Jill is a 27-year-old female who has come in today because she is having problems in her relationship with her husband, Jeremy. She is a nurse who has been working very hard at putting Jeremy through medical school in order to better their lives. She has voiced concerns with being unassertive. She lacks confidence, self-confidence, and seems to be very timid. As she sits in the chair she seems to be in pain as she shifts. She states that she loves her husband very much but that she is unsure how to please him or make him happy anymore. He always seems to be angry no matter how hard she tries. Due to a lack of openness and receptiveness sexually with her husband, she says that he “does things to her”. She has voiced being scared that he will find out that she is here today and asking for help. “The ABC model of crisis intervention is a method for conducting very brief mental health interviews with clients whose functioning level has decreased following a psychosocial stressor” (Kanel, 2006 p. 69)
“Identifying the cognitions of the client as they relate to the precipitating event and then altering them to help decrease unmanageable feelings is the central focus of the method” (Kanel, 2006 p. 69). The crisis intervention was first introduced in 1940 by Caplan and Lindermann. Since that time, others have developed methods that were based on the same methods and procedures. The ABC model that we use today comes from several sources, according to the text, including Jones’s A-B-C method of crisis management and Professor Moline’s class (Crisis intervention). Within the last 20 years the model has been revised to fit more up-to-date information as it is learned. The model‘s theoretical base is derived from scientific information and research along with feedback and experiences of clients and students. Its main purpose is to teach students how to use the model, interview psychiatric patients, and interview those in need of crisis intervention. Although these are the main purposes for using the model, “the components of any one stage could be used at any time” (Kanel, 2006 p. 70).
There are three stages of the ABC Model: Developing and Maintaining Rapport (A), Identifying the Problem (B), and Coping (C). “The foundation of crisis intervention is the development of rapport—a state of understanding and comfort—between client and counselor” (Kanel, 2006 p.70). This stage is so important that no real work can be accomplished before it is established. A person needs to feel understood and validated before they are comfortable enough to open up to you. Some of the skills necessary for this stage are basic attending skills, questions, paraphrasing, reflection of feelings, and summarizations. “The primary purpose of using the basic attending skills is to gain a clear understanding of the internal experience of the crisis as the client sees it” (Kanel, 2006 p. 70). First and foremost, this begins with listening. This is not to be confused with hearing. You really need to listen. You want to show the client that you are completely there for them by maintaining eye contact, using a soft, soothing voice, and have attentive body language (sitting close and having a relaxed posture).
The questions you choose to ask are also important. Close ended questions generally require short answers like “yes” and “no”. These are generally only used to answer factual information. Using open ended questions allows for the client to open up and reveal their true feelings. “When the question is posed effectively, it helps move the interview along and allows gathering essential information about the nature of the crisis” (Kanel, 2006 p. 73). Paraphrasing is also an essential skill. This is done by either restating to the client what it is that you thought you heard, or by using the clarifying technique which is just asking a question that would clarify the information just given by the client. “The intent is to encourage elaboration of the statements to let the client know that you, the counselor, have understood or heard the message; to help the client focus on a specific situation, idea, or action; and to highlight content when attention to affect would be premature or inappropriate” (Kanel, 2006 p. 75), all of which shows the client empathy and helps to establish rapport.
Reflection of feelings is a statement to the client that is based on verbal and nonverbal cues given by the client that expresses the emotional expressions of the situation. This helps the client to see that you truly understand them and their feelings and allows them to open up more. “Clients can then express their own feelings about a situation; learn to manage their feelings, especially negative ones; and express their feelings toward the mental health care provider and agency” (Kanel, 2006 p. 76). Summarization is another component to this stage. This helps to bring bits and pieces of the interview together in order to get a greater understanding of what is going on. It helps to transition over to the next stage which is identifying the problem. Stage B is identifying the problem. This step is said to be the post crucial one. This stage begins at identifying the precipitating event. Obviously Jill and her husband have been having ongoing issues, but it is important to gain knowledge of the exact event that brought her in.
This can be done by asking her “What happened that made you decide to come in?” If she answered with a simple “I don’t know” or “I’m not sure” you would need to problem further. If she answered in a vague way, maybe asking her to explain what the final straw in the situation was. “Another reason for specifying the precipitating event is to be able, later on, to explore how the client has been trying to cope since it happened” (Kanel, 2006 p. 82). Next I want to explore her thoughts about the event. “It is clients’ perceptions of stressful situations that cause them to be in a crisis state as well as the inability to cope with the stress” ((Kanel, 2006 p. 82). Jill has confirmed that her husband hits her on a regular basis. She has stated that he has also raped her on several occasions. He threatens her well-being, her job security, other members of her family, as well as her dog even. Jill may be feeling alone, scared, betrayed, and more.
The person who has vowed to love her and protect her is the very person who is harming. “Assessing the client’s perception of the precipitating event is the most important part of the interview and must be done thoroughly on every visit to check for changing views as well as long-standing views on a variety of issues” (Kanel, 2006 p. 83). Next we want to identify impairment in functioning. This is done by understanding how her perceptions and cognitions of the events have caused problems with functions in other areas of her life such as “occupational, academic, behavioral, social, interpersonal, or family functioning” (Kanel, 2006 p. 83). Different perceptions could cause different effects on functioning in the different areas and should be dealt with separately. How we would help her in one area may not work in another area. Jill is often frightened and scared. She has absolutely no social life outside of work and home. She has missed work on several occasions from either injuries sustained from her husband, or he will not physically let her leave the home.
She enjoys her job and stated that at the current time it is th4 only thing that gives her any joy at all, and now she cannot even enjoy that. She is afraid that even when she is at work that he will show up and somehow get her fired. He has also threatened to spread rumors or make up something that would cause her to lose her license altogether. Within this stage you also want to identify any ethical concerns. Is Jill suicidal or homicidal and if so to want degree? Jill confirms that she is neither of the two and just wishes to get help and understand what she should do next. You want to identify if there are any substance abuse issues. Jill says that she does not drink or use drugs at all, but that she believes her husband does (although she has never physically seen it herself). She stated that he used to be so loving and caring. She can think of no other valid reason for his actions and has concluded that it must be due to drugs. Within the last part of this stage it is suggested to identify therapeutic interventions. This is done by “providing supportive statements, educational information, empowering statements, and reframing statements that will aid the client in thinking differently about the situation and assist them in coping with it” (Kanel, 2006 p. 86).
I would first start by letting Jill know that she is not alone. “When she learns that about 30 percent of women live in such relationships, she may feel differently about herself and the abnormality of the situation” (Kanel, 2006 p. 86). Offering literature that discuss what she is going through will help her to get past the feeling that she is the only one going through something of this nature. Offering such statistics and information will increase her knowledge and offer coping skills in managing her cognitive thoughts. “Battered women, rape survivors, and survivors of child abuse often suffer from learned helplessness stemming from the abuse” (Kanel, 2006 p. 87). They begin that they can only survive the situation rather than escape it. To change this cognitive thought process you give her options. This can include confronting her husband in front of others who will help in the situation, calling the police, pressing charges, support groups, shelters, etc. This helps move Jill from a feeling of powerlessness to feeling like she has some type of control over her life and the situation.
Finally, we move on to the final stage of the model, Coping. You start my summing up the events and asking how they have dealt with them in the past. Jill states that she has not done anything but try not to make her husband mad. She said that she did not feel like the “episodes” were occurring often enough to be considered abuse, and did not want to get her husband into trouble. Exploring what has worked and not worked in the past is helpful, especially if Jill is not ready to leave her husband or press charges. From there we will explore and discuss new coping behaviors. Asking Jill how she thinks she will proceed next is a great place to start. She will be more likely to follow the plan if it is one that she has come up with herself. Jill states that she is ready for a change and that she cannot handle being in this situation any longer. She said that she is not willing to go to a shelter at this point because she fears that she will not be able to keep her job and that she feels like that is just running from her husband and the problem. She said that her course of action is to go file charges against her husband and obtain an order of protection.
She believes that she will stay with family until things have subsided to ensure her safety. In Jill’s case I would support her by stating that these are wise choices and that she should feel proud of herself. I would them offer her information of the support groups in the area and what times they are help. Discussing therapy to help her cope with the situation as well as information on marital counseling if she chooses to go that route. This is not to take away from her previous plan, only to offer other solutions for the future.
I would also make sure that she has emergency shelters and numbers to support lines in domestic violence and rape situations. Giving Jill information that will give her knowledge on what to expect as far as legally and medically is important as well. Knowledge on restraining orders, how to obtain one, and what if covers is applicable to give her since she mentioned this in her plan. The final component in this stage is commitment and follow-up. I will ask Jill for a verbal agreement that she will indeed follow through with our plan of action. “This explains why it is best for clients to develop their own coping plans; they are more likely to follow through with a plan they have formulated themselves” (Kanel, 2006 p. 92).
Kanel, K. (2006). A Guide to Crisis Intervention [VitalSouce bookshelf version]. Retrieved from:http://online.vitalsource.com/books/9781285806457/outline/
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