"Dislocation of expectations" (management of violence on a general hospital psychiatric unit)

An approach to the management of potential violence on a General Hospital Psychiatric Unit is described as it evolved following analysis of the successful handling of a series of problem patients. The importance of an attitude of acceptance towards potentially violent persons is emphasized as is an orientation towards prevention. An approach of consistency and directness with enhancement of the patient's positive personality features is favoured. The initial assessment is considered important and clues to the prediction of violence are highlighted, as are aspects of the supervision plan. A specific technique for prevention of violence based on the principle of Dislocation of Expectations, or doing differently than the subject expects, is introduced.