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MEDICAL SERVICES 
PROVIDED ON BEHALF OF THE DEPARTMENT FOR WORK AND PENSIONS 
 
 
 
 
 
 
 
 
 
 
Training & Development  
 
Dealing with Aggressive and 
Potentially Violent Behaviour 
Self-Directed Learning   
 
MED-CMEP-DWAPVB~0062(a) 
Version: 2 Final 
25th January 2008 
 
 
 
 
 
 
 

 
 
 
 
 
 
 
 
 
 
 
 
 
 

 
Medical Services 
 
 
Foreword  
 
This training has been produced as part of a Continuing Medical Education 
programme for Health Care Professionals approved by the Department for Work 
and Pensions Chief Medical Adviser to carry out assessments. 
All Health Care Professionals undertaking medical assessments must be Registered 
Nurses or Registered Medical Practitioners who in addition, have undergone training 
in disability assessment medicine. The training includes theory training in a 
classroom setting, supervised practical training, and a demonstration of 
understanding as assessed by quality audit. 
This training must be read with the understanding that, as experienced Health Care 
Professionals and disability analysts, the Health Care Professionals will have 
detailed knowledge of the principles and practice of relevant diagnostic techniques, 
and therefore such information is not contained in this training module. 
In addition, the training module is not a stand-alone document, and forms only a part 
of the training and written documentation that a Health Care Professional receives. 
As disability assessment is a practical occupation, much of the guidance also 
involves verbal information and coaching. 
Thus, although the training module may be of interest to non-medical readers, it 
must be remembered that some of the information may not be readily understood 
without background medical knowledge and an awareness of the other training 
given to Health Care Professionals. 
 
 
Office of the Chief Medical Adviser 
 
25th January 2008 
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 Document 
control 
Superseded documents  
 
Version history 
Version Date 
Comments 
2 Final 
25 January 2008 
Signed off by MSCMT 
2a (draft) 
11 December 2007 
Updated by Dr Peter Ellis 
1 Final 
12 July 2004 
Signed off by MP&CT 
1d (draft) 
9 July 2004 
Updates following MP&CT QA 
1c (draft) 
11 May 2004 
Following internal QA 
1b (draft) 
21 April 2004 
Following internal T&D QA 
1a (draft) 
10 March 2004 
First draft 
 
 
 
Changes since last version 
Foreword added 
Atos Origin changed to Atos Healthcare 
Minor style changes 
Outstanding issues and omissions 
Updates to Standards incorporated 
Issue control 
Author: 
Elizabeth Timms 
Owner and approver:  Dr Jennifer Wintle 
Signature: Date: 
Distribution: 
 
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Contents 
Introduction 5 
1. 
Section One – Policy and Procedures 
7 
2. 
Section Two – Behaviour Types 
11 
3. 
Section Three - Techniques and Strategies for Dealing with 
Aggressive Behaviour 
21 
4. 
Section Four – Self Assessment Exercise Answers 
31 
5. 
Section Five – MCQ Final Assessment Exercise 
36 
MCQ Dealing with Aggressive and Potentially Violent Behaviour 
37 
Observation form 
39 
 
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Introduction 
An Introduction to your Learning Path 
Welcome to the learning pack on Dealing with Aggressive and Potentially 
Violent Behaviour. 
The Learning Pack will take you approximately three hours to complete 
which can be done in one go or at smaller separate 'sittings'. It is important 
that you complete learning activities in the order they are given; by doing so 
you will reflect, consolidate and build on your learning throughout. 
A Guide to using this Pack 
The following symbols are used to assist you in completing the learning 
activities included in this pack: 
 
Indicates a time for reading 
 
Indicates you should record / write your reviews and comments 
 
Advises you of the materials that are provided and/or needed. 
 
Suggests the approximate time needed to complete any particular learning 
activity 
 
 
 
 
 
 
 
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Learning Pack Objectives 
Through completion of this learning pack you should: 
  Understand the organisation's procedures for recognising  
potentially violent  persons 
  Understand the procedures to follow in the event of an 
aggressive/violent incident, including reporting procedures 
  Recognise types of behaviour and the triggers for aggressive 
behaviour 
  Be aware of techniques / strategies for effectively handling 
aggressive/violent behaviour 
 
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1. Section One – Policy and Procedures 
Welcome to the first section of your Learning Pack which concentrates on 
the Policy and Procedures for dealing with aggressive and violent behaviour. 
Objectives 
By the end of this section you will: 
  Understand the organisation's procedures for recognising 
potentially violent persons 
  Understand the procedures to follow in the event of an 
aggressive/violent incident, including reporting procedures 
Materials 
You will need to obtain the following materials to assist your learning: 
  'Potentially Violent Persons Procedure' (MED-PVPP01)  
 
Duration 
The learning activities during this section should take approximately 90    
minutes to complete. 
 
 
 
 
 
 
 
 
 
 
 
 
 
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Policy and Procedures 
Medical Services has a responsibility to provide information and training to 
ensure the health and safety of its employees. Medical Services takes this 
responsibility very seriously and has ensured that a robust procedure aimed 
at reducing the risk of aggressive and/or violent behaviour has been 
adopted. 
We also work closely with our customers (Department for Work and 
Pensions, DWP) exchanging information on potentially violent (PV) clients in 
order to minimise the risks to both you and DWP staff. 
Dealing effectively with aggressive and/or potentially violent people is also 
an important element of achieving customer satisfaction and avoiding 
complaints. 
You should have obtained a copy of the organisation's policy and 
procedures document 'Potentially Violent Persons Procedure (MED-
PVPP01). 
You should take time now to review this document and complete the self-
assessment exercise on pages 8 and 9 of this pack.  It is important that you 
give sufficient time to reading and understanding the content of the 
procedures document prior to attempting the questions.   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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Policy and Procedure Self Assessment Exercise 
Having reviewed the document 'Potentially Violent Persons Procedure' 
(MED-PVPP01) you should now answer the following questions.  If possible 
do this without referring to the text. 
Q1  Who is a Potentially Violent Person? 
A1 
 
 
 
Q2  Who is responsible for making sure that all individuals who have 
contact with the public are aware of the dangers in dealing with Potentially 
Violent Persons? 
A2 
 
 
 
Q3  If an incident occurs, the initial responsibility for dealing with the 
Potentially Violent Person rests with whom? 
A3  
 
 
 
Q4  What form should you complete to inform about an incident involving a 
Potentially Violent Person? 
A4 
 
 
 
 
 
 
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Q5  What form will the Site Manager use to report an incident to the 
customer business unit? 
A5 
 
 
Q6  If you communicate with a known Potentially Violent Person, either 
face to face, by telephone or letter, what form should you complete and 
why? 
A6 
 
 
Q7  There are five key actions / considerations that you should complete if 
you are going to visit a potentially violent person - what are they? 
A7 
 
 
 
 
 
 
The answers to the above questions can be found in section four.  You 
should check your own answers against these; if you have any wrong 
answers please revisit the relevant part(s) of the procedure document to 
clarify your understanding. 
 
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2. Section Two – Behaviour Types 
The second section of your learning pack focuses on types of behaviour and triggers 
for aggressive behaviour. 
Objectives 
By the end of this section you will: 
  Recognise types of behaviour and the triggers for aggressive behaviour 
Materials 
 The following material is included in this pack to assist your learning: 
o  Information on 'Types of Behaviour' 
 
Duration 
The learning activities during this section should take approximately 40 minutes to 
complete. 
 
 
 
 
 
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Types of Behaviour 
There is a wealth of information available on types of behaviour; learning about 
them not only gives us information on which to base our views of others but should 
also increase our own self-awareness.  It is not simply a matter of how do we feel 
when others behave in a certain way but it is also important to recognise that others 
will be affected by the way in which we behave. 
Defining Behaviour 
Non Assertive (Passive) Behaviour 
1.  Behaviour that includes: 
2.  Failing to stand up for your rights or doing so in such a way that people can 
disregard them 
3.  Expressing your needs, wants, opinions, feelings or beliefs in apologetic, diffident 
or self-effacing ways 
4.  Failing to express your needs, wants, opinions, feelings or beliefs 
Aggressive Behaviour 
Behaviour that involves: 
1.  Standing up for your own rights, but doing so in such a way that you violate the 
rights of others 
2.  Ignoring or dismissing the needs, wants, opinions, feelings or beliefs of others 
3.  Expressing your own needs, wants, etc inappropriately, e.g., 'What! I'm up to my 
eyes in it already.  I can't do that as well' 
Assertive Behaviour 
Behaviour that includes: 
1.  Standing up for your own rights without violating the rights of others 
2.  Expressing your needs, wants, opinions, feelings and beliefs in a direct, honest 
and appropriate way 
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The Effects of Behaviour 
The Effects of Non-Assertion - Initial 
Initially, non-assertive behaviour can have a positive effect.  We have avoided an 
argument or upsetting the other person and are relieved at the outcome. 
Other people may feel sorry for us and we may feel a little sorry for ourselves (which 
we actually like doing!).  All this helps to reinforce the non-assertive behaviour. 
The Effects of Non-Assertion - Long-term 
However, long-term non-assertive behaviour will inevitably lead to a loss of self-
esteem.   
We may feel angry or hurt and wallow in self-pity; there may be outbursts of 
aggression followed by remorse, and there will be increased stress and possible 
health problems.  The loss of self esteem will also mean that it is more difficult for us 
to act in an assertive way as we begin to feel that others are better than us and have 
more rights than we do. 
The long term effects on others are also negative; colleagues eventually stop feeling 
sorry for us and begin to feel annoyed and irritated.  This will lead to them not 
respecting us and they may avoid us altogether rather than be faced with the self-
pity.  Some people may use the non-assertive behaviour as a signal than we can be 
taken advantage of. 
The Effects of Aggression - Initial 
Initially aggressive behaviour can also have a positive effect.  We have had our say 
and cleared the air; we may have won or got what we wanted and this may give us a 
good feeling.  We may feel a sense of power and other people may admire our 
outspokenness and say so. 
The Effects of Aggression - Long-term 
However, in the longer term aggression is negative; we may feel guilt or shame and 
become very apologetic and over-helpful.  This will lead to us behaving in a non-
assertive manner in order to 'make up' for our aggression in the past. 
On the other hand, we may stay in the aggressive stance and become drained of 
energy, as we have to maintain a constant state of alert in case someone tries to get 
his or her own back.  Very long term this can lead to mistrust and even hatred and 
we will isolate ourselves more and more. 
Long term effects on others are also negative.  People may feel angry or hurt and 
retaliate openly; worse still there may be covert retaliation such as withholding vital 
information, not passing on messages, passing misinformation etc.  People will often 
take fewer risks and decisions around an aggressive person, as they fear the 
consequences of mistakes.  
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The Effects of Assertion - Initial 
Initially assertive behaviour can have a positive effect. Both parties have aired their 
feelings without hurting or upsetting each other.  
The Effects of Assertion - Long-term 
In the longer term assertion is also positive, as we will be able to maintain a sense 
of self-esteem and control. Others will begin to recognise the benefits for 
themselves of dealing with an assertive person and will start to mirror your assertive 
behaviour.  
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How You Come To Be Non-Assertive or Aggressive 
Positive Reinforcement 
Often non-assertive behaviour is positively reinforced since it has resulted in your 
avoiding conflict or upsetting others. In the case of aggressive behaviour, you may 
have got your way and feel a sense of power.   
Others around you may also praise you for standing up for yourself. 
Organisational Culture 
Some organisations encourage non-assertive or aggressive behaviour through a 
climate that discourages questioning or trying out new ideas or by promoting 
aggressive managers.   
Fear of Unpleasant Consequences for Assertion 
Fear of what might happen if you behave in an assertive way, e.g. anxiety about 
causing an argument or upsetting a friend, may cause you to be non-assertive.  This 
is a common reason for people behaving non-assertively, and anxiety will diminish 
only after you start behaving assertively and have not experienced unpleasant 
consequences. 
Perceiving Situations or Other People as Threatening 
If you are unsure of your ability you may wish to avoid drawing attention to yourself.  
You will then keep a low profile and avoid certain situations or certain people, or if 
you cannot avoid them totally, side step them as much as possible. 
Often when we feel threatened we react in an aggressive way, in order to protect 
ourselves. Sometimes the threat is real, but often it is our perception of what will 
happen that makes us brace ourselves and get into an aggressive mode. 
Failing to Accept Your Assertive Rights 
If you do not realise or fully accept that you have certain rights, you will not stand up 
for these rights and become non-assertive. 
Failing to Think Rationally about Yourself 
This often comes about when you start to compare yourself unfavourably to other 
people, e.g. 'I'll never be as good as Tony at getting my ideas across.'  This may or 
may not be true, but it will lead to you putting ideas across tentatively and to 
withdraw them at the first sign of resistance.  This type of thinking can eventually 
lead to a negative self-image and will maintain your non-assertion. 
Sometimes, the comparison with others will lead you to feel jealousy or resentment 
against others, which in turn can lead to aggressive behaviour.  At other times the 
comparisons you make will be exaggerated in your favour, leading you to boast to 
other people. 
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Confusing Assertion with Aggression 
If you are used to an environment where non-assertion is common, you will be likely 
to see any firm statement of assertion from others as aggression.  Because you do 
not want to be seen as aggressive, you bend over backwards to make sure that this 
does not happen. 
Your Beliefs about Aggression 
If you believe that the only way to get results is to be aggressive and you want to get 
results, then you will behave aggressively.  Such a belief stems from seeing the 
world as a hostile place, in which the only way to survive is to 'get them before they 
get you.' 
It is a self-fulfilling prophecy that if you treat people aggressively, then they are likely 
to be aggressive in return.  In addition, you may see non-assertion as the only 
alternative to aggression and so ignore the option of behaving assertively. 
Failing to Develop Assertive Skills 
If you have been encouraged or rewarded from early days for behaving non-
assertively or aggressively, then this is the behaviour you become skilled in using.  
As you only use assertive behaviour in 'safe' situations, you do not become skilled at 
such things as stating your own point of view when it is different from other peoples'.  
The result is that your behaviour pattern will contain a lot of non-assertion and there 
maybe bursts of aggression when the tension resulting from this non-assertion 
becomes too much. 
When you have been non-assertive about something for a period of time, frustration, 
hurt, or anger can build up until you are not prepared to stand it any longer.  It is 
often the straw that breaks the camel's back, and other people can be quite taken 
aback by your sudden outburst. 
Equating Non-Assertion with Politeness 
You have probably been brought up to be polite and considerate to others.  The 
mistake many people make is to believe that in order to be polite you need to be 
non-assertive.  It is both polite and assertive to thank people or to apologise for 
something.  It is however non-assertive to apologise profusely for your own opinion 
or for needing someone to help with some work. 
Confusing Non-Assertion with Helpfulness 
You may believe that when you are non-assertive you are actually being helpful to 
the other person.  In fact, the reverse may well be true.  For example, if during an 
examination/interview you ask questions in a non-assertive way the purpose of them 
may be vague and unclear to the claimant.  You may believe that you are being 
helpful by not asking an assertive/direct question or probing answers but this can 
lead to vague and less valuable information being given by the claimant.  He/she 
may interpret your non-assertive approach as a lack of interest and may eventually 
become irritated. 
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Summary of Verbal Aspects of Behaviour 
 
 
 
 
NON-ASSERTIVE 
ASSERTIVE 
AGGRESSIVE 
 
 
 
 
Long rambling 
Statements that are clear and to  Excess of "I" statements 
 
the point 
 
 
 
 
Fill in words "maybe" 
"I" statements, "I'd like" 
Boastfulness "My" 
 
 
 
Apologetic and permission 
Suggestions not weighted with 
Threatening questions 
seeking "I should", "I ought"  advice 
 
 
 
 
Few "I" statements (often 
No 'shoulds' or 'oughts' 
Requests as instructions or 
qualified) 
 
threats 
 
 
 
Phrases that dismiss own 
Constructive criticism without 
Heavily weighted advice in 
needs, "not important really"  blame or assumptions 
the form of "should" and 
 
 
"ought" 
 
 
 
Self put downs, "I'm 
Questions to find out the 
Blame put on others 
hopeless" 
thoughts, opinions and wants of 
 
 
others 
 
 
 
 
 
Ways for getting round problems  Assumptions, sarcasm and 
 
 
other put downs 
 
 
 
Sometimes wobbly 
Steady and firm 
Very firm 
 
 
 
Tone may be sing-song 
Tone is middle range 
Tone is sarcastic, sometimes 
 
 
cold 
 
 
 
Often dull and monotone 
Sincere and clear 
Hard and sharp 
 
 
 
Quiet, often drops away at 
Not over-loud or quiet 
Often shouting, rises at the 
the end 
 
end 
 
 
 
Hesitant and filled with 
Fluent, few hesitations 
Fluent, few hesitations 
pauses 
 
 
 
 
 
Sometimes jerks from fast to  Emphasises key words 
Often abrupt  
slow 
 
 
 
 
 
Throat clearing frequently 
Steady, even pace 
Blames others 
Whilst not all the criteria outlined above under the heading 'assertive' will be present 
in every case, it is important to ensure that your manner and tone are based on 
these criteria.  This helps you present a confident approach to the examination and 
interview. A non-assertive or aggressive approach can give the impression of 
uncertainty and a lack of experience and/or knowledge. 
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Summary of Non-Verbal Aspects of Behaviour 
 
 
 
 
 
NON-ASSERTIVE 
ASSERTIVE 
AGGRESSIVE 
 
 
 
 
 
FACIAL 
"Ghost" smiles when 
Smiles when pleased, 
Smile may become "wry"
EXPRESSION 
expressing anger and 
frowns when angry 
 
 
being criticised 
otherwise "open" 
Scowls when angry 
 
 
 
 
 
Eyebrows raised in 
Features steady 
Eyebrows raised in 
 
anticipation 
 
amazement or disbelief 
 
 
 
 
 
Quick changing features  Jaw relaxed but not loose  Jaw set firm 
 
 
 
 
Chin thrust forward 
 
 
 
 
 
EYE CONTACT  Evasive 
Firm but not a stare 
Tries to stare down and 
 
 
dominate 
Looking down 
 
 
 
 
 
BODY 
Hand wringing 
Open hand movements 
Finger pointing 
MOVEMENTS 
 
 
 
Hunched shoulders 
Sits upright and relaxed 
Fist thumping 
 
 
 
Nervous movements 
Stands with head held up  Stands upright, head in 
which detract 
the air 
 
 
Arms crossed for 
Strides around 
protection 
 
Arms crossed - 
unapproachable 
 
 
 
Whilst not all the criteria outlined above under the heading 'assertive' will be present 
in every case, it is important to ensure that your non-verbal communication is based 
on these criteria.  This helps you present a confident approach to the examination 
and interview. 
A non-assertive or aggressive approach can give the impression of uncertainty and 
a lack of experience and/or knowledge. 
 
 
 
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Triggers for Aggressive Behaviour 
 
Earlier you will have read about the generic reasons why people behave in an 
aggressive way.  Obviously you are meeting claimants in what may be a stressful 
situation for them and the following outlines some of the specific factors that could 
affect how they behave: 
  They feel their benefits are under threat or that the incapacity / disability is 
under question or not believed i.e.  they think their integrity or honesty is 
in question 
  They are fearful of what the examination entails or are suspicious of  
Medical Services and our role 
  They are ill, tired, under stress or frustrated 
  They feel like victims; powerless in their situation 
  They have not had their expectations met 
  They were already upset with someone else or about something else 
  They do not feel listened to - or that no-one will listen unless they shout or 
make a scene 
  They are out to prove they are right, whether they are or not 
  They have had conflicting stories/versions of events from different 
members of staff/Health Care Professionals 
  They have acted on things they were told by members of staff and these 
were wrong 
  They have already experienced an unpleasant attitude or indifferent, rude 
or discourteous behaviour from someone in Medical Services 
  They believe someone in Medical Services promised something that was 
not delivered 
  They feel they can manipulate you to get what they want if they make a 
fuss 
  They made a wrong assumption about what Medical Services could do for 
them 
  They are embarrassed about doing something incorrectly 
  They are under the influence of drink or drugs 
 
 
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Types of Behaviour Self Assessment Exercise 
Having read the information on 'Types of Behaviour' you should now answer the 
following questions.  If possible do this without referring to the text. 
Q1  Is standing up for your own rights, but doing so in such a way that you violate 
the rights of others, aggressive or assertive behaviour? 
A1 
 
 
 
Q2  Fill in the missing words: 
A2 
Assertive behaviour includes expressing your needs, wants,   _ _ _ _ _ _ _ _,   
feelings and  _ _ _ _ _ _ _   in a direct,  _ _ _ _ _ _  and appropriate way. 
 
 
Q3  Can non-assertive behaviour have a positive effect? 
A3 
 
 
 
Q4  Which type of behaviour can have a positive effect both in the short and long 
term? 
A4 
 
 
 
The answers to the above questions can be found in section four.  You should check 
your own answers against these; if you have any wrong answers please revisit the 
relevant part(s) of section two of this learning pack to clarify your understanding. 
 
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3. Section Three - Techniques and Strategies for 
Dealing with Aggressive Behaviour 

The third section of your learning pack looks at the techniques and strategies for 
dealing with aggressive behaviour 
Objectives 
By the end of this section you will: 
  Be aware of techniques / strategies for effectively handling aggressive / 
violent behaviour 
Materials 
The following material is included in this folder to assist your learning: 
  Information on the techniques for handling aggressive behaviour 
 
Duration 
The learning activities during this section should take approximately 30 minutes to 
complete. 
 
 
 
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Effectively Handling Aggressive Behaviour 
Types of Assertion 
 
We identified earlier that assertive behaviour involves: 
Standing up for your own rights without violating the rights of others 
Expressing you needs, wants, opinions, feelings and beliefs in a direct, honest and 
appropriate way.  This includes offering an apology where appropriate, which can be 
very valuable in maintaining an assertive interaction. 
We also established that this in turn means we will be able to maintain a sense of 
self-esteem and control; it is therefore key in effectively handling the aggressive 
behaviour of others. 
We all find that we can be assertive in some situations whilst in others this is less 
easy.  This is because our repertoire of assertive behaviour is very often limited.  
There are different types of assertion, and the ability to use all types will give far 
more scope to deal with a wider range of situations. 
There are 6 main types of assertion 
BASIC 
EMPATHETIC 
DISCREPANCY 
NEGATIVE FEELINGS 
CONSEQUENCE 
RESPONSIVE 
Basic Assertion 
This is a straightforward statement where you stand up for your rights. It involves 
making clear your needs, wants, beliefs, opinions or feelings.  
For example: 
"Yes Mr… your appointment was scheduled for 10.00am" 
"I need to write down the details of your medical condition because the Decision 
Maker has requested this report" 
Basic assertion is the most common form of assertion used every day to make your 
needs, wants and opinions known.  In addition, you use it to give praise, 
compliments, information or facts to others.  It is particularly appropriate to use it 
when you are raising an issue for the first time.  You can also use it to re-emphasise 
your needs, when you feel your initial statement has been ignored or played down. 
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Empathetic Assertion 
This assertion contains an element of empathy as well as a statement of your needs 
or wants.  By empathy we mean the ability to put yours 
lf in the other person's position and recognise their feelings, needs and wants.  For 
example: 
"I appreciate that you are finding some of the questions difficult however it is 
important that you answer them as fully as you can.  I will help you by taking you 
through the routine of a typical day and in that way we will provide a full report for 
the Decision Maker." 
Empathy is different to sympathy.  Sympathy involves feeling sorry for someone and 
leaves people where they are - feeling sorry for themselves. 
Empathetic assertion can be used when the other person is engrossed in a situation 
and you wish to indicate that you are aware of and sensitive to this situation.  This 
enables the other person to realise that you are not dismissing them.  It is an 
essential ingredient in resolving conflicts where people behave aggressively. 
It is also useful in holding you back from over reacting with aggression since you 
must give yourself time to imagine the other person's position, and so automatically 
slow down your responses. 
Discrepancy Assertion 
By this we mean pointing out the discrepancy between what has previously been 
agreed and what is actually happening or about to happen.  It often concludes with a 
statement of your needs or wants.  For example: 
"Originally I thought that you had agreed to a physical examination but now that we 
have finished the interview you are saying you do not want to be examined is that 
correct?" 
Discrepancy assertion is a useful starting point when you suspect there is a 
contradiction between what has been agreed and what is happening or about to 
happen.  It helps to establish whether there is really a contradiction or whether there 
has just been a misunderstanding.  It helps you and the other person to clarify and 
agree the way forward without conflict. 
 
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Negative Feelings Assertion 
Here you are making a statement that draws the attention of another person to the 
undesirable effect their behaviour is having on you.  It can contain the following 
elements, not necessarily in this order: 
1. 
When.................(an objective description of other's behaviour) 
2. 
The effects are..........(how the behaviour specifically effects you) 
3. 
I feel..............(a description of your feelings) 
4. 
I'd like................(a statement of what you want or prefer) 
For example: 
"WHEN you shout at me in this way, IT MEANS that I'm not able to help you.  I 
FEEL concerned about this, so I'D LIKE you to lower your voice and speak calmly 
with me. 
Negative feelings assertion can be used when a person is still ignoring your rights in 
spite of your having raised the issue on previous occasions.  It allows you to state 
your case objectively rather than in an emotional outburst. 
Consequence Assertion 
This informs the other person of the future consequences for them of not changing 
their behaviour.  It also includes the chance to change the behaviour before the 
consequence occurs.   
For example: 
"If you continue to shout in a threatening manner, I'll be left with no option other than 
bring this appointment to an end.  I'd prefer not to have to do that but I'll be left with 
no alternative." 
This is the strongest form of assertion and is a last resort behaviour, to be used 
sparingly and only when all other types have failed.  It is easy for consequence 
assertion to be seen as aggressive and in order to avoid this you must ensure that 
the words themselves are factual rather than emotional or personal.  You should be 
aware of your non-verbal behaviour and remain in an assertive stance rather than 
an aggressive one. 
Obviously if the unwanted behaviour continues you must take the action your 
previously outlined and inform the other person that you intend to do this.   
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Responsive Assertion 
The emphasis with this type of assertion is upon finding out where other people 
stand - their needs, wants, opinions, and feelings.  This is often done by asking 
questions but can also be done by statements making it clear you would like to hear 
from them.  For example: 
"You say that you are not happy to discuss your medical condition with me, however 
your carer is prepared to help you with this - is that acceptable to you?" 
"What problems does that create for you?" 
"I'd like you to say what activities you do during an average day." 
Responsive assertion is the vehicle for checking that in standing up for your own 
rights you are not violating the rights of others.  It can be very useful when others 
are behaving non-assertively. 
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Additional Key Points 
It's not always easy when feeling 'threatened' to identify and use effectively the right 
sort of assertion - this comes with experience.  However the more you use assertive 
techniques in everyday interactions the more familiar you will become with them and 
thereby the more likely you are to be able to use them in more difficult situations.   
The following are additional points you should take into consideration to help you 
recognise,  prevent and deal effectively with aggressive behaviour: 
Your Feelings 
  Your feeling of fear is a better indicator of something threatening than 
looking for signs of anxiety in others 
  Fear is information for you to use.  Therefore if the hair stands on end at 
the back of your neck, stop and assess.  It may just be a natural reaction to 
change or the unknown 
Your Actions 
  Do not respond to aggression with aggression 
  Stay calm; speak slowly and clearly.  Do not argue or be enticed into 
further argument 
  Do not hide behind your authority, status or jargon.  Inform the customer 
who you are, ask his/her name and discuss what you need / would like him 
or her to do 
  Try to talk things through adult to adult in order to defuse the situation, but 
remember your first duty is to yourself 
  Avoid an aggressive stance: crossed arms, hands on hips, a wagging 
finger or raised arm will challenge and confront 
  Never put a hand on someone who is angry, they may see this as 
threatening 
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Safety First 
Finally it is important that you maintain your safety 
  When you feel frightened ask yourself: 
  Is this person's anger/hostility directed at me, the organisation, 
themselves, or is it a form of distress? 
  Am I in danger? If you think you are, leave and get help immediately 
  Am I the best person to deal with the threat? If you find particular 
situations difficult, perhaps someone else could handle it more 
effectively.  This is a positive step / decision 
  Never underestimate the threat 
  Keep a safe distance from your aggressor 
  If the threat of violence is imminent, avoid potentially dangerous locations 
such as the top of stairs, restricted spaces or places where there is 
equipment which could be picked up and used as a weapon 
  Keep your eye on potential escape routes.  Keep yourself between the 
aggressor and the door and if possible behind a barrier such as a desk or 
table 
  Be mindful of Health and Safety matters.  Arrangement of furniture in the 
examination room should leave you with a clear pathway from your desk 
and seat to the door.  Avoid seating the claimant in the exit path 
  Never turn your back.  If you are leaving move gradually backwards 
  Never remain alone with an actively violent person.  Be prepared to move 
very quickly if necessary 
  Do not have objects that could be used as tools of aggression within 
reach of an aggressive person e.g. pens, letter openers, hot drinks  
  Do not visit a known potentially violent person unless accompanied by 
another member of staff 
 
 
 
 
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Self Reflection 
Having reached this part of your pack, take time now to reflect on a previous difficult 
and/or threatening situation that you have faced.  Record your thoughts below. 
 
Describe the situation 
 
 
 
 
 
 
 
 
 
 
What warnings did you receive that the situation was going to be or become 
difficult and/or threatening? 
 
 
 
 
 
 
 
 
 
 
 
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How did you react? 
 
 
 
 
 
 
 
What was the outcome? 
 
 
 
 
 
 
 
What would you do differently if you faced a similar situation? 
 
 
 
 
 
 
 
 
 
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Effectively Handling Aggressive Behaviour Self Assessment     
Exercise 

Having read the information on 'Effectively Handling Aggressive Behaviour' you 
should now answer the following questions.  If possible do this without referring to 
the text. 
Q1  List the six main types of assertion 
A1 
 
 
 
Q2  True or False? 
Sympathy is described as 'putting yourself in the other person's position and 
recognising their feelings, needs and wants 
A2 
 
 
 
Q3  Negative Feelings assertion contains four main elements, what are they? 
A3 
 
 
 
Q4  Which type of assertion is considered the strongest? 
A4 
 
 
The answers to the above questions can be found in section four.  You should check 
your own answers against these; if you have any wrong answers please revisit the 
relevant part(s) of section three of this learning pack to clarify your understanding. 
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4.   Section Four – Self Assessment Exercise 
Answers 
The fourth section of your Learning Pack provides answers to the various self-
assessment exercises you have completed in previous sections. 
Objectives 
By the end of this section you will: 
  Have compared your own self-assessment exercise answers to the ideal 
   Identified any areas of the Learning Pack that you should revisit for   
clarification 
Materials 
The following material is included in this folder to assist your learning: 
  Self-Assessment Exercise Answers 
 
 
 
 
 
 
 
 
 
 
 
 
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Policy and Procedure Self Assessment Exercise - Answers 
Q1 
Who is a Potentially Violent Person? 
A1 
Someone who threatens or conducts violence against an employee, associate 
or self-employed contractor 
 
Q2 
Who is responsible for making sure that all individuals who have contact 
with the public are aware of the dangers in dealing with Potentially Violent 
Persons? 

A2 
The Director of Service Delivery DWP through the Company Security Officer 
 
Q3  If an incident occurs, the initial responsibility for dealing with the 
Potentially Violent Person rests with who? 

A3 
The Site Security Co-ordinator 
 
Q4  What form should you complete to inform the Team Leader of an 
incident involving a Potentially Violent Person? 

A4 
IF1 
 
Q5  What form will the Site Manager use to report an incident to the 
customer business unit? 

A5 
IF2 
 
Q6 
If you communicate with a known Potentially Violent Person, either face 
to face, by telephone or letter, what form should you complete and why? 
A6 
Form Appendix 2(PVP) 
 
To assist the DWP with a PVP status annual review 
 
 
 
 
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Q7 
There are five key actions / considerations that you should complete if 
you are going to visit a potentially violent person - what are they? 
A7 
You must not visit a potentially violent person unless you: 
Are accompanied by another individual, unless it is believed that the presence 
of a third party would increase the risk of an incident 
 
Consider carrying a personal alarm 
 
Let your office know when and where you are going to make the visit 
Have agreed with another individual, a report back time, when you expect to 
have completed the visit and returned to the office, or a place of safety e.g. 
home 
Provide the nominated individual with a contact number to check with you, if 
you do not call in 
 
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Types of Behaviour Self Assessment Exercise - Answers 
 
Q1 
Is standing up for your own rights, but doing so in such a way that you 
violate the rights of others, aggressive or assertive behaviour? 
A1 Aggressive 
 
Q2 
Fill in the missing words: 
A2 
Assertive behaviour includes expressing your needs, wants, opinions,   
feelings and beliefs in a direct, honest and appropriate way. 
 
Q3 
Can non-assertive behaviour have a positive effect? 
A3 
Yes, in the short term 
 
Q4 
Which type of behaviour can have a positive effect both in the short and 
long term? 
A4 Assertive 
behaviour 
 
 
 
 
 
 
 
 
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Effectively Handling Aggressive Behaviour Self Assessment 
Exercise - Answers 

 
Q1 
List the six main types of assertion 
A1 Basic 
 Empathetic 
 Discrepancy 
 Negative 
Feelings 
 Consequence 
 Responsive 
 
Q2 
True or False? 
Sympathy is described as 'putting yourself in the other person's position and 
recognising their feelings, needs and wants 

A2 
False, empathy is described in this way 
 
 
Q3 
Negative Feelings assertion contains four main elements, what are they? 
A3 
An objective description of the other person's behaviour 
 
How the behaviour specifically affects you 
 
A description of your feelings 
 
A statement of what you want or prefer 
 
Q4 
Which type of assertion is considered the strongest? 
A4 Consequence 
 
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5. Section Five – MCQ Final Assessment Exercise 
Welcome to the fifth and final section of your Learning Pack.  This section includes a 
multiple choice assessment exercise which you should complete and forward to 
your local Training and Support Manager at your local Medical Service Centre 
(MSC) 
As this exercise is 'open book' it is anticipated that you will achieve 100% correct 
answers.  If you should get any incorrect answers your Training and Support 
Manager will advise you so that you can complete a second attempt. 
Objectives 
By the end of this section you will: 
  Have completed the multiple choice assessment exercise 
 
Materials 
The following materials are included in this folder to assist your learning: 
  Self-Assessment Exercise Answers 
 
Duration 
The activities in this section should take approximately 15 minutes to complete. 
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MCQ Dealing with Aggressive and Potentially Violent 
Behaviour 

Instructions: 
This is a multiple-choice questionnaire, which means you are asked a series of questions 
and given a choice of possible answers for each. Only one answer is correct in each case. 
You should attempt all questions, tick the answer you believe to be correct and return your 
completed MCQ to your local MSC. 
 
Name (Please Print): 
Date: 
 
Signature: 
Base (MSC): 
 
 
 
 
 
Question  
Possible Answers 
Tick 
box 

 
 
 
 
 
 
Which type of 

Passive 
behaviour includes 

 
 
 
an open, relaxed 
posture in its non-

Aggressive 
verbal aspects? 
 
 
 


Assertive 
 
 
 
 
 
 
 
 
 
 
Who can designate a 

The Customer Business Unit(s) 
member of the public 

 
 
 
as a Potentially 
Violent Person? 

Any member of Medical Services' staff 
 
 
 

A Medical Services' Site Manager 
 
 
 
 
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Question  
Possible Answers 
Tick box 
 
 
 
 
 
 
Who would complete  A 
A Medical Services' Site Manager 
form IF3 following an 

 
 
 
incident? 

A witness 
 
 
 

The claimant 
 
 
 
 
 
Which type of 
 
 
 
assertion is useful 
 

Consequence 
when you suspect 
4  there is a contradiction 
 
 
 
between what has 

Basic 
been agreed and what 
is happening or about 
 
 
 
to happen? 

Discrepancy 
 
 
 
 
 
 
 
 
 
 
How does the 

A yellow circle 
customer business 

 
 
 
unit indicate on a 
claimant's referral 

A red chequered square 
documents if he/she is 
a Potentially Violent 
 
 
 
Person? 

A green square 
 
 
 
 
 
 
 
 
 
 
Which type of 

Aggressive 
behaviour includes 

 
 
 
'shoulds' and/or 
 
'oughts' in its verbal 

Assertive 
aspects 
 
 
 

Passive 
 
 
 
 
 
If you are asked to 
 
 
 
visit a potentially 
 

Complete the visit and report the lack of information 
violent person where a 
afterwards 
7  full account of the 
incident that led to the 
 
 
 
 
person being 

Do not complete the visit and return the file to the 
classified  as 
Administration section 
potentially violent is 
not included in the file 
 
 
 
you should: 

Complete the visit making sure you take another 
individual with you 
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 Observation 
form 
Please photocopy this page and use it for any comments and observations on this 
document, its contents, or layout, or your experience of using it. If you are aware of 
other standards to which this document should refer, or a better standard, you are 
requested to indicate this on the form. Your comments will be taken into account at 
the next scheduled review. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Name of sender: 
________________________ Date: 
_____________ 
 
Location and telephone number:____________________________________ 
 
Please return this form to:  Angie Rhodes 
                                   
Training and Development Co-ordinator 
 
 
 
 
 
Atos Healthcare 
     3300 
Solihull 
Parkway 
     Birmingham 
Business 
Park 
     Birmingham 
B37 7YQ 
 
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