Day-to-day do’s and don’ts

Defusion is a term for verbal and non-verbal ways of reducing tension. These tips work – they were developed from practice and experience. The more you try these tips the better you will become.

The principle is to change 'acting out to talking out’ and to try talking things through, rather than acting impulsively.  Here are some practical tips below which we hope will help you with difficult situations and to look after yourself in your care-giving role.

Body language and physical space... 

Don't invade defensible space: people like their own bit of territory - their own chair etc.

• Stay an arm's length away.

• Avoid being in a corner, or cornering the person.

• Always knock on their door.

Get to know signs of rising tension: rocking, stuttering, colouring of the face, pacing, hand wringing. 

Keep neutral body postures

• Keep hands in sight - showing the palms is a sign of peaceful intentions.

• NO clenched fists, hands on hips, pointing, leaning over people.

• Make eye contact - but don't stare!

• 90% of communication is non-verbal so SMILE!

If you defuse the situation you are successful. If the person has not lost face, and has kept their pride - then they are successful.

Self-awareness: this is not a vague thing

If you are in a grotty mood don't pretend you are feeling great, or that it doesn't matter. Just being aware of your mood can help you make adjustments on how to deal with any given situation.

Establish a warm environment

• Physically turn up heat (a side effect of some medication can be to feel chilly).

• Sit in a warm place to talk. • Be sensitive about colour schemes - décor, clothing etc.

• Keep a quiet place for talking or for space to get away.

 “Walk don't run”      Apply this in different ways: lower your voice, walk slowly.

Count to ten This really does work. When first faced with a situation start counting. As you do: check your mood, assess the situation, decide on a first course of action, confirm it to yourself then do it. You will be more likely to gain control because unwell people are very often frightened people and do not know what will happen next. If you come up with safe solutions the unwell person will develop confidence in you.

Use humour A good one-liner can be worth all the other tips put together. Avoid negative humour like sarcasm, put-downs or jumping to conclusions one may jump back!

Empathise      This means that you are identifying with or feeling for e.g.  “This must be very difficult for you.”   You can't always understand how the other person feels, but if you think you do then use it.

Sympathise This means, “I agree with you.” Someone may be right to show anger or distress - develop this by talking about ways of doing something about it.

Ventilation    Once someone is talking, let them let off steam, don't try to stop them. Don't interrupt and don't argue with them.

Ask open-ended questions like... “How did that make you feel?” rather than closed ones like "Did you do that?" 

Make general statements of acknowledgement:

• “Lots of people feel like that when they're ill.”

• “You're not alone in thinking like that.”

• “That's not you that's the illness.”

Dealing with argumentative / threatening situations

Split up the antagonists Take one off for a chat or get them both talking to you rather than at each other.

Sit out a threat: employ a stand-off NEVER join in a fight. This will be appreciated because you become safe. By setting a limit you reassure. Always take threatened violence to an individual seriously. Ask for weapons to be put down NOT handed over.

Individuals have different strengths in defusing situations There are natural differences between the sexes. So if your partner is dealing successfully with the situation just be visible; be around to be called on.

Physical contact Don't wake someone abruptly or aggressively; this carries a high risk of an equal response. Don't touch the back of the neck during tension. Don't take a grip on an arm.

Don't put up with the unacceptable Zero tolerance of violence or aggression has to be the rule. Discuss this in a calm setting not when a situation has reached crisis. Set limits and keep to agreed ground rules.

Know who to call and how to call for help in an emergency Keep important numbers (e.g. Crisis team), next to the phone or in the phone memory.

Don't become involved in an argument Try to divert the conversation to a subject which is not controversial.

Develop ways of defusing situations... That are appropriate to your family, your personality or the person who is ill. Apply the solution that fits at the time.

Discussion after a tense situation - wait for a cooling off period Then have a discussion to devise a plan. Always try to have a plan in place that has been agreed by everybody for an emergency or crisis. If you think things through before a problem arises you will be better able to cope and to continue coping.

Down tools Accept that your life has changed - at least for as long as your loved one is ill. There may be times when you just have to stop everything, in order to keep yourself or your loved one safe. It won't hurt to ignore a deadline or be late for something. Take breaks yourself - even if that inconveniences someone – no-one is indispensable! If you become unwell you cannot continue to care. Your health and well-being is crucial too!

Talking to someone with delusions

Don't dismiss the delusions Recognise that these ideas and fears are very real to the person - but show that you do not agree with them. Try, for example, “I don't believe … is out to get you, but I can see you are really upset about it.”

Don't be obviously alarmed by bizarre words or unfinished sentences etc. Say, “I don't really understand what that means.” Or remind them what the conversation was about “Remember we were talking about…”

• Don't let others laugh about the hallucinations or the strange talk

• Don't ask the person to try to force the voices to stop

• Do act calmly

Do try to distract the person by involving them in something interesting, looking for something, chatting or mixing with close friends or family.

Do give the person space and time if they don't want to talk Say, “I can see you don't want to talk now, but I'll be here if you want to talk later.” Allow them time to recover their thoughts, their composure etc.

Helping someone who self-harms

People injure themselves for many reasons. It may replace emotional distress with physical pain. Many people say that when they cut themselves they experience a release of tension and so they often feel calmer. In a strange way, self-injury may help people feel that they can achieve some degree of control back in their lives.

Self-injury is very often not a suicide attempt.  However, people who do self-harm are at a greater risk of suicide than the general population and should never be dismissed as just 'attention seeking' or being 'manipulative'.
Relatives, friends or professionals trying to help the person can find it very stressful, especially when the person does not want to talk about or explain their behaviour.

It is easy to feel 'shut out' and just left to pick up the pieces at times of crisis. If someone we care about is deliberately damaging his or herself and not willing to let us help, we can feel isolated and powerless.
The person usually has very low self-esteem and poor self- worth and they think that others will see them in the same light and be critical. There are therapies which can be used that have been shown to be effective in breaking the negative cycle.

Useful pointers...

• Respond to an incident of self-harm in the same way that you would for the victim of an accident; provide first aid as for any other physical injury or contact emergency services if the physical injury is serious and needs expert medical attention.

• Do not assume that the person either enjoys or does not feel pain. A response which implies criticism or some form of punishment simply reinforces the person's feelings of self- blame and guilt.

• Acknowledge the person's distress. Say something like 'I can see you are very upset. How can I help you?' This can be very reassuring and can help the process of communication.

• Aim to be positive and comforting; don't be negative or highly emotional. It may be hard but don't be judgemental, critical or dismissive. This applies to non-verbal as well as verbal communication. Try to show concern rather than disapproval, facially as well as in what you say.

• Try not to be over protective i.e. promising that everything will be alright. Acknowledge that there is a problem, but that it is possible to get help. Help them to think about their self-harm not as a shameful secret but as a problem to be sorted out.

• Having contingency plans in place ready to use in times of crisis is vital and can often prevent a crisis happening. Knowing what to do and who to contact in an emergency can be very reassuring for the person and those who care for them.

• If you think someone may be suicidal then contact the relevant agencies such as the emergency services and anyone else involved in their care, like their CPN, social worker or the GP.