4 the tools of the trade

 
Chapter Four

©2013, Brooks/Cole Cengage Learning

 Open-ended questions

 Closed-ended questions

 Restatement and summary clarification

 Owning feelings

 Facilitative listening


 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

 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


 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

 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.


 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)


 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.

 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.

 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.


 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.

 Three
conditions crisis worker must
demonstrate to facilitate client growth:
• Empathy
• Genuineness
• Acceptance


 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.


 Essential components:
• Be role free
• Be spontaneous
• Be non-defensive
• Be consistent
• Be a sharer of self


 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.


 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).


 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.


 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.


 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.


 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.


 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.

 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.

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