19. People experiencing strong emotions
Health professionals assist vulnerable people who experience a range of emotions. This chapter considers three strong emotions that may be a barrier to effective communication: aggression, extreme distress and reluctance to engage or be involved in communication or intervention.
SMALL GROUP ACTIVITY: STRONG EMOTIONS
Aggression
Extreme distress
Reluctance to engage or be involved in communication or intervention
• Decide what it means to be experiencing these strong emotions.
• List the specific behaviours that might indicate the presence of these strong emotions.
• List the individuals most susceptible to feeling these strong emotions.
• Decide the possible events or environments that might produce the strong emotions and explain why.
• List principles for effective communication to remember when communicating with a person experiencing these strong emotions. Give reasons for the need to remember these principles.
• Suggest strategies for communicating with a person who is experiencing these strong emotions. Decide why you might see such a person in your particular health profession.
• Check your answers against the information below, noting any additional thoughts or ideas.
A person who behaves aggressively
Definition of aggression
Consider anger at one end of a continuum and violence at the other end, with aggressive behaviour in between. A person who behaves aggressively may demonstrate anger initially and violence ultimately.
A person who behaves aggressively is someone who
• Exhibits apparently unprovoked behaviours that threaten those around them
• Feels vulnerable and out of control
• Wants their ‘own way’ and will intimidate or threaten to fulfil their desires
• May confuse aggression with assertion
• May believe aggressive behaviour is the only way they can ‘win’ or achieve their desired results
• … and so on (this list is not exhaustive).
Behaviours related to aggression
An aggressive person might
• Be verbally abusive and loud when interacting
• Threaten (verbally or in writing) to physically harm someone or something
• Use non-verbal gestures to indicate feelings of aggression.
Individuals most susceptible to behaving aggressively
A common belief suggests that individuals who behave aggressively are found mostly in mental health settings. This is not always true because aggressive behaviour can occur anywhere.
Individuals may be susceptible to behaving aggressively because of
• Eroded self-esteem
• Emotional trauma (e.g. disappointment, loss, frustration, bewilderment)
• Unresolved anger or frustration
• Stress
• Unfulfilled desires.
People who behave aggressively may have an emotional reason (e.g. unfulfilled desires) to which they respond with aggressive behaviour. However, such people do not always behave aggressively in the environment that provides the trigger for their emotions.
Possible stimuli for aggression
Individuals may become aggressive due to
• Loss of something important (e.g. family, job, health)
• Unexpected events
• Excessive use of addictive substances or withdrawal from addictive substances
• Reaction to medication
• Forgetting to take or deciding not to take medication.
Principles for effective communication with a person who behaves aggressively
When communicating with a person who behaves aggressively it is important to
• Respond with patience and understanding
• Empathise with the person, not necessarily with their feelings
• Use active listening and careful observation
• If appropriate, focus on the problem and possible solutions
• Avoid responding to the aggressive statements or threats with aggression – do not retaliate
• Demonstrate interest, attention and concern through non-verbal behaviours
• Remember the principles of assertive communication (see Ch 14); however, some people may become more aggressive if you attempt to discuss what they are expressing at that time
• Validate if appropriate
• Avoid confronting if they are violent
• Always remember safety of self and others
• Position self closest to the door
• Use emergency call buttons or duress alarms if necessary and available.
If there is a risk of violent behaviour it is important to
• Inform the immediate supervisor of the possible risk
• Wherever possible have another health professional present
• Ensure the health service knows the exact whereabouts of the health professionals who work with the person, whether on or off site
• Plan the interaction carefully considering the safety of all involved individuals
• Be alert for the safety of everyone involved and if necessary remove self and others from the scene
• Stay close to the door or exit
• Avoid attempting to physically connect with the person
• Call the police if necessary.
Strategies for communicating with a person who behaves aggressively
• Remain calm to maximise observation and problem-solving skills.
• Ask them to ‘tell you their story’ to explain their strong emotions. This may allow them to calm themselves.
• If the person is still in control, state they are being inappropriately aggressive. This may stop the behaviour, potentially providing an opportunity to become calm.
• Be aware of non-verbal behaviours and remove yourself if the person is becoming overly agitated. Among group members, brainstorm ways to respond verbally so you can remove yourself safely.
• Engage the person in consideration of their plans for the future and how they might fulfil these plans.
ROLE PLAYS
Role-play the following scenarios. Before acting the roles you may wish to decide what type of assistance Person 1 requires. If it is not possible to role-play these scenarios, consider and explore the possible responses and communication strategies that will achieve effective communication and family/person-centred practice.
Scenario one: The male and the health professional
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