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Roger N. Meyer "...of a different mind "
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Copyright 2001 Roger N. Meyer

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     [A person wrote to ask how I handle infantile outbursts with my young adult clients when we are in agency and public settings.  I described one client's obliviousness to social rules of reciprocal conversation and appropriate social behavior.  I used the term "Black Hole" to depict how enlightenment offered by others seems to disappear when the client is particularly upset.  The poster suggested that with his AS spouse and son, being direct and actually ridiculing them seemed to work sometime.  I disagree about ridicule.]


     The poster wrote:


     "I've noticed X shuts out criticism, but she doesn't seem to shut out ridicule as easily.  I think  that's probably the best hope of reaching her  .As far as your adult clients, are the people working  with them afraid of their anger and does the client use that to back people off?  Has anyone kept  pushing even when the person got angry to see if anything gets through?  I have a theory that if someone has shut down so much that nothing gets through, you might be able to sneak in through he crack that appears when they get mad."


     I responded:


     My response is different depending on how "far gone" the client is.


     The first thing I do -- especially if it looks as though the client is about to escalate her responses -- is to divert her attention to something positive that she's done or said in that meeting.  The referent must be to something that is very close in time to her outburst.  If the meeting has run on for some time, I fish for the most recent example, even if it's small.  That is usually enough to stop the ramping up behavior and actually cause a rather rapid de-escalation.  The reason this often works is that she actually doesn't remember what she just did during the ramp-up to an outburst, so it's possible to reshape her working memory by providing factual, not emotional information.  It's as if we are starting with an almost fresh slate.  With that information, she is ready to re-engage people.  Since these are stressful or strange situations, that means she is then ready to learn.


     My second approach is geared towards working with the client when the situation still seems "workable." 


     If I were to join the client in her tirade through a tit for tat, I may feel some inner satisfaction in correcting an act of personal abuse directed at others, but what would be the point?  I have yet to lose it, my cool or my temper, when "acting" in the disability advocate mode.  Sometimes you wouldn't want to ride in the same car with me afterwards, but at least I've learned to keep untoward reactions to myself.


     Most of the folks working with my most temperamental client don't have a clue about how to deal with her when she throws a snit fit.  What I do is model direct, forceful confrontation of the behavior, not the person.  I can't ask the others to come along on that route because to do so would require a likely violation of long-held professional prejudices and myths regarding confronting persons with difficult behaviors.  I say that what she has done or said isn't adult, and that everyone, including her, are adults at the table.  That's usually been enough to stop that infantile demonstration.  That's usually not the end of it, though.  At each repeat, I do the same.  As her advocate, my principle role is not to re-educate others but to represent her interests.  Educating them is incidental.  In the past these meetings have dragged on and derailed when my client "pulls her act."  As her advocate, my job is to keep the discussion businesslike, concrete and to the point.


     I'm not "buying into" the expectations of others when I intervene, but I am modeling the kind of intervention that is positive and supportive by naming the name, and going for "the game."  I never do that without proposing at least a couple of optional behavioral responses the client can adopt.  It's no good to cut a client off at the knees when a tantrum is the first thing in her behavioral vocabulary she reaches for when she is frustrated or unhappy with the way things are going.  With this client, tantrum or whatever, I pose at least two other optional responses that I know the client HAS made in the past, successfully. 


     In this intervention, which I call a "Stop and Process", there are elements involved similar to those in creating a Social Story.  First, I stop the behavior by naming it.  I then partially demonstrate it to the client, and indicate verbally and with slightly exaggerated posture, gesture and facial expression that her behavior is unacceptable.  I then connect that mirrored behavior with at least two alternative options from her "behavioral vocabulary" that are communication-based.  By adopting the alternative behavior, she can express--even if by behavior alone--what it is, a thought or an issue, which has gotten her dander up.  With her revised verbal expression, she is better able to advocate for herself, even if her expression is limited and not perfect.  Her new expression provides a handle -- something that others in the room CAN work on.  Give-and-take then ensues during which she has a chance to clarify her needs, and others have a chance to engage in the game of "Twenty Questions."  At this point, she is interested in communicating verbally, and finding the words and expressions that have a universal meaning for others in the room.


     When the person is in the midst of a big tantrum I use another tactic.  This I use rarely, and only if I really know the client and how she is liable to respond.  Regardless of who is in charge of the meeting, I may ask everyone to get up and take a break--to actually leave the room.  That provides the client with no target and no audience.  Incidentally, everyone leaves including me.  Sometimes I explain why, and sometimes not.  It depends upon how far "shut down" the client is at the moment.  Nevertheless, I'm not going to stay there and baby-sit her through a tantrum.  This has the effect of causing her to ask herself, "OK, what do I do now?"  By the time she asks that of herself, she is ready to learn.


     When the need arises to intervene directly, I view my role as that of a foreign language coach to someone who has temporarily forgotten a word or expression that they have just learned, or that they use all the time and now have difficulty recalling during a temporary period of stress.  With all three techniques, I view the client's behavior as a pre verbal or non-verbal effort to communicate.  I don't make a big distinction between language and behavior, since most communication is nonverbal.  Although I am not a speech/language pathologist, what I do at these times is engage the client and others in the room in a working lesson on language pragmatics.



Copyright Issues


This article is copyright, all rights reserved by the author, Roger N. Meyer.  It may be reproduced in single copy once for personal use, and in no more than ten copies total for educational purposes.  Fair Use is authorized for all purposes and under conditions established by US Statute and the International Copyright Convention, to which the United States is a signatory nation.  No person shall publish, distribute, copy, or by other means make this material available to others for purposes of personal gain or professional self-aggrandizement.  Individuals wishing permission to exercise other than fair use or limited distribution as outlined above must contact the author, in writing, and receive explicit written permission from the author prior to engaging in further use of this material.

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