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CHAPTER11HN330

CHAPTER 11: Addressing and Disarming Anger Introduction People do become angry. They express anger and hostility in ways we might find quite unpleasant. We can expect that there will be times when the people with whom we are working will forcefully express their anger. As professionals, it is helpful to view the anger as a clue to other underlying issues or as a clue to problems that need to be resolved. Using the anger to help us better understand the other person is better than reacting to it defensively or personally. When people are angry, it is not about you. It is about frustrations and concerns in their own lives. If you are an effective, reflective listener, you will hear these underlying causes and feelings, and you will respond in a manner that disarms rather than provokes the anger. Common Reasons for Anger When clients are angry, it is often because of one of the common reasons listed here: • The client is angry about something the agency has done. The agency in which you work will have policies and regulations that you must follow. Sometimes the agency is bound by state and federal laws as well. These laws work better for some clients than for others. Clients who feel that the agency’s policies have caused them to be treated unfairly or with insensitivity to their particular circumstances may react angrily. • The client is angry about something you have said or done. As noted earlier, there will be times when the client or the client’s friends and relations will have a problem with something you have said or done. Without your intending that it should happen, a client may completely misunderstand what you have said or may misread your intentions. On the other hand, you may not always be completely tuned in to where the client is at any particular moment and may unwittingly say or do something the client finds upsetting. • The client is fearful. Many people are frightened by the turn their lives have taken. The changes that have occurred that brought them to your agency may make them feel as though their lives are out of control. They may attempt to reassert control through the use of anger, and they may lash out at you because you are the safest target or the closest person at the moment. • The client is exhausted. Some clients you see will be exhausted. These people may have been grappling alone with an issue or problem for a long time, or the circumstances they are facing now may be taking all their energy. They sense that they may not be able to carry on, which may cause them to direct anger at you. • The client feels overwhelmed. Other people feel overwhelmed by problems. They may feel that they cannot handle all that is facing them. Sometimes they feel the extent of the burden is unfair, and so they lash out at you. • The client is confused. Some people are confused by policies, circumstances, others’ reactions to them, or the steps they must take to right a difficulty. Rather than admit to feeling confused, some clients become angry and blame the system or you or your agency. • The client feels a need for attention. Some people feel insignificant and demeaned. It may have nothing to do with you, and it may very much relate to a lifetime of living in the margins or having one’s problems or contributions trivialized. These people need to feel valued and worthwhile. The problem for you is that your best efforts may not always be good enough. Sometimes such people are extremely tuned in to slights and suspected rejection. They may become angry with you for reasons that you feel are unfair or unwarranted. As always, you are the professional person and need to speak to the condition of the client in a professional manner. People become angry for many reasons. Knowing how to disarm anger is important. It will enable you to move toward a more meaningful dialogue and a better resolution. Digital Download Download from CengageBrain.com Why Disarming Anger Is Important You cannot be as effective in your work if you are dealing with a client who is angry. The client cannot be expected to move the relationship to another level; but you, as the professional, can be expected to practice the techniques that will allow the relationship to move beyond the anger. The major reasons for disarming anger are as follows: • Eliminates an obstacle to true understanding. Disarming anger diffuses the anger, making it less of an obstacle to true understanding. People who are angry cannot really hear each other. If you are genuinely interested in why the client is reacting in this manner, you need to reduce the anger so that you can better understand what is fueling these strong emotions. • Shows clients you respect their message. Disarming anger shows the other person that you respect the message even if the way it is expressed is not helpful. By moving to another level beyond the anger, you can indicate to angry clients that their concerns are important to you even when you are having trouble with the way they are addressing these concerns. • Enables you to understand the problem. Disarming anger allows you to become aware of the actual problem. Only when you have disarmed the anger can you and the client actually address the underlying concern. As clients feel heard and understood, they are more likely to begin to collaborate with you in looking at their problems and the solutions. • Allows you to practice empathy. Disarming anger allows you to practice empathy, seeing the situation as the other person is seeing it. Disarming anger is an important part of establishing rapport. If you become angry yourself, you are caught up in your own feelings and needs at the moment. On the other hand, if you think about the reason the person is angry and you speak to that situation or to those feelings, you are responding empathically. This lets the client understand that you are not going to engage in an angry exchange, but you are going to respect the client’s concerns and feelings. • Focuses work on solving the problem. Disarming anger focuses on solving the issues and problems, and not on who is to blame. Disarming anger techniques do not allow for exchanges of blame. Angry clients may hope for such an exchange with you wherein they blame you and you defend yourself, often by blaming them in return. The purpose of disarming anger is to fix those things that legitimately need to be fixed. Many people sound angrier than they mean to. They are often anticipating the angry response of the other person. As human service workers, we read anger as a signal that the client’s needs have not been met, and we focus on resolution of the problem that has caused the angry emotions, regardless of whether we think the client’s anger is legitimate. Avoiding the Number-One Mistake Countless times human service workers encounter people who are openly angry. Many of those workers choose to take that anger personally. Taking anger personally is the number-one mistake when dealing with an angry person. It is a foolish mistake to make. As noted earlier, people become angry for a number of reasons. Some of these reasons have nothing to do with the worker specifically. Other times the anger may be caused by something the worker or the agency has done, and the anger may be rude and denigrating. Nevertheless, beyond disarming the anger, it is important that when you encounter an angry client, you refrain from taking the anger personally. It is not about you and how you feel. It is always about the client and your professional response to the client. A worker who chooses to take the anger of a client personally might end up in a conversation something like this. CLIENT: Where the hell were you on Tuesday? WORKER: What do you mean? CLIENT: Where the hell were you? I came in to get a voucher for food, and you weren’t here. WORKER: Why are you shouting at me? I wasn’t here, but you don’t have to shout. CLIENT: I do have to shout! You say to come in here for a voucher, and I did that, and you were not even here. Where the hell were you? WORKER: Look, Mr. Peters, I don’t have to tell you where I was. If you came in and I wasn’t here, why didn’t you tell someone else what you needed? I’m not the only person who can help you. CLIENT: I get so damn tired of the way you guys act like prima donnas. Who the hell gave you the right to tell all of us when to come and when to go? You say come in, I come in, like a fool, and you decide you’ll just go someplace else. WORKER: Well, if that’s the way you feel, you certainly don’t need my help. I’ve spent quite a lot of time with you, may I remind you? You have gotten a lot from this agency. I’m not sure I’m going to put up with this shouting at me. CLIENT: Well, what are you going to do about it? I can tell you that you are a piss-poor caseworker if I want to. I can’t do much else around here, but I can do that! WORKER: You’re an idiot. Go out and get the voucher from Mrs. Charles, bring it back here, and I’ll sign it (begins reading papers on her desk). In this example, the relationship is damaged, and there is an unsatisfactory resolution. Bitter feelings remain for both the worker and the client. There is a better way to handle situations like this one. This chapter will explain how to use a four-step process to deal with anger. The central question you want to ask yourself is this: Can I feel empathic toward this angry person and hear the pain behind all this anger—or am I likely to get into a power struggle with this angry person to show I won’t be pushed around? Empathy is the professional response. Power is the unprofessional response. Erroneous Expectations for Perfect Communication: Another Reality Check Some human service workers have the erroneous expectation that their clients will give them no trouble. In their view, clients not only will never get angry, but they will follow suggestions, be appreciative, and never raise doubts, criticisms, or resistance. This sort of thinking is a trap, and workers who fall into it often become exasperated or punitive with clients who become angry. Workers who are susceptible to the trap have envisioned themselves as helpful people dispensing good works to people in need. The reality that some people will not want their help, will criticize the help they receive, will show no appreciation or will become angry has not entered their thinking when they chose this field. We all have had bad times in our lives, and we look back on those times later and think, “I wasn’t myself then.” These times may have been isolated incidents, or they may have been prolonged periods when we were under a lot of stress. The people who seek our help are under a lot of stress. In addition, many of them have problems precisely because they have trouble communicating easily with others. Anger and other forms of negative communication may be all they learned. Expect anger, disarm it, and treat it matter-of-factly. In this way you will not allow a client’s anger to obstruct your work with the client, nor will you carry completely unrealistic notions in your head that clients won’t or shouldn’t get angry. They will get angry, but you will know what to do. For example, Jane was a worker in a home for three individuals with mental illness. Kip had a bipolar diagnosis and was doing well. In fact, maintained on his medication, he was pleasant and cooperative. He was working at a local supermarket and seemed about ready to move to an apartment of his own. Then it was discovered that the medication he was taking, Lithium, was adversely affecting his liver. Liver function tests came back showing this deterioration. Doctors immediately removed Kip from the Lithium and placed him on an alternative medication. Almost at once Kip’s personality turned irritable and angry. He accused Jane of spying on him, and he became erratic about going to work. When the residents in the home went shopping for their groceries, he either sat in the van with his arms folded, refusing to get out, or he created scenes in the supermarket about things he wanted to buy that would have shattered the careful budget he and the others had constructed. His outbursts in public were embarrassing to Jane, and in the home she often endured a lot of his anger. Jane’s approach was twofold. She actively advocated for a reexamination of Kip’s medications, and she was firm with Kip but never angry. Many times she told him she understood that he was not feeling like himself. She refused to take anything he said personally. On more than one occasion, his accusations actually made her laugh, and Kip laughed with her, recognizing momentarily how silly his accusations were. Jane’s superiors, and particularly the treating psychiatrist, all believed that Kip could have become dangerous had Jane not steadfastly refused to escalate the situation or take it personally. The Four-Step Process In his book Feeling Good, David Burns (1980) suggests a four-step process for disarming anger. The material in this section is adapted from his book. First, we will look at the individual steps, and then we will look at how these steps work in actual practice. 1. Be appreciative. It is frightening enough to tell people you are angry about something they have said or done. You will put clients at ease if you can say something like “I appreciate your coming to me with this” or “It is helpful to know how you are feeling about this” or “Thank you for bringing this up.” 2. Ask for more information. A client who is upset may be skimming the surface of an issue. To understand the issue better, ask for particulars. Do not grill the person or sound defensive. You might say, “Can you tell me when this happened?” or “I guess I’m not sure when this happened. Can you help me out?” or “How often did this happen?” 3. Find something with which you agree. Never make up something just to sound agreeable, but see if there is not some little piece of what the client has said with which you can agree. You might say, “I think we have probably done this in the past.” or “I can see where you would look at it that way.” or “There probably was a lapse the day you are referring to.” 4. Begin to focus on a solution. Focusing on a solution should involve collaboration whenever possible. Remember, however, that the client owns the problem; the extent of your assistance is a conscious and strategic decision that you must make. Digital Download Download from CengageBrain.com Begin with your objective point of view. Listen to the client’s point of view. Then decide if you will make changes or leave things as they are. You might, after explaining your point of view, say, “I can see where you thought that. I think from now on I’d like to write you ahead of time.” or “I can see where you thought that. Right now we are really short-staffed, so writing to you ahead of time isn’t really an option. But I’m glad you brought this up. In the future, we will take another look at it.” Own your perceptions and own your decision regarding the problem. Use “I,” not “you.” Let us return to the situation we looked at earlier and see a more effective approach for handling the problem. CLIENT: Where the hell were you on Tuesday? WORKER: I’m not sure I know what you mean. CLIENT: Where the hell were you? I came in to get a voucher for food, and you weren’t here. WORKER: What time were you here on Tuesday? CLIENT: Oh, about 2:00. You say to come in here for a voucher, and I did that, and you were not even here. Where the hell were you? WORKER (USING ACTIVE LISTENING FIRST): Well, this must have been really inconvenient for you. I appreciate your telling me about this. Did you ask anyone else to help you? CLIENT: No, I didn’t. I didn’t know I could. WORKER: Sure you can. I can see where you would think I didn’t care about your getting food when you expected me to be here. CLIENT: I know. We didn’t have any dinner Tuesday night. Just potato chips and cheese—oh, and there was a little milk left. WORKER: I’m really sorry that happened. Let me see that you get the food you need today, and let me explain better than I did the other day how this works. If I or any of the other workers tell you to come in for a voucher, then you can come right to the office, and whoever is doing the intakes can take your information and see that you get the food you need. This shouldn’t have happened this way, and we don’t want it to happen again. CLIENT: Thanks. As is rarely the case, all the elements of the four-step process are present in this exchange. In this example, the worker asks for more information with genuine interest (“What time were you here on Tuesday? Did you ask anyone else to help you?”). She goes on to express appreciation (“I appreciate your telling me about this.”). She indicates that she agrees with the way the client viewed the situation (“I can see where you would think I didn’t care about your getting food when you expected me to be here.”). Finally, she moves on to focus on a solution (“Let me see that you get the food you need today, and let me explain better than I did the other day how this works.”). The worker in this example does some other things that make it clear she is not going to take the client’s anger personally. She uses reflective listening (“Well, this must have been really inconvenient for you.”), letting the client know that he is being heard and respected. She also takes some responsibility for the mix-up even though she may actually have explained it perfectly (“And let me explain better than I did the other day how this works.”). We might change this vignette just a bit. Perhaps the worker actually did explain to the client on the phone before he came in how the agency works. There are many reasons he might not have heard her: anxiety over trying to make sure his kids would eat that night, anger over having to go to the agency in the first place, uncomfortable feelings of helplessness or inadequacy over his inability to fix his situation on his own, and the stress of not eating and having hungry children at home. Although the worker may not know specifically what has generated the angry outburst, she is fully aware that there are forces at play in this man’s life beyond his need for her to be present when he arrives at the agency. For that reason, she remains respectful throughout the entire exchange, and she moves with genuine interest and concern through the steps of disarming anger. In other words, she does not take his anger personally and feel a need to confront it with anger of her own. What You Do Not Want to Do There are a number of things you need to avoid doing. Figure 11.1 contains examples of these things. The incorrect example for each point illustrates what you want to avoid, and the correct example shows you a better way to handle the situation. As you read, refer to the figure and compare the correct and incorrect examples that illustrate each point. FIGURE 11.1: Examples of What Not to Do • Avoid becoming defensive. Do not fall into the trap of defending yourself. It is okay to have made a mistake or to be wrong. When you defend yourself you indicate that you wish to argue the points the other person is making. It is better to indicate that you want to hear the points the other person is making. If you begin to defend yourself, it makes the other person angrier, and you lose an opportunity to really resolve the problem. • Avoid sounding sarcastic or facetious. When you thank people for their comments or agree with something they told you, it is possible that you will sound sarcastic or facetious. This is especially true if you are feeling defensive. “Thanks so much for telling me” can sound cynical or it can show a genuine desire to understand. Monitor the tone of voice you use in these encounters to be sure your tone of voice is not escalating the situation. • Avoid coming across as superior. It is all right for you to be wrong in your perceptions or behavior, and it is all right for the client to be wrong too. If you feel especially threatened or angry at your clients, it may be tempting to denigrate them in some way, pointing out how little they actually know about the situation or how little experience they have and how much more knowledgeable you are. This is a good time to show that you and the other person need to work together equally to solve a problem. • Avoid grilling the client. In order to better understand the problem from the client’s point of view, you will need to ask questions. However, too many questions can make the other person feel as if she is being cross examined. Avoid grilling the client by asking numerous questions, one after the other, in a doubtful tone of voice. If people are nervous, you will only make their nervousness worse. Most people grill another person in a triumphant attempt to prove the other person wrong. That is not your goal here. Your goal is to genuinely try to understand. Look for Useful Information It is hard when someone is angry or irritated with you or your agency to really hear what the issues are. However, you can benefit from the feedback you are receiving if you really hear it. Sometimes the client is bringing you valuable information that will help you to make constructive changes in yourself or in your agency. In one agency, there were a lot of angry clients calling for help. They all had been discharged from a certain program without follow-up services or with follow-up services that had not been confirmed. This often left clients without much-needed medications or months of waiting to be reinstated. The agency was grateful for the clients’ feedback and developed a questionnaire for the receptionist to use when such calls came in. She was instructed to handle each call with a genuine interest in what exactly had happened with each client. Gradually, a picture emerged of precisely what was wrong and how to fix it. In this example, an entire agency benefited from the clients’ feedback. A more efficient operation will keep clients from returning with recurring problems and will save money and time for other clients. When people are angry they are telling you that something is not working, something is wrong. Listening carefully can help you to discover what that is. It may be something you can change or something happening at the agency or something you have done or it could be something the client is doing that interferes with his care. If you can hear it you have an opportunity to address it. Safety in the Workplace Agencies where there are clients likely to be assaultive generally have in place policies and procedures to minimize the danger these people might pose for staff and other clients of the agency. Your agency should have policies and procedures related to how to handle situations that could become dangerous. Who do you call? Where do you conduct interviews where others are nearby? How is the furniture positioned in your office and interview rooms to prevent someone from blocking the door and preventing your being able to leave? If a person has been assaultive or combative in the past what is the agency’s policy related to how that person is served in the future? There is research that indicates that staff training plays a considerable role in preventing dangerous situations and harmful outcomes. Staff training was shown to increase the confidence of professionals dealing with clients who might become assaultive (Kynoch et al., 2011; The Joint Commission, 2010). When you go to work in an agency, look at the policies that are in place and attend any training that is offered. If none of these is offered at your agency ask that they be developed. The Importance of Staff Behavior On rare occasions, people become so angry they seem to be about to lose control. Their demeanor moves from rational expressions of anger to increased belligerence, threats to the safety of others, or actual aggression toward people and objects in the vicinity. Research shows that staff people play an important role in defusing these explosive situations (Kynoch et al., 2011). An even tone of voice, continued reflective listening, and relaxed movement work best. Lisa, a nurse in a community program for the mentally ill, discovered Phil eating lunch one day with a gun lying by his plate. He had been angry about his medications earlier in the day, but that problem seemed to have been resolved. Instead of quietly approaching Phil and suggesting the gun be left with the nurse until the end of the day, Lisa became hysterical. Rushing about the room, she loudly began to clear out the startled patients, thrusting them through the door. “Call the police, call the police,” she kept shouting to other workers. Phil, alarmed by her actions, grabbed his gun and pointed it at her. He began to yell at Lisa, “Just shut up, shut up, before I shoot you. Be quiet.” Lisa dashed from the room and cleared the entire building. Police came from every direction. The area was cordoned off, and a standoff ensued into the afternoon. Lisa’s loud, hysterical tone of voice, her panic, and her hurried actions all combined to make Phil agitated. Before long, the situation had escalated. What Lisa should have tried first was asking Phil to come with her to another part of the building. If Phil left the gun at his place, another worker could have secured it. If he brought the gun with him, Lisa might have said matter-of-factly that perhaps it would be better to leave the gun with the staff for the time being. If Phil gave her the gun, she could have taken steps to secure it. Even if Phil were resistant and wanted to keep his gun, the staff could have asked the clients to bring their lunches into the group rooms for after-lunch groups. If they made this request in a tone of voice that indicated that it was nothing out of the ordinary, clients would have complied. In the meantime, police could have been called to come quietly and help to disarm Phil. In another situation, Jim, a young mental health case manager, was working with Alex. Alex wanted to go into the hospital, fearing that he was getting sick again and would hurt someone. On that particular day, there were no beds, and Jim’s supervisor suggested he help Alex find an alternative to hospitalization until a bed was available. Jim was afraid of Alex, who spent most of that day sitting in the waiting room. Each time Jim explained that no beds were available yet and that an alternative needed to be found, Alex grew more belligerent. The last time Jim returned to report that there were still no available beds, he did so in what he thought was a very firm manner. Reasoning that Alex seemed about to become uncontrollable, Jim assumed that if he approached him with a firm, superior tone of voice, he could keep Alex from getting any angrier. In fact, Jim’s superior tone was harsh and was heard by Alex as denigrating. He began to shout and pound the wall to demonstrate to Jim “just who is in charge here.” Clearly the way in which staff react to a person who appears angry and out of control often plays a role in whether the situation escalates or is defused. Remaining matter of fact, practicing empathic reflective listening, and remaining calm are important in maintaining a controlled situation. If you or your clients are in danger, certainly the first thing to do is to secure the safety of everyone. However, situations that escalate because workers fuel them—inflaming the client’s anger by becoming loud, agitated, or angry themselves—can rapidly spiral out of control. Remaining calm and moving deliberately to prevent a dangerous situation from worsening is the responsibility of the professional. Summary Disarming anger is an important skill used to preserve your relationships with your clients and to prevent anger from escalating. The goal is to reach an understanding about the problems or concerns that are fueling the anger and to resolve those where possible. Becoming angry yourself can only escalate the situation, making real problem solving and collaboration with the client impossible. In previous chapters, you have learned many techniques by which to convey to clients their importance and your interest in what they have to say. Use these to advantage when dealing with a client who is angry. Remain matter of fact, refuse to take the anger as a personal insult, and reflect back the underlying concerns and feelings of the client. Video Examples To view the videos that accompany this book, go to CengageBrain.com. • In “An Angry Consumer,” Keyanna practices the skills discussed above when Michelle comes in angry about not being able to fill her prescription. You will see that when Michelle recognizes Keyanna’s genuine desire to help, Michelle becomes less distressed. Exercises These exercises can also be filled out online at CengageBrain.com. Exercises I: Initial Responses to Anger Instructions: In the examples that follow, formulate an initial response to the anger and criticism you hear. On a separate piece of paper construct your answer, looking at the steps for disarming anger, and use those steps that seem appropriate. The four steps are: (1) thank the person for the comments, (2) ask for more information, (3) find some point on which you can agree, and (4) begin to look for a negotiated solution. 1. A man is coming to your agency for assistance after release from a drug rehabilitation center. He wants you to do more for him than you think is wise. You have been very helpful in ways you could, but you have also insisted he do some things for himself because you do not want him to become dependent. He is frustrated, and one day when you suggest to him that he try to call his lawyer himself, he blows up and yells, “This crazy place, sucking up the taxpayers’ money—and for what? I get so sick and tired of your trying to make me do everything when that’s what you’re paid for. A bunch of idiots is what you are! Incompetents! Sure, I can do it myself! If I wanted to do it myself, I wouldn’t have come to you, would I?” What is your initial response? 2. A woman who is in your shelter feels neglected. Twice you are interrupted when you are talking to her because of severe emergencies. You apologize both times and continue your discussion with her, but you are short-staffed and things at the agency are unpredictable. The second time this happens, when you are able to get back to her, she cannot remember what she had been saying. That upsets her. She says, “You all sure can find plenty of reasons to avoid talking to me. Every time I sit down to talk about my case, you get up and run off. Now I can’t remember where we were. I don’t see you running off when you talk to Alice or Cindy. Just seems like every time I need help, well, you have something more important to do.” What is your initial response? 3. Do you see differences between the issues the man is having with the agency and the issues the woman is having with the agency? Are you and your agency more to blame in one instance than in the other? How does your response differ as a result? Exercises II: Practicing Disarming Instructions: Following are some opening sentences said by angry clients. It is up to you to develop the exchange, including more information regarding what the client is angry about and the responses of the worker. You do not have to use the disarming steps in any particular order. See if you can add some active listening and open questions as you go along. See if you can put yourself in the clients’ shoes and empathize with their feelings. 1. CLIENT (talking loudly, and banging his fist on the desk): I have a beef to pick with you! You tell me I’m a mental case and then give me medicine that makes me feel like a nut case. WORKER: 2. CLIENT (barging past the receptionist to the worker’s office, obviously angry): My kids and I are hungry! Know what that means—to be hungry? We’re hungry and you … WORKER: 3. CLIENT (looking at the worker cynically): So you say the agency is understaffed. Really? Understaffed? Who are all these young girls running around here doing nothing? Is it too much to ask that I get an appointment without waiting 4 weeks? WORKER: 4. CLIENT (Sits down unsmiling, looking past the worker): I am just furious. I’m tired of trying to get into group on the phone. I talk to someone who says there is an opening for me. That’s happened three times now. Every time I come in for group the leader says the group is full. A misunderstanding they tell me. Well, what I want to know is how many of these little misunderstandings do you people have a day? Do you think the rest of us aren’t busy? If I ran my life the way you run this agency I would be all screwed up. I want a place in group. I want it now. I don’t want to hear excuses or come in next week or call me tomorrow. (Voice rising) I want to go home today with this matter all settled. Am I being clear enough for you? WORKER:

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