At 4:59 p.m. on a rainy Halloween night, an officer working complaint duty at a local police office was notified that there was a “walk up” complainant named “John” wanting to speak to an agent. Upon approaching the man, the agent noted a slightly disheveled appearance. The man relayed his story of being surveilled by “organized crime,” stating that he was afraid for his life. He recently flew in to a local airport and suspected the flight attendants were working with “them” and had poisoned him with something during the flight. The man suspected his wife was working with “them.” As the man continued describing his paranoia, the agent resigned himself to what would likely be a long interview. John was asked if he had weapons in his possession, and he advised he had a handgun that was loaded and wedged between the driver’s seat of his vehicle and the console. Over the course of the evening, several agents and local police officers engaged the man with a “rolling with resistance” approach to the interview. Rolling with resistance is but one tool of many from the world of psychology and therapy that have practical applications on the streets, especially when officers confront those with mental illness.
Here is an ominous statement: In 2008, the World Health Organization predicted depression will rise to rival heart disease by 2030.1 This predicted rise means officers have an increased chance of confronting someone with mental illness, such as John in the preceding example. As first responders to crisis situations, officers should learn basic principles of therapeutic engagement and possess a knowledge of mental illness. Engaging those with mental illness in a more empathetic manner and with the knowledge provided by crisis intervention training (a training protocol designed to bring awareness to mental illness) can make an encounter between police and persons with mental illness a safer and more effective encounter for all parties. The continuing conversation with John that follows demonstrates how officers can “condition” an environment (make it ripe for good dialogue) through both verbal and nonverbal communication. Simple nonthreatening de-escalation skills can serve as conditioning devices for appropriate behavior, and verbally rolling through resistance can help an officer gather critical information.
Rolling With Resistance Techniques
Rolling with resistance has been metaphorically likened to dancing with a subject, as opposed to engaging in a cerebral wrestling match by constantly challenging resistant statements with an endless back-and-forth dialogue.2 Police are used to being lied to by subjects—it’s a hazard of the job. At times, however, a subject may have had a previous negative encounter with police that makes him or her resist sharing information. Interviewers can work through resistance simply by using open-ended questions, appropriate probing questions, emotional validation, and enhancing the subject’s vision to see other alternatives beyond his or her current constricted view by rolling through the displayed resistance in an effort to break through it:
Example: John, I understand that must have been a scary experience you had on that flight. I really want to help you. Please tell me why you think you may have been poisoned.
Motivational interviewing (MI) is a therapeutic initiative that relies on the premise that change is possible only when the client is motivated to change. When confronting individuals reluctant to cooperate, officers can use some basic skills from motivational interviewing to encourage cooperation. MI is a technique that expresses empathy about the individual’s current situation, develops discrepancy (between the client’s current situation and a more hopeful situation), rolls with resistance (as discussed above), and supports self-efficacy (empowering the individual to believe that positive change is possible).3 This simply translates to verbalizing empathy for the subject’s current plight, pointing out the disconnect between the present situation and where a resolution may lie, tolerating and verbally negotiating through the subject’s verbal challenges, and empowering the subject by amplifying (describing) their more positive qualities. Those officers skilled in Active Listening, a form of listening used in hostage negotiation, have a strong foundation for MI, as they are already well versed in labeling emotions and validating the subject’s feelings in the midst of high-stress situations. However, MI goes a step beyond Active Listening by “rolling through” the interviewees’ challenges or protests in a conversational tone that empowers them and supports their dignity and autonomy. The process involves continuous validation but with an eye toward peaceful resolution.
So often those in distress focus on the negativity of a current plight, and subtle reframing or paraphrasing can assure the subject that he or she is understood by the officer, assay fears of isolation, and provide positive alternatives for the subject to resolve the distressing matter.
Example: John, on one hand you came to us wanting help, but with all your shouting, I am having a difficult time trying to do just that. John, do you think you may be over-analyzing the amount of attention the flight attendants paid to you? It is their job to be attentive to passengers, isn’t it?
In psychology terms, Clinically Relevant Behaviors One (CRB1) pertain to in-session dramatic outbursts that signal a resistant client, while Clinically Relevant Behaviors Two (CRB2) pertain to improvements that lead people to accept feedback and responsibility for their actions.4 Just as psychologists employ certain techniques to engage with resistant clients, officers on the street who engage with subjects during explosive outbursts, may see gradual behavioral changes in the subject through the application of motivational interviewing, rolling with resistance, and active listening. Being aware of the subject’s verbal and nonverbal responses can help an officer gauge the quality of a conversation, and, with gentle prompting, effective techniques can be used to break through denials and resistance for admissions.5 Equally important is officers’ being cognizant of their own body language and behaviors. Officers’ verbal and nonverbal behavior can serve as conditioning devices that model appropriate behavior for the subject during the interview.
Example: John, it takes a great deal of courage to come to our office and share this experience. I am appreciative of your willingness to hear me out on this, as I think we can resolve this problem together.
Another factor officers should be concerned with when interviewing persons with mental illness is interrogative suggestibility, especially in individuals with autism spectrum disorder. Subjects with autism may be prone to anxiety and distrust, which can make them appear uncooperative.6 Further, although individuals with autism are not any more likely to lie, they are more prone to avoid conflict and be overly compliant, increasing their capacity for suggestibility. To assess the risk for suggestibility, it is incumbent on the officers to assess the cognitive ability of the subject and his or her capacity for processing directives. Suggestibility issues is a significant consideration in dealing with those with mental illness especially during an interview or custodial setting. As a solution for some individuals with intellectual impairment, a variation of the cognitive interview developed by psychiatrists, can be used to increase memory and retrieval of information. Specifically, individuals are instructed to report everything in detail, restate the environment, visualize for imagery, and change perspectives for better sensory recall, all as a means to accurately recollect the event.7
Example: John, can you walk me through the sequence of events on that plane? Let’s say I was sitting all the way in the back of the plane, what would I have seen from that perspective in the encounter with the flight attendant? You could draw it and describe it to me while you are drawing if that is helpful.
Cognitive interviewing can be useful to those with intellectual impairment, but caution is suggested regarding its use when interviewing individuals with autism due to the impaired social dynamic that usually accompanies autism. For individuals with autism, the use of a take-home interview questionnaire and sketch pad is suggested in order to capture critical sensory imagery.8
Research speaks to the power of Active Listening as a means to demonstrate interest on the part of a therapist.9 A therapist using Active Listening validates the emotions of the individual, accepts them, engages in an empathetic dialogue, and then mutually arrives at a shared goal to de-escalate the stressful interaction. Researchers note Active Listening is highly valued by psychotherapists; the technique is often used to forge a positive therapeutic relationship and can counteract learned helplessness brought upon by previous negative encounters with society.10 Incorporating Active Listening into an officer’s verbal toolbox can be especially useful for situations in which officers are engaging with those with mental illness as a means to counter resistance and foster acceptance.
One way to promote Active Listening is to link on similar language during the interview. A 2005 study on 122 MI transcripts observed that sessions that rated high in empathy had greater language style synchrony (LSS) between the client and therapist.11 Linking with and adopting the word usage of the subject may help foster the empathy and understanding on the part of the officer. Famed psychotherapist Irvin Yalom coined the term “fellow traveler” as a descriptor of the relationship between a therapist and a client.12 Being a mutual companion to the truth, the goal of any interview, involves the interviewer (e.g., officer) being emotionally and verbally synched with the subject.
Example: John, you mentioned you felt scared and alone, and I am sorry that other officer didn’t listen to you. I have been scared before too, and that is not a good feeling. I want you to know you are not in this alone. I know you were suspicious of your wife as well, but I just spoke with her and she seems very nice. She is worried about you. I told her you were fine, and she is looking forward to seeing you. I think she is on your side. Can you feel how she cares for you?
Equality in the interview is critical to having a good dialogue with those with mental illness. For example, a therapist facilitating a sex offender group will forgo a seat of power to facilitate participation and promote a non-superior atmosphere. Famous psychologist Carl Rogers once characterized this equitable interaction in the form of unconditional positive regard toward a client.13 Expressing positive regard during a police interview can help aid in both engaging the subject and gaining admissions to crimes. A 2002 study of 83 sex offense and murder convictions noted that interviewers regarded as humane and empathetic were more successful in obtaining confessions.14 Expressions of appropriate empathy can help those individuals feeling shame and guilt to share their struggles and enhance the quality of the interview.
Example: John, it’s really important that you are healthy and safe. I know you have a permit for it, but can we hold on to your gun until you are feeling better? Your wife agreed to take you to the doctor, and, afterwards, you can certainly come back, and we can talk. You mentioned you used to take medicine to help you, but suddenly stopped taking it. I am taking everything you say seriously, but I also need you to understand my perspective, too. Let’s go make sure you’re feeling well so we can both give our full attention to this.
Nearly all approaches to therapeutic interventions amplify or validate emotion, use reflective listening, and roll through resistance with a client. All of the above elements can be weaved into the interview process between an officer and a subject as a means to defuse a verbally resistant subject. Researchers have reported that those with mental illness desire police officers to have an awareness of their conditions and display compassion during the interview process.15 By expressing empathy, using motivational interviewing, being aware of mental disorders with associated suggestibility, and forging an alliance, investigators can have a more productive (and safer) encounter with a subject, mental illness notwithstanding. In the example presented herein, John voluntarily left that evening (without his firearm) with his wife and went for an evaluation at a local mental health facility. John was diagnosed with Paranoid Personality Disorder and received medication. The biggest fear of that evening was that John would leave the officers with his loaded gun in a state of paranoia and dejection and be pulled over by an unsuspecting officer on the highway. Instead, officers achieved a safe resolution by “rolling with it,” a practice inspired by therapeutic principles with practical applications for police work on the streets. d
Notes:
1 Yasmeed I. Krameddine et al. “A Novel Training Program for Police Officers that Improve Interactions with Mentally Ill Individuals and Is Cost Effective,” Frontiers in Psychiatry 4 (2013): 1–10.
2 Henry Westra and Adi Aviram, “Core Skills in Motivational Interviewing,” Psychotherapy 50, no. 3 (2013): 273–278.
3 Bryan L. Steinkopf, Kori A. Hakala, and Vincent B. Van Hasselt, “Motivational Interviewing: Improving the Delivery of Psychological Services to Law Enforcement,” Professional Psychology Research and Practice 46, no. 5 (October 2015): 348–354.
4 Alessandra Villas-Bôas et al., “The Use of Analytic Interventions in Functional Analytic Psychotherapy,” Behavior Analytic Research and Practice 15, no. 1 (2015): 1–19.
5 Ray Bull, “What is ‘Believed’ or Actually ‘Known’ about Characteristics That May Contribute to Being a Good/Effective Interviewer,” International Investigative Interviewing Research Group Journal 5, no. 2 (December 2013): 128–143.
6 Alice North, Alisa J. Russell, and Gisli Gudjonsson, “High-Functioning Autism Spectrum Disorders, An Investigation of Psychological Vulnerabilities during Interrogative Interview,” Journal of Forensic Psychiatry & Psychology 19, no. 3 (2008): 323–334.
7 Laura Crane et al., “Police Interviewing of Witness and Defendants with Autism,” Network Autism (June 2015): 1–8.
8 Crane et al., “Police Interviewing of Witness and Defendants with Autism.”
9 Allison Abbe and Susan E. Brandon, “The Role of Rapport in Investigative Interviewing: A Review,” Journal of Investigative Psychology and Offender Profiling 10 (December 2012): 237–249.
10 Andrew Soundy et al., “The Value of Social Support to Encourage People with Schizophrenia to Engage in Physical Activity: An Internal Insight from Specialists in Mental Health Psychotherapists,” Journal of Mental Health 23, no. 5 (October 2014): 256–260; Gary W. Noesner and Mike Webster, “Crisis Intervention: Using Active Listening Skills in Negotiation,” Law Enforcement Bulletin (August 1997).
11 Sarah Peregrine Lord et al., “More than Reflections: Empathy in Motivational Interviewing Includes Language Style Synchrony between the Therapist and Client,” Behavior Therapy 46, no. 3 (May 2015): 296–303.
12 Jerry Jennings and Adam Dennings, “Effectively Utilizing the ‘Behavioral’ in Cognitive-Behavioral Group Therapy of Sex Offenders,” International Journal of Behavioral Consultation and Therapy 8, no 2 (2013): 7-13.
13 Stephen T. Fife et al., “The Therapeutic Pyramid: A Common Factors Synthesis of Techniques, Alliance, and Way of Being,” Journal of Marital and Family Therapy 40, no. 1 (January 2014): 20–33.S
14 Mark Kebbell, Laurence Alison, and Emily Hurran, “Offenders’ Perceptions of Effectiveness and Fairness of Humanity, Dominance, and Displaying an Understanding of Cognitive Distortions in Police Interviews: A Vignette Study,” Psychology Crime and Law 14, no. 5 (2008): 435–449.
15 Krameddine et al., “A Novel Training Program for Police Officers that Improve Interactions with Mentally Ill Individuals and Is Cost Effective.”
Please cite as
Robert J. Ambrosini, “Roll With It: Tips from the World of Psychology for Engaging Those with Mental Illness,” Police Chief online, July 3, 2019.
