Matthew R. Roosa

Helpful tools

Use the empathy/trust spiral. Use empathy by listening, which creates trust, which brings about dialogue. If you have the time, you can ask, Why does that happen? Remember that big problems have multiple causes.

Similarly, don’t just do something, sit there. Hear the person out through a compassionate presence. Compassion is empathy in action.

Control the “righting reflex,” the urge to fix the problem right away and telling the person what to do. When people are in crisis, however, a clear direction is needed. 

Use empathy. Empathy is not sympathy. It’s not feeling sorry for someone or excusing reckless or dangerous behavior. Empathy means understanding. It means trying to understand the thoughts and feelings that led to a person’s words or actions. 

Be aware of your triggers. What causes strong emotional reactions in you? Beware of transference and countertransference—such as someone blaming you as a result of something that was done to them and your reacting instead of remaining neutral.

Every person is unique

If you’ve seen one distressed person, you’ve seen one distressed person. There are some generalities that can be explored, but it’s important to think about each person as an individual and to keep trying to understand that individual person’s experience.

Use elements of grounding. The process of grounding takes people out of their upsetting thoughts or emotions and brings them back into their body and surroundings. This helps clear their mind and their thinking ability. Ask them to squeeze their hands tightly for a few seconds, then relax them. Taking a deep breath can be grounding. People do not have to close their eyes; they may not feel comfortable doing so. Simple shortcuts like talking with them about the weather can bring them back into their surroundings. I like your hat. Some weather we’re having. How did you get here today? Is that chair comfortable? It focuses on their physical present moment, helping them feel less anxious and probably safer, because they’ll have an awareness that they are okay right now, that they’re in a safe space. That’s better than telling them they’re safe, because when people are feeling really anxious, they won’t necessarily trust that message. Noticing something about their surroundings can be a helpful strategy to engage people. Although probably not practical in the moment, meditation is a grounding practice. Grounding may not work for some angry people, who may feel that their concerns are being discounted.

Use elements of motivational interviewing (MI)

Motivational interviewing uses open-ended questions to help people figure out for themselves what they really want or need. Provide them with the dignity and respect of exploring their options rather than telling them what to do. Motivational interviewing uses reflective listening, repeating back your understanding of what someone said. “Do I have this right?” It affirms people by giving them positive responses and regard for their challenges. “I’m sorry that you’re struggling with this.” It helps people make their own arguments for changing their life as they desire and the best way to do so, which helps avoid the pushing and pulling sometimes associated with getting help and then resisting suggestions. Help them focus on an area of concern, talk about maybe doing something differently or figuring something out, and then help them to plan.

Four Motivational Interviewing processes

Engage. Ask open-ended questions. Why? How? Tell me more. Questions lead to ideas, and ideas lead to solutions.

Focus. Ask, What are you hoping for? Use “agenda-mapping”—set the agenda. Form a collaboration with the person, especially when there are time or other constraints: What are your concerns? Here’s what I need to get done. Look at options. Zoom in on them.

Evoke. Use DARN to prepare for change: Desire to change. Ability to change. Reason to change. Need to change. Use CAT for talking about change: Commitment to change. Activation to change. Taking steps to change.

Plan. Is the person ready to make a plan? Is the path clear? Does the person want support for change? Use OARS for planning. Open-ended questions. Affirmations. Reflections. Summarizing.

Be aware of ineffective responses

Feeling fear or anger—pulling back, pushing away, flight or fight impulses (see “Safety first,”below). 

A tendency to want to fix it fast—intolerance of distress; frustration over the time needed for dealing with distress; difficulty in sitting with someone’s distress. Use a few minutes to listen. 

Using rule-based responses and language based in power, judgement, direction, and control:

  • Try to calm down.
  • We do not do that here.
  • I can’t help you with that.
  • Our policy is…
  • Please do not take that tone with me.
  • If you continue to do this, I am going to need to …
  • The form clearly states …
  • Yelling at me is not going to change the fact that…

Safety first

Rule No. 1 for safety: Never go it alone. Get help when your safety may be at risk, no matter your level of experience. It requires a team. Moreover, different staff members can offer different expertise and solutions. 

De-escalation strategies include:

  • using a calm voice and manner
  • showing support and concern
  • avoiding logic and argument
  • limiting stimulation and eye contact
  • providing space
  • moving slowly
  • announcing an action before doing it
  • offering options for moving forward
  • soothing activities such as music and grounding (may include deep breathing and muscle relaxation)

See First Aid for Mental Health.