Restraint When and Why

I was conducting the Nonviolent Crisis Intervention^® course this week when an interesting discussion developed on the use of physical restraint when a person (client, patient, student, etc.) is screaming, swearing, and making threats. I reminded the group that CPI recommends restraint only when someone is a danger to self or others, and even then only as a last resort. Expanding upon that, I pointed out that those particular behaviors do not fall under that description of a danger to self or others. The participants acknowledged that this was true, but that some staff were using restraints to deal with the aforementioned Release behaviors regardless. In order to prevent improper use of physical intervention, it's important to look at why staff would be motivated to use it when unnecessary.

Screaming, swearing, and threat-making fall under the Verbal Escalation Continuum^SM, which is a closer examination of the Defensive Behavior Level from the Crisis Development Model^SM. We know to take a Directive approach with this behavior, which does not include physical restraint. So, what is motivating staff to overreact?

It really boils down to staffs' own Precipitating Factors. Perhaps staff restrain because their self-esteem suffers as a result of the verbal abuse. It could be the fear staff feel from the Release behavior—the fear that their safety is in jeopardy. Fear can cause staff to panic. Staffs' loss of personal power could certainly figure into the equation. Staff members don't want the screaming to influence onlookers' behavior. Might staff displace some of their anger through use of restraint? This is certainly an unfortunate, but realistic reason.

If employees feel that they are failing at de-escalating the release, they may get impatient and resort to physical management. Then, of course, there are the psychological and physiological causes staff suffer from that could influence them to overreact. Staff who are imbalanced, stressed, or just plain tired of verbal abuse. Even the need for attention may motivate staff to restrain. Let's not discount employees who feel physical restraint should be used for purposes other than de-escalation. Restraints that are used to punish, inflict pain, or make someone an example can all lead to poor judgment in their use.

In the end, a robust discussion led to a better understanding of when and why to use a restraint. I hope you can all use this particular blog to get the same result.