Conflict deescalation and managing aggression

Aggression and violence is a potential hazard in caring for those with behavioral health problems. In your role of providing services to clients, you may encounter aggression including verbal and physical altercations. However, we cannot respond in kind without violating the oaths we have taken to help and protect clients.

Behavioral and mental health problems change how a person thinks and reacts. While the majority of people with these conditions are not aggressive, the clinical environment is at an increased risk for aggressive behavior.

Your safety and the safety of staff members, other clients and surrounding people depend on your ability to effectively manage aggression in behavioral health. This includes understanding, developing and using strong communication skills with clients, utilizing deescalation techniques, learning to recognize the warning signs

Professionalism In-The-Moment

Remember to be professional.

Again, it sounds simple but there are times when you are tested with irate clients or family members. The key is to take a step back and remember that they are contacting you to help them solve a problem. Sometimes you have to get past the tone and volume and focus on what is being said. Respond in a calm, professional tone. It’s easy to forget and respond with something inappropriate and unprofessional.


Prevention is the best form of managing aggressive behaviors. As you gain more experience working with people, you can discover what mannerisms and behaviors are signs of frustration and be able to prevent a situation from getting out of control. In direct care settings it is critical to recognize signs of frustration and anxiety in your clients. Clients who are non-verbal can still communicate frustration through their behaviors.

Recognition of Escalation

Here are just a few signs to look for in order to prevent aggressive behaviors:

  • A person clenching his or her fists or tightening and untightening their jaw.

  • A sudden change in body language or tone used during a conversation.

  • Pacing, tapping or fidgeting.

  • A change in type of eye contact.

  • The “Rooster Stance” – chest protruding out more and arms more away from the body.

  • Disruptive behaviors – yelling, intimidating, actively defying or refusing to comply with rules.

  • Intensified breathing; breathing only through the nostrils; loud breathing

What to do

Remain Calm (or Calm Yourself)

  • If you’re upset, it’s only going to escalate the situation.

  • Take a deep breath.

  • Use a low, dull tone of voice and don’t get defensive even if the insults are directed at you.

Be Aware of Your Situation and Environment

  • Other people in the room,

  • Objects; such as chairs, tables, items on a table,

  • The space around you (exits, openings, trip hazards, etc.)

  • Are you blocked from exiting?  Are you blocking them from exiting?

Try to Appear Non-Threatening as Possible

  • Appear calm and self-assured even if you don’t feel it.

  • Maintain limited eye contact and be at the same eye level.

  • Encourage the client to be seated, but if he/she needs to stand, stand up also.

  • Maintain a neutral facial expression.

  • Place your hands in front of your body in an open and relaxed position.

  • Don’t shrug your shoulders. Don’t point your fingers at the person.

  • Avoid excessive gesturing, pacing, fidgeting, or weight shifting.

  • Maintain as much interpersonal distance as possible

Listening to the Persons Concerns

  • Acknowledge the other person’s feelings without passing judgment on them.

  • Empathy needs to be shown during conflict situations. Even if you do not agree, expressing an understanding why that person feels a particular way will help resolve the conflict.

  • Clarifying, paraphrasing and open-ended questions all help the person know you are listening.

  • Ask to take notes.

  • Ask for their ideas or solutions.

  • Help them talk out angry feelings rather than act on them.

Skillfully Shift the Conversation to the Future (if you are making progress)

  • If you inspire hope and demonstrate empathy, you make yourself less threatening.

  • Using “we” helps include the person and implies a partnership or team.

  • Get them to say yes; It is very hard for someone to stay angry if they are agree with you.

If You Are Getting Nowhere, Politely End the Conversation and Offer to Talk Later When Everyone is Calm

  • But Be Prepared to Run or Call for Help