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

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 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

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 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

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 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

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 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.

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 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)

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 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.

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 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.

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 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.

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 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

 Three conditions crisis worker must demonstrate to facilitate client growth:

• Empathy • Genuineness • Acceptance

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 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.

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 Essential components: • Be role free • Be spontaneous • Be non-defensive • Be consistent • Be a sharer of self

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 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.

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 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).

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 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.

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 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.

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 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.

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 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.

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 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

 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