Q: A co-worker was in a situation where a client became angry and left the building. The client continued her outburst on the sidewalk outside. The co-worker then followed the client outside the building. The co-worker confronted the client and asserted, "If you have anything to say to me, say it to my face." Is it ever appropriate to pursue a client outside the building to confront them? Paula, Mobile, AL

Kim Tierney: There is no situation where it is appropriate for a staff member to follow an angry client outside of a building. From what you describe, it sounds like the client was venting and the staff person became defensive.

Confronting an angry, venting client escalates an already bad situation. It is best to listen to the client and wait until he or she has calmed down. Sometimes a staff person and client need to disengage if the conflict is not resolving. It appears that this is what the client was doing by leaving. In my opinion, the staff person's defensive behavior escalated the conflict.

I would recommend that a manager meet with the client at a later time to review the incident and discuss how to avoid future confrontations. It is best to do this after the staff member and client are calm and in control. In turn, the staff member should learn to remain rationally detached and not take a client's anger personally.

To learn how to stay rationally detached, I recommend taking CPI training. If that's not an option, the staff member can pretend to be an distant observer:" Isn't it interesting that when I told you this, that you reacted in this way?"

From my experience as a manager, I would also suggest counseling. It might help the staff person to identify their own behavior patterns and sensitivities. Maybe the staff member has difficulty dealing with clients who have specific issues. Perhaps the client should be switched to another provider..

Many of our clients have personality disorders and are challenging. We need to remember that reacting defensively plays into the client's inappropriate behavior. Some clients love having an audience and claiming the staff person is persecuting them. Choose not to play

Monte Hanks: Neither is it appropriate - nor productive - to follow a client outside, especially when one or both participants are angry. When an angry client leaves the premises, the conversation is complete. Following a client outside exacerbates the situation and may result in a physical confrontation. A staff member at my workplace followed a client who was verbally threatening, which resulted in an attempted assault and police intervention. The staff member should have simply locked the door temporarily. Fortunately, no one was hurt.

As Kim recommends, never take a client's anger personally! The Fourth Street Clinic Safety Manual advises, "There are reasons for [a client's negative or aggressive behavior], and most likely it is not you." It is a good idea to speak with a supervisor to de-escalate or diffuse tension. The incident may be charted and a note attached for the supervisor to discuss the incident when the client is seen again. Sometimes a written contract, stating appropriate behavior for the client on future visits, is useful. Ask the client for ideas for the contract and have the client and supervisor sign and attach it to the chart.

The manager should also encourage the valued staff member to examine his or her contribution to the incident. A word of caution: Finger-pointing and blame should be avoided. This is a learning situation.

If it is the clinic's practice to meet and discuss such incidents, I think it serves the staff member better if only peers who witnessed the incident attend. The manager or supervisor can facilitate, and focus the meeting on specifics. With our new Behavorial Health Consultant board (LCSW) we are planning monthly group discussions to address similar issues. This way, staff can express their concerns and seek assistance concerning the difficult, emotionally-charged situations we face. These open meetings, however, do not replace ad hoc briefing sessions.

© 2005 National Health Care for the Homeless Council