As a general rule, there are two ways a hostile person will vent his aggression or hostility: verbally and physically. This is one of the essential tenets of managing aggressive behavior which at first seems obvious, but upon closer examination is a critical key to intervening. Clarification of this point allows the staff member to begin formulating concrete guidelines regarding the procedure utilized during interventions.

These two types of “acting-out” behaviors often become somewhat muddled or confused and are not separated from each other. This leads to inappropriate actions on the part of the staff intervening in the situation.

For example, let us assume that we have an agitated person in an emergency room and his agitation escalates to the point of screaming at select staff who are present.

Occasionally, one will see staff overreact and attempt to use a “hands-on” (physical intervention) strategy in an effort to calm down the individual. Thus staff action may actually precipitate a “physical acting-out” episode. In attempting to use a hands-on approach, the staff has escalated the person’s behavior into a more difficult and more dangerous level. An appropriate analogy is running up to a fire and throwing gasoline on it in an attempt to put the fire out. It does not work, and makes matters more difficult to manage.

On the other side of the coin, we have the staff who may attempt to utilize verbal intervention to safely manage the physically acting-out person. Words are an ineffective means of intervening when a person is hitting, biting, or choking you. In many cases, the person’s auditory channels shut down and they cannot hear you during the peak of the violent outburst. The analogy here is attempting to use a squirt gun to douse a bonfire; it is ineffective.

Therefore, the first principle which must be established is: Avoid overreaction and under reaction. Use verbal intervention skills to intervene with a verbally acting-out person. However, when the aggression becomes physical, you must also have in your repertoire of skills, safe physical intervention techniques to control the physical acting-out behavior.