What therapeutic communication techniques could the nurse have used with Frances to prevent her from becoming angry and aggressive?


Case Study, Mohr

CHAPTER 32, Anger and Aggression

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In completing the case study, students will be addressing the following learning objectives:

Discuss various interventions to manage anger and aggression.

Define broad factors that can increase risk for anger, aggression, and violence.

1. Frances, a 49-year-old African American client, is a newly admitted patient to the psychiatric hospital. Frances has the dual diagnoses of Bipolar I and Borderline Personality Disorder. Frances refuses to abide by the unit rules of being out in the day room after breakfast and is staying in her room. Her treatment level permits her to make two telephone calls daily, and Frances is demanding unlimited access to the telephone Frances is becoming increasingly frustrated and angry at the staff and has used some expletives in telling them what she thinks of the unit rules. The primary nurse attempts to defuse Frances’ anger but finally becomes frustrated and angry herself, and she commented to Frances that if she did not cooperate with unit rules, she could expect to be in the hospital longer than usual. Frances then lunged at the nurse, striking her on the head with her fist. Frances was taken to the calming room and given a medication for her aggressive behavior.

(Learning Objectives: 2)

a. What therapeutic communication techniques could the nurse have used with Frances to prevent her from becoming angry and aggressive?

b. What factors could have contributed to an increase in Frances’ level of anger?


Factors Contributing to an Increase in Frances’ Level of Anger


Anger and aggression can arise from a multitude of factors, and in the case of Frances, a combination of individual and environmental factors may have contributed to the escalation of her anger. Understanding these factors is crucial in managing and preventing aggressive behaviors in individuals with mental health conditions. The following essay explores some possible factors that could have contributed to Frances’ heightened anger level.

Mental Health Diagnoses

Frances has been diagnosed with Bipolar I and Borderline Personality Disorder, both of which are associated with emotional dysregulation and impulsivity. Individuals with these diagnoses often struggle with intense mood swings, difficulty managing emotions, and impulsivity, which can increase the risk of anger and aggression (Chapman, 2022). It is essential for healthcare professionals to recognize the impact of these diagnoses and tailor interventions accordingly.

Unit Rules and Restrictions

Frances’s refusal to abide by the unit rules and restrictions suggests a clash between her personal autonomy and the structured environment of the psychiatric hospital. The limitations imposed by the rules may have triggered feelings of frustration, powerlessness, and a sense of being controlled (Isobel, 2015). Individuals with mental health conditions, especially those with personality disorders, may be more sensitive to perceived infringements on their freedom, leading to anger and resistance.

Communication Challenges

Effective communication plays a crucial role in managing anger and aggression. In this case, the primary nurse attempted to defuse Frances’ anger but eventually became frustrated and angry herself. This breakdown in communication may have contributed to Frances’ escalating aggression. Communication challenges, such as misunderstandings, lack of empathy, or ineffective therapeutic techniques, can fuel anger and hinder the establishment of a therapeutic relationship.

Unrealistic Expectations

Frances demanded unlimited access to the telephone, which suggests unrealistic expectations on her part. Unrealistic expectations can create frustration and anger when they are not met. It is possible that Frances had difficulty accepting the limitations placed on her due to her treatment plan and hospital policies. Helping individuals with mental health conditions develop realistic expectations and coping strategies can mitigate anger and aggression.

Lack of Coping Mechanisms

Individuals with mental health diagnoses, such as Bipolar I and Borderline Personality Disorder, often struggle with limited coping mechanisms for managing intense emotions. The absence of healthy coping strategies can lead to a reliance on maladaptive behaviors, including aggression, as a means of expressing frustration or seeking control (Nitzburg et al., 2016). Teaching and reinforcing effective coping mechanisms, such as mindfulness, relaxation techniques, and assertive communication, can empower individuals like Frances to manage their anger more constructively.


In conclusion, managing anger and aggression in individuals with mental health conditions requires a comprehensive approach that addresses both individual and environmental factors. By utilizing therapeutic communication techniques, acknowledging the impact of mental health diagnoses, considering the influence of unit rules and restrictions, improving communication skills, managing expectations, and promoting healthy coping mechanisms, healthcare professionals can reduce the risk of anger and aggression and foster a more supportive and therapeutic environment for patients like Frances.


Chapman, J. (2022, October 25). Borderline Personality Disorder. StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK430883/ 

Isobel, S. (2015). ‘Because That’s the Way It’s Always Been Done’: Reviewing the Nurse-Initiated Rules in a Mental Health Unit as a Step Toward Trauma-Informed Care. Issues in Mental Health Nursing, 36(4), 272–278. https://doi.org/10.3109/01612840.2014.982842 

Nitzburg, G. C., Russo, M., Cuesta-Diaz, A., Ospina, L. H., Shanahan, M., Perez-Rodriguez, M. M., McGrath, M., & Burdick, K. E. (2016). Coping strategies and real-world functioning in bipolar disorder. Journal of Affective Disorders, 198, 185–188. https://doi.org/10.1016/j.jad.2016.03.028 

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