High Conflict People in Healthcare – and Everywhere!

© 2013 By Bill Eddy, LCSW, Esq.

Those who have been following this blog for High Conflict Institute and our publisher/sister blog, Unhooked Books, have probably noticed that May 2013 was the busiest month we have ever had speaking around the world about high conflict people. I spoke 8 days in 6 cities – from Ottawa to Los Angeles, from Wisconsin to Texas – while Megan Hunter spoke two days in Australia. (My tightest connection was finishing with mediators at 5pm in Albany, New York, and then speaking to judges in Los Angeles at 10am the next morning! Whew!) We are not a big organization, but we seem to have been correct when we predicted several years ago that high conflict people and their difficult behavior was increasing in society around the world. Last Thursday I was pleased to speak in San Diego (where I live) to professionals with the Sharp Healthcare System, especially those working with patients in Behavioral Health (generally mental health issues). Interestingly, 25 years ago I worked at Sharp Mesa Vista Hospital, one of Sharp’s facilities, with adolescents and chemically dependent patients. This is where I learned to understand some of the problems of managing high conflict patients and also where I learned about “staff splitting” and how to avoid it.

Staff splitting occurs in hospitals, drug treatment programs (and even legal disputes), when a high conflict patient or client treats half the staff as wonderful and half the staff as hateful, and the staff start absorbing this split and start getting angry with each other over the patient’s care. The way to avoid staff splitting is to realize it is occurring and treat each other with Empathy, Attention and Respect, regardless of differences of opinion about patient treatment. It also helps to avoid all-or-nothing solutions in solving problems related to that patient’s care.

I gave a two-hour session to the Behavioral Health staff at Sharp Healthcare. While they are trained in mental health issues, the issue of managing the high conflict behavior of personality disorders is still evolving for all healthcare professionals – even those in behavior health. One of the  tools that they like the most was using “E.A.R. Statements™” to calm any patients who are highly upset, whether they are high conflict people in general or not. This is one of the key principles of working with high conflict situations in the workplace: it doesn’t matter whether someone has a high conflict personality or is just having a hard time but is usually pretty reasonable – you can use these techniques on anyone!

E.A.R. Statements™ show Empathy, Attention and/or Respect. For example: “I can see how upsetting this is to you. I will pay attention to your concerns. I respect your efforts to solve this problem.” Saying such a statement in a tone of voice that is truly empathetic calms people down almost all the time (say, 90% of  the time) from my experience and the experience of many who have taken our seminars. This is especially helpful in dealing with those with borderline personality disorder, narcissistic personality disorder and other personality disorders. This seems to be because they are highly sensitive to the emotions of others around them, and they tend to “mirror” the emotions of those with whom they are in conflict (or think they are in conflict with). By making EAR Statements, it puts both people on the same “team” in solving a problem, rather than working against each other.

I noticed this recently when I was sitting on an airplane, which had not taken off because it was delayed due to a part that needed to be replaced. As we were waiting on the plane, a couple passengers started complaining about having to wait and that this problem should have been discovered earlier and fixed earlier. The pilot or co-pilot came out and spoke with them – ideally to help them stay calm. But the pilot quickly said: “Well, you have a choice. You can fly with us or change planes.”

While the pilot may have been well-intentioned, he had not communicated any Empathy, Attention or Respect before saying that, so that one of these two passengers responded even more negatively and said: “Are you kicking me off the plane?” The pilot said, “No,” I’m just pointing out you have a choice.”  Someone in another row said: “I don’t know why you’re even arguing with him.” I’m not sure if this was to the pilot or to the passenger, but the problem was clear: it had become an argument when it could have been a time of shared frustration and empathy, in a non-defensive tone, such as: “Yeah, it’s always a drag when this happens. Fortunately, it’s pretty rare. But I understand how frustrating it can be and I appreciate everyone’s patience. We want to get you there as soon as we can, as safely as we can.” Instead, the pilot just decided it would be best to walk away at that point.

The end of this story is that the wait turned out to be 1 ½ hours, so they had us unload the plane so we could move around and then reloaded. Back on the plane, we noticed that the two complaining passengers were no longer with us. I don’t know if they were encouraged to change planes or just did it on their own. We arrived safely at our destination – and I had another example for our seminars!

Bill Eddy is a lawyer, therapist, and mediator. He is the co-founder and Training Director of the High Conflict Institute, a training and consultation firm that trains professionals to deal with high conflict people and situations. He is the author of several books and methods for handling high conflict personalities and high conflict disputes with the most difficult people.

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