Smoke or Steam?

Potential Escalation in Peer Interactions

 Workplace Violence

Mental Health professions include 1% of the workforce,

but experienced of the .

Unless otherwise noted, all statistics are according to Bureau of Justice Statistics report “Workplace Violence” released 3/29/2011.
Traditional “Profiles”…

“It’s Personnel as Well as Personal”

Psychology Today Jan 1st 1994
You can’t Stop what you
don’t Recognize.
 Bullying
• Pattern of behaviors.
• Each one individually considered a form of
intimidation, aggression or other violent act.
Together, they create a Hostile Environment:
• Bullying: When the behavior of another
interferes with an individual’s ability to work
through the creation of a hostile, offensive,
and/or intimidating environment.
 Escalation Causes Violence, right?

Escalation
is someone becoming more and more intense.
Emotions working overtime can eventually
move behavior in the direction of crossing
safe boundaries.
 Escalation
• Is it a bad thing?
• Ever had a difficult, resistant or “sour”
patient?
• You had to escalate your intervention in order
to work with them.
• But when emotions escalate out of proportion
to the situation, or for an extended duration
without a break…
 Elements of a [Useful] Profile:
• Demographics Red Herring: Useful for study,
but not prediction.
• Situational Factors
• Personality Traits [Useful] =
• Interpersonal Skills Defined rigidly
• Positive Behavioral Queues enough to
• Negative Behavioral Queues describe,
Focus on why a trait or yet flexibly
behavior made the List. enough to
Not on the List. adapt.
 Situational

Factors
 Situational Factors
May come as a surprise, but our jobs can
actually create a powder keg.
• Highly stressed work environment
• Understaffing
• Minimal room for advancement
• Overly controlling management/regulations
So can our personal lives.
• Loss (failed relationships, death of loved one)
• Finances
• Kids!
Low Self Esteem?!?
 Self Esteem
Low Self Esteem (Standard definition): a
generally negative view of self (life, future, skills,
physical body) and a general lack of will to enjoy
life.

Using this definition, and indeed the term Low

Self Esteem as a trait is incomplete and
frequently misleading.
 Cognitive Dissonance
Roughly 234 Points in Scrabble

Subjective view of self VS Expectations of self

When these images don’t match it creates an

internal conflict.

That internal conflict creates discomfort or stress.

Healthy reaction uses that discomfort to provide

the motivation for self improvement.
 Cognitive Dissonance
Roughly 234 Points in Scrabble
Unhealthy reaction 1 – rejecting the discrepancy:
• Defensiveness: refuses to consider constructive criticism
• Unreasonable expectations: of Self and others
• Sabotage others: If you have an artificially high opinion of
yourself but others are keeping up with you, knocking them
down a peg or two may be the only way to maintain or validate
your inflated self image.
• Elitist: Views the work they are required to do as “beneath
them”. Either beneath their skill set or as demeaning in some
manner.
 Cognitive Dissonance
Roughly 234 Points in Scrabble
Unhealthy reaction 2 – resigning to:
• Pessimism/hopelessness (as in the standard definition above)
• Victimstance: The persistent belief that any failures are
the result of oppression or other external factors, never due
to a personal error or mistake.
• Hyper-sensitivity: reacts adversely to constructive
criticism.
• Belief that others see will never accept them,
which is often self-fulfilling.
Loner?
 Loner?
• On the Edge? Or just looking for some space
to breathe?
• Introverted?
• Introspective?
• Excluded?
• The internal perception of solitude or isolation
makes a big difference in their external
perception of the world.
 Obsession
• Popular one is obsession over guns or
violence. Be careful of over emphasizing this.
• What about obsession over a coworker: AKA
Stalking.
• What about obsession over their work to the
point that you become hypercritical of others.
• Paranoia/conspiracy theories
• 7% of the general population commit violent acts.
• 5% of all persons with mental illness commit violent
acts.
• 16% of those with Serious Mental Illness (especially
untreated) experiencing a crisis commit violent acts.

Keys are #1 Experiencing a crisis

And #2 Untreated conditions!
Richard A Friedman M.D. “Violence and Mental illness – How Strong is the link?”
New England Journal of Medicine 2006; 355:2064-2066
Accessed online at: http://www.nejm.org/doi/full/10.1056/NEJMp068229
 Top 3 mental illness associated with
increased suicide/violence risk:
• Psychotic disorders (such as schizophrenia)
– Highest risk symptom – Delusions of control with
command hallucinations
• Bipolar Disorder: Manic side – impulse control
• Depression – often missed! Risk as the depressed
person with a grudge may feel they have nothing
to lose by acting on some impulse of revenge.
• NOTE: % noted above is for 1 or more violent
episodes or events in their lifetime.
 Positive
Behavioral
Queues!
 Positive Behavioral Queues
Positive refers to things that are present or
observable.
May include:
• Obvious displays of aggression, threats etc.
• Evident distortions in their view of reality:
misunderstandings or psychosis
• Substance abuse
 Negative Behavioral Queues
Negative Refers to things that are absent from
observations.
May include:
• Lack of reaction to events
• Lack of motivation
• Lack of empathy (for coworkers or patients)
• Lack
Change Factor
 Life Changes and Stress Happens
Holmes-Rahe Life Stress Inventory, also called Life
Change Inventory introduced the concept of that:
change = stress
Even “good” changes like a promotion, are
stressful.
• It stands to logic that changes, in absence of
another explanation, may indicate the person is
stressed!
• When you see change, explore what may have
caused it.
Trust your
intuition.
 Intuition
When something doesn’t sit right, likely
something the person is doing or saying doesn’t
mesh with subtle signs your mind is picking up
on, even if you can’t identify the issue.
That discrepancy is often cited as the origin of
“gut” reactions.
Follow up on those reactions.
Connect the dots!
Connect the Dots: Share Information
Each “dot” may be easy to dismiss as
insignificant, but when we connect the dots,
share information, we may discover there is an
elephant in the room.
 Triggering Event
A triggering event is a situation where the
person:
• Perceives the situation as unfixable.
• Responsibility or simple blame is projected
outward.
• A violent act is perceived as the only way to:
– Get noticed.
– Get revenge or “Justice”.
– Release their emotion.
– Etc.
 Triggering Event
Not all workplace violence incidents have an
identifiable trigger, but most do.
a bad performance review
passed over for a “deserved” promotion
lay-off
personal trauma (e.g. divorce, death of a loved one)
conflict with co-worker – usually the “straw”

Portions of this presentation adapted from: The Gift of Fear by Gavin De Becker
 Pop Quiz
• If an employee often overreacts or views casual
comments as criticism, it’s best to ignore his/her
responses and just chalk it up to a bad temper.
T_____ F_____.
X
• An employee’s excessive blaming of others is a
behavior all supervisors should be concerned
about. T_____
X F_____.
• In the months and weeks before committing
workplace violence, some perpetrators become
convinced that someone is watching them, begin
to believe in space aliens, or think that UFOs have
X F_____.
landed in their backyard. T_____
Quiz Adapted from a CIGNA EAP handout on workplace violence awareness. Used with permission.
• In some cases of workplace violence, there are
few to no warning signs that the perpetrator is
X F_____.
troubled and a threat to others. T_____
• Verbal threats should always be taken seriously
and literally. Action should be taken immediately.
T_____
X F_____.
• Employees who commit workplace violence have
sometimes been treated in ways that they
X
perceive as unfair by their organization. T_____
F_____.
• Some physical sparring between employees is
acceptable as long as it doesn’t go too far. T_____
F_____.
X
• Since supervisors must deal with employee behaviors
only as it relates to job performance, we should not
pay attention if we learn about stressful situations in
our employees’ personal lives. T_____ F_____. X
• An employee’s romantic obsession with an
uninterested co-worker can be a warning sign,
predicting possible future violent behavior. T_____X
F_____.
• If no one has complained about feeling threatened or
harassed, you should assume that no violence or
aggression has occurred in your workplace. T_____
X
F_____.
• There is a typical profile of a disgruntled individual who
is likely to commit workplace violence. T_____ F_____.X
Conclusion