Webinar presenter Denise Beagley of Arizona State University's Center for Applied Behavioral Health Policy answered a number of your questions after her presentation, Verbal De-Escalation. Here are some of her responses.
Audience Question: Can you talk a little bit more about tone of voice? How we can think we're saying something completely friendly or neutral and the other person takes it the wrong way?
Denise Beagley: That's definitely a skill and practice. We need to watch our tone of voice. Don’t be like a kindergarten teacher where you're always trying to be empathetic, but it comes across as patronizing or talking down to that person. In using motivational interviewing skills, we're cautious of the fact that we don't want to make everything a question. We want to give a statement and that statement, the tone, it doesn't incline at the end. Having the incline at the end has a connotation of judgment, whereas when it's a neutral, flat tone, it's a reflection that person is able to connect with it.
Audience Question: Can you give examples of start requests?
Denise Beagley: We constantly tell people what not to do but maybe asking things that have been helpful in the past like, "Focus on your breathing," "Listen to music," "Sit down." What things make you feel calm. You might have to ask questions to get those from them, but things they need to start doing. Often, people are always worried about everybody else and you can say, "It's time to put yourself first, focus on yourself, and then you can help others."
Audience Question: Is there a time or place where verbal de-escalation tactics aren't necessarily appropriate to use?
Denise Beagley: Yes. In the event where safety is an issue. When you're feeling threatened, or society is threatened. I feel like I can always treat that person with respect. If there is a place that is just not safe, then you'll go to a different mode. A lot of you are trained that way. It's not the end all be all, you can try these skills on someone and it won't work. We look at individuals with serious mental illness, where 1% to 4% have tendencies to be hostile, the thing that seems to be advertised. Most people who have mental health consideration can get away from people. Certainly, we need to look at safety as most important. I know I don't arrive on scene unless PD has staged for PD, I totally listen to those. And I wait till it's clear, and then I can proceed. I really appreciate that back up from PD.
Audience Question: Please give a few suggestions for verbal interactions with someone under substance abuse. Can you apply what you've just talked about and give some suggestion to those encountering drug users?
Denise Beagley: We still use motivational interviewing techniques, verbal de-escalation. I see substance use and drug use as a continuum. It depends on how intoxicated, how under the influence of something they are. Obviously, it's a lot easier to use these skills when a person isn't under the influence of drug or alcohol. But people will remember how you treated them, even in the most acutely psychotic episode I had patients that would tell me, "I remember when you came to visit me in the hospital and you were always so kind." I was impressed that they were tracking, that always stayed with me that even though the person might have been in an altered state, they were still tracking me and listening. He had said to me, "You gave me hope because you said it's not always going to be like this and things will change, I believed you and things did change." It resonated with me that way. You can use them and obviously, just be aware is that person responding, and again, safety.
Audience Question: Do you find people in crisis are more likely to open up and familiar environments or in some place more neutral? Like speaking inside their house versus asking to go outside to sit and talk.
Denise Beagley: In Arizona, I find that in the summer, people generally don't like to be outside and it actually makes them more upset. But during the nice weather, I tend to take people outside. If there's grass, I often sat and talk to somebody and that really calmed them down. Touching earth, it can have a good effect on a person's ability to connect. It just depends where you're at with them and if it's safe. A lot of us feel like if we got into a situation where it's someone who's smoking a lot, or we don't feel safe, we tend to pull the person outside. I've got Maslow's hierarchy of needs on our van, we've got water, snacks, I'm like a soccer mom with this van. We've got everything on board. Sometimes it's just back to basics and ask them, "When was the last time you ate something? Are you thirsty? I have some water or Gatorade here." And then all of a sudden, it's like a different person. I think we get hangry and so does the people we engage with.
Audience Question: When you know you have an Achille's heel, whatever it might be, how do you working on not letting it bother you? How do you manage that hot button?
Denise Beagley: That goes back to that emotional intelligence. We need to be aware of what sets us off and we even must have our own coping mechanisms. Partly, I use humor a lot.
Sometimes I use it with the patients and clients, or in the van on the way back to debrief. I think that's a protective factor and a self-preservation factor for us as first responders that we just need to be aware that there will be people that do that. A lot of times I just try to turn it back around to that person and I use those engagement skills and not necessarily address it.
Early on in my career, a woman said to me, "I have shoes older than you — what are you going to do for me, you're too young?" And I said, "I figure that we're a good team though because you're the expert on you and I just went to school and together it will be amazing." Then I said, "We should get you a new pair of shoes because that's way too old." She laughed, and we were cool, it was fine. Sometimes you got to be careful because humor can be misconstrued. As long as they think you're not laughing at them, you're laughing with them.
Like, "Do you really believe the voices in your head, I want to understand your side of the story." And they'll say, "I really don't believe it, but they kind of mess with me." And I say, "Yeah, that must be frustrating." Again, it's up to the situation but you can definitely use different scales to engage that person.
Click here to watch a recording of "Verbal De-Escalation."