Pic 22: In this slide, the figure has one clenched fist and the other pointing with exaggeration marks. The text next to it reads “Aggressive hand gestures.”
Pic 23: In this slide, the figure has narrowed eyes, and they are now purple. The text next to it reads “Leering.”
Pic 24: In this slide, the figure is now pink and has clenched fists with narrowed eyes and an open mouth with marks denoting a loud volume. The text next to it reads “Raising voice or shouting.”
Pic 25: The figure is standing and has clenched fists with downturned eyebrows with anger marks. The text next to it reads “Standing up.”
Pic 26: The figure is red, and walking past the chair with a little storm cloud above its head. The text next to it reads “Leaving the room unexpectedly.”
Pic 27: The screen returns to Dr. Owens.
Peggy gave several of these signs. I could have realized that pushing forward with my agenda would only make things worse.
Pic 28: The acronym “CAF” appears next to Dr. Owens before expanding to read “Calm Assess Facilitate.”
When we see these signs, we should consider using steps in the CAF model to de-escalate confrontational situations.
Pic 29: The screen changes to one with the word “Calm” at the top, and the following information:
Decrease the emotional, behavioral, and mental intensity of the situation.
Pic 30: This screen is titled “Assess.”
Determine the appropriate response based on the facts.
Pic 31: This screen is titled “Facilitate.”
Promote the most appropriate resolution based on information gathered.
Pic 32: The screen returns to Dr. Owens. Next to her, the word “Calm” appears, with a curved arrow pointing from it to the word “Assess.” After a moment, another curved arrow leads from “Assess” back to “Calm.”
CAF is a fluid process. As tension fades in the Calm step, you can move into the Assess step where you can learn more. You can build on what you learn to de-escalate even further.
Pic 33: The word “Calm” is highlighted.
In the Calm step you’re showing empathy, partnership, and validation.
Pic 34: The word “Assess” is highlighted.
In the Assess step you’re using clear language to get at the root cause of their problems. You want to show them you’re there to solve problems, not add to them.
Pic 35: The top and bottom arrows alternatively flash yellow.
You can alternate working through the Calm and Assess steps as needed.
Pic 36: An arrow points down from the “Calm/Assess” circle with the text “Facilitate” at the end.
Once the client seems calm and you've assessed the root cause of their problem, you can move towards talking about solutions and next steps which happens in the Facilitate step.
Pic 37: The previous image and text disappear, and the word “Techniques” appears next to Dr. Owens.
Let’s discuss specific techniques of how to work through the Calm and Assess steps.
Pic 38: A title card appears that reads “Techniques for Calming and Assessing” before transitioning back to Dr. Owens. The acronym “MI” appears next to Dr. Owens before expanding to read “Motivational Interviewing.”
MI has been proven as a highly effective, evidence-based framework for having difficult conversations.
The overall approach is simple:
Pic 39: This slide is titled “Motivational Interviewing” with the following text below:
MI is a way of being with clients and treats decisions about change as a conversation, not a lecture. Clients already have what they need to resolve internal conflicts, and we’re here to facilitate. (Stanhope 2020 p. 420)
Collectively known as the “OARS” techniques. (Weaver 2017 pp. 200 to 201)
You can learn more about these MI techniques in the Supplemental Materials.
Pic 40: The screen returns to Dr. Owens.
MI is helpful for de-escalation because it can strengthen relationships with clients.
Pic 41: This slide is titled “Motivational Interviewing” and contains the following list:
You can learn more about these MI techniques in the Supplemental Materials.
Pic 42: The screen returns to Dr. Owens. Next to her are the words “Calm” and “Assess.”
Let’s focus on two techniques for the Calm and Assess steps:
Pic 43: This slide is titled “Techniques to Calm and Assess” and includes the following information:
Empathy: Affirm, validate, or normalize the individual’s feelings and show them you understand.
Open-Ended Questions: Help the individual share more about their experiences and help you better understand where they’re coming from
Pic 44: The screen returns to Dr. Owens. The words “Empathy” and “Open-Ended Questions” appear next to her.
When an individual is frustrated, it's best to start with Empathy, then ask Open-Ended Questions.
Let's walk through a situation that shows how this model can work. Imagine you're starting a visit with this individual.
Pic 45: The screen transitions to a scene where Dr. Owens sits across from a middle-aged man with glasses.
Dr. Owens: Hi Frank! It’s nice to see you again.
Frank: Yeah, you too. Look, can we just get this started? I’m kind of in a hurry.
Pic 46: A screen with a symbol of two word bubbles at the top appears over the scene. It includes the following information:
This client seems agitated: short, curt response and impatient body language.
Let’s see how the provider can empathize (affirm, validate, or normalize the client’s feelings and show them you understand) and follow up with a question. This is the first step: Calm.
Pic 47: The screen returns to Dr. Owens and Frank, with a word bubble over Dr. Owens’ head. The speech bubble includes the title “Step 1: Calm.”
Dr. Owens: I can understand being in a hurry. Let’s jump in. Anything you wanted to chat about in particular?
Pic 48: The screen zooms in on Frank, who is pointing with his arm. There is a small image of a lightning bolt behind the text.
Frank: Well, to start with I couldn’t find a parking spot. Now I’m late, which means I’m going to be late for my next appointment. You need to tell people when the parking lots close!