Recommendations
on neighbour
problems

1.3 Setting limits through authentic engagement

Guideline for neighbour problems / PREVENTING: 1.3 Setting limits through authentic engagement

Interventions and evidence explained

Most plausible interventions explained

During the orientation process of the available literature, we identified the following interventions as most plausible for containing (preventing the escalation of) a neighbour dispute:

Setting limits through authentic engagement
Authoritative de-escalation interventions

De-escalation involves the use of verbal and nonverbal skills to gradually resolve potentially aggressive situations by redirecting the party to a neighbor dispute to a calmer personal space. It is often recognized as an important part of aggression management in mental health settings, particularly with regards to decreasing the use of seclusion and restraints. Available literature on aggression and mental health makes a distinction between two types of de-escalation techniques: setting limits through authentic engagement and more authoritative de-escalation techniques.

Setting limits through authentic engagement

Limit setting through authentic engagement in neighbour disputes includes the following 3 steps:

Set limits and make sure to provide adequate personale space, use open body language, speak in a low and calm tone of voice, use open-ended sentences and avoid punitive and threatening language.
When setting limits elicit the person’s story and actively try to understand the situation.
Apply active limits to set limits in the best possible way by using i-statements, restating statements, mirroring/reflecting statements and summarising/paraphrasing statements.

Limit-setting is an aspect of the de-escalation process that involves knowing when to exert control and implement constraints on people’s behaviour (Price and Baker). Limit-setting involves establishing the parameters of desirable and acceptable behavior. It refers to setting limits on people’s behavior before a person has become aggressive. Humane limit-setting involves the integration of two values: respect for the party to a neighbor dispute as a human being and the need for order and discipline in society (Robertson et al.).

A limit-setting intervention begins with understanding how the party to a neighbor dispute is feeling and what he or she needs in the situation. This is established through the use of therapeutic communication, which is founded on respect for the rights and dignity of the party to a neighbor dispute. It involves (Robertson et al.):

Providing adequate personal space;
Using open body language;
Speaking in a low and calm tone of voice;
Using open-ended sentences;
Avoiding punitive or threatening language.

An important de-escalation technique that can be applied when setting limits is authentic engagement, where the third party is able to stay sincerely connected to the party in the dispute. According to this style, the third party(or other helper) elicits the person’s story and actively tries to understand the situation. Authentic engagement requires strong interpersonal skills and acknowledging feelings of others.

Acknowledging the feelings of others can be done by applying active listening. Active listening skills are an essential tool when de-escalating a crisis situation. When a police third partyor other third party involved in a neighbor dispute engages in active listening, he or she is listening for the total meaning of the words spoken by the individual in crisis. The third partyor other third party attempts to focus on the actual meaning of the words spoken rather than becoming distracted by the individual’s delusions, hallucinations, or other psychiatric symptoms that may be present. The applicable third party should provide reflecting statements—i.e., “I understand that makes you angry”—to indicate that he or she is listening.

The techniques of active listening allow the third party to convey that he or she wants to understand the individual’s thoughts, feelings, and behaviors. The third party should be sincere and genuine so the individual in crisis is aware that the third partyis supportive and attempting to lend assistance (Oliva et al. p. 20). Some active listening techniques include:

Using “I” statements: These statements convey that the third partyis listening to the individual and understanding him or her, and that the third partygenuinely cares. Some examples of “I” statements commonly used by officers are: “I can see that you are upset [or angry],” “I hear in your voice that you are worried,” “I’m here to help you,” “I want to help you,” “I will keep you safe,” “I care …. I have time …. I’m listening,” and “I appreciate your help and cooperation.”
Restating statements: This technique consists of stating back to the individual—in words somewhat different from the individual’s own words—the essence of that information. For example, the individual in crisis might say, “I don’t know what I’m going to do; my family doesn’t want me here,” to which the third partyresponds, “You’re not sure where you can stay for a while, but home doesn’t seem like the best place right now.”
Mirroring/Reflecting statements: Mirroring/reflecting expresses to the individual an understanding of his or her main feelings (Goldstein et al., 1979). These types of statements are commonly used to facilitate communication with an individual and are accomplished by repeating the last few words of the individual’s last statement. For example, the individual in crisis might say, “I’m tired of no one listening to me, and it makes me angry,” to which the third partyresponds, “It makes you angry.”
Summarizing/Paraphrasing statements: Summarizing statements are often used to recap or summarize the information already received from the individual by restating the information in the officer’s own words. These statements should include the main points of the previous content. For example, the third partymight say, “Okay, so what you have told me is that [restating the information], and you feel [identify the emotion]. Do I understand you correctly?” (Oliva et al. p. 21).

Authoritative de-escalation interventions

More authoritative approaches to de-escalation [in neighbour disputes] are associated with higher risk behaviour and should be used in proportion to the risk posed by the person to themselves or others. If a person is presenting with threatening, intimidating, or violent behaviour, a firmer approach can be taken. In more authoritative approaches, there is no focus on discussing the person’s feelings (Price and Baker, p.16).

Examples of authoritative de-escalation interventions are alerting the neighbour in a conflict to the seriousness of their behaviour and giving the option of de-escalating before unwanted containment methods are used [such as arrest and use of force]. There are four distinct techniques of this type (Price et al. p.2):

Environmental manipulation (control of environmental conditions to reduce stimulation, maximise safety and limit contagion of aggression),
Reprimands (expression of disapproval of a conduct often accompanied by reminders of ward rules/expected standards of conduct),
Deterrents (deterring further aggression through highlighting potential consequences) and
Instruction (providing instruction to the person).

Selected interventions for comparison (defined as a PICO question)

For parties looking to prevent the escalation of (contain) a neighbor dispute, is setting limits while engaging in an authentic way or applying authoritative de-escalation techniques more effective for well-being?

Search strategy

The databases used are: HeinOnline, Westlaw, Wiley Online Library, JSTOR, Taylor & Francis, and ResearchGate.

For this PICO question, keywords used in the search strategy are: conflict, de-escalation, limits, neighbour issues, resolution

Assessment and grading of evidence

The main sources of evidence used for this particular subject are:

Janet R. Oliva, Rhiannon Morgan and Michael T. Compton, Practical Overview of De-Escalation Skills in Law Enforcement: Helping Individuals in Crisis While Reducing Police Liability and Injury (2010)
Scott L. Zeller, Kimberly D. Nordstrom, Michael P. Wilson, The Diagnosis and Management of Agitation (2017)
Owen Price and John Baker, Key components of de-escalation techniques: A thematic synthesis (2012)
Owen Price, John Baker, Penny Bee, Karina Lovell, The support-control continuum: an investigation of staff perspectives on factors influencing the success or failure of de-escalation techniques for the management of violence and aggression in mental health settings (2017)
Terri Robertson, Michael Daffern, Stuart Thomas and Trish Martin, De-escalation and limit-setting in forensic mental health units (2012)
S. Vatne and M. S. Fagermoen, To correct and to acknowledge: two simultaneous and conflicting perspectives of limit-setting in mental health nursing (2006)

Quality of evidence and research gap

The article by Oliva, Morgan and Compton provides a practical explanation of de-escalation techniques that can be applied by police officers who face a crisis or conflict. The authors present an overview of available literature on the different de-escalation techniques. This is an expert opinion. The strength of evidence can therefore be regarded as very low.
This article by Vatne and Fagermoen reports about a study of nurses’ limit-setting in mental health and the rationality behind correcting and therapeutic limit-setting interventions. Qualitative data were collected from various data sources; namely participant observations, interviews and written narratives. The size of this observational study is relatively small. The strength of evidence can therefore be regarded as low.
The purpose of the review by Robertson and others is to examine the extant literature on limit-setting and de-escalation and consider how these activities could be enhanced. In concluding, this review emphasizes the potential benefits of drawing upon (1) a model of aggressive behavior and (2) a theory and literature examining interpersonal behavior, to enhance limit-setting and de-escalation skills. According to the GRADE method (as part of our research method), the strength of evidence of this expert review is classified as very low.
Baker and Price present a thematic synthesis literature review from 11 international papers. They examine how de-escalation approaches are being applied by staff in clinical practice. According to the authors, de-escalation techniques are an example of a complex intervention, which has been overlooked by rigorous research, and it is often assumed that staff are able to perform these techniques in clinical practice. According to the GRADE method, the strength of evidence of this meta-analysis can be regarded as high.
Baker et al. conducted a small observational study to obtain staff descriptions of de-escalation techniques currently used in mental health settings and explore factors perceived to influence their implementation and effectiveness. Participants described 14 techniques used in response to escalated aggression applied on a continuum between support and control. This strength of evidence of this study can be regarded as low, according to the GRADE method in light of our research method.
The book by Zeller and others is a practical guide that explores the origins of the condition and the differing approaches and treatments available. Treatment options including psychiatric work-ups, medical work-ups, psychopharmacology, de-escalation, and calming techniques are provided. The strength of evidence of this guide is classified as high.

According to our research method, we grade the evidence comparing setting limits through authentic engagement and authoritative de-escalation techniques as very low.

A significant research gap is noticeable in containing neighbour disputes. Very limited evidence is available focusing on specific de-escalation techniques in neighbour dispute settings. Most literature focuses on interventions that can be applied by police officers in general and by medical staff in mental health settings.

Comparing the two interventions

Desirable outcomes of the interventions

Setting limits through authentic engagement	Authoritative de-escalation techniques
“Authentic engagement allows the [party or parties to a neighbour dispute] to maintain a sense of dignity by recognizing their aggression as a way to express emotion and communicate need” (Robertson et al.).	Being authoritative gives the impression of having expertise, the ability to explain one’s rationale, the power to influence or persuade, a thoughtful openness to being influenced by others, and knowledge of one’s own limitations. “A study conducted by Fried, discovered that the less sure doctors are about prescribing an intervention, the more opinionated the patient needs the doctor to be. On the other hand, the more certain doctors are, the more the doctor should solicit the patient’s opinion” (Zeller et al., p. 151). [If we apply this to a neighbour setting: the police and other helpers can use authority in their interventions, and at the same time gain insight on possible solutions or outcomes from the parties to a neighbour dispute].
Authentic engagement prevents escalation of negative feelings and behaviour. “Acknowledging a party’s feelings is effective in preventing the escalation of feelings of powerlessness, as well as disruptive behavior” (Robertson et al.).
Authentic engagement is seen as more therapeutic and successful than other response styles such as inflexibility and disengagement. “Interpersonal skills such as empathy, reciprocity, respect, and mutuality are seen as important components of de-escalation that produced more helpful outcomes in aggressive situations. Staff members [and police officers] who are able to respond to the situation and not their own frustration are considered to be more successful at de-escalating aggressive people” (Robertson et al.).
Acknowledging and co-operating interventions )two forms of limit-setting] can be extremely useful in preventing the arousal of angry or aggressive counteractions. A dialogue of wondering reflection about a person’s feelings or problems and the helping third party’s own feelings in certain situations is presented in the literature as a form of intervention that is most helpful in toning down aggression (Vatne and Fagermoen, p. 44).

Undesirable outcomes of the intervention

Setting limits by authentic engagement	Authoritative de-escalation
Less authoritative approaches to de-escalation might not be good enough to prevent escalation of conflict. “The risk of the more tolerant approaches is that in the worst case scenario [the third party] may neglect a [party to a neighbour dispute] requiring a more authoritative intervention and increase the possibility of violence to others and/or self-harm” (Price and Baker, p. 318).	“More authoritative ‘non-physical control’ techniques, such as instructions, deterrents and reprimands may lead to escalations of aggression and use of restrictive practices when applied in certain contexts” (Price et al., p. 19). Approaches that are too rigid, unnecessary, or excessively restrictive are known to increase the risk of violence.
Setting limits might be seen as being offensive. “Some people might experience being offended and sometimes punished, [especially] when limits are set in an authoritarian way” (Robertson et al.).	Authoritative techniques should be applied when there is increased risk of escalation. However, often increased risk is not identified, which might result in applying these techniques in wrong situations. [“Authoritative] assertive techniques have previously been identified as an important aspect of the de-escalation process, but should be applied on the basis of increased risk. [A 2016] study found that increased risk was often not a key factor informing use. Rather, moral judgements regarding the function of the aggression, trial-and-error and ingrained local customs surrounding the management of aggression were common explanations for use” (Price et al., p. 19).
	Applying authoritative techniques can be risky when one or more of the parties involved suffers from a personality disorder. “More authoritative techniques applied to [people with personality disorders] appear especially problematic, potentially because they a) increase the perceived need to secure dominance or respect through further aggression and / or b) engender a sense of [third party helper] rejection or re-enactment of past abusive relationships provoking fight or flight responses” (Price et al., p. 20).
	Authoritative interventions such as moving people to other rooms/places can lead to power struggles and use of restraint. “[People’s] refusals to move to [separate spaces such as side rooms] can result in power-struggles and potentially avoidable use of restraint. Existing de-escalation evidence indicates suggestions to move to [separate spaces] should be on [party’s] terms, unless there is an immediate risk of violence” (Price et al., p. 20).

Balance of Outcomes

Taken together, the available research suggests that setting limits through authentic engagement is most beneficial to the well-being of parties to a neighbour dispute, as well as of the third party involved (a police officer or other third party involved). Authentic engagement allows the person dealing with conflict to be taken seriously by feeling acknowledged and able to share their emotions. Most importantly, authentic engagement is most effective in preventing and toning down aggressive behaviour.

On the other hand, third parties should be mindful when setting limits. They cannot neglect people’s needs. In certain crisis situations, a more authoritative approach might be needed.

Authoritative ways of de-escalating can be effective when applied in the correct way. This means using authority carefully and leaving room for parties to provide their insights. Authoritative techniques to de-escalate can harm people involved in a conflict. It can increase aggression, result in power struggles and use of restraints.

Therefore, applying authentic engagement when setting limits is preferred.

Recommendation

Taking into account the balance of outcomes, the effect on well-being for all parties involved in a neighbour dispute, and the quality and consistency of the evidence, we make the following recommendation: For parties looking to prevent the escalation of (contain) a neighbor dispute, setting limits while engaging in an authentic way is more effective for well-being than applying authoritative de-escalation techniques.

Technichal remarks

Applying an authoritative approach to containing a neighbour dispute or setting limits through authentic engagement depends on the extent to which the dispute has already escalated or has become violent. In cases with a high risk of violence it is too late to set limits and only authoritative approaches are appropriate.