4 the tools of the trade

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4 the tools of the trade

  1. 1.  Chapter Four ©2013, Brooks/Cole Cengage Learning
  2. 2.  Open-ended questions Closed-ended questions Restatement and summary clarification Owning feelings Facilitative listening ©2013, Brooks/Cole Cengage Learning
  3. 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. 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. 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. 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. 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. 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. 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. 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. 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. 12.  Three conditions crisis worker must demonstrate to facilitate client growth: • Empathy • Genuineness • Acceptance ©2013, Brooks/Cole Cengage Learning
  13. 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. 14.  Essential components: • Be role free • Be spontaneous • Be non-defensive • Be consistent • Be a sharer of self ©2013, Brooks/Cole Cengage Learning
  15. 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. 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. 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. 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. 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. 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. 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. 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

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