Week 3 Discussion: Client Case, Summary & Reflection Chapter 4,5&6

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 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

Learning

 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.

 The crisis worker’s level of involvement is on a continuum ranging from:

• Directive → Collaborative → Nondirective

 Appropriateness of 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

Learning

 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

Learning

Chapter Four: The Tools of the Trade
Fundamental Listening Skills
Open-ended Questions
Closed-ended Questions
Closed-ended Questions Cont.
Restatement and Summary Clarification
Owning Feelings
Owning Feelings Cont.
Facilitative Listening
Nine Basic Strategies of Crisis Intervention �(Myer and James, 2005)
Nine Basic Strategies Cont.
Climate of Human Growth
Communicating Empathy
Communicating Genuineness
Communicating Acceptance
Acting in Crisis Intervention
Directive Counseling
Collaborative Counseling
Nondirective Counseling
Types of Immobile Clients
“Rules of the Road” for �Crisis Workers
“Rules of the Road” Cont.