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       
Chapter Four




               ©2013, Brooks/Cole Cengage Learning
 Open-ended       questions

 Closed-ended      questions

 Restatement      and summary clarification

 Owning   feelings

 Facilitative   listening



                    ©2013, Brooks/Cole Cengage Learning
 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
   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
   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
 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
   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)




                         ©2013, Brooks/Cole Cengage Learning
   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
 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
   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
   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
 Three
      conditions crisis worker must
 demonstrate to facilitate client growth:
    • Empathy
    • Genuineness
    • Acceptance




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




                   ©2013, Brooks/Cole Cengage Learning
 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
 Thecrisis worker’s level of involvement is on a
 continuum ranging from:
     • Directive → Collaborative → Nondirective
 Appropriatenessof 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
   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
   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
   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
   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
   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
   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

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4 the tools of the trade

  • 1.  Chapter Four ©2013, Brooks/Cole Cengage Learning
  • 2.  Open-ended questions  Closed-ended questions  Restatement and summary clarification  Owning feelings  Facilitative listening ©2013, Brooks/Cole Cengage Learning
  • 3.  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
  • 4. 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
  • 5. 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
  • 6.  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
  • 7. 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) ©2013, Brooks/Cole Cengage Learning
  • 8. 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
  • 9.  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
  • 10. 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
  • 11. 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
  • 12.  Three conditions crisis worker must demonstrate to facilitate client growth: • Empathy • Genuineness • Acceptance ©2013, Brooks/Cole Cengage Learning
  • 13.  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
  • 14.  Essential components: • Be role free • Be spontaneous • Be non-defensive • Be consistent • Be a sharer of self ©2013, Brooks/Cole Cengage Learning
  • 15.  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
  • 16.  Thecrisis worker’s level of involvement is on a continuum ranging from: • Directive → Collaborative → Nondirective  Appropriatenessof 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
  • 17. 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
  • 18. 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
  • 19. 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
  • 20. 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
  • 21. 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
  • 22. 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