may be specifically true in early contacts.  Once a relationship is formed, information may be given more freely and clients will talk about themselves and their problems.  In working with involuntary clients, Children’s Service Workers must assume the responsibility for the directions of interviewing.  This requires the use of directive or assertive interviewing techniques.
• It is important that Children’s Service Workers not confuse assertive interviewing with aggressive interviewing.  In assertive interviewing the worker acts with authority.  In aggressive interviewing the worker acts with authoritarianism.  The first is from a non-defensive stance.  Assertive interviewing implies an understanding of one's right to intervene in family dynamics in order to protect a child.  It also assumes a respect for the parent of the child as a worthwhile individual whose concerns will be listened to but whose actions, in regard to treatment of the child, must change.  Assertive techniques include:
  • Active Listening - It is important that the Children’s Service Worker focus on what the client is saying.  The worker listens to the client rather than focusing on concerns about how the worker will respond.

  To let the client know the Children’s Service Worker is listening, from time to time, the worker states in his/her own words what he/she thinks he/she has heard.  This technique is called reflection of content.  For example:

  Mother:  Mary is my problem.  She isn't as grown up as she wants you to think.  She's got a mind of her own and does she know it!  She thinks she has the answer to everything.  If I make a suggestion she always finds some reason it won't work.

  Worker:  Mary won't follow your suggestions.
  OR

  Mary:   Everything I do around her is wrong.  My mother nags, nags, nags.  Nothing ever works.  It's all my fault.

  Worker:   Your mother constantly finds fault with what you do.

  Another technique is the reflection of feeling in what is stated.  By using this technique, the Children’s Service Worker's response to the mother might have been:

  Worker:   You are frustrated because Mary won't follow your suggestions.

                                      OR to Mary

  Worker:  You are angry because your mother constantly finds fault with what you do.

  Reflection is especially helpful in trust building.  If the Children’s Service Worker accurately reflects what the client has said, the message is conveyed that what was said was important.  If the reflection is not what the client really meant, he/she had been given the opportunity to clarify for the worker.  The worker has trusted the client enough to risk being wrong in stating his/her perceptions.

  Reflection skills are especially valuable at the beginning of an interaction because they are trust building.  They are also helpful when the speaker is angry or defensive.  Reflection tells the client that the Children’s Service Worker is trying to understand his/her point of view, but only the client knows what the point is and must clarify what it is.

  • Confrontation - In child welfare services, the Children’s Service Worker must be a skilled confronter.  Confrontation is, basically, facing the client with the facts in the situation and with the probable consequences of behaviors:

  Client:   The doctor is telling lies about me.  I didn't hurt Angie, she fell downstairs.  She is always having accidents.

  Worker:  I understand that children have accidents.  Angie's injuries could not have been the result of a fall down stairs.  There are two partially healed fractures in addition to the new head injury.  Angie's buttocks and back are marked with bruises in the shape of a hand.

  Client:  I know we haven't been to counseling in three weeks.  Get off my back!  My husband and I have other things to do.

  Worker:  Going to counseling regularly is a part of your agreement with us to regain custody of your children.  If the agreement is not followed, we can't recommend that the children come home.

  Or confrontation may be tempered with reflection which puts the client less on the defensive.

  Worker:   I know it is difficult to get into counseling.  However, getting there is necessary if we are to recommend return of the children in our agreed time limit.

Questioning Techniques

Asking questions effectively is an essential skill in child protective services interviewing.  There are two general types of questions:

• Closed-ended questions

These can be answered with "yes," or "no," or a brief word or phrase.  They are used to structure conversation and to get to the point quickly.

Worker:   Who was there when Angie fell?
Client:   No one.
Worker:  Where were you at the time?
Client:   In the kitchen.
Worker:  Did you hear her fall?
Client: Yes.

• Opened-ended questions

These encourage discussion and give the client a more free range to come up with information than in a closed-ended question.

Worker:   What did you do when you heard Angie fall?
Client:  (generally feels obligated to describe a series of behaviors)
Worker:   How do you see the situation now?
OR
What would you like to do at this point?

• Probing questions

These may be either open or closed-ended.  They are questions designed to clarify the facts.  They ask the questions:  Who, When, What, Where, and How.

Client:  She had those bruises on her when she came home from school.
Worker:  When was that?
Client:  Tuesday evening.
Worker:  What did you say when you saw the bruises?
Client:  I didn't say anything.
Worker:  Who else saw her come home in that condition?

Questions are often used in non-productive ways in interviews.  Children’s Service Workers need to be aware of some habitual ways of using questions that can be threatening, devaluing, or apologetic.  For example:

Don't you think you'd better stick to the agreement?  (or else!)

Why don't you follow through as you agreed?  (You're inadequate.) 

Let's review the agreement.  How about it?  (I'll back down, if you insist.) 

Avoid:  Is that O.K.?  Why don't we __________?  Do you agree?  Do you mind telling me __________?  Would you like to know why ____________?  Why did you _________?

"Why" questions are among the most provoking of defensive responses.  They imply an attack by insisting on a defense of some action.

Self Awareness in Communications and Interviewing

The following questions should provide the Children’s Service Worker with a quick overview of issues that relate to his/her ability to function effectively as a child welfare worker.  The list of questions can help the worker check his/her self-awareness in communicating and interviewing others.  Read the question and review to see what themes emerge:

1. What emotions or attitudes do you seem to have difficulty expressing?  Emotions or attitudes which cause the Children’s Service Worker distress or to experience difficulty in expressing will interfere with effective communication and the ability to form a relationship.
2. What have you tried to overcome these difficulties?  Once an individual recognizes that he/she feels that "all poor people are lazy" or "I have difficulty in letting people know I am angry" work should be focused on changing these attitudes or managing to communicate feelings where appropriate.
3. What emotions or attitudes are easy for you to express?  Expressing emotions can be healthy and personally rewarding but may also create conflict and direct hostility towards the Children’s Service Worker if the worker's expressions threaten the client.
4. Which emotions or attitudes do you have difficulty identifying when expressed by someone else?  Which are easy for you to identify?  Do you avoid or deny anger when expressed by others?  Have difficulty acknowledging compliments, etc.?  Then you have normal reactions which are often socialized into everyone at an early age.  Getting in touch with these attitudes and emotions aids the Children’s Service Worker in the development of skills and recognition of areas in which he/she may feel vulnerable.
5. Can you communicate your interest in another person?  Do you come across as a person who can be helpful?  These skills are essential in the development of good working relationships.  The Children’s Service Worker who holds him/herself in reserve and avoids involvement may be interpreted by the client as lacking interest, hostile, or fearful.
6. Can you correctly mirror the content of the other's statement?  Can you "hear" the feelings expressed along with the content or context of what has been said?  This is a good listening and communication skill which can be very useful in helping the Children’s Service Worker who feels particularly threatened by the client or the situation.  Many people "hear" the words but avoid or ignore the feelings expressed.  The tone and pitch of voice and the compatibility of verbal and non-verbal content are important to listen for, along with the words expressed.
7. Are you able to time your leading responses (influencing, advice giving, questioning) from your perception.  What aspects of your verbal response behavior are of poor quality?  It is important to accurately communicate feelings and attitudes.  For example, the Children’s Service Worker should avoid the use of "I understand" as a show of empathy when he/she may not have a firm grasp of the problem as it not only cuts off information but may unintentionally alienate the client.  If the worker feels strongly about a situation but communicates an easy-going attitude, expectations may be misunderstood.
8. Are you free to respond with your personal reaction (feelings rather than beliefs or thoughts) to client systems expression, behavior or attitude?  Are you free to express the reasons behind your personal reactions?  Are you able to judge when these are appropriate?  The Children’s Service Worker should be able to appropriately share personal feelings that contribute to relationship formation or working to change client problems.  Do you avoid any personal contact or expression with the clients?  If so, it is important that the worker examine this and consider what effect this may have on practice.
9. Do you tend to categorize people?  Do you tend to have similar reactions or feelings toward most people?  If the answer is yes, this may interfere with accurate understanding of the client and his/her life situations which bring him to the agency.  While particular characteristics or diagnostic symptoms may hold generally true of a client group, the risk of over-generalization should be avoided.
10. Do you criticize quickly - or feel critical?  Individuals who criticize quickly may cause the client to withdraw or react with anger or hostility.  The Children’s Service Worker should give praise when appropriate and not only point out negative or destructive behaviors by the client.  Some clients resort to withdrawal when criticism is constant in the worker's involvement on his/her case.
11. Do you minimize or universalize problems of others in an attempt to make them feel better?  Do you feel a need to offer immediate solutions?  In an attempt to make the client feel better, the Children’s Service Worker might try to state the "problem isn't as bad as you think" etc.  This may result in the client feeling put down, or otherwise misunderstood.  This may also indicate that the worker feels the need to resolve problems quickly either to help the client or to gain success for themselves.  It may also indicate that the worker has some problems in dealing with conflict.
12. Do you tend to shy away from distressing problems?  Do you feel a need to shy away from expressed feelings which are troublesome to you?  Essential to the role of the Children’s Service Worker is the ability to deal with distress both in others and in themselves.  Avoidance usually results in delaying appropriate intervention and may at times have life and death results in abuse cases.  The ability to express troublesome feelings serves to enhance communication and to set examples for the client.

Below are some simple and effective responses to commonly made remarks and questions that can help you to be more comfortable in dealing with threats to your authority.  Face-to-face encounters can be threatening enough that you may lose track of what you know about yourself and how you want to act with the client.  It helps to have some stock answers you can give no matter how you feel.  The following is an introductory sample of suggested responses to some usual remarks and questions.

Understanding Crisis Situations and Reactions

It is also important that Children’s Service Workers are able to know and be able to recognize that there are many reactions to crisis situations.  The following is a good reference to point out some causes for disorganized thinking and behavior as well as poor and ineffective methods of coping.

It is important that each Children’s Service Worker review and understand the variety of reactions a crisis situation creates.  Individuals vary in personality, specific situational circumstances, and timing of events.  However, there are some common reactions to stress and crisis which should be considered when a worker responds to a family plagued with chronic problems or reported for abuse or neglect.  Generally, crisis events tend to produce difficulties in terms of intellectual, emotional, and social functioning.  The client system in crisis may display disorganized behavior and thinking, poor functioning, hostility, impulsive behavior, dependence or psychiatric problems.  The troublesome behavior may be intensified by the client's chronic anger and a continuously frustrating environment.

Disorganized Thinking and Behavior

People in crisis may have a difficult time giving information or relating ideas and events in a logical fashion.  They may overlook or ignore important details, confuse sequences of events or fail to see environmental factors which may contribute to the problems.  The individual may jump from one idea to another in a manner that interrupts communication or repeat the same statement and phrase regardless of the question or comment made by the interviewer.  Under severe stress, fears and wishes may be confused with reality.  Difficulty with memory may be apparent when significant or stressful questions are asked; or the individual may give various responses to the same questions at different points during the interview.  The client's activity may be disorganized and at times aimless.  Solutions attempted in resolving problems may seem illogical or poorly thought out.  The client may pace constantly, check the door or otherwise act suspiciously.  In summary, when a client is in crisis he/she may not know what to think about the problem or how to realistically evaluate what course of action to take.  It is important to note that upon initial intervention the client's disorganization of behavior and thought may be compounded in response to having to deal with an external agent.

Poor or Ineffective Functioning

When confronted with a crisis, people tend to become involved in activities that relieve tensions arising from their fears and inability to cope.  When too much emphasis is placed on insignificant activities, the individual's ability to deal with the crisis is decreased.  For example, the mother who focuses on her favorite soap opera or talks about her activities as a child when questioned about an injury or problem with one of her own children.  It is the Children’s Service Worker's responsibility to redirect thinking toward more important activities and assist the client in the development of appropriate behavior.  Disorganized thinking and/or behavior are normal in stressful situations.  However, there may be indications for psychiatric or other psychological assessments.  These indications include:

• Severe depression, withdrawn or suicidal behavior.
• Religious or culturally-biased fanaticism that interferes with daily functioning.
• Drug/alcohol addiction.
• Bizarre ideas that make little or no sense.

Dealing with Your Own Omissions

It is very important that the Children’s Service Worker deal with his/her own omissions in working with the client.  The worker's behavior can increase the client's feelings of anger and hostility.  Every worker has experienced times when his/her caseload became unmanageable, either because of the number of cases requiring some action or the number of families who were all in crisis at the same time.  During these times it is quite easy to work on those cases requiring immediate action such as a court hearing or locating a run-away, and "forget" promises the worker has made to a client especially if the client is a child.  Failing to keep promises may include:

• Failing to inform the client that you would be several hours late for an appointment, or even worse forget to cancel an appointment;
• Failing to make an appointment and "just dropping in" for an important visit;
• Not including your clients, especially children, in the decision-making process;
• Failing to treat your clients as professionally as you do other team members who are involved in the treatment process.

As a Children’s Service Worker, you become an important person to your client, and, therefore, how you treat the client can affect how he/she feels toward you.  As a child welfare worker you may have to help the family members confront things about their behavior which they must change.  How you conduct your professional responsibilities may justify the client's being very angry or "mad" at you.  In a situation where you have failed to follow through on your part of the contract or promise that you have made, it is important that you acknowledge that you did "goof up" or that you failed to keep a promise.  Explain the reasons honestly why you didn't follow through as planned.  It is also helpful to acknowledge that your client has every right to be upset, angry, mad, or whatever feelings he seems to be having.  Say that you plan to try and avoid something like this happening again in the future.  It is important to remember that not all anger or hostile behavior of clients is unwarranted.

Interviewing and Practice Techniques in Working with Hostile Clients

There are a variety of interviewing techniques the Children’s Service Worker may use in the development of a working relationship with the client.  These can help the worker and client move from helplessness to competence, from anger to acceptance and finally to a willingness to change.  These techniques include:

• Focusing

The Children’s Service Worker should maintain the focus of the interview at all times with a clear understanding of the purpose and ultimate goal.  For example, a client who has come in contact with the agency for abuse or neglect of a child may have great difficulty in maintaining focus due to high levels of anxiety and fear.  It is the worker's responsibility to redirect the subject when necessary, acknowledge the client's anxiety, and finally refocus the interview by a repeat of the purpose of the interview.  When clients feel anxiety, fear, or hostility they often wander from point to point, give extraneous information or avoid questions.  The worker can empathize with the client while moving the interview forward.  Statements such as:

"I know this is difficult for you, but we must get back to how your child was injured."

"Let's get back to the problems you say you are having since your husband lost his job."

"It is not clear to me how your oldest daughter left home.”

"You stated on the phone that everything was going wrong.  Can you tell me the two things that are causing you the most problems?"

These statements show concern for the client while moving the interview on to what may be painful issues.

• Partialization

Clients who enter the child welfare system often present multiple problems.  They may be confused and/or overwhelmed by their environment, and/or their feelings.  They may also feel urgent need to solve or avoid the presenting problems.  The Children’s Service Worker should assist the client in partializing by:

1. Setting priorities based on the most urgent needs of the client and agency;
2. Determining what can be realistically handled within the context of the agency; and
3. Separating out and dealing with one problem at a time.
• Universalization

The Children’s Service Worker uses this technique to point out that most individuals in the client's situation would have similar reactions.  Clients often believe that they are different from most other people.  A word of caution:  this technique may be misunderstood by the client resulting in his/her feeling that the worker is minimizing his/her concerns.

• Recognition of Difference

The Children’s Service Worker and the client may be from different socio-economic, cultural, or ethnic backgrounds.  It is important to establish that the worker recognizes these differences and will make every attempt to understand the client.  This technique may also be used as a method of engaging the client around issues of special concern.

• Acceptance

It is important to all people that they feel accepted.  Acceptance of the client demonstrates an attitude of receptivity by the Children’s Service Worker.  It is important that the client feels comfortable enough with the worker to begin to face himself, the problem and the situation that brought the client and the agency together.

• Education

The sharing of information and the provision of new knowledge become important aspects of work with clients especially when external agencies such as court systems and juvenile authorities or collaborating agencies are involved.  In order to make informed decisions and contract for goal attainment, the client needs to be given information and facts.  Education involves repetition and elaboration on the information in relation to new situations.

• Logical Discussion

Organization of interview material to be covered in a given session is the responsibility of the Children’s Service Worker.  The maintenance of flow in conversation and the integration of the client's needs and the agency's purpose are achieved by the use of logical discussion.

• Relating to Affect

Relating to affect is a method of engaging the client in the casework relationship and becomes important in specific treatment techniques and processes.  The Children’s Service Worker may want to explore the affect,

i.e., "You seem depressed today." or acknowledge and accept the affect, i.e., "Your housing problem puts you in a depressing situation."  It is appropriate to name specific feelings or accept feelings only if the worker understands the feeling and there is a therapeutic reason for the client becoming aware of and working through feelings.

• Demonstrating Behavior

The Children’s Service Worker should set the tone and expectations of counseling sessions by demonstrating expected behaviors such as openness, listening, and giving direct feedback.  The worker may serve as a role model to the parent having difficulties in parenting.  How to handle discipline, sharing and play activity with the child can all be readily demonstrated by the worker.  A second method of demonstration may be role-playing with the client.  If employment is a goal for the client, role playing what the client should expect may be useful for developing a client's skills.

• Setting Realistic Limits

It is the Children’s Service Worker's role to set the limits on the nature and type of contact that will take place in the interview situation.  Contracting is one method that clearly states what is expected of each party in the casework relationship.  If unrealistic goals or limits are set in the working relationship, the worker runs the risk of building-in failure.

• Ventilation

The client may come to the relationship with many pent up emotions or reactions to current or previous life situations.  The Children’s Service Worker should encourage and/or allow the clients verbal and non-verbal expressions of anger, frustration, depression or simply a sharing of information and feelings.

• Direct Intervention in the Environment

Modification of the environment may be accomplished by providing concrete services (housing, financial assistance, homemaker, parent aides, medical assistance, job placement, etc.) or assisting in the client's use of available community resources.  When the client is overwhelmed by environmental problems, offering concrete services provides a beginning point for change both in physical surroundings and personal feelings of worth.

• Summarization

The process of summarization involves the Children’s Service Worker adding up for the client all feelings and facts shared in a given situation.  This should be done in a concise, organized and purposeful manner.  Summarization should enable the client to see the inter-relatedness of fact and feelings, analyze the positive and negative of a situation, develop clarity on the scope and nature of the problems, and finally to share in the selection of alternative courses of action.  The worker summarizes after sufficient exploration of information and sharing has taken place in the interview situation.

• Confrontation

The goal of confrontation is to point out inconsistencies and/or contradictions in the client's affect, attitudes, behavior or information given during the interview and casework process.  The goal is not for the Children’s Service Worker to interpret or otherwise explain what the client means, but to point out the problems with the client's functioning or ability to handle a problem.

When the Children’s Service Worker Feels Threatened

Several specific interviewing techniques should prove particularly useful when the Children’s Service Worker deals with a difficult or uncooperative client:

• Negotiating

The client who does not cooperate often reacts to a fear of authority or sense of loss of power.  It is important that the Chidlren’s Service Worker aid the client by allowing any degree of autonomy possible.  Use comments such as:

"I know this is difficult for you but it is a requirement that we get this information.  Would you like to rest a minute before we go on?"

"If you are able to keep the agreements we made two months ago, your children will be able to come home."

Ultimately, negotiating with a client should result in a verbal or written contract.  Contracts are useful in the development of a working relationship and in the completion of a case plan.

• Identification of Danger

While this is not a specific verbal technique, it is important that the Children’s Service Worker develop strategies for insuring personal safety in potentially problem situations.  Identify:

• Is the client usually loud or aggressive in manner?
• Is there evidence of drug use such as alcohol, pills, or cocaine?
• Does the client move to cover the door as soon as the Children’s Service Worker enters?
• Does the client use direct verbal threats that seem likely to be carried out?
• Is there evidence of a weapon or potential weapon?

The Children’s Service Worker should develop a "sense of judgment" with time and experience.  If a new worker feels unusually uncomfortable, request a more experienced worker accompany him/her.  If in a situation where fear of safety arises, leave as soon as it is reasonable or possible.

Defusion of Potentially Violent Situations

The following information was obtained from the Homebuilder Resource Guide provided by the Behavioral Sciences Institute, Homebuilder's Division, and used with their permission:

• If you have reason to believe the situation might be violent:
  1. Call first and consider spending a lot of time calming people over the phone before you go out.  Consider asking them to wait for you in separate rooms so you can meet with them one at a time without their having a chance to re-escalate before you get there.
  2. Ask if they mind if you bring a co-worker.
  3. Consider asking clients to come to your office.
  4. Ask them if they're worried about losing control.  Do they have any ideas of what might help them to avoid doing something they'll regret?
• When you get there:
  1. Separate people if they are all yelling at each other.  Structure the situation with "I messages" of concern - where they go and what they do.
  2. Be sure to ask clients' permission - check out everything you do - don't steal territory and make clients feel even less in control than they already do.
  3. Listen until what to happen next appears obvious.  Keep thinking about trying to understand instead of trying to fix things.
  4. People are usually really hurting or really scared when they are angry.  Be very gentle with them now.  They are very vulnerable.
  5. Some people respond very well to touch when they're upset.  Be sensitive.  Do not invade territory unless it looks like they will respond positively.
  6. Your compassion is more important than your "handling" the situation at this point.  Keep this in mind.
  7. Liking the people is probably the best thing you can do for them.  They have good, sensible reasons for doing what they're doing.  It will help you to be aware of those reasons.  Work on your own feelings of acceptance.
  8. Believe everything and at the same time withhold judgment.  People are telling you how they see things; but how they see them will change as they calm down.
  9. Try to model relaxation and calmness.  Take a deep breath when you feel yourself tighten up.
  10. Leave the door open; both of you may feel less trapped.  Consider staying between them and the door.
  11. Don't back the client in a corner; give them plenty of room.
  12. Keep your voice low.
  13. Don't be afraid to have silence.
  14. Remember that you can't deal with anger perfectly.  Let up on your self demands to do everything exactly right.  You will.
  15. Look concerned.
  16. Ask "Do you like what is going on?"  If they say no, you can get them on to "What can we do about it?"
  17. Use the person's name; make the contact personal.
  18. Self disclosure - "I feel attacked now and I wish we could find a better way of dealing with this."
  19. Just keep on being calm.
  20. Nod and feedback instead of asking questions.
  21. If they're too furious, no feedback - just sit there.
  22. Let them cry.
  23. Agree they're right - "You have a right to be angry."
  24. Once things are calmer, focus on one thing:  help prioritize and minimize being overwhelmed.
  25. Remember that this anger won't go on forever.
  26. Set anger limits - "I have 15 minutes to listen now."
  27. Call your supervisor or co-worker from the home to get ideas.
  28. Take a half hour break to go to a nearby restaurant and sort out your own feelings.
  29. Call the police if it looks like things are really getting out of hand.

• When you're out of time and want to give them some quick techniques to hold them over until you can return or, if you're talking on the phone until you can get there, the following techniques are good.  It is also sometimes helpful to put them on 3 x 5 crisis cards so the clients can keep reminders handy and begin using themselves more, and you less, right away.

Ideas for clients to try when they feel they might be losing control of their anger:

1. Take three deep breaths.
2. Send an "I message" that you really need a few minutes to be alone and to calm down.  Consider a code system with self and others - "I'm at 'stage 1' so please don't say any more."
3. Focus not on your feelings of anger, but feelings which are more basic and true, hurt, lonely, embarrassed, afraid.
4. Lock yourself in the bathroom for five minutes or until you're calmed down.
5. Run around the block.
6. Call someone who has helped to calm you down in the past.
7. Call the therapist (or Children’s Service Worker).
8. One or more family members stay in their own rooms until the next appointment.
9. One or more family members stay with friends or relatives until next appointment.
10. Schedule many outside activities until the next appointment.
11. Tell it all to a tape recorder.
12. Write down all the things that are going through your mind; bring to next appointment.
13. Call crisis clinic (write down the number).
14. Practice identifying irritation feelings and take time out before they reach such a high intensity.  Keep a log.  Therapist reinforce.
15. Do push-ups.
16. Do relaxation exercises.
17. Go for a walk.
18. Do some housekeeping task.
• When you've gotten to the point of trying to help them deal with their anger:
1. Active listen.  Find out what the person wants to change and what ideas he has about doing this.  Find out what he has tried before, what worked and what didn't.
2. Reflect back the feelings of hurt and/or fear or helplessness that frequently underlie the feelings of anger.  See if the client wants to work on these.
3. Disclose your own feelings about their anger.  Scared?  Confused?  Give an "I message" about your experience.
4. See if they're interested in a crisis card - options for the clients when they feel like they're starting to blow up.  Put these on a 3 x 5 card:
1. Locking self in the bathroom five minutes.
2. Doing push-ups.
3. Going for a walk.
4. Brushing the dog.
5. Calling the therapist (or Children’s Service Worker).
6. Telling himself "stop" over and over loudly in his head.
7. Other ideas that they may have.

They carry this in their wallet and contract with you to at least pull it out and look at it the next time they feel like they're blowing up.

5. See if they're interested in learning to identify and respond to anger at a lower level of intensity.  Have them log their feelings of annoyance and irritation on a 1 to 10 scale where 1 is very mild and 10 is exploding.  Many people feel that angry feelings are "bad" and then try to block them out and ignore them until they just explode.

Ask the clients if they are interested in trying it out (writing things down).  If they are, ask them how long a period they'd like to start with.  Encourage them to keep it short (one day or three hours) so they'll have a successful experience.  Be interested in the log.  Reward them for noticing anger before it gets overwhelming.

One message to get across is that we all get annoyed, but it is important to respond to these feelings in a way that doesn't get us into trouble.  It's possible to learn ways to do this, although sometimes tedious to do so and it often requires a fair amount of practice.  Don't promise them results.  Stress how hard it is to really change.

6. See if they're interested in learning to be assertive instead of aggressive or hostile.  The main point is learning to give gentle "I messages" at low levels of irritation.
7. See if they're interested in role playing new ways of handling anger with you.  Be sure and reinforce attempts even if they're not perfect.
8. See if they're interested in fair fighting where you and a co-worker play their roles and exchange information using good communication skills.  Gradually phase them into their own roles.

1. Safe and Effective Work With Threatened and Hostile Clients.  Training packet developed by Paul D. Schult, DFS Staff Development Specialist I, September, 1983.
2. Working With Threatened/Hostile Clients, from Region VI Child Welfare Training Center; Tulane; New Orleans, Louisiana; Publication No. 11, 1982.
3. Empowerment for Our Clients and Ourselves; Elaine Pinder Hughes; Social Casework, Volume 64, No. 6, June, 1983.
4. Survival Skills for Working With Potentially Violent Clients; Stephen G. Kaplan and Eugenie G. Wheeler; Social Casework, Volume 64, No. 6, June, 1983.
5. Defusion of Potentially Violent Situations was obtained from Anger and Defusion chapter of the Homebuilder Resource Guide, Copyright 1978, Jill Kinney and David Haapala; Behavioral Sciences Institute, Homebuilders Division, Federal Way, Washington.  It is used with their permission.

Other material in this chapter was adapted from Basic Job Skills Training in Child Welfare Services Trainees Coursebook, developed by the Texas Department of Human Resources, Protective Services for Children, Staff Development and Personnel Services.

Chapter Memoranda History: (prior to 1/31/07)

Memoranda History: