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What Do We Learn From Today's Episode:

  • Crisis Negotiators MUST employ active listening to be able to respond effectively to an individual in duress.
  • Approaching a counterpart with sensitivity and determination helps to diffuse tensions and engage in rational dialogue.
  • Commercial negotiators can learn how to present options and provide a comprehensive breakdown of the

Executive Summary

Welcome back to the NEGOTIATEx podcast. Joining us today is Andy Prisco, the founder of Jumpstart Mastery, a network of public safety and behavioral health professionals who share a common interest in reducing episodes of anger, aggression and violence. The author of the crisis intervention certification handbook: Best Practices for First Responders , Andy is also the founder of the psychiatric emergency response team program for the state of Washington’s care and services system.

Everything Leads Back to Our Past

Andy’s foray into the world of crisis management and de-escalation began in childhood. As we’ve discussed previously on the show, formative experiences often inform a negotiator’s ability to empathize and listen. His family environment caused a fair degree of suffering that ultimately led Andy to overcome all odds and get an undergraduate degree in psychology.

For him and others who work in the mental and behavioral health space, selflessness is a virtue that develops naturally. This allowed him to work towards a cause that would help to reduce suffering all around the world. Andy goes on to state that when there is potential for substance abuse in a family ecosystem, people like him have to shape themselves according to the situation which might deteriorate at any given time.

Growing up, Andy developed a sensitivity to the emotional states of the people around him and actively tried to influence moods when he could. The work he has done in his career in adulthood, and the experience of treating patients in the care and services system was hugely influenced by his formative experiences.

His introduction to the “psychosocial rehabilitation model” happened in an urban care center in Patterson New Jersey. The therapeutic structure was one of shared spaces and shared relationships, with patients having access to all areas of the building except for the medical records room. This experience informed much of Andy’s later work as he found an appreciation for egalitarian caregiving and building human connections with the patients under his observation.

Crisis Negotiation Requires Tactful Skills

In psychiatric services, there is no preemptive way to dissuade a patient from aggressive or violent behavior. With no use-of-force policies, it is tantamount for the individual at the scene to be able to communicate with a patient in psychological duress. For a negotiator handling a mental health crisis, words and body language become key to diffusing a hostile situation. Until the point where there is imminent risk to the care-giver, there is no justification for using force or restraints. Even with the presentation of risk, the spirit of the behavioral health community dictates that the individual will try to communicate with the patient till the very end, attempting to engage their capacity for self control.

Andy recalls the time when a crisis incident involving a patient in forensic care resulted in a massive SWAT response to the clinic. In tandem with the crisis negotiation personnel from the SWAT unit, he managed to de-escalate the situation and get the patient to cooperate with medical staff and surrender. This incident paved the way for Andy to formulate the psychiatric emergency response team program that’s still in use today, with the goal of preventing crises escalation and disruption of treatment and care services.

The main difference between crisis negotiations and commercial negotiations that Andy has observed in his career involves the neurological activity of the people involved and their capacity for engaging in rational thought. Terms like paralanguage, mirroring, reflection and active listening are employed in both forms of negotiations, but the goals are different. Andy likens commercial negotiations to a complex chess game taking place across a boardroom table, while crisis negotiations can happen anywhere with an individual in duress. A crisis negotiator’s main goal is to activate the regions of the brain that dictate higher cognition, and to engage the individual’s capacity for self-regulation.

So what does Andy do when the stakes are high? Well the objective is to value and assist the person in crisis through active listening and get them to “want to stop”. It begins with getting a case history from the nurse or other people involved and then providing descriptions to the individual, of the undesirable possible outcome of the disruptive/aggressive action they are committing in duress.

An outburst of anger and aggression reliably demonstrates that there is high activation in the brain stem and people undergoing that physiologically are impaired in their ability to have a diverse expression of emotions and thoughts.

It Starts With Training

In the care and services philosophy, a violent/aggressive incident does not mean that the caregiver will move the patient over to a different institute. Relationships need to be cultivated in-between crisis incidents and are necessary to develop goodwill with the patients and their families. Anchoring someone to a bed with wristlets and waist belts might prevent an escalation in the moment, but it will not address the underlying reasons for a violent outburst.

Therefore, mental health crisis negotiators need to be prepared using competency exercises that simulate these conditions in a training environment. In the same way that servicemen and women in other organizations are trained using a combination of academic and scenario-based methods, Andy’s program inculcates progressively more complex learning exercises to inculcate the sequence of actions that the individual has to take to manage a crisis.

Andy, Aram and Nolan discuss a lot more on this episode of the NEGOTIATEx Podcast. Write to us at team@negotiatex.com and let us know your thoughts on this very insightful episode.

Thank you for listening.


Nolan Martin : Hello, and welcome to the negotiate X podcast. I am your co-host and co-founder Nolan Martin, with me today is my good friend, co-host co-founder Aram and also another important guest. But Aram, how are you doing today, sir?

Aram Donigian : I'm good. How are you, Nolan?

NM : I am doing excellent. Do you wanna go ahead and kick off this podcast by introducing our guests?

AD : Sure. Hi everyone. Great to see you today. Today, we are joined by Andy Prisco, founder of Jumpstart Mastery, a network of public safety professionals, behavioral health professionals, and private enterprises who all share a common interest in reducing episodes of anger, aggression, and violence through shared training, education and collaboration. Andy is the founder of the psychiatric emergency response team program within the state of Washington's care and services system. The program structure, advanced training and people are credited with significant reductions in violence, injuries, and the use of seclusion and restraint in state hospitals, forensic psychiatric facilities, and total confinement facilities. Andy is also a fellow with the national anger management association and a co-developer of the only certification available in crisis intervention from a professional mental health association. He is also the author of the crisis intervention certification handbook, Best Practices for First Responders. Andy has provided de-escalation training and presentations across the United States and Canada, the law enforcement professionals, hostage crisis negotiation teams, fire EMS personnel, behavioral health professionals, and psychiatric nurses.

In addition to behavioral health credentials, he maintains public safety credentials as a firefighter, an EMT, fire training instructor, rescue swimmer, rope rescue technician- might have to hear more about that Andy- and company officer. In 2017, Andy was a nominee for the hero of the year award from the Washington Council of Behavioral Health. He won the prestigious award in 2019. He is the founder of the Omada Erite thought group. I probably didn't say that right, did I?

Andy Prisco : It's okay. Erite

AD : Erite

AP : Yeah. Erite, yeah. Team of virtue.

AD : Team of virtue. Thanks Andy, which is a think tank of cross discipline, global experts, revisiting values and first principles in care and service programming. Andy, thank you so much for joining us today.

AP : Yeah. I’m almost embarrassed by the length of my bio, but I'm seeing all the images over the, you know, the 20 years that that represents. And I'm realizing as I'm looking at myself in this software at my gray beard and yeah. You know, there's been a lot of experiences there and I thank you so much for your willingness to witness me and my work in this context. I thank you both very much Nolan and Aram, it's been a long journey and I've really been kind of not visible, to the world in any, uh, public way until recently.

AD : And, and is that a dog? We hear Andy.

AP : No, it it's my wife crashing around, you know

NM : 😊

AP : I apologize guys.

AD : Yeah. That's, it's fine. No, I got two dogs here with me, so I ...

NM : Yeah I got three with me…

AD : … I'm always aware of the noise that they make. So yeah.

NM : All right, Andy. Well, let's talk about your professional journey. How did you get to this point? You know, what really brought you into the negotiation space or de-escalation space? I don't know how you want us to refer to it, but definitely excited to hear about the journey of you getting to where you're at today.

How Formative Experiences Influence Innate Negotiation Skills [4:48]

AP : You know, I think our formative experiences carve and shape the overall orientation of where we find ourselves as human beings. Flourishing, whenever we do flourish and we look back and recognize that these things that we went through were so material to what we're doing today. And I would imagine you gentlemen, could think of formative experiences in your development that set the stage for you to be doing the work you're doing. For me and many people who work in the behavioral health space, people who work I think in any space where their mission and purpose is from some place of selflessness to reduce suffering elsewhere. I had my own kind of suffering I had to live through and work through as a young boy and in my family system and without taking too much time and getting into too much detail, I think the jury is back on that now.

And I think that nearly everybody that we encounter can recognize the formative experiences- when in your family system, there is potentially alcoholism, drug use other forms of influences in the family system that can influence the presentation of a family member or someone else in a way where we might as human beings, growing up, feel unsafe. We might feel particularly, acutely attentive to the environment and sometimes on occasion have to adjust our own behavior so that other people in the environment are manageable. You know, we grow up very often, in settings where people's emotional state can be regulated by who we are in the moment. And if things for them, aren't just right, they can explode. So I grew up with a high sensitivity to the emotional arousal of others I'd say, so that I could get through a day, you know, without, without a problem.

And the work I have done in my adult career has been heavily influenced by that sensitivity; my formative experiences in observing someone else's distress and acting and conducting myself in a way so as not to make that worse. And if anything, try to make that better. I think that's what set the stage and my fascination with psychology, which could probably be credited to a number of things, is what led me to a long struggling undergraduate career of driving a truck and going to school at night and taking an extraordinary amount of time just to get my undergraduate degree. And then beginning the process of working in a care and services system, which began in, believe it or not, in Patterson, New Jersey, a very urban setting where I was working in what's known as a psychosocial rehabilitation model. So, my introduction into care and services was a model of care where there were no staff-only areas, no staff-only bathrooms, no staff-only break rooms, no staff-only offices. There was only one area that was off limits to people served, and that was the medical records room. But that kind of place of equity, if you will, in the delivery of care and services was my initial exposure to the work. And from then on, I was hooked.

NM : That's great. Thank you for sharing.

AD : Did that help lead to- I'd love to know more about the psychiatric emergency response team program that, that you created in Washington- so how did that experience kinda lead to your creation of the team?

AP : Yeah, so that experience of being in an environment, particularly where the, the therapeutic structure was one of shared space and shared relationship, you know, those environments for all the people who work in them require those people- when someone presents some kind of discontrol or dysregulation, you know, care environments don't have use of force policies. We don't use that word in psychiatric care and services. So anyone who presents aggressive and even violent behavior, property destruction, or assaultive behavior, until the threat itself becomes imminent, until the fist is cocked, until the chair is proffered over the head, until the golf pencil is in their hand and they want to jam you with it- words are the requirement. There is no preemptive seclusion or restraint. There is no preemptive manual restraint. There is words until the presentation of imminent risk and even under imminent risk conditions, the spirit and the expectations of the regulations in our world is that we're going to the last moment to give someone an opportunity to engage in capacity for self-control.

The psychiatric emergency response team in our state was largely inspired after an event in which I was involved, was the single largest joint Metro SWAT response to a psychiatric facility in our state where in short, a patient in the forensic care area of the facility- and I'll leave it nameless- attempted to start a fire successfully started the fire in a lock treatment unit resulted in evacuation and disruption of daily operations. We had to move this person to a different secure area. The person monitoring the person served in this new area actually fell asleep. That person served plucked the magnetic key card off the sleeping monitor, moved through two electromagnetic secured doors to a non-patient care area, barricaded themselves with a knife taped to a crutch from a break room and then bleach and ammonia and cleaning chemicals at the door and fire load. And his intention was to start another fire and defend himself you know, from anyone trying to stop him.

AD : Wow.

AP : And without getting too deep into the weeds in collaboration with the wonderful crisis negotiation personnel from the joint Metro SWAT unit, I was able to move into position with armed and armored personnel. And while a tactical response was being conceived and produced through the use of words and meaningful deescalation programmatically that we had developed at the facility, we were able to get the person to cooperate with staff and surrender and they've since gone through the legal process and gone to prison. This was in a state psychiatric facility. But nonetheless, the demonstration to the hospital at that time was, there's nothing worse in a care and services setting for there to be 25 armed people and vehicles outside, and very, very disruptive to the clinical environment. If there was a way that that could be prevented the hospital and the stakeholders in it had upon seeing the conclusion of this event, entrusted me with the responsibility of developing a program to make sure that that never happens again.

And that was the basis. That was the, the formative experience of the team. And the team has since programmatically gone on to be the embodiment of words-only response to high-risk emergency. And this doesn't mean careless response where they're putting themselves in inappropriate risk. But in a psychiatric care and services setting, what the data is in and the jury is back that we have had our hands on the same people over and over again, secluding and restraining them. And we now know that that doesn't modify behavior. It may acquire safety in the moment, but it doesn't modify behavior. It doesn't influence. In fact, it very often just makes things worse. So we have to meet the challenge of the presentation of high risk behavior differently if we want to change the outcome and reduce the likelihood of future emergency. That's what the psychiatric emergency response team was all about.

NM : What a pretty powerful story. I kind of wanna use that story as we kind of continue our discussion. And that's obviously very intense situation, very tense situation for you as well. So it's what kind of skills were you able to use to deescalate that situation?

De-escalating High Stress Situations In A Psychiatric Care Environment [14:10]

AP : In our work? We have a need in reducing violence to engage in- the big distinction between, I think, crisis negotiation, crisis de-escalation, and let's say commercial negotiations. I've had some time to think about this over the years, because the skills we use are the same. There are some objectives, different objectives that we have, and there are different ways in which we can sequence and stack the skills based on the objective. Here's what I mean: In the commercial negotiation space, we hear terms all the time, like active listening or minimal encouragers, or you guys have had Gary Noesner on, you know, like these terms. Gary is so articulate at describing the formative years of the crisis negotiation program and how they collaborated with counseling psychology to develop curriculum. And in the course of curriculum development, when they went to the psychology world and they went to these Rogerian concepts; Carl Rogers is the founder of these terms in the late 1950s.

These things that we use para-language, mirroring, reflection, statements, active listening, which is listening to confer the clear understanding to the person, making disclosure that everything that they're communicating is seen, heard and understood and how we leverage that. That occurs in commercial negotiations every day. In our space, we use some of the same and different terms to describe that phenomena, the use of validation statements, listening and observing accurately reflecting what has been stated, articulating the unverbalized, validating in terms of history, validating in terms of circumstances. So what do we do in those high stake situations that's really different? Not much, but here's our objective. I think the world in which you gentlemen provide such meaningful education and value is by assisting people in these chess games across the boardroom table, where everybody largely speaking is in a self-regulated state. So their capacity for diversity of thought and diversity of expression in the higher cortical regions of the brain is very wide.

You're not in an environment where someone is about to bludgeon you with some double A batteries in a sock, right? Everyone's trying to leverage to get to an objective. We have an objective too, but it's compressed in the timeframe to something far more brief. The objective is not to solve the problem that the person in crisis claims is responsible for their dilemma. Our responsibility and objective categorically is to help someone engage a capacity for self-regulation right now, so that they have the freedom and the liberty to solve their problem later. Well, what do I mean specifically by that? Let's say someone in an acute care admissions environment is completely in dis-control, engaged in the common area, in the use of racial slurs, inciting potential group violence in the environment. And someone says, you gotta bring that to a stop right now.

Okay so what's pretty clear? We have a circumstantial objective. We have to get this to stop, but we have rules in place that regulate how we go about doing that. So now I have to get this person to want to stop. I'm not gonna be able to stop them. I can't muzzle them. I can't tackle them. I can't drag 'em away, with a big hook like we used to see in the cartoons as kids, when someone would pull you off the script. I can't do any of those things. I have to get this person to want to stop and I have to figure out how to do that. We follow a very sequential approach to the use of validation, identifying as quickly as possible a way that this person and me can engage in a shared appreciation of a rule, value law.

And then I'm gonna suggest or propose a course of action and describe how it better serves them right now. So even if I have to provide a description of an undesirable outcome, if I have to say, “Hey, look, if this continues, if this course of behavior continues, the likelihood here is that you could be escorted against your will by a number of people to a place of isolation or segregation. But if you engage in more safe, appropriate language right now, you'll have an opportunity to stay.” We attempt to, no pun intended, jumpstart the evolved brain, because unlike the boardroom or the conference table, this person is in a state of very high limbic activation. So diversity of thought and expression is not there as compared to someone who is self-regulated. So I have to help stimulate that function by giving opportunities to stop and think that are reasonable. If they could have solved their own problem, I never would've been there.

AD : Is it overly simplistic, Andy, to talk about that in terms of the activity that's in occurring in a prefrontal cortex versus the amygdala hijacking sort of activity. I mean is that an over simplistic way to think about what's happening from a kind of limbic stimulation perspective? Or is that accurate, or is there accuracy to that kind of where they're at, they're being hijacked there? There's not a lot of occurring prefrontal lobe activity.

Neuro-Physiological Determinations Of High Stress Activity [19:59]

AP : I would say that whether it's people like Chris Vos or Steven Porges from Polyvagal Theory or Becker, excuse me, The Body Keeps the Score. The author, the pronunciation of the author's name escapes me at the moment. I think the jury is back now and that when we're having just general nonacademic conversations about the presentation of anger, aggression, and violence. Rather than an oversimplification, I will say that I think it's reasonable to, in a general way, describe- anger and aggression upon presentation reliably demonstrates neurophysiologically that there is high activation in the brain stem and that when people are engaged in safer states with greater diversity of thought and expression- activity is far more measurable in the higher cortical areas. So I don't mean to oversimplify, but I do mean to make general that there are some principles now that we know are reliable. When you're pissed off, you don't have as wide of diversity of thought and expression as you do when you're in a safe state. And those are automatic functions.

AD : I'm curious. The extension then to, you know, do you see maybe to a lesser scale then some of those emotional reactions, occurring even in a boardroom sort of setting?

AP : Oh, yes.

AD : And so these skills have some other application. Yeah, go ahead.

AP : Oh, precisely. I mean, how often- I've been humiliated in the conference room. I remember being in a meeting where I was terribly triggered and there were labor representatives there. I was defending my program, because strangely when a new phenomenon shows up in a complex bureaucratic system and suddenly starts producing excellent outcomes, not everybody is thrilled with it.

AD : We don't know what you're talking about. We haven't spent careers in the, the military, no bureaucracy there. Right.

AP : So right. Oh, like, yeah, they got the mission done easy, but what do you mean? Yeah, so I remember feeling absolutely triggered and prone to dis-control. And consequently, when that happens, I remember the physical experience myself of finding it hard to articulate complex ideas. I'm feeling shame and insecure, cuz I'm in a room with a bunch of psychiatrists and nurses who all look down their nose at, you know, some kid from the New York metropolitan area who eats pizza and only has his undergraduate degree that he's getting in between someone's clinical judgment and someone with a cup of urine and trying to prevent that that person is unnecessarily tackled. So having to defend myself in that environment, that was a very formative… And I remember my CEO who I loved and still do. He watched, he let me squirm. He wanted that to be a learning experience for me. And he didn't defend me. And I remember just feeling trampled. He was from Elizabeth New Jersey, by the way.I just wanna point that out. Anyway.

AD : He knew you could handle it as a good New Yorker. Yeah.

AP : And, and as, and as someone who he was interested in seeing move up and become a more mature administrator manager, supervisor, man, someone who was interested in my wellbeing saw the learning opportunity for me to get my ass handed to me in this meeting.So yes, I would say that I think that the commercial negotiators enjoy collaboration with the people who have experience in these, let's say less ornate, complex negotiations that can occur in the commercial setting, but still in that environment, there are in some cases, strategically people trying to trigger one another to create an experience of dis-control so that something could potentially be leveraged in a commercial negotiation and trying to capitalize on speed to get people to not think through options so that they execute commitments that maybe they shouldn't. So yeah, gentlemen, we have an opportunity to engage in so much shared learning opportunity with one another, because there are so many, the methods are the same. The neuroscience is the same, the environments in which these play out, there's great learning that can occur from our shared spaces on the subject matter.

AD : Yeah. And I liked how you said that, you know, the stack and sequence of the skills may be different because the objectives that you're trying to achieve are different. I think that's something as I've talked to FBI hostage colleagues, right? That's something that certainly comes to light.

AP : Yeah. We have an agenda in crisis de-escalation, and the agenda is to assist this person, engage a capacity of self-regulation right now. And the reason that we have the agenda and we propose choices and describe how it served them, because we recognize that their ability to conceptualize their own solution is offline or diminished right now. And I'm generally there because I have to prevent something bad from happening, someone getting beaten up or worse, property being destroyed or worse, a riot occurring. I have to get in there and stop something bad from happening. And in order for me to do that, my agenda is pretty simple. So we're trying to influence. So for instance, practically speaking, what does that mean? In a crisis negotiation, we don't ask open ended questions to a great degree because open ended questions that are too complex when someone's capacity for diversity of thought and expression is diminished or offline is only gonna piss them off.

So like the whole idea: “Well, what do you think would be the way that we solve the situation?”- if I acted in character right now, I can tell you what I have been met with when asking that kind of question, as opposed to saying, “Hey, look, it's apparent. It's totally clear that you're pissed off and you want to take everyone's head off. We get it right. Safety here is fundamentally important to everyone. If you can use your words to tell me what it is that you're upset about, maybe we can try, we'll move heaven and earth to try to make your problem go away.” In other words, I'm not saying, explain to me the ornate nature of what you're going through and educate me as to the circumstances. I'm saying, use your words and tell me what's going on. Like I'm keeping it real simple.

And then as the person demonstrates that they might be online a little more than my appraisal, I might start floating some open-ended questions. “Well, tell me a little bit more about that. What is it that you do want out of this situation?” And if I get someone doing that and they're answering successfully, I got 'em because I want them to move through their evolved brain anyway. This place where they have greater diversity of thought and expression and their fight or flight mobilization state is diminishing. That's what I'm after. That's my goal, right? So it's not to solve the problem that they said is making them responsible to go into crisis. My problem is getting solved right now. Now I'm getting this person to calm down. That's the objective.

NM : So with the psychiatric emergency response team, obviously when these emergencies pop up, there's not much time to prepare. So what do you do to teach the response team on what they need to hastily do in order to get in there and be effective?

Training Emergency Teams To Engage In Mental-Health Crisis Negotiations [28:19]

AP : In our context, we're interested in aggression type. So, remember in a care and services setting, we have this high and noble calling after someone wants to fight to maintain relationship. Someone takes a swing at us, we don't not see them again or move them down the continuum to some other security environment and we don't see 'em anymore. We're gonna see 'em in an hour, and maybe in the TV room or out on the yard. Like, so the whole idea of forming relationship in between crisis events can be very useful in developing goodwill accounts with human beings. So if we're responding to a crisis and we have the benefit of knowing the person, the appraisal that I'm gonna suggest that we do first is easy. When we don't know the person, it's great to get some kind of intel from a reporting party before we make contact, and I'll tell you why. We look at aggression in psychiatric emergency response in three ways: It's either reactive or impulsive, which is generally what the three of us in this conversation encounter most frequently every day anyway. This happens at the pizzeria, the Verizon store, the office,

AD : The home

AP : Yeah, the home; something is okay until something occurs and it's not okay. There's deviation. And that's very common. Instrumental aggression is very calculated, premeditated aggression that's organized to twist environment for someone to get their needs met. It's very triggering to others, especially when it's a parent. And you know, the fact is, is that what we know from the research now is that instrumental aggression is a product of learned behavior and very often deep, early trauma and ambivalent attachment problems growing up in the world. So the world is engaged in a very destructive maladaptive way for someone to get their needs met so they say and do extreme things like, “Hey, you know, what's gonna happen when I don't get my snack at two o'clock, you know what these things can do. So you better make sure that this is here" or someone will stand up on a table with a 44 gallon bag tied in a half knot around their neck.

And they're really not choking themselves out, but they're getting the entire environment to respond to them. Or they're engaging in cutting where they're really not trying to get down to an artery, but they're doing this kind of behavior to manipulate you. That kind of aggression is responded to strategically differently than instrumental and psychotic aggression or, aggression that's biologically anchored due to substances, that offers another strategy. So when we're responding to these events, we're interested in knowing, first of all, what category, this is like scene size up scene size up in active shooters, scene size up in fire service. What, what the hell are we dealing with here? So when we identify the aggression type, it informs a strategy. That's kind of the first thing we're doing Nolan. And this happens in seconds. This happens in terms of observation or interaction with the nurse or, you know, point of contact upon arrival at the scene.

“Gimme a quick overview. What am I dealing with here?” “Well, Joe is inside the office, max busting up every printer with a bat.” Okay. “Tell me about Joe.” “He's an employee.” Okay. “We never had a problem with Joe until he got divorced a month ago. He's been coming in with alcohol on his breath.” Okay. So now I'm getting the story real quick. Before I go to work on Joe, that this is probably, you know, reactive aggression, maybe sprinkled with a little poly substance if he was drunk in the morning. His solution strategically is probably gonna be anchored somewhere in the emotional triggered states where he feels out of control or feels shame or is engaged in some kind of self-loathing, which means I'm gonna treat him with extraordinary respect. And my objective is to get him to put the bat down and come out of the store with me and we can go someplace more appropriate. And I'm figuring that out in seconds, and this can be done by anybody. This is not like, you know, you gotta be some high credentialed academic thinker, cuz I'm not that. And the people I work with who do this are not that.

AD : So how do you train that though? Because I would think in the moment: one, I would just to… taking all this in to be very observational and then not to react and even become judgmental in the moment. I mean, how do you do that?

AP : Beautiful observation you're right. How do you train it? You train it by competency exercises that simulate these conditions in the training environment, which means that we engage not only in a presentation of the sequencing of the academic material in a way that we want people to carry it out in the environment, the work environment. We engage in scenario-based training where people following the academic experience, move through measured basic to more complex exercises to inculcate the sequencing. So in the fire service and if I'm not mistaken, you gentlemen were in our armed services for many years so you'll relate to this: in the fire service, we have six rescue knots. And very often when people come to the fire service, they don't know how to tie any of them. So we start in the classroom with a piece of string and a diagram and someone ties the figure eight on a bite, the bow and you know, the figure eight follow through bend.

And they're following a diagram and someone's coming around and looking at the knot. “Okay, pull the standing part of the line back a little bit, take the running end, move it this way. Okay. That's the knot. Now try that again. I'll be back in a minute to check it.” And in a short period of time, people with the string and the diagram were tying the knots in the classroom, then we go out in the truck bay, we give them a larger piece of 11 millimeter line, give them a pair of gloves and a helmet with a face shield, tie the knot this way. Okay. Now we're going to ask you to put your bunker gear on, take your hood, turn it around so you can't see as if you're in a No-Vis environment, do the knot that way. Now let's go outside to the fire ground.

I want you to put that chainsaw on that line and get it up to the second floor. And all of this occurs in a day and a half. We're not talking about, you know, nine months of graduate education to get this done. This is a day and a half of immersion experience in progressively more complex learning exercises to inculcate certain sequences. So in psychiatric emergency response, we're interested in sequential thinking and sequential action. What's a core reason for that? We wanna bring structure and order to the chaos that someone is experiencing. Chaos, lack of order. So, I'm happy to say that very often, the outcome is generally one of two things. It's either deep collaboration with the method, during their crisis where trust has been engendered reduction of the likelihood of future emergency has been engendered or someone's cooperating and they're highly irritable about it, but here's what it's not, it's not rolling around on the ground.

It's not anchoring someone to a bed with wristlets, hobbles and a waist belt. It's not throwing Haldoll, Benadryl and Ativan into someone to get them to stop moving. It's not those things. What it is, is someone having a formative experience of potentially engaging other human beings in a way that they previously don't have a lot of experience doing. And in that way, it's very noble because very often people who present that kind of behavior are not met with that kind of method. They're met exactly with what you just described. People get pissed off. They don't wanna deal with it. They get triggered, they get angry. You use a racial slur I'm triggered. And I'm not the guy to deescalate you because all I want to do is be punitive, which is an indication that your limbic system is active anyway. So you're right. You're not the right person to be there. You know what I mean?

NM : Hey, everyone, Nolan here. I'm gonna have to jump in and end the show right here. Sorry about that. But if you haven't already, you can go over to wherever you listen to your podcast and rate review and subscribe to the NEGOTIATEx podcast. It's would mean a lot for Aram and I to continue getting this podcast, helping it grow and get into the hands of other leaders. So we'll greatly appreciate that if you could do that, and make sure they join us next week as we continue part B of this interview with Andy.

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