Are you looking for specific information on the topic of physical containment? Do you want to know how and when it is applied and if there are differences between cases? In this article, you will find all the information you need.
In different disorders, we may encounter patients who must face situations beyond the resources they have to cope with them. Therefore, they can enter a crisis that triggers a behavioral outburst. These crises can be due to a lack of impulse control or emotion management, difficulties in accepting limits (especially in children and adolescents), in showing prosocial behaviors, low tolerance for frustration and immediacy, lack of planning skills, or difficulties in trial-and-error learning.
What physical containment is and what you should know about it
Physical containment is a therapeutic resource used in extreme situations to keep behaviors under control that pose a high danger to the patient themselves, to others, or to professionals working in the area. Likewise, we must be very clear that containment is carried out after all other alternative techniques and measures taken have failed.
If the perceived risk is low, basic safety measures will be carried out, such as preventing objects near the patient that could be used as “weapons”. If the risk is perceived as medium, we will begin to use verbal containment measures, showing a calm and affable, secure and firm attitude, without being defiant or authoritarian. Finally, if the perceived risk is high, we will simply try to restrain the individual or isolate them from the context that caused the crisis. Thus, physical containment will be resorted to when the individual’s behavior endangers their integrity or that of another person.
Physical containment techniques
The main measures in physical containment for the prevention of physical harm in individuals presenting a behavioral crisis are:
– Remove dangerous objects (glasses, pens, watches, rings, laptops, scissors, etc.)
– Reduce stimuli that cause restlessness (light, noise, activities).
– Have a reference space where they can calm down, isolate, or contain them (both physically and verbally).
– Have mechanisms to alert others in case help is needed.
– Avoid using one’s body as a shield.
– Stay alert, do not relax even if the situation seems more controlled.
– Do not consider a crisis over until we are completely sure.
– Always approach the individual from the front.
Once all possible preventive measures of physical containment have been carried out, we will consider measures for physical restraint. This can range from a single limb (such as the arm) to the entire body. We must always initiate verbal containment and announce the intensity of the containment. Also, if containment is carried out with more than one professional, only one person should direct it, preferably the one with the strongest bond with the patient in crisis.
If held by the arms, it is better that the restraint is by the wrists and not by the hands. In this way, if we want to isolate them from the place where the outburst occurred, we can place one of their hands on the nape of the neck and the other on the back, accompanying them as they walk with our own inertia.
If we have been able to reach the previously mentioned reference environment, we will try to release them and perform verbal containments again, indicating that we understand how they feel and that we also do not like having to perform the containment.
How to manage an aggressive patient using physical containment
In cases where the agitation is so high that restraint is not enough, the safest place for the patient is the floor. In this way, we will accompany them to the floor by gently pressing their calf with our foot or knee until we manage to have them face down. Once on the floor, the safest thing for the individual is for their head to be to the side with their cheek touching the floor and holding their back. This way, we will avoid self-injuries such as headbutting or biting.
On the floor, we will speak to the patient calmly and serenely, and positively reinforcing any attempt they make to be more relaxed. In this way, they will be warned that little by little the pressure we apply will be less, but if they increase their strength, we will have to apply more pressure on them again.
Finally, when we observe that the patient begins to return to their usual state, we will lead them back to a quiet and safe place, without ceasing to observe their tension level. Depending on the patient’s problem, we will try to address what happened at that moment or it will be advised that it will be done later or in another visit.
All these techniques and knowledge for the understanding, application, and use of physical containment are taught in the Master in Child and Adolescent Clinical Psychology.