On the last track, we discussed two factors concerning identifying a crisis. These two factors are definitions of crisis, and key elements of crisis. We have also discussed the common denominators assessment technique.
On this track, we will discuss two important concepts regarding the first stage of interviewing during a crisis intervention. These two concepts are, beginning preparation, and important questions. We will also discuss two simple interviewing techniques.
First Stage of Interviewing During a Crisis Intervention - 2 Concepts
#1 - Beginning Preparation
As you are aware, the first important concept in the first stage of interviewing a client in crisis is beginning preparation. I have found that this stage begins as soon as I begin to get information about my client, for example when an intake worker calls as says simply, "you have a woman coming to see you who is very upset and crying." I have found that the knowledge that a client in crisis will be arriving often makes me feel anxious.
What is your self-awareness like at this stage? Whenever possible, I address my anxiety by taking five minutes before seeing a client in crisis to review questions I will want to ask the client, and to mentally rehearse my introduction. When the client arrives, I try to make clear at the outset of the first interview who I am, and the purpose of the interview. During the introduction, I try to avoid committing to a narrow response, and express that I am flexible and ready to adapt depending on the client’s needs and reactions.
Since a client in crisis is seeking immediate help and support, I find that the severe anxiety the client is experiencing will not be alleviated unless she or he is given a good reason to feel she or he is understood by, and understands, me in my role as crisis therapist. Would you agree? I realize these are basics. But sometimes I forget the basics under stress.
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Technique: Open Invitation to Talk
To facilitate the beginning of the first crisis interview, I open whenever the client’s state of mind permits it by stating simply, "My name is XX, and I am the crisis therapist." I then make use of the Open Invitation to Talk technique in order to phrase my questions and comments in an open-ended matter that invites the client to talk about her or his situation freely, and precludes yes or no responses.
As a review, I find that the two most helpful phrases in my Open Invitation to Talk technique are "Tell me about yourself!" and "Would you start out by telling me your story as you see it?" As you are aware opening an interview by asking "What time did you call this morning" or "Who is your regular physician?" clearly close the invitation to talk freely, and may make the client feel she or he is at a job interview rather than a counseling session.
#2 - Reviewing Important Questions
A second important concept in the first stage of interviewing a client in crisis is reviewing important questions. As you know, broadly speaking the goal of every initial crisis interview is to gather, collect, and organize information about the client’s crisis. As I conduct the first interview, I try to keep the following list of basic questions in mind to help me structure and organize my listening and note-taking.
What prompted the client to seek help now?
What happened to cause this crisis?
How is the client trying to solve the crisis? What is working? What is not working?
How was the client behaving before the crisis?
How is the client behaving now?
Has anything like this happened to the client before? How was it handled?
What is the client’s history of handling other crises? What was successful? What was not successful?
What are the client’s psychological strengths?
What are the client’s environmental strengths?
What does the client see as the two or three most important problems to be worked on immediately?
How much immediate success is the client likely to have in these or other problem areas?
How life threatening is this situation? Immediately? In the near future?
What things are likely to stand in the way of successful crisis resolution?
What is the client’s mental status?
Another simple interviewing technique which I use to further facilitate the organization of the initial interview is the "One-Question-At-A-Time" technique. In the early process of getting information from a client in crisis, I often find myself tempted to ask more than one question at a time. Do you have this issue too? As you know, this is a natural tendency, especially when the client may be presenting a great deal of information at once, which occurs in most crisis interviewing sessions. I have found that if I ask a series of questions at once, the client will often respond by answering the last question in the series, and either forget about the others, or answer in an obscure way.
Here is an example of how asking multiple questions was counterproductive in the case of Charlene, 23, who had been admitted to the hospital with a broken collarbone. She had been referred to me when it was discovered the injury had been caused in a fight with her husband.
I stated to Charlene, "Let’s return to our discussion of hitting. Is that something new? It’s obviously something you have difficulty dealing with. Has it gone beyond that?"
Charlene stated, "No. In many areas there is so much that is wonderful between us… in this communication bit. It just seems like we fight each other. We’re both strong people personality wise…"
Clearly, asking Charlene a series of questions drew her focus away from the important question of whether or not her husband had hit her before.
Here is an example of how I used the One-Question technique with Darla, 34, who had recently divorced her husband. I stated, "What caused the divorce?" Darla stated, "I didn’t like him at all. We got along okay. I don’t know if it was because I was so young and didn’t know the difference of what. I knew it wasn’t really what I thought love was. But, I just stayed with him…" Clearly, asking only one question of Darla not only resulted in a relatively clear answer to the question, but invited Darla to keep speaking about the specific issue of the feelings that caused her divorce.
Think of the current strategies you use with clients in the initial stage of crisis intervention interviewing. Might adding the One Question technique be helpful to you as a therapist?
On this track, we have discussed two important concepts regarding the first stage of interviewing during a crisis intervention. These two concepts are, beginning preparation, and important questions. We will also discuss two simple interviewing techniques.
On the next track, we will discuss three important factors of the middle phase of the crisis interview. These three factors are Strupp’s conditions, Jacobson’s guidelines, and the smooth focus phrases technique.
Peer-Reviewed Journal Article References:
Beers, T. M., & Foreman, M. E. (1976). Intervention patterns in crisis interviews. Journal of Counseling Psychology, 23(2), 87–91.
Faubert, S. E. (2020). Review of Crisis intervention: Building resilience in troubled times [Review of the book Crisis intervention: Building resilience in troubled times, by L. G. Echterling, J. H. Presbury & J. E. McKee]. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 41(3), 237–238.
Kamen, D. G. (2009). How can we stop our children from hurting themselves? Stages of change, motivational interviewing, and exposure therapy applications for non-suicidal self-injury in children and adolescents. International Journal of Behavioral Consultation and Therapy, 5(1), 106–123.
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What are two techniques that can be useful in the first stage of crisis intervention interviewing?
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