In my last series of posts, I described how to do a suicide assessment. In this post, I will discuss crisis counseling.
Crisis counseling is different from suicide assessment, but is still an important activity. Often in clients’ lives unexpected traumatic events happen and clients can feel overwhelmed. They may not have suicidal ideation, but they may feel so confused and stressed out that they cannot cope. In these cases, crisis counseling is necessary.
There are many different approaches to crisis counseling. This post will outline two different approaches that are brief and focused.
ABC Crisis Counseling
This model is cognitively based. The client has thoughts in response to the negative event. It’s those thoughts about the event that bring on negative emotions. Those negative emotions then bring on a level of confusion; clients start to feel overwhelmed, and ineffective coping behaviors are a result. The goal of ABC crisis counseling is to QUICKLY change the way they think, so that emotions can change, so that behaviors can change. Better coping behaviors will help clients manage their emotions, and as a result clients won’t feel so overwhelmed.
3 stages:
A: Develop and maintain contact: In this stage we get the client’s story and develop a therapeutic relationship. Listening skills are vitally important during this stage. We need to actively draw out the story and clients’ strengths in such a way that we will be ready to provide action and coping ideas for clients who may need immediate answers.
B: Identify problem and therapeutic interaction: In this stage, we set doable goals that can be achieved today or in the very near future. We continue to explore the clients’ story as well as strengths that the client offers.
C: Coping: In this stage we develop a specific action plan and establish a contract for follow-up; goal is for client to know exactly what they need to do.
Brief Counseling
This model of crisis counseling utilizes the brief counseling model.
In brief counseling the focus is on the solution not the problem. Brief counseling is focused on goal setting; therefore questions may be the central skill. The goal is positive change with brief therapy: only intervening related to the crisis is done, we are not doing psychotherapy. Other issues may be present, but the focus is on the crisis. Brief counseling recognizes it is normal to have problems, we all benefit from occasional sessions with helpers.
Building rapport is critical in this model. As we are working with clients, we establish a positive expectation. Brief counseling is a very collaborative process in that we work with the client to problem solve. The client’s history and what happened in the past is not important. We listen for strengths, are concrete, and avoid abstractions.
The miracle question can be used to identify specific desired coping behaviors, i.e. “If you were coping w/ this effectively, what would it look like?” It is important to note that the miracle question is not used to establish goals in the same way that it is used in regular counseling. Goals are set mutually by negotiating small specific goals that can be reached. The idea is to instill hope and action- small change will lead to bigger change. It is also important to normalize, i.e. “it’s common to feel overwhelmed…” In addition, give feedback about progress to keep the client moving and engaged. The client must also be prepared for obstacles and barriers.
Yours in the Joy of Knowledge,
Dr. Barbara LoFrisco
Source: Personal communication with Dr. Caroline Wilde, November 20, 2013
