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Chapter 5

Chapter 5. THE ABC MODEL OF CRISIS INTERVENTION. A: DEVELOPING AND MAINTAINING RAPPORT. Basic attending skills 1. Attending behaviors: good eye contact, attentive body language, verbal following, soothing calm voice, warmth. Questioning.

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Chapter 5

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  1. Chapter 5 THE ABC MODEL OF CRISIS INTERVENTION

  2. A: DEVELOPING AND MAINTAINING RAPPORT • Basic attending skills • 1. Attending behaviors: good eye contact, attentive body language, verbal following, soothing calm voice, warmth

  3. Questioning • Open-ended questions allow for exploration of what the client just said • Begin with “how” and “what” • Attach the question with something the client just said • Don’t ask “why” questions • Avoid “have you” questions, they are usually forms of hidden advice

  4. Close-ended questions such as “do you”, “does it”, and “are you” lead to answers such as “yes” and “no” which go nowhere. Change them into what and how questions. • Be specific and direct. • Avoid “would you mind”, “could you tell me more”. Direct the client about what to explore

  5. PARAPHRASING • Help client and HS worker know that each understands the other. • Restatement: saying back to client in the HS worker’s own words what s/he heard the client just say. Mostly facts and ideas. • Clarification questions: The HS worker repeats something the client just said in a questioning tone to clarify the whole thing or part of what was said.

  6. REFLECTION OF FEELINGS • KISS (keep it simple student) • The best reflections are short, and focus just on the emotion expressed either verbally or nonverbally.

  7. SUMMARIZATION • This helps move the interview along and into other areas, such as the C section. • Useful when the HS worker is not sure where to lead the client. • Includes emotions, facts, cognitions disclosed throughout the entire session

  8. B: IDENTIFYING THE PROBLEM • Human Service workers need to identify the nature of the crisis: • 1. precipitating events • 2. cognitions about these events • 3. emotional distress • 4. how the client is functioning socially, academically, occupationally, and behaviorally since the crisis.

  9. ETHICAL ISSUES • HS worker must assess for the following: • 1. suicide • 2. child abuse • 3. elder and disabled adult abuse • 4. danger to others • 5. medical or organic illness, substance abuse

  10. COGNITIVE EXPLORATION • HS worker climbs the cognitive tree with client to understand the inner world, the cognitive schema that has created the crisis. • HS worker must understand client’s frame of reference in order to begin altering these perceptions

  11. THERAPUETIC INTERACTION STATEMENTS • 1. Validation and support statements: these make clients feel that their point of view and subjective experiencing is valid and that the HS worker empathizes with their plight. HS worker lets clients know that their feelings are normal and difficult.

  12. 2. Educational statements: HS worker offers information based on HS worker knowledge about various aspects of the client’s crisis. This helps normalize the experience or corrects false ideas the client might hold.

  13. Empowering statements: these comments help the client feel more powerful and in control. HS worker points out choices available and how client can overcome feelings of helplessness.

  14. 4. Reframing statements: HS worker helps the client view the situation from a slightly different point of view using the client’s frame of reference. Sometimes a positive perspective is changed into a negative one, sometimes a negative perspective is changed into a positive one.

  15. C: COPING • Have client explore their own attempts at coping and think of what they would like to do now. • HS worker then offers alternative coping ideas such as referrals to support groups, 12 step groups,long term, family, or marital therapy, shelters and other agencies, physicians & lawyers

  16. Sometimes HS workers might recommend that clients journal, or read books, view films or participate in assertive training or stress management courses.

  17. Chapter 6 When crisis is a danger

  18. SUICIDE • Myths: • Discussing suicide will make client more likely to attempt • Suicide threats don’t need to be taken seriously • Suicide is an irrational act • Suicide tendencies are inherited • Once someone thinks of suicide, it never goes away • Suicide is always impulsive

  19. Facts and statistics • 1 out of 59 individuals in the U. S. has been affected by the suicide of someone close to them • Rates have remained stable over the past 40 years • About 40,000 people commit suicide and almost 800,000 attempt

  20. Males more likely than females to successfully complete suicide • Females more likely to attempt, but not be successful • Psychiatrists have the highest rate of all professions • Suicide occurs within the first 3 months of improvement from an episode of depression

  21. 15-19 year olds: 2nd highest cause of death, car accidents are the main cause • 25-30% of alcoholics will attempt suicide • 25% of schizophrenics will attempt • 25% of dysthymic disorders will attempt, 12 out of 100,000 will succeed

  22. Clues and symptoms • Giving things away and putting things in order • Writing a will • Withdrawing from usual activities • Preoccupation with death • The recent death of a friend or relative • Feeling hopeless, helpless, and worthless

  23. Increased substance abuse • Displaying psychotic behaviors • Verbal hints, “I’m no use to anyone, what’s the point?” • Agitated depression • Living alone

  24. Suicide Assessment,Risk Level and Strategy

  25. Suicide Assessment,Risk Level and Strategy

  26. MANAGING CLIENTS WHO ARE A DANGER TO OTHERS • Must keep in mind the Tarasoff decision and duty to warn • Must determine if danger is due to a mental disorder (eg. Hearing voices) • Must assess for client’s potential for really harming others • Some have impulse control problems

  27. Assessment • 1. Is the client actively or passively engaged in violent or dangerous behavior now? • 2. does the client state s/he is going to carry out violent/dangerous behavior? • 3. Does client have a plan? • 4. Does the client have the means? • 5. Does the client have a background of violence and dangerous behavior? • 6. Has the client acted on plans for violence in the past?

  28. Intervention • May need involuntary hospitalization • Must report to police if deemed violent to another • May teach clients ways to contain violent urges through anger management groups. • Medication may be useful if client shows severe psychiatric symptoms • Antisocial disorders may be cases to refer to law enforcement • Informing clients that therapists are required by law to report abuse helps control impulses

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