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Healthcare Training Institute - Quality Education since 1979

Section 26
Domineering Resident Technique #11
Responding Self-Confidently to the Requests of Domineering Residents

Table of Contents | NCCAP/NCTRC CE Booklet

In situations that require you to respond to the actions or requests of your Domineering Resident, you may find it important to practice these situa­tions and role-play them repeatedly, because in these stressful situ­ations you may respond impulsively.  Sound familiar?  So, here are five approaches you might try to respond self-confidently to your domineering residents. 
1.  Thoughtfully using the word "No"
2.  The Broken Record Technique
3.  Silence. 
4.  A Firmer Approach
5.  Knowing They Are Heard

First, let's talk about using the word "no."  “No” has a great deal of power and clarity.

1. Thoughtfully Using the Word "No"
"No" can be a double-edged sword.  Sometimes, just the use of the word “no” puts you at such opposition with the other person whether resident or staff member, it is similar to waving a red flag in front of a bull.  So, "no" is a word you want to avoid at all costs with some individuals.  However, the other side of this double-edged sword is that some residents will push and push and push until finally, you need to firmly state, "No, Hester, I cannot take you shopping again today.  It is not your turn on the schedule."  In other cases, such firmness is not needed, and when your Hester asks to go shopping, all you need to merely say is, "Hester, I don't think so."  So, which side of the sword do you use?  As you know, the only answer to this can come from you.  You might use the centering technique suggested previously, and visualize an "I don't think so" reply as compared to a "no" reply.  You have probably found, like I, that long excuses can become accusations or reveal your tendency to­ward over-responsibility.  The Domineering Resident can use your excuses, a.k.a. explanations, to manipulate you and as ammunition to make points in an argument .

Would it be beneficial to continue the exercise above regarding saying "No" in your Journal?

2. The Broken Record Technique
Especially if the resident has a long history of controlling the activity program, you will probably find it necessary to refuse the request several times before the Domineering Resident “hears” you. In this case, you can use a technique that has been popularized by Manuel Smith, Ph.D. He calls it the “broken record.” To use this technique, you calmly repeat your no, with or without your original reason for declining. You do so as often as is required. You may find it helpful to practice your broken-record technique in a role-play.  The Broken Record Technique is similar to rephrasing mentioned in Section 4 of this Manual.  However, in rephrasing you state an approximation of what the resident said.  With the Broken Record, you state the same words over and over again. 

One of the best situations in which to use the broken record is when you want to make a strong statement. Outside of the facility, it is also particularly useful with repair­men, waiters, customer service people, etc. In these cases, you con­tinue saying no to any compromise that is unsatisfactory. Be sure to speak in a firm, relaxed manner. Role-playing these situations can help you to realize how frequently you may have to play your broken record in a situation with a Domineering Resident.  For example state, “Hester you are on the shopping schedule for next Tuesday.  Not today.”  Or, “Hester, we have one Bingo game now and it is on Tuesday.”  Or simply state, “Hester we’ve talked about this.”  As you can see your broken record statement summarizes the bottom-line results of your previous discussions with Hester.  So no matter what your Hester says, just like a broken record you repeat your summary statement in a calm, friendly, mater-of-fact manner.  Does it sound like a broken record summary statement is worth a try?

3. The Power of Silence
If you have tried a firm but friendly “no” and a mater-of-fact broken record statement, don't forget, silence is a very potent form of nonverbal communication. If a Domineering Resident continues to badger you after you have turned on your broken record, use silence.  To use silence, you state your Broken Record statement of, "Hester, there is no Bingo today."  She responds, "But the other Activity Director had Bingo twice a week!" or "It's your job to provide us with activities!"  Since you have used techniques outlined in previous sections regarding restating feelings, and providing the rationale for your decision, at this point, silence seems to be appropriate.

4. A Firmer Approach
You may also want to assert yourself about what is happening when you are being badgered.
A. If you deem appropriate, especially if the resident is completely alert, you may want to say, “Hester, I really wish you would stop pressuring me about the Bingo game.  I have explained this to you before.”
You might add, if you feel it is suitable, “I’m not going to change my mind.”
B. If this does not work, you may need to tell your Hester what you are going to do next. You may say that you are going to change the topic or leave. "Hester, I am going to leave now."  And it may be nec­essary to follow through and do what you say you are going to do. 

What would you say?  The clearer you can envision saying these words, the easier it will be at the time.  Is there an activity staff member with whom you might role play to practice these possible replies.

5. Knowing They Are Heard
As mentioned previously consider repeating what you feel your Hester is saying or asking for. "Hester, I understand that you want Bingo twice a week and that you really enjoy Bingo."  In this way, before you say no, you acknowledge the resident's problem and show that you understand what the other is communicating.  This technique is outlined further in Section 4 of this Manual and is referred to as "rephrasing."

You may want to reflect on your Hester’s feelings after she has stated them, saying something like, “I know that you’ve been hoping that I would spend the afternoon talking with you and that this may be a disappointment, but I won’t be able to.”

Avoid saying “I’m sorry”
1. Why “I’m sorry” is ineffective:  Apologizing is often unnecessary and perhaps even dishonest. Apologizing also tends to compromise your basic right to say “no” to your Hester.  Saying “I'm sorry” can be a crucial mistake with some Domineering Residents.  They sense you are not truly sorry and had chosen to spend time with someone else rather than with themselves.

2. Compromises are dangerous:  You may wish to offer a compromise, but it is important that you realize you also have the freedom not to com­promise at all.  However, this is a dangerous one to implement because if you tell Hester, for example, "Instead of having two Bingo games, I can guarantee that you will always have your favorite seat at Bingo," you can readily see the bind this creates for you. 
--First of all, you may not be able to follow through with your "guarantee." 
--Secondly, this may make her angrier, feeling hurt that what she really wants is two Bingo games and not a special seat. 
--Thirdly, and perhaps worst of all, she may feel by your placating behavior that she "has a tiger by its tail."  Perhaps you feel guilty about the program change, and that she now has the right to request special treatment in other areas as well.  
3. Avoid showing feelings of guilt:  Be sure to refuse the major request clearly and without feel­ing guilty, and it goes without saying without a hint of guilt not only in your voice but in your nonverbal body language as well.  Would role playing be beneficial, if not with someone else how about in front of a mirror to not your body lean, hand and arm movements, stance facial expression, etc.

4. You can change your mind:  Finally, you have the right to change your mind and refuse a re­quest to which you may have originally agreed. You have to weigh the consequences, but if you find yourself hedging or feeling ma­nipulated, you may want to reconsider your initial decision.  And in fact, reconsidering your original decision is exactly what you are doing when you shift the focus of your perhaps group activity program to spend more time with the Alzheimer's and Low Functioning resident activities.
-Adapted from Charlesworth, Ph.D., Edward A. and Ronald G. Nathan, Ph.D.  Stress Management: A Comprehensive Guide to Wellness. Random House Publishing Group, New York, 1982.