Lately, encounters with angry clients seem to be more frequent and sometimes violent. While I do not claim to know why this is happening, in the course of 20 years of practice, I have developed insights into managing the angry and violent and de-escalating these situations.
KEYWORDS: Angry clients; violence in therapy; de-escalating techniques
Most of us know what it is like to have clients become angry, but lately these encounters seem to be more frequent and sometimes violent. A psychotherapist told me of hiding beneath his desk from a shotgunwielding client; an overworked emergency room nurse related how she was viciously cursed when she could not immediately help a patient; a social worker spoke about being verbally attacked with racial slurs; a physician related her fear after a coworker was stabbed in their office. These men and women were concerned by a level of anger they did NOT typically encounter, and which they felt unprepared to manage.
I do not have an answer as to why there seem to be more angry and violent clients. However, after 20 years of clinical work with hostile individuals and contentious couples, back-stabbing family members and dangerous felons, aggressive individuals on street drugs and psychotic patients off prescribed drugs, I have insights and practical techniques on how to defuse angry clients and to protect yourself from violent patients.
Fifteen years ago I noticed a client staring menacingly at his social worker, and when I intervened he suddenly struck me. I, like the abovementioned victims of verbal and physical abuse, could not have predicted the terrible moment in which violence disrupted (and in some situations shattered) lives. But if we cannot precisely predict occurrences of rage or violence, then all the more reason for having tools with which to manage them when they occur.
Tom (not his real name) was late for his doctor appointment and became frustrated when the receptionist told him the doctor was no longer available. When he explained it was not his fault, but that the bus was late, the receptionist said it was not her fault either, to which he replied that she was a "bitch" who did not care he would be without his medication. She told him not to use offensive language, which resulted in his making a veiled threat about what happens when he did not take his medicine.
Our jobs would be easier if clients like Tom did not get angry. While this is true for us, it would not necessarily be good for them. Anger for most people is a healthy emotional response to feeling frustrated or hurt. It is a legitimate reaction to an injustice and a way of emotionally standing up for one's self when abused. People like Tom yell to make us listen when they feel ignored or disrespected.
There is a vast difference, however, between standing up for oneself in order to be heard and standing up in order to abuse or knock another person down. "Standing up" is an image I use throughout this paper to describe anger at particular stages, for example, early-stage standing up as a defense action against being hurt or misunderstood and later-stage standing up as an offense action to hurt or intimidate others. Anger is the emotion while standing up is the giving voice or action to it, whether it is yelling, cursing, venting, bullying or physically striking someone. This work examines these various expressions of anger - beginning with manageable venting of frustration and concluding with toxic threats or violence - and provides the stage-appropriate techniques to defuse anger and to protect from harm.
HOW TO DEFUSE ANGER
What might have the receptionist done to prevent Tom's anger escalating from frustration to hostility and ultimately threats of violence? She (and I, with my assaultive client) might have learned how to identify accurately peoples' anger so that we would recognize when a particular client's anger is not simply an expression of a need to be heard and instead is capable of eruption into violence. …