Working with potentially assaultive clients

Social workers and other helping professionals have increasingly become the targets of violence and attack by clients (Guy, Brown, & Polestra, 1990; Star, 1984). It is estimated that all direct-service practitioners, including social workers, are in danger of being assaulted during their careers (Wagner, 1990). It is clear that social work, along with such fields as teaching, nursing, and psychiatry, has become a profession in which the constant risk of assault is "part of reality" ("Risk of Assault," 1989, p. 3). Thus, there is a growing need to increase the abilities of practitioners to predict and control dangerous behavior by clients (Newhill, 1992). This article examines the potentially assaultive or preassaultive client and suggests some ways to minimize the risk of assault by such clients. The data used in this article are derived from the author's 10-year experience in providing social work services on an acute psychiatric ward in a large public medical center. Although the data are limited to one setting, recent studies indicate they may be generalizable to other settings as well (Newhill, 1992). POTENTIALLY ASSAULTIVE CLIENT CONDITIONS Several authors have developed categories to describe clients who may become assaultive or events that may lead to assault (Kaplan & Wheeler, 1983; Madden, 1983). For the purposes of this article, the most serviceable set of categories is that provided by Kronberg (1983), and we have adapted her analysis for use in this discussion. In general, the potentially assaultive client's condition and behavioral cues determine which treatment approaches and therapeutic goals are used. Table 1 outlines some of the most important factors associated with five commonly observed preassaultive conditions, the cues associated with each condition, and the approaches and goals that have been found to be helpful in the management of these conditions (Kronberg, 1983). It should be stressed that these conditions do not represent diagnostic categories but instead signify commonsense definitions of behavioral events frequently encountered in psychiatric settings. Panic Clients can sometimes become so overwhelmed by fear that they lash out in panic at all who attempt to influence their choices or constrain their behavior. Victims of attack can include helping professionals as well as friends or immediate family (Kneisl, 1988). These behaviors are illustrated in the following vignette: A 39-year-old male psychiatric patient became distraught while speaking with the ward social worker about making arrangements to see his estranged wife. His distress grew as the social worker attempted to explore and analyze his feelings until he finally became threatening toward the TABULAR DATA OMITTED worker, claiming he feared that his wife was leaving the state with his infant son and that staff were keeping him from seeing her. The worker quickly exited her office and sought assistance from ward staff. Such clients generally show signs of severe anxiety, such as pressured speech, obsessional thinking, and fears of catastrophe or abandonment. They may exhibit clinging behavior toward staff, in which they claim helplessness and the need to rely on staff for even minimal assistance. Apparent unconcern by staff or even attempts to objectify the client's feelings are often interpreted by the client as indifference and can trigger desperate explosive reactions. The task of calming a severely frightened individual places constraints on the reactions of the helping professional. Because such clients feel as if they are under attack, it is important for the practitioner to avoid any appearance of threatening behavior. Responses to the client should be calm and reassuring, deliberate without haste, with purposeful avoidance of eye contact unless this is sought by the client, because eye contact is often interpreted as a threat. Practitioners should avoid physical closeness unless desired by the client. …