week 2 crisis intervention

Week 2: Question for Discussion

Chapter 3 – The Intervention and Assessment Models
Chapter 4 – Tools of the Trade

Question(s): Case of Elizabeth.

Maria is a 48-year-old white female who is recently divorced. She is not doing well in her love life and comes to you to get some immediate help because she is depressed and thinking about suicide. She spends the first ten minutes weeping uncontrollably and has a hard time putting words together.  Of the nine intentional strategies depicted in your book, which ones are the most important ones in this situation (mention 3 in the order of priorities) and why (explain and justify your answer)?  

Guidelines:The answer should be based on the knowledge obtained from reading the book, no just your opinion. If there are 2 questions in the discussion, you must answer both of them. Your grade will be an average of both questions (50% each question). First question: Mention the adequate strategy for this case scenario (50%). Second part of this question:  explain / justify your answer (50%). 

Chapter Four: The Tools of the Trade

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Fundamental Listening Skills

Open-ended questions

Closed-ended questions

Restatement and summary clarification

Owning feelings

Facilitative listening

©2013, Brooks/Cole Cengage Learning

Open-ended Questions
Encourage clients to respond with more thoughtful answers.
Very helpful during Task Two: Problem Exploration.
Developing open-ended questions:
Request description – “Tell me about…”
Focus on plans – “What will you do…”
Expansion – “So then what happened?”
Assessment – “When that happened, how did you handle it?”
Stay away from “why” questions – client may become defensive
©2013, Brooks/Cole Cengage Learning

Closed-ended Questions
Seek specific, concrete information.
Usually begin with verbs.
do, did, does, can, have, had, will, are, is, and was
Enable the crisis worker to make a quick assessment.
Often used during:
Early stages of intervention
Obtaining client commitments
Assessing safety issues

©2013, Brooks/Cole Cengage Learning

Closed-ended Questions Cont.
Guidelines
Request specific information
“Where are you going to go?”
Obtain a commitment
“Are you willing to make an appointment to…?”
Increasing focus
“Are you on track with me?”
Avoid negative interrogatives
Subtle way of coercing the client
Don’t, doesn’t, isn’t aren’t, and wouldn’t seek agreement
Instead, use an assertive owning statement
©2013, Brooks/Cole Cengage Learning

Restatement and Summary Clarification
The client may not be able to communicate effectively because of the chaotic environment or their cognitive status.
Restatement lets the client know that you are listening.
Often used in Task 6: Obtaining Commitment either by the client or the crisis worker.
©2013, Brooks/Cole Cengage Learning

Owning Feelings
Use “I” statements.
Helps to create a bond between the client and the crisis worker.
Only use “we” when referencing the crisis worker and the client.
Relational markers shorten the psychological distance between the client and crisis worker.
Use right here, right now words (this, these, we, our, here, and now)
Do not use distancing words (that, those, mine, there, and then)
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Owning Feelings Cont.
Do not disown feelings of confusion or frustration.
Convey understanding
Use “I understand” to convey comprehension of the situation, not what the client is going through.
Make value judgments about the client’s current behavior not about their personal character.
Use positive reinforcement to successively approximate a client toward the larger goal.
Set clear limits to maintain personal integrity and safety.
Use assertion statements – direct, specific, owning statements – to obtain a commitment from the client.
©2013, Brooks/Cole Cengage Learning

Facilitative Listening
Four keys aspects:
Really listen to the client.
Focus entirely on the client.
Attend to both verbal and non-verbal messages.
Assess the client’s readiness to enter into psychological/physical contact with others.
Demonstrate attention by both verbal and non-verbal behavior.
Convey understanding of the crisis situation, both the facts and the emotions, to the client.
Help the client to expand their view of the crisis.
Assist the client in comprehending the full impact of the crisis.
©2013, Brooks/Cole Cengage Learning

Nine Basic Strategies of Crisis Intervention
(Myer and James, 2005)
Creating Awareness
Support the client in becoming cognizant of their emotions, behaviors, and thoughts that may hinder mobility.
Allowing Catharsis
Allow the client to cathart but do not let them escalate.
Appropriate for a client who is not able to express their emotions rather than a client whose feelings are already out of control.
Providing Support
Affirm that the client’s reactions are “common” instead of “normal.”
NEVER support a client’s intentions to harm self or others.
Promoting Expansion
Help the client open up their tunnel vision of the crisis.
©2013, Brooks/Cole Cengage Learning

Nine Basic Strategies Cont.
Emphasizing Focus
Assist the client to compartmentalize the crisis into specific manageable components.
Providing Guidance
Offer education and referral information to the client.
Promoting Mobilization
Help the client to develop coping and problem solving skills.
Implementing Order
Aid the client to organize and prioritize problems.
Providing Protection
Protect the client from engaging in psychological or physical harm to self or others.
©2013, Brooks/Cole Cengage Learning

Climate of Human Growth
Three conditions crisis worker must demonstrate to facilitate client growth:
Empathy
Genuineness
Acceptance
©2013, Brooks/Cole Cengage Learning

Communicating Empathy
Five vital techniques:
Attending
Verbally communicating empathic understanding
Reflecting feelings
Non-verbally communicating empathic understanding
Using silence to communicate empathic understanding
Must differentiate empathy from sympathy and distancing.
©2013, Brooks/Cole Cengage Learning

Communicating Genuineness
Essential components:
Be role free
Be spontaneous
Be non-defensive
Be consistent
Be a sharer of self
©2013, Brooks/Cole Cengage Learning

Communicating Acceptance
Complete acceptance of the client
Surpasses the client’s personal qualities, beliefs, problems, situations, situations, or crises.
Crisis worker is able to prize the client even when they are speaking or behaving in a way that is contradictory to the crisis worker’s personal values and beliefs.
©2013, Brooks/Cole Cengage Learning

Acting in Crisis Intervention
The crisis worker’s level of involvement is on a continuum ranging from:
Directive → Collaborative → Nondirective
Appropriateness of crisis worker’s level of involvement depends on the client’s degree of mobility.
Crisis worker attempts to move from directive to non-directive from the initiating crisis event (client is immobile) to resolution (client is mobile).

©2013, Brooks/Cole Cengage Learning

Directive Counseling
An “I” approach to crisis intervention.
Necessary when the client is immobile and can not cope with the crisis situation.
Crisis worker is responsible for defining the problem, exploring alternatives, developing a plan, and guiding the client to follow the plan.
Crisis worker takes temporary control and responsibility for the situation.
Triage score in the high teens or twenties.

©2013, Brooks/Cole Cengage Learning

Collaborative Counseling
A “we” approach to crisis intervention.
The crisis worker is in partnership with the client to assess the problem, explore alternatives, implement a plan, and commit to the plan.
Crisis worker serves as a temporary catalyst, consultant, and facilitator.
Triage score in the high single digits to middle teens.
©2013, Brooks/Cole Cengage Learning

Nondirective Counseling
A “you” approach to crisis intervention.
Desired when the client is able to initiate and follow through with their own action plan.
Client owns the problem, coping mechanisms, plan, action, commitment, and outcomes.
Goal is to give the client as much control as possible.
Crisis worker serves as a support person who listens, encourages, and reflects.
Triage score in the low to mid single digits.
©2013, Brooks/Cole Cengage Learning

Types of Immobile Clients
Needs immediate hospitalization due to chemical use or organic dysfunction.
Suffering from severe depression.
Experiencing a psychotic episode.
Suffering from severe shock, bereavement, or loss.
Suffering from severe anxiety.
Experiencing delusion for any reason.
Is a current danger to self or others.
©2013, Brooks/Cole Cengage Learning

“Rules of the Road” for
Crisis Workers
Recognize individual differences
Each crisis situation and client is unique.
Assess yourself
Consistently examine own values, emotional status, limitations, and readiness.
Show regard for client safety
Seek consultation if necessary.
Provide client support
Demonstrate unconditional positive regard for the client.
Define the problem clearly
Focus on one specific problem from the client’s point of view.
Consider alternatives
Be creative and when possible use alternatives generated by the client.
©2013, Brooks/Cole Cengage Learning

“Rules of the Road” Cont.
Plan action steps
Short-term plans will allow the client to increase their mobility.
Use the client’s coping strengths
Do not ignore the client’s strengths and coping skills.
Use referral resources
Have an up-to-date and easily accessible list of names, telephone numbers, addresses, and contact people for referral.
Develop and use networks
Each individual in a network is a referral source; it is the personal relationship that makes it a network.
Get a commitment
Have the client verbally summarize the action plan and their commitment to it.
Commitment may need to be written and signed if lethality is a factor.
©2013, Brooks/Cole Cengage Learning