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Understanding behaviour as communication

Behaviour is a means of communication, and all behaviour has a functional element. 'Challenging' behaviour is often described as communicating unmet needs.

Understanding challenging behaviour

People with complex needs have many unmet needs and often find it difficult to express them. Unexpressed needs can result in a person being perceived as having challenging behaviour. People can then find themselves being labelled by service providers as unmotivated, antisocial, offensive, treatment resistant, having a borderline personality disorder, or being aggressive or passive aggressive.

When people behave in a way that challenges us, we need to question why they're behaving in this way. Consider the origins of the behaviour and what the message behind the behaviour might be. This will help you to understand the meaning behind the actions and help avoid attaching labels to a person.

All clients who are part of a drug and alcohol program, including those with complex needs, at times will display behaviours perceived as challenging. Behaviours perceived by services as challenging may include: showing up late (or not at all) to group or other compulsory activities, not sticking to or participating in parts of the program, or breaking program rules (see the table below).

For you, these behaviours can impact on the running of the service or a program, or the dynamics and interactions of a group. This can be one of the biggest challenges facing workers, as it can be hard to find effective strategies to address the person's behaviour while managing the effect these behaviours on other clients and staff.

Some of these behaviours can be interpreted as 'resistant' and/or 'unmotivated', that is, indicating an unwillingness to participate in or cooperate with the program. However, we need to examine the possibility that the behaviours are a way of the client expressing an unmet need or a communication misunderstanding. For you as a worker, finding out what this unmet need is may provide clues to how to respond to the behaviour and help the person remain in treatment and experience a successful treatment outcome.

It's also important to separate behaviours that can be challenging in an individual from behaviours that can be challenging because you're working in a complex environment, such as a residential treatment setting.

Understanding behaviour - three approaches

There are three approaches to understanding behaviour:

  • The internal approach views the behaviour as originating from the individual, including mood, mental health and character.
  • The external approach views the behaviour as a result of the environment, including the physical environment (such as noise levels) and the systemic environmental (such as policy and procedures, staff-to-client ratio, work culture and level of freedom for clients).
  • The interactional approach considers the interaction of both internal and external factors. This approach looks at the interactions among staff, clients and the environment and tends to prioritise an examination of the function of the behaviour.

Using an interactional approach will help you understand the internal and external factors influencing a person's behaviour, and help you identify the factors influencing both negative and positive behaviour. Taking the time to work with the person will help you identify what it is that's causing the problem and if it's caused by underlying complexity.

This table gives some handy tips on how to read people's behaviour and what to do about it.

It lists behaviours identified as challenging by drug and alcohol services through the consultation process of the NADA and CRC No Bars Project. It identifies a possible alternative reason for the behaviour to non compliance or non motivation, linked to the possibility of an underlying complex issue and suggests effective strategies to address these behaviours.

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The spiral of negativity

The 'spiral of negativity' was identified in care staff working in residential settings with older people who had an alcohol related brain injury (ABRI). It refers to the impact of negative perceptions, views and labelling of challenging behaviours on both the client and the caregiver in a service setting (Smith 2006, in Rota-Bartelink 2012) and can occur in any care giving situation.

If staff don't have the appropriate knowledge and skills required, they may perceive the way a person with complex needs communicates or behaves as personally hurtful or offensive, and may behave negatively (subtly or overtly) towards the person. For example, staff may tell colleagues the person is 'unappreciative' or 'manipulative', or may simply avoid contact with the person.

Spiral of negativity

By recognising that negative perceptions, views and labelling of people with complex needs contribute to developing a cycle of mutual distress (the client continues to have unmet needs that cause underlying stress impacting on their treatment, and the worker also suffers from anger, resentment, ineffectiveness and frustration), drug and alcohol workers can become attuned to how their perceptions and reactions can have an effect on the treatment and care a person receives.

The figure above shows the consequences of the downward spiral in a drug and alcohol treatment environment when perceived challenging behaviours are misunderstood, leading to staff frustration and client expulsion.

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