Chapter 11: Addressing and Disarming Anger

Anger is an unfortunate side effect of life; we all experience from both perspectives (being angry and being the object of anger) throughout our lives.  Anger is a defensive mechanism and when people direct their anger towards you it is important to keep in mind that the anger is not about you; rather, it is about a frustration or concern in their life.

Common Reasons for Anger:

• The client is angry about something that agency has (or has not) done
• The client is angry about something you have said or done.
• The client is fearful
• The client is exhausted
• The client feels overwhelmed
• The client is confused
• The client feels a need for attention

Knowing the reason that the client is angry provides valuable insight on how to disarm the client's anger.  It would make sense that disarming anger would be important, but why?  Disarming anger is crucial because:

• It eliminates an obstacle to true understanding
• It shows clients that you respect their message
• It enables yo to understand the problem
• It allows you to practice empathy
• It focuses work on solving the problem

As a human services worker, it is our job to make sure that we view the anger from the client as a sign that their needs are not being met and seize the opportunity to find a resolution.

Know the no-nos

• Avoid the number one mistake: do NOT take the anger personally.  Remember remember remember  - the client is taking their anger out on you but they are upset about something else in their life - some need that is not being met.
• Let go of the erroneous expectations that communication with your client will be perfect.  Never, ever assume that all communication with your client will be flawless.  They will get angry, they will not always follow directions and they will raise doubts, criticisms and you will encounter resistance.

The David Burns 4-Step Process to Disarming Anger

1. Be Appreciative - let the client know that you appreciate them bringing the concern to your attention.
2. Ask for more information.
3. Find something with which you can agree. 
4. Begin to focus on a solution - collaborate.

What to avoid when dealing with an angry client:

• Do not become defensive
• Do not become sarcastic or facetious
• Do not act superior
• Do not grill the client

According to others out there...

In perusing the internet on the topic, I came across some articles that just restated that same information herein - boring!  Then, a gem jumped out on page 5 of Google Scholar and I thought, yes! I must share this!  How to Disarm an Angry Person highlights the steps to disarming anger paralleled to the biblical instructions on dealing with anger.  Definitely a short but intriguing read.

Confucius say... Confusion!

I recognize that most times people are angry because of something that is going on in their lives and the nearest person becomes the scapegoat for the anger.  Isn't there times though that you really are the reason for the anger and that the client really is angry at you?  I know there are times that I, as a human, get angry at someone for how they are treating other people, not how they are treating me.  I would think that working under the presumption that the client is never mad at you is at times causing more harm; wouldn't the greater benefit come from accepting your part of the blame?

Chapter 10: Bringing Up Difficult Issues

Confrontation: (Noun) - the act of bringing something out into the open.  Unlike the hostile connotation that the image has in the general public, in the helping industry, confrontation means matter-of-factly bringing something out to gain a better understanding and perhaps make meaningful  changes or take important new steps.

The textbook states that the use of confrontation in the helping arena is a strategic decision used when you have reason for concern, such as:

• concern for the well-being of your client
• fear that the client will do something harmful
• destructive thoughts or behavior by the client
• someone interfering with your ability to perform your job

Confrontation is not always negative.  In fact, when used correctly, it can be a very powerful tool to help both you and your client in explorations and resolutions. So, when do we use it?

• Discrepancies: when the client communicates 2 different messages
• The client says one thing but does another
• The client has one perception of events or circumstances and you have another
• The client tells you one thing, but the client's body language sends a very different message
• The client purports to hold certain values, but the client's behavior violates those values
• The client has unrealistic expectations for you
• The client has unrealistic expectations for themselves
• The client asks for assistance, but actions indicate the client is not interested
• The client's behavior is contradictory.

The I-Message in Confrontation

The term, "I-message" was coined by Dr. Thomas Gordon because it avoids the use of "you" which is accusatory and instead uses the words "I" and "Me"; the problem is, after all, yours.  There are 4 parts to a complete I-message:

1. Your concerns/feelings/observations about the situation
2. A non-blaming description of what you have seen or heard of the behavior
3. The tangible outcome for you as a result or the possible consequences for the client
4. An invitation to collaborate on a solution

The Rules for Confrontation

Yes, just like everything else in life, there are rules...these rules are meant to make the I-message more listener friendly and less threatening.

• Be mater of fact - not judgmental or excited
• Be tentative - remember that you can be wrong
• Take full responsibility for your observations
• Always collaborate
• Do not accuse the other person
• Do not confront because you are angry
• Do not be judgmental
• Do not give clients a solution
• Instead, ask permission to share ideas with the client and be prepared with more than one so that the client feels that they have a choice.

Advocate!

When someone is interfering with your client's treatment or your ability to interact with the client, their progress is being effected. When this happens, advocate for your client. Speak up! But, follow the rules:

• Do not sound tentative
• Be pleasant but firm; smile but mean every word that you say
• Contain an implied or explicit request for help
• remain firm but diplomatic

Avoid ineffective I-messages

Think the I-message through and do not imply opinions or values of your own.  There are 5 common ways that we can make an I-message ineffective:

1. Using the words "but" or "however"
2. Failure to invite the client to describe how he or she sees the situation
3. Suggesting a solution without asking client their solution
4. Implying that our view of the situation is the only way to view the situation
5. Failure to consider the possibility of extenuating circumstances that you are not privy to

In other news...

Dr. Barton Goldsmith offers excellent advice in his column in Psychology Today.  Whether you be in the helping field or just trying to broach a difficult topic with a family member or friend, 10 Tools To Deal With Difficult Conversations is a must read!

Mirror, mirror on the wall...

I understand that you is the verbal pointing and/or wagging of a finger but I wonder isn't I sometimes just as ineffective?  I would think that "I" could imply that you are making everything about you and could do equal amounts of harm to the session, is there room for both, a healthy mix, in the helping field?

 

Chapter 9: Asking Questions

I admittedly have a bit of OCD tendencies.  One of those is a need to make a list for everything.. a list for a list for a list.  Turns out I'm not so weird after all; I live in a world where there are instructions for asking questions!  Love it!

Curiosity is a natural part of being human and those of us entering the helping or case management field will certainly experience an abundance of stories that peak our desire to inquire.  While generally the questions are well intended, the client tends to see them as prying.  And while the proverbial cat remains alive and well, the client/helper relationship will likely have exhausted the final of it's nine lives.

When questions are important:
Just because questions can be detrimental to the helping relationship does not mean that they have to be.  At times, questions are an important and necessary part of the relationship.  Specifically, there are three times when questions must be asked:

1. To gather identifying information when you are opening a new case or chart on a person
2. To compile the necessary facts and information for assessment or referral purposes
3. To encourage the client to talk freely about the situation in order to better understand what aspects are the most important to the client.

Types of Questions
Generally, there are two types of questions:

• A Closed Question is one that only requires a single answer.  These questions are most beneficial when opening a new case on a client or when putting together information for either an assessment or a referral.  While closed questions do serve a purpose, i.e. ascertaining basic information, asking too many closed questions can make the client feel as thought the helper is merely searching for a solution rather than listening to the concerns.
• An Open Question is one that gives the client more opportunity and leeway to talk about what is important to them; it opens the door to discussion.  Open questions put the client at ease because it puts them in the drivers seat; they are in control of the conversation as well as the pace and direction the conversation takes.

Questions That Make The Client Feel Uncomfortable

Coming to an office for help is a scary experience no matter who you are or what kind of helping you are requesting.  Here are some questions to avoid increasing the level of discomfort felt by the client; why make matters worse?

1. Avoid the use of "why" questions
2. Avoid asking multiple questions
3. Do not change the subject
4. Do not imply there is only one answer to your question
5. Do not inflict your values on clients
6. Do not ask questions that make assumptions

A Few Pointers About Asking Open Questions

• Avoid asking questions in the same manner every time; instead, try interchanging different words from the figure below:

• Asking open questions takes time and practice; often times we are well intended but inadvertently close the question due to a poor choice in wording.  Words that "snap" the question close include the following and should be avoided whenever possible:
• how
• why
• what
• when
• where

According to others in the field...

With on going fiscal problems at the local, state and federal levels case management is an on-going, ever evolving concept.  This is clearly evidenced by the Oregon Department of Human Services policy update to the Family Services Manual in April 2012.  The move tends to be toward a brokering model for services in which actual meetings between case manager and client are limited as the client is taught how to be their own broker for resources.  I found it interesting that, at the top of its list of utilized skills for the most effective case manager, was asking open-ended questions.  The policy update herein gives a good overview of the inner workings in the case managers life and is a good read for gaining that real-life insight.

How much wood could a wood chuck chuck...
In so much of my research in looking for an article to accompany this blog, I came across stories about cutting number of visits, cutting funds, moving the client quickly toward self-determination actualization... How does it leave time for real, honest to goodness effective case management?  With time being limited, is there really time for open-ended questions any more?  They are deeply important to the process but it seems that with policy changes and fiscal pressures, the field is turning into more of a cattle corral with the case manager just herding them through the gate...