Final Project
Kishon
Week2GuidedReading.pdf
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Week 2 Guided Reading
Site: Welcome to LSU Online! Course: 2021 Second Spring SW 7807 for Charlotte Tryforos Book: Week 2 Guided Reading
Printed by: Kishon Hunter Date: Monday, April 26, 2021, 9:23 AM
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Description
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Table of contents
1. E�ective Crisis Intervention
2. ABC Model of Crisis Intervention
3. A: Develop & Maintain Rapport 3.1. Attending Skills
3.2. Restatements & Summaries
3.3. Reflection of Feelings
3.4. Telehealth considerations
4. B: Identify & Explore the Problem 4.1. Review of Key Concepts Related to "Exploring the Problem"
4.2. Questioning
4.3. Identifying the precipitating event and hazardous atmosphere
4.4. Identify and explore cognitions
4.5. Identify emotional distress
4.6. Identify precrisis level of functioning and current impairments in functioning
4.7. Making ethical checks
4.8. Using therapeutic Interaction
4.9. Blocks
5. C: Coping 5.1. Explore client's coping e�orts
5.2. Explore alternative coping strategies
5.3. O�er alternative coping strategies
5.4. Secure commitment to plan of action and arrange follow-up
6. Putting it All Together
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1. E�ective Crisis Intervention
Experts in crisis intervention have identified 12 di�erent traits or characteristics that e�ective crisis counselors o�en share. They are listed in the table below.
Traits of E�ective Crisis Counselors
Tolerance for ambiguity
The ability to enter a high-stress environment without at first fully understanding the event itself or the victim’s involvement in it is critical for the crisis counselor.
A calm and neutral demeanor
The counselor must be able to maintain a calm, reassuring demeanor to manage the waves of emotion expressed by the victim. Remaining neutral and not being shocked by the strong feelings expressed by the client are also critical. This demeanor will show the client that it is safe to communicate strong emotions without overpowering or frightening the counselor. Additionally, the counselor can serve as a role model of strength and serenity for the client to emulate in the face of the crisis.
Tenacity
It may only be the determination and tenacity of the counselor that will allow them to “hang in there” with the client and to persist through the crisis until a resolution is reached.
Optimism The counselor’s belief that people are resilient and resourceful creatures, capable of recovering from horrific circumstances and emerging (perhaps) stronger than before is a core value in crisis intervention. Without this belief, the counselor would have difficulty developing an action plan for this client.
Adventurousness The unpredictable nature of crisis, the sense of never knowing what to expect, and its frenetic pace all cry out for adventurousness in any individual seeking this kind of work.
Flexibility As the counselor observes the client needs and as crisis demands shift and change over time, they must also have the ability to adapt to these changes and to be flexible enough to adjust the course of the intervention.
Confidence The counselor’s self-knowledge and strong belief in one’s self-efficacy in helping others are critical ingredients for success in crisis work.
Little need to rescue
A counselor’s “rescue fantasy” invites over-involvement with a client, tends to assume ownership of a problem, and obscures objectivity in crisis work.
Capacity for listening
The crisis counselor must be able to demonstrate effective listening skills and all that listening implies. The counselor with a capacity for listening knows when to let the victim lead the way, when to be active in gathering information, and how to avoid being too intrusive with a distressed victim wishing to talk.
Awareness of trauma indicators
The counselor must be prepared to make decisions based upon observations of the client’s response to crisis. Are there more critical safety issues that should be addressed? Medical concerns? Need to move to a more secure environment?
Openness to individual crisis reactions
Because crisis victims bring to the experience their own unique contexts consisting of family relationships, learning histories, unmet and satisfied needs, and their own unique modes of perceiving and responding to the world around them, the effective crisis counselor will not enter this encounter with any preconceived notions about how the client should react to the crisis. Rather, the counselor will understand the client by listening to their expression of the crisis experience.
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Capacity for information management
When information floods the counselor, they must be able to sort it out and make an assessment of the client pertaining to the action plan.
From Cavaiola, A.A., & Colford, J. E. (2011). Crisis intervention case book. Belmont, CA: Brooks/Cole Cengage Learning.
REFLECT: Think about yourself. Which of these characteristics are your strengths? Which of these do you think you may struggle with?
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2. ABC Model of Crisis Intervention
Before discussing specific skills, let’s review the A-B-C framework for crisis counseling that we will be using in this course. The figure below illustrates the flow of the model.
In Week 2 Guided Reading, we will review the purposes of each stage, learn about key skills for working in each stage, and discuss a tool for following the model and documentation.
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3. A: Develop & Maintain Rapport
The purpose of the A stage is to build a trusting relationship with the client. In order to develop this rapport, social workers must create an environment that establishes empathy, congruence, and acceptance. Social workers need to be skilled in active listening, which includes techniques like reflecting feelings and paraphrasing. These techniques help a client to feel heard and feel comfortable accessing the help they need to manage their crisis.
Active Listening
Active listening allows helpers to show that they understand the person in crisis without actually saying the words “I understand.” People want to feel heard and validated. As social workers, we cannot get to other steps in the model until the person in crisis feels understood and a rapport is built. Before a person will be open to suggestions for planning and committing to a course of action to address a crisis, the worker must establish rapport. This video below captures this concept well in a scenario that may feel familiar.
Active listening is influenced by nonviolent communication and Carl Rogers’ client-centered therapy. Specifically, most crisis intervention experts believe that client growth only occurs within an empathetic environment in which the client feels accepted. Three key components of empathy are positive regard, acceptance, and congruence.
Some of the skills related to active listening that we will cover in this Guided Reading are restatements, summaries, reflection of feelings, owning feelings, open and close-ended questions, and attending skills.
Therapeutic Alliance
Therapeutic alliance is another Rogerian principle. The video below was created for substance abuse counselors but is useful nonetheless (and the narrator has a fun accent).
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Keep these concepts in mind as you move through the course--no matter how much you learn about crisis assessment and intervention, the most important thing is to make sure the client feels heard and understood.
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3.1. Attending Skills
How can we tell when someone is not listening?
They may not be looking at you. They may be slumped in their chair and looking at their phone. They may be looking in your direction but not making eye contact, seeming to gaze behind your head.
These are all examples of attending (or, rather, lack of attending).
Attending skills help us to convey to clients that we are listening to what they are saying using nonverbal communication.
Some examples of aspects of nonverbal communication:
• Head nods
• Eye contact
• Facial expressions
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You also may use minimal encouragers to attend to the person in crisis to let them know you are listening. Some examples are "uh huh" and "yeah."
Some other tips for attending to a person in crisis:
Avoid touch-- this may trigger someone who has a history of trauma, or may just be uncomfortable for the person in crisis. Be sure not to interrupt the person. You may be eager to ask questions and help, but be sure to allow time before speaking to make sure the person is finished.
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3.2. Restatements & Summaries
De�nition
A restatement is a repeating or rephrasing of the content or meaning of the client’s statement(s) that typically contains fewer but similar words and is more concrete and clearer than the client’s statement. Restatements can be phrased either tentatively or as a direct statement. Restatements can paraphrase either the immediately preceding material or material from earlier in the crisis interview.
Examples
“You want to be an e�ective helper.” “It sounds like you are saying that you want to go to the hospital.” “So, to summarize, you think you know what you need to do next.”
When do you use restatements & summaries?
To clarify To focus To support
Helpful Hints
Focus on the content of what the client is trying to communicate Pick the most important part of the client’s statement to paraphrase—the “cutting edge”, the part that is most salient, for which the client has the most energy Keep short and simple Pause before restating to see if the client has finished talking Give restatements slowly and in a supportive tone Focus on the client rather than on other people Vary the manner in which you deliver restatements
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3.3. Re�ection of Feelings
What is a feeling?
In this section, we will discuss feelings versus non-feelings. A feeling is something that the client owns. A feeling is an emotion. O�en, people will say "I feel..." when they actually are stating a thought or cognition, and some words look like feeling words but don't actually refer to a feeling. We want to emphasize true feeling words to keep the focus on the client and their experience. This is a central concept in nonviolent communication. To learn more about NVC, you have an opportunity to do some more practice exercises for Extra Credit--see the Enrichment Exercises for Week 2.
This section will give you some common examples of "non-feelings." You will find a Feeling Words List under Resources on the Week 2 page--this is a great resource of true feelings to expand your emotional vocabulary. You may find it helpful to have this list available as you are completing the role play for this week's assignment. The more specific we can be, the more empathetic we can be. Accurate reflections of specific feelings help to convey that the counselor truly understands. It can also help the client develop insight. You should not hand the client the list of feeling words and ask them to choose from the list. Rather, use this list to help you choose how to reflect feelings as you listen to the client.
Why is it important to distinguish between feelings and cognitions? Feelings can be coped with and cognitions can be reframed. It's a subtle and important di�erence. We will learn more about reframing cognitions later in this reading.
In the discussion below, statements are rephrased to more clearly express feelings. Non-feelings are in blue italics and feeling words are highlighted.
Distinguishing between feelings and thoughts
In general, feelings are NOT being clearly being expressed when the word “feel” is followed by
Words such as “that” “like” “as if” I feel that you should know better.
I feel frustrated because I think you knew better. I feel like a failure.
I feel disappointed that I wasn't successful. I feel as if I’m living with a wall.
I feel hopeless. The pronouns “I” “you” “he” “she” “they” “it”
I feel I am constantly on call. I feel exhausted because it seems like I've been on call a lot lately.
I feel it is useless. I feel annoyed because I think it's useless.
Names or nouns referring to people I feel Amy has been pretty responsible.
I feel confident that I can trust Amy because she's been responsible in the past. I feel my boss is being manipulative.
I feel resentful because I think my boss is being manipulative.
Distinguishing between what we feel and what we think we are
I feel inadequate as a guitar player. I feel disappointed that I'm not a better guitar player yet. I feel impatient with my progress in learning guitar I feel frustrated when I make mistakes while playing guitar.
Distinguishing between what we feel and how others react or behave toward us
Description of what we THINK about how others behave:
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I feel unimportant to the people with whom I work. I feel sad because it seems that my co-workers do not think I am important."
Examples of non-feelings : abandoned, abused, attacked, betrayed, boxed-in, bullied, cheated, coerced, co- opted, cornered, diminished, distrusted, interrupted, intimidated, let down, manipulated, misunderstood, neglected, overworked, patronized, pressured, provoked, put down, rejected, taken for granted, threatened, unappreciated, unheard, unseen, unsupported, unwanted, used.
These words reflect the actions of other people, which we have no control over. If you rephrase to a feeling word that then empowers the client to take control of their own feelings.
What is a re�ection of feelings?
A reflection of feelings is a repeating or rephrasing of the client’s statements, including an explicit identification of feelings. The feelings may have been stated by the client (in exactly the same or similar words), or the helper may infer feelings from the client’s nonverbal behavior, the context, or the content of the client’s message. The reflection may be phrased either tentatively or as a statement.
Examples
“You feel angry at your husband for not being home.” "You seem pleased that you told your boss you didn’t want to work late.” "It sounds like you're feeling frustrated because you think it's unfair, is that right?
Standard Format
You feel ________ because _________.
When do you use a re�ection of feeling?
To identify and intensify feelings To encourage catharsis To clarify To instill hope To encourage self-control To help the client develop insight
Helpful Hints
Listen for the underlying feeling Capture the most salient feeling to reflect to the client Reflect only one feeling at a time State the feeling tentatively, with empathy, and without judgment Try to match the intensity of the feeling Focus on the client’s feelings rather than feelings of other people Vary the feeling words you use Vary the format of reflections
o “I wonder if you’re feeling…”
o “Perhaps you’re feeling…”
o “You sound (or seem)…”
o “I hear you saying you feel…”
Reflect: Think back to your Week 1 assignment. What feelings can you identify from the piece of media that you chose?
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3.4. Telehealth considerations
The Coronavirus pandemic rapidly expanded the use of telehealth services in mental health. However, this is nothing new to the field of crisis intervention. Crisis hotlines have been providing services exclusively over the phone for decades. Connecting with clients via phone and video chat o�ers flexibility and convenience for both you and the client and also helps provide access to clients who may lack transportation or are located in rural areas with scarce resources. But it is not without challenges. Here are some tips for success:
If possible, ensure that you have a physical address (not just mailing address!) on file for each client in case you need to contact emergency services. Casually inquire as to the client's physical location at the time of the call. Don't make a big deal of it and freak the client out, but it is smart to have some idea of whether they are at home. Some agencies may have a policy that you can only provide services when the client is located at their primary residence. Also, most state social work boards require you to be licensed in the state where the client is located. So if the client is traveling away from home and currently located in a state where you are not licensed you may not be able to talk with them. In this case, I would facilitate a warm transfer to the National Suicide Prevention Lifeline at 1-800-273-8255--this hotline is for anybody in crisis or emotional distress, even if they are not currently having thoughts of suicide. Since the client cannot see you making eye contact and nodding your head over the phone, take extra care to use a warm and empathetic tone of voice. If appropriate to the content of the conversation, smile while you are speaking--it really does come through in your voice! Give the client your undivided attention. Resist the temptation to "zone out" or work on other tasks while a client is talking. Even if it seems like they are going on, and on, and on, they will notice if you are not paying attention.
My full-time job is actually in a telehealth format, and has been since before COVID! We obtain and document verbal consent instead of having clients sign paperwork. It definitely takes some creativity and willingness on the part of your organization to be flexible and consider new ways of doing things. It also requires you as a clinician to be willing to let go of the idea that you have to be sitting face to face with someone to connect with them. On the contrary, I think that when a client is in the privacy of their home and with the feeling of anonymity that comes from not being able to see each others' faces, they feel more willing to open up than if they were in an o�ice setting with a clinician sitting across from them. There is something freeing about opening up to a stranger on the phone.
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4. B: Identify & Explore the Problem
The goal of the B stage is to explore the problem to better understand what is happening. We must identify the precipitating event (PE) and determine how the PE a�ects a person’s emotions, behavior, and thoughts. Remember, the PE is the event that pushed a person into a crisis state. It is usually something that occurred very recently. The worker should also assess pre- and post-crisis coping and functioning. This includes eating, sleeping, medication compliance, mood, academic/occupational performance, social activity, etc.
During the stage B phase, the worker must also determine whether the person is at risk for suicide or homicide and if child or elder abuse has been identified. These situations require extra considerations in the Plan and Commit stages in order to keep the person in crisis and others safe. We will discuss assessment and intervention for suicide and violence in detail in Week 3. We will discuss child abuse and elder abuse in later weeks.
It is very important for the clinician to clearly identify and di�erentiate between the precipitating event, hazardous atmosphere, feelings, and decline in functioning. This may seem trivial, but part of e�ective crisis counseling is wading through the chaos to see the situation as clearly as possible. Consider the depiction of counseling below:
If you can identify that, for instance, the client's history of substance abuse (hazardous atmosphere) made them more vulnerable to relapsing (decline in functioning) when they lost their job (precipitating event), then you can more e�ectively help the client.
Here's another example:
Precipitating event: Megan's friend, who lives out of state, canceled a trip to visit at the last minute
Feelings: frustrated, disappointed, resentful, hurt, lonely, sad, nostalgic
Hazardous atmosphere: Decreased social support because many of Megan's friends moved away a�er college. She has a one year old child. She has been struggling to find her footing in her career a�er college.
Perception of Precipitating Event: Megan thinks that she is not important to all of her friends who are now living in other cities. She believes that they have le� her behind for bigger and better things. She thinks that she will never again be able to form the kind of friendships that she once had.
Decline in Functioning: Megan has been tearful, not getting dressed or showering daily, not eating or sleeping well, not exercising like she usually does. She usually talks and video chats with friends o�en but is currently avoiding all of them. She has been less patient with her child and her husband lately.
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This section will focus on strategies to help you explore the problem with the client and break down each component of the crisis scenario. It is rare for a client to come to you and be able to communicate the entire scenario clearly. It is up to you, the counselor, to sort through everything they're telling you to understand the big picture.
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4.1. Review of Key Concepts Related to "Exploring the Problem"
Let's review a few key concepts before moving into new content on Stage B: Identifying & Exploring the Problem.
4 Components of Crisis Formation
flowchart title: 4 parts of crisis formation; box 1: precipitating event, box 2: a person's perception of the precipitating event, box 3: emotional distress, 4: decrease in functioning when usual coping fails
A crisis forms when a person experiences an event that they perceive as a threat or loss, which leads to emotional distress and ultimately a decrease in functioning when the person's usual coping methods do not work.
As mentioned last week, I would add one more component--Hazardous Atmosphere. Hazardous Atmosphere describes the circumstances in a person's life that make them vulnerable to crisis.
Phase B of the ABC Model of Crisis Intervention model focuses on gathering more information about each component of the crisis. In this phase you will need to identify the precipitating event and hazardous atmosphere, understand their perceptions of the event, and assess their level of emotional distress, functioning, and coping.
Targets of Crisis Intervention
It is important that the client's problem and functioning are explored thoroughly to inform the next step: Coping.
To meet the goal of improving functioning, the counselor will focus on modifying two targets:
1. The client's perceptions of the precipitating event 2. The client's coping
One of the goals of Phase B is to assess the person's cognition, or perception, related to the crisis. This is also a point in the model that these cognitions can be altered through a crisis worker's use of therapeutic interaction.
You will learn about four key strategies for therapeutic interaction later in this chapter:
1. Validation statements 2. Educational statements 3. Empowering statements 4. Reframing statements
You will also learn to identify and rephrase "blocks," which are words that block e�ective communication.
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4.2. Questioning
Crisis counselors o�en use questions to elicit more information from a client about the crisis. There are two types of questions: open-ended and closed-ended. Open-ended questions are used most o�en because they encourage elaboration and let the client set the flow of the conversation; however, there are situations where closed-ended questions should be used.
Open-Ended Questions
Open-ended questions help elicit authentic responses from a client. When using closed-ended questions, clients may be led to answer a certain way.
Closed-ended: “Are you feeling scared?”
Open-ended: “How are you feeling about that?”
Sometimes open-ended questions are not actually “questions,” but rather statements.
“Tell me about the last time you thought….”
“Tell me more about that.”
Closed-Ended Questions
Closed-ended questions narrow the response choices to yes or no, or two other options. These do not allow for a broad exploration of thoughts and feelings, which is what most questioning is used for in crisis intervention work. However, there are times when closed-ended questions should be used.
Closed-ended questions can be used when a client is resistant to begin the conversation then transition into more open-ended questions to explore the situation
CW: “So, did you feel scared when you got into the car wreck?”
Client: “No!”
CW: “Okay, tell more about how you were feeling.”
Closed-ended questions are also used for clarification, especially surrounding safety issues like homicidal and suicidal ideation and plans.
“So, you said that you have thoughts about suicide. Do you have a plan for how you would complete suicide?”
“You say that you are so angry that you could kill her. Do you have specific plans for killing her?”
Closed-ended questions can also be used to gather demographic and basic information.
“How old are you?”
“Have you ever been hospitalized before?”
“Why” Questions
“Why” questions should be avoided. They can make a client defensive or feel interrogated.
“Why”: Why did you let him come back into your apartment?
Rephrased: So tell me about the events that led up to coming back into your apartment.
If a client is resistant to doing something and you don't understand why:
“Why”: Why won't you talk to him?
Rephrased: What's holding you back from telling him how you feel?
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4.3. Identifying the precipitating event and hazardous atmosphere
De�nitions
The precipitating event (PE) is the trigger of a client’s crisis. It is usually something that happened very recently. Stress may have been building leading up to the PE; however, the PE is the event that marks a sudden and significant decrease in functioning. You might think of it as "the straw that broke the camel's back." It might even be something that is relatively minor, but it is what pushed the client over the edge into crisis. A crisis worker must know what the PE is in order to explore perceptions about the PE and coping alternatives.
Hazardous atmosphere (HA) is a term that refers to other stressors or events in a client's life that may contribute to their ability to cope. Stress at work, family conflict, a history of childhood trauma, underlying mental illness, financial insecurity, etc. may combine to create a vulnerable state that makes clients susceptible to crisis. It's important to explore this and reflect it back to the client to help them gain insight. Keep in mind that Hazardous Atmosphere are factors that were in the client's life prior to the PE.
Everyone has some hazardous atmosphere--it's just the very nature of life. Identifying the client's stressors can help give both of you more insight into the situation. For example, imagine that a client calls you in crisis and is all over the place, talking about family/relationship stu� that happened 10 years ago, stress at work, financial stress, etc. Exploring with the client to find out which of these factors are hazardous atmosphere and which was the PE can help focus your conversation.
Remember this visual from Week 1:
Strategies for Identifying the PE
One way to begin to identify the PE is by starting the crisis interview with, "What brought you to call/come in today?" or "Did something happen recently that led you to call?"
Another helpful question is: "When did you start to feel poorly (or notice changes in your mood/daily routine/etc.)?"
You may also ask: "What was the 'straw that broke the camel's back'?" Using this expression helps you to di�erentiate between the HA and PE and clearly define the PE, or the event that set the crisis into motion.
By identifying the PE, you will then be able to explore changes in coping. Without knowing the PE, it will be di�icult to understand how the client's functioning has changed over time or to o�er alternative coping strategies. It is important to emphasize that the client's emotional distress and change in functioning is tied to an event, rather than an innate failure on the client's part.
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Remember that in most cases, normal crisis responses last between 6 and 8 weeks (at most). If the PE you've identified was longer ago than that, reassess to be sure that something else didn't occur more recently to trigger the crisis. If the client has truly been experiencing symptoms of crisis for longer than 8 weeks they may meet criteria for a psychiatric diagnosis.
Strategies for Identifying Hazardous Atmosphere
Clients sometimes volunteer information about hazardous atmosphere without any prompting. Listen closely during your conversation for information about stress that the client had in their life prior to the PE. Prior trauma also falls into this category. Remember the depiction of the client with a tangled jumble of yarn in their thought bubble, and the clinician rolling it into neat balls? The client will not come out and say: this is my hazardous atmosphere. It is up to you to listen closely and sort the information you receive into categories. If the client does not volunteer information about hazardous atmosphere, I might ask questions like, "So tell me, what else has been going on in your life that has been causing you stress lately?" You might also pick up on Hazardous Atmosphere when exploring functioning and coping, both of which we will discuss later in this reading.
Summarizing
Reflect and summarize what you hear back to the client to help them understand the relationship of hazardous atmosphere and the
precipitating event to their current crisis state. For example, "Wow, it sounds like you have really had a lot going on lately (you may
summarize some of what you have heard), and/or you have been through a lot in your life, and now this has happened (the PE) and you are
really struggling to cope." This not only helps the client feel heard and understood, but also helps them focus on the here and now.
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4.4. Identify and explore cognitions
The Cognition Tree
Kanel, the creator of the ABC Model of Crisis Interventions, uses the metaphor of climbing a tree to explain the process of exploring a person's perceptions related to their crisis.
At the beginning of the crisis interview, the client o�en describes the precipitating event, their emotional pain, and their impairment in functioning. This is the "trunk" of the tree. In order to help tie these components together, the crisis worker is tasked with "climbing the trunk" to get to the "branches and leaves," which are the client's perceptions related to the crisis. This is also called a cognitive key. The goal of the B stage in the ABC model is to "climb the tree" to explore how all the components of the crisis are related to the client's cognitions of the PE.
The crisis worker does this through the use of open-ended questions until the client's underlying thoughts related to their crisis is fully understood. The crisis worker then helps "the leaves change from brown to green" through the use of therapeutic interaction, which we will explore further at the end of this chapter.
Why Exploring the Cognition of the PE is Important
In Week 1 you learned that the client's perception of the PE is what determines whether it's a crisis or merely an unfortunate circumstance.
Recall the example of two classmates who both fail a test. Classmate A thinks, "I failed the test. This is horrible. I'm gong to fail the class and lose my scholarship." With this perception of the event, failing the test is likely to be a crisis. On the other hand, Classmate B may experience failing the test with the following thought pattern: "I failed the test. I'm not happy that I failed the test but it is not a big deal because I can get As on all the other assignments." For Classmate B the event is unlikely to be perceived as a crisis.
Like the branches and twigs of the tree in the image above, cognitions related to a crisis can be windy and intertwined. It is common for there to be multiple thoughts to elicit. A crisis worker o�en will have to use as many as 6 questions to fully understand the meaning of the PE to the client. If you o�er a therapeutic statement before the client truly feels heard and understood, you may be met with resistance from the client. When this happens, you should go back to asking more questions to explore cognitions.
Changing a person's internal perceptions is easier than changing external factors. The crisis worker should aim to focus the crisis interview on exploring things that can easily be changed. Sometimes, it will be necessary for the crisis worker to redirect the client back to their own perceptions of the crisis rather than what other people did or other details of the crisis.
Let's consider a client that comes to talk to a crisis worker at a walk-in mental health clinic. Her 20 year-old- daughter has recently been sentenced to 15 years in federal prison for drug tra�icking. Her daughter moved out of the house at age 18 a�er completing high school, and she seemed to be doing well with a good job
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because she lived in a nice apartment and never asked for money. The daughter's 40-year-old boyfriend is a drug dealer. Her daughter was arrested a�er making a delivery of a large quantity of heroin to an undercover police o�icer. Notice how the crisis worker brings the client's attention back to her own perceptions of the crisis.
Client: I feel so bad. I should have known that she was struggling, then maybe she wouldn't have looked for love in all the wrong places. Now she's in prison. It happened so quickly.
Crisis Worker: It sounds like you are feeling guilty because you think that you could have done something di�erently and your daughter would not be in prison. Does that sound right?
Client: Yes, incredibly guilty. I'm her mom. I'm supposed to know these things. And now she's in prison. She'll never get a job because she's a felon. Her life is ruined....And she is not taking well to life inside. She's been threatened and beaten by other inmates, and now she's on suicide watch!
Crisis Worker: It is hard to see your daughter in so much pain. I want us to focus for a few minutes on you. How have you been doing since you received the verdict?
So in this case the PE was her daughter's sentencing, and her perception of the PE is that it's her fault. She believes that she should have done something di�erently to prevent her daughter from getting involved with a drug dealer. She believes that her daughter's life is ruined and also believes that her daughter is not safe in prison
We can't change the fact that her daughter is in prison, but we can help her find a way to accept and cope with it. Cognitive restructuring, or helping clients to change their thought patterns about their crisis, is a valuable tool in crisis intervention. However, a crisis worker can only use restructuring when they fully understand the client's perceptions of the PE. You should not attempt restructuring until you fully understand the client's thought pattern. We will learn more about using therapeutic interaction to help change the client's perception at the end of this chapter.
In summary, there are two reasons why it is important to thoroughly explore and reflect the client's cognitions of the precipitating event:
1. So the client feels heard and understood. If you o�er a therapeutic statement before the client truly feels heard and understood, you may be met with resistance from the client.
2. So that you can help the client change their perception. One of the targets of crisis intervention is to modify the client's perceptions of the precipitating event, and a crisis worker can only do this when they fully understand the client's perceptions of the PE.
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4.5. Identify emotional distress
Focus Feeling
An important component of crisis intervention is allowing a client to express their emotions surrounding the precipitating event (PE). The crisis worker can gather information about a client's emotions during Phase A when establishing rapport through reflecting feelings. In Phase B, the crisis worker will focus on establishing a "focus feeling."
The focus feeling is the salient emotion that the client is experiencing. People o�en experience more than one feeling at time, and it is important to help the client to identify the emotion that is most distressing, prevalent, or intense. This focus feeling will be used in the Coping phase to help the client build a "plan of action" for addressing the crisis.
The example below provides sample language for helping a client identify a focus feeling.
Crisis Worker: We've been talking for awhile now, and I want to make sure we are on the same page.
Client: Okay.
Crisis Worker: You've shared that, since the court date when your daughter was sentenced, you've felt guilty because you didn't know about the illegal activities she was involved in and so you weren't able to intervene. You've felt scared that your daughter will be hurt in prison and that she may kill herself in prison. You also shared that you've been feeling angry that your daughter would participate in illegal activities. Out of these feelings-- guilty, scared, angry--which is the main feeling you are experiencing?
Client: Well, I was pretty angry for awhile, but since she's been on suicide watch, I've been mainly scared. I'm scared I'm going to lose my daughter. I'm scared that she is going to die and not know how much I love her.
You may find it helpful to make a list of feelings you identify as you are building rapport and exploring the problem, and read it back to the client to summarize and invite them to identify a focus feeling. The Crisis Contact Note you will utilize in this course provides a template for this.
Standard format: I’ve heard you say that you’re feeling ____, _____, _____, and you’re also feeling _____. I’m wondering, which of those do you think that you’re feeling the most right now?
Note: in crises involving suicidal or violent ideation, the focus feeling is always ambivalence. We will learn more about this next week.
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4.6. Identify precrisis level of functioning and current impairments in functioning
A drop in functioning is a key criterion for a person to be in a true crisis. To understand if there is a drop in functioning, we must explore both current and usual functioning in all areas of the person's life: occupational, academic, behavioral, social, interpersonal, family, self-care, etc.
The crisis worker must explore functioning in all areas at both the client's current and precrisis states. To know if there is a change in functioning since the PE, the crisis worker must know the client's usual and current functioning. The goal of crisis intervention is to bring the client's functioning back to the precrisis level or to improve beyond the precrisis level.
A client's decline in functioning a�er a PE is linked to their emotional distress. The more emotional distress a person experiences, the more likely their functioning will be impaired.
Assessing changes in coping will help the crisis worker and client work together to select coping strategies during the Coping phase. Exploring functioning together also helps the client gain insight. It's important to ask questions regarding functioning, rather than simply relying on whatever information the client volunteers.
Strategies for Exploring Functioning
One tool to assess a client's functioning is by asking questions about the client's daily activities and how they have changed since the precipitating event.
A client's usual daily activities (UDA) refer to precrisis functioning. A client's current daily activities (CDA) refer to their current functioning level.
Consider how the crisis worker explores functioning in the scenario below:
Crisis Worker: So, you are mainly feeling scared that your daughter will die in prison. I imagine that is very overwhelming, and I am wondering how this has a�ected your day-to-day life.
Client: I'm a mess, and my life is a disaster. I can't stop thinking about it.
Crisis Worker: It sounds like this has had a big impact on your life. What do your days typically look like since your daughter went on suicide watch?
Client: Well, my boss has been really understanding. She told me to take all the time o� that I need. It's really nice, but I still have to pay the bills. I've been going to work, but I've been late most days because I've been oversleeping. I try to sleep as much as I can because then I don't have to think about it.
Crisis Worker: So, it sounds like you've been sleeping more since this has happened.
Client: Yes, I sleep all the time. When I'm not sleeping, I'm at work or drinking. I usually don't drink. But since my daughter was arrested, I've been drinking a little more every night.
Crisis Worker: Were you usually late for work before your daughter's sentencing?
Client: No, I'm usually early. I like to have time to myself to get settled before everyone else gets there. I've been feeling so "out of it" and overwhelmed when I'm late.
Crisis Worker: It sounds like getting to work late stresses you out even more, and it kind of snowballs from there. How's your appetite?
Client: I haven't been hungry at all. I know I've lost weight since this all started but I don't even think about eating.
Crisis Worker: Is that normal for you?
Client: No not at all. I love to eat. I used to love cooking and having friends and family over for dinner all the time but these days I'm doing good if I manage to eat a sandwich.
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Crisis Worker: Let's talk more about friends and family. Have you been able to spend time with any of them?
Client: My friends have been calling to check on me but I've stopped answering the phone. We all have kids the same age that grew up together. We usually talk about everything but it's just so hard knowing that their kids are still happy and safe while Sarah's not.
Crisis Worker: And your family?
Client: I usually go check on my mom and bring her dinner a few times a week but I haven't been. I know if she sees me she'll know how much I've been struggling and I don't want to worry her.
Here's an example of how the crisis worker may document this client's functioning in a Crisis Contact Note:
Domain Usual Current
Occupational/Academic Usually arrives to work early
Late to work most days
Family Usually sees her mother a few times per week
Has been avoiding her mother
Social Has a close group of friends with kids the same age. "We talk about everything."
No longer answering her friends' calls or having them over for dinner like she used to
Self-Care
Usually wakes up early to get to work
Doesn't drink
Loves to eat
Sleeping more than usual
Drinking alcohol
Has lost weight due to decreased appetite
Other
Enjoys cooking and entertaining Not cooking much or having anyone over
"I'm a mess, and my life is a disaster."
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4.7. Making ethical checks
Ethical checks are a key part of the crisis interview.
These include:
Suicide Homicide/violence Abuse: child, elder, intimate partner abuse Medical and/or mental health issues Substance misuse/abuse
We will not discuss ethical checks further now because the rest of this course is focused on exploring these issues in more depth.
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4.8. Using therapeutic Interaction
De�nition
The crisis worker can help the client to think di�erently about their situation by determining the client's beliefs and feelings, and then providing therapeutic statements to validate, educate, empower, or reframe.
It is during this stage that the worker relies on more advanced techniques than just active listening.
Types of Therapeutic Interaction
Validation Statements
Purpose: validate and normalize a client's reactions and feelings related to their situation
Examples:
“Right now you feel like everything is falling apart. I want to let you know that other people have gone through this same situation and have survived. You have every reason to believe you can survive, too.”
“It's understandable that you might feel that way.”
“Your pain is understandable considering how di�icult your situation is.”
Because clients see counselors as experts in crisis situations, they o�en take comfort from validating comments from these helpers. Receiving validation from a crisis worker can help a client to realize that their feelings or experiences do not make them weak or bad.
Educational Statements
Purpose: providing information about specific crises to educate the client on common reactions and experiences
Examples:
"You're not alone in this. Research shows that actually 1 in 4 women experience intimate partner violence."
"Many victims have adapted to survive in their circumstances rather than try to escape."
"Leaving an abuser is the most dangerous time for a victim of IPV. It's important to have a plan in place to keep you safe."
It is important for crisis workers to learn statistics about the prevalence of di�erent types of crises and about social, interpersonal, and psychological dynamics. You will learn about these topics throughout the course.
Empowering Statements
Purpose: helping regain power or control over their life
Example:
"It's not your fault that he chose to abuse you. You didn't ask for this. But you do have a choice in what you do now. You can press charges, get into counseling, make a plan to leave, or you can choose to stay. I support you no matter what you decide."
Empowering statements are particularly important to use when someone is crisis has been violated or victimized.
Reframing Statements
Purpose: change the client's thought pattern about the crisis
Examples:
"This has been one of the most di�icult periods of your life. You've been beaten and isolated. You feel weak and powerless. But you're not. You reached out for help, and that was incredibly brave. The need to survive has made you stronger. If you can survive what you've been through already, you can do anything."
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As mentioned before, it is not possible to reframe if the crisis worker does not fully understand the client's perception of the precipitating event. It is important to thoroughly assess the client's thoughts before using reframing statements.
The goal of the reframing statement is to o�er a remedy for the problem that allows the person in crisis to preserve their self-identity.
Reframing can take a lot of practice for crisis workers to use e�ectively. It is an advanced technique.
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4.9. Blocks
The training I received at Baton Rouge Crisis Intervention Center included a discussion of “blocks,” which are, put simply, words that are
inaccurate or ine�ective. I haven’t been able to find this information anywhere else, but it feels reminiscent of Nonviolent Communication.
Listening for these words and rephrasing statements to be more accurate is a helpful tool in reframing cognitions. It’s also important for
clinicians to be aware of and avoid their own use of these words in therapeutic interactions. Remember not to attempt to reframe cognitions
early in the conversation. It is important to build rapport with the client first.
Always and Never
These words are usually an exaggeration. Replacing them with words like usually, o�en, rarely, etc., is more accurate and helps gently reframe the situation. For example:
“He never comes home before midnight,” or “He always goes out with his friends a�er work,” can be rephrased and connected with a reflection of feelings by saying, “It sounds like you’re really feeling frustrated because he o�en stays out late with his friends a�er work.”
“I always choose the wrong guys and get hurt,” can be reframed and connected with an empowering statement: “It sounds like you’ve had a hard time in past relationships, and you think it’s because you chose the wrong guys. Just because you’ve had these experiences in the past does not mean that you’re doomed to repeat them. You can learn from these experiences.”
But
When you say “but,” you subtly contradict whatever came before that. For example:
“I love my husband but he is so lazy.” Try restating and validating that with, “I’m hearing that you really love him, and at the same time you feel frustrated that he doesn’t help out more around the house. That’s understandable.”
Make (as in “you make me so mad” or “how does that make you feel?”)
This word implies that the person is not in control of their own feelings. Nobody and nothing else can make you feel anything. And if it were true that outside forces are in control of your feelings, then it would be impossible to change them. Rephrase to, “When X happens, you feel X.” This opens the door to help the client either reframe their perspective on the situation so that they don’t have that unpleasant feeling or find a way to cope with the feeling.
“It makes me so mad when he stays out late like that,” can be restated as “You feel really angry when your husband stays out with his friends past the kids’ bedtime.”
Instead of saying, “And how does that make you feel?” say, “And how do you feel when that happens?”
Have to, or Need to
You always have a choice. There are really very few situations in life where you have no choice. Choices have consequences, and you may not like the consequences, but reframing obligations as choices is really powerful in helping people feel more in control of their own lives.
“I have to do everything around the house and for the kids on my own because he’s not there,” can be reframed to, “It sounds like it’s really important to you that your kids and your home are well cared for, even if you don’t have help and support.” This leads the client to hopefully respond with something along the lines of, “Yes, it is really important to me,” and now her cognition has been framed from “I have to” to “I choose to because this is important to me.”
“I have to go to work even on days like today when I feel like I’m falling apart,” can be rephrased as, “I think that says a lot about you that you choose to get up and go to work even when you are really struggling. It sounds like your job is really important to you.” This could lead to a discussion of either how they find
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fulfillment and satisfaction in their work, or they feel obligated to keep their job for financial stability. Either way, you can reframe their decision to keep going to work every day as a choice.
"You need to do XYZ to recover from this crisis." Avoid telling clients what they need to do. We will learn more in the C section about why it's important that the plan of action be driven by the client.
"I need to be there for him," can be explored to identify why the client feels obligated and to highlight that you always have a choice. This is a common theme in codependent relationships.
Should
Consider the definition of “should”: used to indicate obligation, duty, or correctness, typically when criticizing someone's actions. When someone says they “should” do something, what they o�en mean is that they are feeling doubt, frustration, guilt, or regret. Digging into this can bring clarity. For example,
A potential response to “I shouldn’t be so upset,” might be “It sounds like you’re feeling guilty for feeling this way. Why do you think that is?” This opens the door to reframe cognitions that the client’s feelings are invalid.
If the client says, “I should have le� him by now,” I might ask, “What has held you back from leaving in the past?” This opens the door to an exploration of what the client truly wants and barriers to achieving their goals. Does she actually want to leave her husband, or does she feel pressured to by others? Or maybe she does want to leave him and is worried about how she will survive financially. This discussion can help the client break free from talking about what they should do and instead decide what they will do.
If a client uses “should” when speaking of someone else, reframe it to focus the client’s ownership of their own feelings. For example, “He should want to be home to spend time with his family,” can be reflected as, “It sounds like you feel hurt that he doesn’t spend more time with you and the kids.”
Can’t
People o�en say, “I can’t,” when what they really mean is, “I don’t want to.” It’s okay to choose not to do something, and it’s important to be honest about that.
Rephrase “I can’t” with some of the following phrases:
I’m not able to
I choose not to
I don’t want to
Try
As Yoda said, “Do or do not. There is no try.” When you say, “I’ll try,” that indicates that something is holding you back. Is it that you don’t really want to do this? Or is there some barrier you’re facing?
For example, if you were to say, “I’ll try to make it to the party tonight,” the true meaning behind that could be, “I don’t really want to go, and at the same time I feel obligated either by social pressure or my own knowledge that it would be good for me to get out,” or alternatively, “I really want to go, and I will need to find a babysitter for my kids.” If a client says, “I’ll try,” I might respond with, “What’s holding you back?” Or even, “It sounds like you don’t really want to.” Remember to avoid asking "why" questions as this phrasing o�en has an accusatory connotation.
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5. C: Coping
The purpose of the C stage is to create a plan of action in collaboration with the person in crisis, establish a commitment from the client to the plan, and arrange follow-up services.
There are three goals to keep in mind when identifying coping strategies:
1. Restoring functioning (refer to your exploration of usual and current daily activities to assess which domains have been impacted)
2. Reducing emotional distress (refer to the focus feeling you identified) 3. Empowering the client to come up with their own solutions and o�er referrals or resources if appropriate
It is very important that the person in crisis is an active participant in this stage. If a plan is created that the person does not agree with or feel comfortable with, they are less likely to follow through. Also, including the person in crisis helps the person to regain a sense of control and self-e�icacy over the problems they are experiencing.
Therefore, the first step of the C stage should be asking questions like: “What have you done in the past when you have been in a similar situation that has helped?” “What have you done so far to manage this problem?” “What do you think would help?” “What do you think you should do next?” Only a�er exploring these alternatives, the worker should suggest options, educate, and provide referrals.
It can be helpful during this stage to continually refer back to the focus feeling. For example, "You said that the main feeling you're experiencing right now is fear. What do you think you can do to cope with that fear?
It's also wise to refer back to your exploration of functioning. Has the client been eating and sleeping poorly, self-isolating, etc? Address these self-care issues in the plan.
Clients who are in crisis are easily overwhelmed and can become paralyzed by indecision. For this reason, it's helpful to have a very specific plan that focuses on small, achievable steps over the next 24-28 hours.
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5.1. Explore client's coping e�orts
The first task of the Coping phase is to explore how the client has coped with crisis or similar problems in the past.
The crisis counselor should begin by asking the person what they want to do in response to the crisis.
" What do you want to do next?"
"What do you think you will do first?"
The crisis worker may also ask what the person has already done to cope with the current crisis.
"You've already made it this far. What have you been doing to get through this?"
"What have you been doing to take care of yourself so far?"
The crisis worker can ask how the client has coped with similar crises or situations in the past.
"You've shared that you are unsure about what to do next. I'm wondering--what have you done in the past when you've felt lost?"
All coping should be considered (whether adaptive or maladaptive). Even maladaptive coping is some action the client has taken to reduce their own su�ering. It can be empowering for the client to hear you validate this. It can also help clients see what has not worked in the past.
"When you've been through di�icult times in the past you withdrew from friends and family because you felt like that's what you had to do to survive. And I'm glad you did that because it helped you get through that di�icult time. I'm wondering, what else have you done to get through di�icult times in the past?" "In the past you've turned to alcohol to help you cope, but I've heard you say that drinking led to some pretty unpleasant consequences, like losing your job."
Remember to work from a strengths perspective. You may have to push some clients to identify past and current coping e�orts, but do not skip this stage. It's appropriate to be persistent in your e�ort to identify and work with the client's strengths.
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5.2. Explore alternative coping strategies
The second step of the Coping phase is to explore alternative coping strategies.
This gives the client the opportunity to come up with solutions to their own problems, which can be empowering and therapeutic.
Clients are more likely to follow through on plans that they create themselves or have "buy in."
"You've mentioned that you o�en talk to your friends to manage stress, and you do not think they will understand this problem. What else do you think may help you to cope?"
It is appropriate for the counselor to be challenging and persistent in this if the client resists. Focus on empowering your client to generate their own ideas.
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5.3. O�er alternative coping strategies
The third step of the Coping phase is to o�er alternative coping strategies. This includes self-care and referrals to resources.
When appropriate, “seed” resources throughout the interview. For example, "I know you are worried about having a safe place to stay. When we finish our conversation, I can help you get connected with a domestic violence shelter, if you'd like."
Avoid being too directive or telling clients what to do. Remember, they will be most likely to follow through on a plan that they developed themselves. Instead of saying, " I think you should do XYZ," try saying, "What do you think about XYZ?" or, "You know, XYZ has been helpful for other people in your situation. Do you think it might be helpful for you?"
The following are several ideas for alternative coping suggestions:
Self-Care
The crisis worker should suggest activities that promote self-care for the client. These activities should be linked to areas of functioning that have been impacted by the crisis. For example, diet, exercise, and sleep are common areas a�ected negatively. Refer to your exploration of usual and current daily activities to assess which domains have been impacted. Resist the temptation to suggest big goals that may be overwhelming for a client who is struggling with basic functioning. A weekly meal plan may do wonders for you, but is probably too ambitious for someone who is in crisis. Focus on small, specific steps over the next 24-48 hours. For example, imagine that the client says that exercise has been a helpful coping tool in the past. Instead of asking the client to set a goal that they will work out 5 days per week (too ambitious) or just that they will start working out again (too vague), ask whether they might like to take a walk outside today. If the client has not been eating regularly, resist the urge to suggest that the client eat three healthy meals per day every day (too ambitious) or start eating regularly again (too vague). Instead, ask whether they might like to get something to eat a�er the call/session today and ask what specifically they will eat: "You mentioned that you have been forgetting to eat since your dog died. When was the last time you ate?" Depending on the client's response, you might say, "Do you think it would be helpful for you to get something to eat once you leave here today?" Ask specifically what they will eat to prevent the client from later being paralyzed by indecision when they walk into the kitchen and deciding it's easier to just go sit back down. "You said that you have not been getting good sleep, and it also sounds like you are exhausted. I'm wondering if you would consider going to bed early tonight to get some good rest."
Natural Social Supports
Natural social support refers to existing relationships in a person's life that provide support. "Who are the people that you usually talk to when you are stressed?" "You seem close to your mother. I'm wondering if she is someone you would be willing to talk to about how down you have been lately?" "Who do you have who is there for you, who you can turn to when you need support?
12-Step Groups
12-step groups are mutual self-help groups that are free and have no time limits for attendance. Sessions can be found in most cities at various hours of the day. Ex: Alcoholics Anonymous (AA), Al-Anon, Co-Dependents Anonymous, Narcotics Anonymous, Cocaine Anonymous We will learn more about substance abuse in Week 5. Keep in mind that referring a client to a 12-step group or substance abuse program is not a magic wand that will instantly fix the problem. These clients o�en struggle with readiness to change. Don't assume that just because you refer a client to one of these programs that they will go.
Long-term Therapy
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O�en, there are long-term underlying issues that accompany crises. In these cases, it is helpful to refer the client to long-term counseling or therapy. "You have mentioned your disappointment with your sister's past life choices several times, and this is more of a long- term issue that would be better addressed in individual or family counseling. I'd like us to 'shi� gears' to the 'here and now' and help you to cope with the loss of your job." "It sounds like you have really been struggling with the loss of your dad since he died last year, and that has made it so much harder for you to cope with everything else in your life. I'm wondering, do you think that grief counseling would be helpful for you?"
Shelters and Community Resources
Crisis workers must be familiar with a variety of community resources Keep an up to date resource list Use 211 and other information and referral lines Create working relationships with sta� at frequently used referral agencies Follow-up on referrals with client and possibly agency within 24 hours Don’t assume clients have the skills to access the services they need. Be prepared to provide assistance with helping clients. On the other hand, you can help build self-e�icacy by encouraging the client to do as much on their own as they are able to. Use your clinical judgment to assess whether a client may need assistance accessing services. If appropriate, go with clients to referral agencies or call together to assist and ensure e�ective communication takes place Know eligibility requirements and referral process in order to give clients a preview of what to expect when calling.
Legal and Medical Referrals
Legal and medical issues o�en accompany crises. It is important for the crisis worker to stay within their scope of practice and refer clients to appropriate professionals as needed. "I'm concerned that you said you hit your head when you fell. You may need to be evaluated for a concussion." "I'm hearing that you have really been struggling with depression lately. Do you think it would be helpful to see your primary care provider to discuss whether medication for depression may be appropriate for you?" "You have options to protect yourself. If you are fearful of your abuser, you can file a restraining order. I'd like to give you the phone number to the Louisiana Bar Association--they can help you get connected to a pro bono lawyer to help you."
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5.4. Secure commitment to plan of action and arrange follow-up
The fourth step of the Coping phase is to review the plan of action developed and secure a commitment from the client that they will follow through.
The plan of action should be detailed, specifying exactly what the client will do. The plan of action should focus on the next 24-48 hours. The plan of action should be generated by the client.
"You've come up with several good ideas for taking action. What do you think you will do first?"
The crisis worker should review the plan of action for the client to approve or modify.
"You've come up with some great strategies for taking care of yourself. You said that a�er you leave here you will call your brother to tell him about how you have been struggling lately, then you'll call and set up an appointment with your therapist. A�er that you'll eat some soup for dinner, take a shower, and then get to bed by 10pm so you can get a good night's sleep. Is there anything you want to add or change?
The crisis worker should elicit a commitment from the client about their plan of action.
"I'd like for you to make a commitment to yourself that you will follow this plan to take care of yourself."
The crisis worker should arrange for follow-up whenever possible, especially when suicide or other ethical risks may be involved. It is important to make sure you have the information you need to make the follow-up.
"I'm worried that you have been so depressed and are alone. I'd like to call you tomorrow to check in with you. What is the best phone number to reach you?"
"This sounds like a great plan. I'd like for us to set up another appointment to check-in in a week."
4/26/2021 Week 2 Guided Reading
https://lsuonline.moodle.lsu.edu/mod/book/tool/print/index.php?id=135771 37/38
6. Putting it All Together
Putting it Together
Let's review the ABC Model by watching some videos. The first two videos are role play scenarios with students from a prior module who graciously agreed to play the role of the client while I acted as the counselor. I have also uploaded a completed Crisis Contact Note for each client. The third video is of Dr. Krista Kanel, the creator of the ABC Model of Crisis Intervention, describing the approach and demonstrating it with a client.
Crisis Contact Note Kaitland
Crisis Contact Note Ebony
4/26/2021 Week 2 Guided Reading
https://lsuonline.moodle.lsu.edu/mod/book/tool/print/index.php?id=135771 38/38
Watch a video of Dr. Kristi Kanel discussing and demonstrating the ABC Model of Crisis Intervention at this link. (Note: You may need to log in using your LSU PAWS information to access the video.)
