Prevention and Crisis Intervention

A crisis can be a terrible burden on any individual that has or is suffering through one; a crisis can leave a person with a great deal of anxiety and stress. As a crisis intervention worker it is my responsibility to at least try to help those that come into my office. Most that do come to me are going through a crisis of some kind or another and need to work through it. To help them work through their crisis I find that the ABC Model of Crisis Intervention is a great asset.

The ABC Model of Crisis Intervention is an effective approach because I can provide temporary immediate relief. A crisis can be difficult to define but there are three essential parts for a worker to look for while working with a client to define if they are in or have been in a crisis. These parts are 1) a precipitating event; 2) a perception of the event that causes subjective distress; and 3) the failure of a person’s usual coping methods which causes a person experiencing the precipitating event to function at a lower level than before the event (Kanel, 2007).

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I should also make sure to use this three parted definition of a crisis only as guidelines, a crisis should be identified for each client on an individual basis. The reason I find the ABC Model of Crisis Intervention so useful is because it provides me with the guidelines to help the client overcome their crisis. The ABC Model can also be broken down into three stages: (A) Building rapport; (B) Identifying the problem; and (C) Coping (Kanel, 2007).

My goal is to help the clients change their perceptions of the crisis and assimilate the precipitating event into their daily lives. By doing so we can ensure that they keep and/ or gain ego strength and eliminate the possibility that they will become crisis prone. Today I will be working with a new client named Jill who has come to me seeking help as so many other clients have. Jill informs me that she works long hours and is tired by the time she gets home.

She goes on to say that she is usually too tired for intercourse and that because of her lack of sexual responsiveness her husband gets angry. Jill states that he sometimes gets so angry that he does things to her that provokes fear in her. She is even afraid that her husband will find out that she has come to me today for help. The very first thing I did when Jill came into my office was to start the first stage of the ABC Model of Crisis Intervention. This stage, stage A, is about building rapport and can be considered the foundation of the therapeutic encounter (Kanel, 2007). First off I informed Jill of her confidentiality so that I may start to gain her trust. I need to gain her trust so that I may be able to help her help herself. Once she does start to feel rapport and begin to trust me then she will become more open to me, allowing the interview to proceed. I tried to be careful with my attending skills so that I could convey to Jill that I was actually listening to her and was here for her.

I used the SOLER method to manage my nonverbal behavior so that I presented a receptive presence. SOLER refers to: (S) Squaring off; (O) Open posture; (L) Leaning in; (E) Eye contact; (R) Relaxed (Cameron, 2008). By that I mean that I sat Square with Jill while keeping an Open posture and Leaning in slightly; I also kept Eye contact and held a Relaxed natural posture. Using the SOLER method alone is not enough so I also was careful with my facial expressions, hand gestures and other body movements as well. Even after being careful on how I act myself I was also careful to observe Jill’s nonverbal communication. Another main aspect was my listening skill; I listened to everything she said and how she said it. The demonstration of attending, observing and listening skills has an impact on effective reflective verbal responses (Cameron, 2008). Paraphrasing, questioning, reflection and summarization are all important aspects that cannot be performed properly without the skills I mentioned. After I had established rapport with Jill and ensured that we had a reciprocal relationship I was then able to move on to the next phase.

Stage B of the ABC Model of Crisis Intervention is mainly focused around identifying the problem. This can be considered the most crucial aspect of the ABC Model for providing therapeutic interaction. Identifying the precipitating event is important but exploring the client’s perceptions and cognitions are even more important. If I was to actually help Jill then I had to find out her thoughts and feelings revolving around the situation. I already know that Jill is scared of her husband and that he does stuff to her when she does not respond the way he wants sexually. But now that I have gained Jill’s trust and we have moved into the B phase I can now get more specific. I decided to start out with some open-ended questions so that I was able to guide the conversation but also let her take over talking.

After the opening question I posed I was then able to tie all of my other questions to what Jill had just said. My reasoning for this is because when a question is posed effectively essential information can be better gathered (Kanel, 2008). In addition to posing my questions the best I could I also made sure to paraphrase throughout the interview. Paraphrasing is very useful because it helps me clarify what my clients have said. It is smart to clarify so that not only you know that you understand what the client has said but also so that they know you understand. I find it vital that the client knows that I really do hear what they are saying and that I want to understand. Clients can feel comfortable knowing that someone is there for them and can be encouraged to continue on. Not only is paraphrasing important but reflection is also valuable no matter what part of the interview process you are in.

I had to let Jill know that I understand that she is scared and that I was willing to help her work through her feelings. Jill needed to tell someone that she was scared and knowing that I validated that feeling made her feel more powerful. By being able to express their own feelings clients are then more able to manage those feelings and express them in a more positive manner (Kanel, 2007). Knowing that I was there to hear what she had to say and to accept her feelings Jill was able to feel more comfortable talking. The reason that all of that is so important is because we need to identify the client’s perception of the event. The perception of the event is by far the most crucial because it can be most easily and quickly altered (Kanel, 2007). By knowing how the Jill sees the situation and knowing how she feels I can then reframe. Reframing is aimed to change the internal cognitive experience of the client once the current cognitions are known (Kanel, 2007).

Instead of letting her believe she is weak for being scared I reframed Jill’s situation that she is strong for seeking my help today. Reframing is considered part of therapeutic interaction, which helped me aid Jill, as with my other clients, in thinking differently about the situation. I used validation and support statements as well, informing Jill that it was okay for her to be scared and that she is not alone. Further I used educational statements because providing factual information is vital in every crisis (Kanel, 2007). Lastly with the therapeutic interactions I tried use empowering statements so that I could encourage Jill. My main goal was to inform Jill that she is not powerless but that she does have control in her life. Another important aspect that I conducted throughout the B phase was making ethical checks. I had to find out if Jill was vulnerable to suicide and also if she has any homicidal tendencies toward her husband. I also had to discuss with Jill if she has been diagnosed with any mental or emotional problems. Finding out any medications that she was currently taking was my next step.

I had to check for substance use and/ or abuse as well, which I did so by using my questioning and probing abilities. The last part of the B phase is summarization which was helpful in allowing me to sum up the interview thus far. The key purpose of summarization is to help the client pull their thoughts together (Kanel, 2007). I also had to make sure that I understood everything Jill said correctly and to clarify anything misinterpretations. Summarizing also helped me make a smooth transition into the next phase of the ABC Model. I was able to gather together everything that Jill and I have discussed and start in on the coping. Coping is the C stage of the ABC Model of Crisis Intervention and is the last step of the process. I started out by asking Jill how she has been dealing with the whole situation thus far. I informed Jill that I needed to know everything that she has been doing whether it has been helpful or not. I had to let her know that crying, sleeping, talking, and even eating can be considered coping.

Jill explained to me more about the situation and what she has done to try to make herself feel better. While Jill was informing me of past and current coping methods I was careful to make mental lists of what seemed to work and what did not. Eliciting unhealthy attempts at coping was especially valuable for Jill. The reason for this is because she was became aware of her behavior she was then more open to alternative methods. I knew that Jill would be more likely to follow through with a plan she has developed herself (Kanel, 2007). This is when I decided to encouraged Jill to start thinking of new and better coping methods. After Jill expressed her own ideas I decided I would then propose some suggestions of other ways of coping. My first suggestion was to contact the authorities about the things her husband does to her. I informed her that there are multiple support groups available to her no matter her choices on.

I also let Jill know that if she wanted to try to work things out then marital therapy could be an option for them. Jill was very attentive when I listed different places that could help her and her husband if they wanted to try. Alternatively I suggested different shelters and agencies that she could seek out if she so wished to. With all of the suggested places I offered I was sure to present them in written form as well for her convenience. Clients that feel overwhelmed are more likely to follow through with a referral when it is presented in written form with choices, addresses, phone numbers and fees (Kanel, 2007). I also thought that Jill could do well some bibliotherapy and Reel therapy; I suggested a handful of books and movies that she may be able to relate to.

Lastly I suggested that Jill keep a journal and write in it as often as possible and that she may share it with me if she wishes. By now the session was coming to a close and I started to summarize everything we have discussed including the coping methods. I knew that Jill was scared but I informed her that I would like her to commit to trying some new coping methods. When Jill agreed that she would do so I then asked her to be sure to follow up with me at some point. I wanted to help Jill and I really do hope the best for her. But unfortunately the choice of bettering her situation lies in her own hands and she must make the ultimate choice.

References

Cameron, H. (2008). The Counseling Interview: A Guide for Helping Professions. New York, NY: Palgrave MacMillian. Kanel, K. (2007). A Guideline to Crisis Intervention (3rd ed.). Belmont, CA: Thomas Brooks/Cole.