Grace under Fire

Individuals suffering from psychiatric or substance use dis- orders sometimes display any one of a number of frightening behaviors: verbal outbursts, physical threats and even violence. In this comprehen- sive guidebook, Ellis Amdur walks professionals working in healthcare and social services settings through a multitude of steps they can take to keep themselves, their colleagues, and their clientele safe. Amdur covers a wide array of topics, intent on sharing his expertise with staff...
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Individuals suffering from psychiatric or substance use dis- orders sometimes display any one of a number of frightening behaviors: verbal outbursts, physical threats and even violence. In this comprehen- sive guidebook, Ellis Amdur walks professionals working in healthcare and social services settings through a multitude of steps they can take to keep themselves, their colleagues, and their clientele safe. Amdur covers a wide array of topics, intent on sharing his expertise with staff in executive, management, and front line positions alike. Amdur’s focus is based on behavior rather than diagnosis. The first sections of the book discuss specific behaviors ranging from such relatively minor irritants as reluctance to complete tasks and obsessive concerns to more troubling, pervasive syndromes such as psychosis, mania and disorganization. In one very important section, he discusses inter- actions with anti-social and psychopathic individuals, people who present danger to the psychological and physical well being of both staff and patients. In the second major section of the book, he focuses on us: what we can do to achieve a state of integrity and powerful calm. Rather than abstract pronouncements, he offers specific strategies, including a method of breathing that is for the purpose of maintaining one’s center in crisis situations. He then moves on to direct face-to-face encounters, covering situations that may occur within a clinic or office, as well as out in the community, be it someone’s residence, on the street, or even one’s car. This includes how to handle tense situations before they de- teriorate into chaos, and how to de-escalate once a crisis has started. Amdur elucidates the various motivations that drive aggression and further delineates the different types of aggression that result. De-escalation tactics are specific — one learns how to instantly rec- ognize what mode of aggression the person is in, and then, well-trained and practiced, one can almost instantaneously shift into the correct de-escalation tactic that fits the aggression one is facing. The final sections of the book offer a macro-view: how to establish and maintain a culture of safety both within your agency and your personal life. The likelihood that one will have to use de-escalation skills or other self-protective strategies is far diminished when such a culture of safety is in place.