Chapter 3 Exercise
The Six-Step Model of Crisis Intervention
A Crisis Worker’s Narrative
Write your own narrative describing how you would use the six-step model of crisis intervention with Rita whose story is given below. This assignment should be one page long with one paragraph for each of the six steps. This exercise should be completed after reading the entire chapter in order to incorporate other techniques discussed in the chapter into your plan of action in the six-step model.
The Case of Rita
The case of Rita, based on a real situation in my counseling practice, is presented here for you to consider because it clearly demonstrates and emphasizes the six steps in crisis intervention. We suggest that you make notes as you read and reread it. Suppose you were the crisis worker to whom Rita had come for help (in person, not on the telephone).
As an exercise to discover how well you have learned the six-step crisis intervention model, write a personal narrative description of how you might use the six-step model to help Rita during the initial session you have scheduled with her. (We have also written our description. Please write your description before reading ours, found at the end of this case, then compare your crisis intervention strategies with the narrative we have prepared. Remember that in crisis intervention, there is no one best way. Yours may be as effective as ours or more so. We hope this exercise will prove instructive for you.)
Rita is a 35-year-old businesswoman. She is a graduate of high school and a post–high school vocational-technical institute. She holds a certificate in auto mechanics. She has never been to a counselor before. She has come to the crisis worker at the suggestion of a close friend who is a school counselor. Rita owns and operates an automobile tune-up and service shop. She employs and supervises a crew of mechanics, tune-up specialists, and helpers. She works very hard and keeps long hours but maintains some flexibility by employing a manager. Rita’s husband Jake is a college-educated accountant. They have two children: a daughter who is 13, and a son who is 8. The family rarely attends church, and they don’t consider themselves religious, but they are church members. Their close friends are neither from their church nor from their work. Rita’s problem is complex. She constantly feels depressed and unfulfilled.
She craves attention but has difficulty getting it in appropriate ways. For diversion, she participates in a dance group that practices three nights a week and performs on many Friday and Saturday evenings. Rita, Jake, and their children spend most of Sundays at their lake cottage, which is an hour-long drive from their home. Their circle of friends is mainly their neighbors at the lake.
Rita’s marriage has been going downhill for several years. She has become sexually involved with Sam, a wealthy wholesaler of used automobiles. She met him through a business deal whereby she contracted to do the tune-up and service work on a large number of cars for Sam’s company. Sam’s contracts enable Rita’s business to be very successful. Rita states that the “chemistry” between her and Sam is unique and electrifying. She says she and Sam are “head over heels in love with each other.” While she still lives with Jake, she no longer feels any love for him.
According to Rita, Sam is unhappily married too, and Sam and his current wife have two small children. Rita states that she and Sam want to get married, but she doesn’t want to subject her two children to a divorce right now. She is very fearful of her own mother’s wrath if she files for a divorce. Sam fears his wife will “take him to the cleaners” if he leaves her for Rita right now. Lately, Sam has been providing Rita with expensive automobiles, clothing, jewelry, and trips out of town. Also, Sam has been greatly overpaying Rita’s service contracts, making her business flourish. Jake doesn’t know the details of Rita’s business dealings with Sam, but he is puzzled, jealous, frustrated, impulsive, and violent. Jake used to slap Rita occasionally. Recently however, he has become more frustrated, impulsive, and violent. Jake has beaten Rita several times in recent months. Last night he beat her worse than he ever has. Rita has no broken bones, but she has several bruises on her body, legs, and arms. The bruises do not show as long as she wears pantsuits.
Rita has told her problems only to her school counselor friend. She fears that her boyfriend would kill her husband if he found out about the beatings. Rita is frustrated because she cannot participate with the dance group until her bruises go away. Rita is feeling very guilty and depressed. She is not particularly suicidal, however. She is feeling a great deal of anger and hatred toward Jake, and she suffers from very low self-esteem.
She is feeling stress and pressure from her children, from her mother, from Jake, and even from Sam, who wants to spend more and more time with Rita. Recently, Rita and Sam have been taking more and more risks in their meetings. Rita’s depression is getting to the point where she doesn’t care. She has come to the crisis worker in a state of lethargy—almost in a state of emotional immobility. Rita has decided to share her entire story with the worker because she feels she is at her “wit’s end,” and she wouldn’t dare talk with her minister, her physician, or other acquaintances. Rita has never met the crisis worker, and she feels this is the best approach, even though she is uncomfortable sharing all of this with a stranger.
Chapter 3: Basic Crisis Intervention Skills
I. The Six-Step Model of Crisis Intervention
Steps 1,2 & 3 are Listening Activities: Core Listening Skills are Empathy, Genuineness and Acceptance
1. Step One: Defining the Problem
A. Define and understand the problem from the client's (victim's) point of view
B. The crisis worker must understand how the client views the crisis or the intervention strategies may be of no use
2. Step Two: Ensuring Client Safety
A. Minimizing the physical and psychological danger
3. Step Three: Providing Support
A. Communicating to the client (victim) that the crisis intervention worker is a person who cares about the client
Steps 4,5 & 6 are Acting Strategies
4. Step 4: Examining Alternatives
A. Helping clients recognize that alternatives are available and that some choices are better than others
B. Effective crisis workers may recognize many alternatives but will present only appropriate alternatives to the client
5. Step Five: Making Plans
A. An effective plan should:
1. Identify additional persons, groups and resources that can be contacted for immediate support
2. Provide coping mechanisms - something concrete and positive for the client to do now. This is designed to help restore the client's feeling of control and autonomy
6. Step Six: Obtaining Commitment
A. The objective is to enable the client to commit to taking one or more definite, positive, intentional actions designed to move that person toward restoring equilibrium
II. Assessment in Crisis Intervention
1. Definitions:
A. Equilibrium: A state of mental or emotional stability
B. Disequilibrium: Lack or destruction of emotional stability
C. Mobility: Being flexible or adaptable to the physical or social environment. Changing or coping in response to moods, emotions, conditions
D. Immobility: Inability to adapt to the immediate physical or social environment
2. Assessing the Severity of Crisis - ABCs
A. Crisis workers (often law enforcement officers) do not have time to perform complete diagnostic work-ups or obtain in-depth client histories
B. The severity of the crisis is assessed objectively by the crisis worker based on the ABCs of Assessment:
1. Affective: Feeling or emotional tone
a. Is client denying the situation or attempting to avoid involvement?
b. Is the emotional response normal?
c. Is the client's emotional response driven by outside influences or other people?
d. Do others show similar responses in similar situations?
2. Behavioral: Actions or psychomotor activity
a. Lack of activity (immobility) creates feelings of loss of control.
b. Once the client is involved in doing something concrete an element of control is restored.
c. Facilitate positive actions the client can take at once.
3. Cognitive: Thinking patterns
a. How realistic are the client's thinking patterns?
b. To what extent is the client rationalizing or exaggerating?
3. Assessing the Client's Current Emotional Functioning
A. Two major factors:
1. Duration of the crisis: Is it a one-time crisis or a recurring crisis?
a. One time = acute or situational
b. Recurring = chronic, long-term or transcrisis
2. Degree of emotional stamina or coping ability at the client's disposal.
B. Determining the client's current acute or chronic state
1. Determining whether the client is:
a. A normal person in a one-time situational crisis
b. A person with a chronic crisis oriented life history
C. Client's reservoir of emotional strength
1. Feelings of hopelessness is a clue to low reservoir
2. Distorted view of past and present and inability to envision a future
D. Strategies for assessing emotional status
1. Some factors to be considered: age, education, family situation, marital status, job stability, financial stability, drug/alcohol abuse, arrests, social background, intelligence, religion, physical health, medical history, past history dealing with crisis
III. Assessing Alternatives, Coping Mechanisms and Support Systems
1. Questions the crisis worker should ask themselves:
A. What choices does the client currently have that would restore them to a precrisis state of autonomy?
B. What realistic actions (coping mechanisms) can the client take?
C. What institutional, social, vocational, or personal (people) supports are available?
D. Who would care about and be open to assisting the client?
E. What are the financial, social, vocational, and personal impediments to the client's progress?
2. Assessing for suicide/homicide potential
A. Crisis workers (LEO's) must always explore the possibility of the client doing harm to self or others. (covered in depth in Chap. 5)
IV. Listening in Crisis Intervention
Crisis intervention is a pragmatic system of counseling that abbreviates the therapeutic schedule and condenses strategies. These strategies are used by both professional therapists and first responders. Accurate and well honed listening skills are required. Brief descriptions of listening techniques follow:
1. Open-ended questions: Encourage clients to respond with full statements. Are used to elicit from clients something about their feelings, thoughts or behaviors.
A. Request a description: "Please tell me…….", "Tell me about……..", "Show me………"
" In what way does……………?"
B. Focus on plans: "What will you do…….?", "How will you make it happen?", "How will that help you to….?"
C. Stay away from "why" questions: Forces the client to justify their actions.
2. Closed-ended questions: Used to obtain specific information that will help the crisis worker make a fast assessment of what is happening.
A. Request specific information: "When was the first time this happened?", Where are you going to go?", "Does this mean you are going to kill yourself?"
B. Obtain a commitment: "Are you willing to make an appointment to…?", Will you confront him about this?", "When will you do this?"
C. Negative interrogatives: A closed question designed to coerce the listener into agreeing with the speaker: "Don't you agree that….",
3. Owning feelings: Taking ownership of your statements
A. Crisis workers sometimes have to be directive because of the client's immobility: "You know the Family Center is a branch of the police department, and we can have you arrested, don't you?"
4. Taking ownership of confusion: Admitting to the client that you don't understand the situation
A. "Right now, I don't know what to think. You say you love her, yet your actions do everything to drive her away".
5. Conveying understanding: Clients in crisis often feel that no one understands what they are going through
A. "I understand how you feel when she does this".
6. Value judgments: At times crisis workers have to make judgments about the client's behavior, particularly when there is a danger of violence. Owning statements can be used to convey the judgment to the client:
A. "The way you say that really concerns me. I believe it would not get you what you want. I'd have to call the police to see that you are kept safe."
7. Positive reinforcement: Genuineness requires the crisis worker to say what they feel. When clients do well the crisis worker should say so:
A. "It took real guts to come here today and admit you have some problems".
8. Personal integrity: When clients begin to browbeat or attempt to control it does little good to hide feelings:
A. "I don't appreciate your demeaning comments, your language or your attitude"
9. Assertion statements: Crisis workers often have to take control of the situation. Requests for compliance in the form of owning statements ask for specific actions from clients:
A. "I want you to commit to me and yourself that you'll stay away from her fro the next week.
V. Communicating in Crisis Intervention
1. Communicating empathy
A. Attending:
1. Looking, acting and being attentive to the client
2. Nodding, keeping eye contact, smiling, showing appropriate seriousness of expression
3. Focusing fully on the client
B. Verbally communicating empathic understanding:
1. When you can accurately hear and understand the core emotional feelings of the client and accurately and caringly communicate that understanding to the client
C. Nonverbal communication: By the client, transmit emotions - anger, fear, doubt, rejection, emotional stress
1. Body posture, body movement, gestures, vocal pitch, movement of eyes, arms & legs
D. Silence:
1. Clients sometimes need time to work through problems
2. Silence is often a positive & crisis workers should remain attentive and not feel compelled to fill the void
2. Communicating Genuineness (being honest)
A. The crisis worker's awareness of self, feelings and experience is freely and unconditionally available and communicable to the client during a crisis situation
B. Crisis workers often engage in self-disclosure, allowing others to know them through open verbal and nonverbal expression.
3. Communicating Acceptance
A. Crisis workers need to care for and fully accept clients even if the are doing things and saying things that are contrary to the worker's personal beliefs.