Walking on Down Virginia Avenue: Crisis Intervention for I&R”

Walking on Down Virginia Avenue: Crisis Intervention for I&R”
AIRS 31st Annual I&R Training and Education Conference “Mining for I&R Excellence” Reno, NV Tuesday June 2, 2009 Part 1 – 10:30 AM – Noon Part 2 – 2:15 – 3:45 PM John Plonski Database/Training Coordinator Covenant House International President NYS AIRS Voice: (212) Fax: (212)

Your Presenter John has been involved in crisis intervention since Beginning as an overnight volunteer crisis counselor for six years at Response of Suffolk County. Since 1989 John has worked for the Covenant House Nineline, a national crisis hotline for youth under 21 and their families. Over the years he has served Nineline as a crisis worker, shift supervisor, and is currently Nineline’s Database Coordinator. In this position he oversees the maintenance of the agency’s call entry and referral databases. At present Nineline’s referral database consists of over 30,000 records providing referrals throughout the United States and its territories. John has presented basic and advanced crisis intervention skills development training for his own and other agencies. His presentations of various topics at training conferences on the state and national level have been well received. He has also developed skills development trainings for individual agencies. John has consulted on several of the AIRS on-line training modules as well as the AIRS/United Way “Managing the Surge: Volunteer Surge Management Curriculum”. His involvement at the call center in Monroe, LA following the 2005 Gulf storms lead to his becoming a member of the AIRS/United Way Disaster Response Team. He has been a volunteer board member of the New York State Alliance of Information and Referral Systems (NYS AIRS) since 2000 and is currently their President. John can be reached at or by calling Covenant House International at (212) At this point if the group is manageable we can ask them to identify themselves…briefly…I like to do this because it gets them used to talking.

Getting To Know You Now that you know about me and since we are going to be together for a while tell us a bit about yourselves. However, given the size of the group we do ask that you be brief. Name… Agency… I really like… I really don’t like… I think learning about crisis intervention is... After the go around ask the group “Is there anyone in the room who has not ever had a crisis. The lack of response exposes them to the universality of crisis. Should someone raise their hand it is most likely that they did not realize the question was asked in the negative which can be circumspectly explained and an indication of the priority the presenters will place on listening. Any person who has actually never experienced crisis will be congratulated and should probably be invited to do a workshop on how to avoid crisis.

Ground Rules Don’t worry about right and wrong.
Forget about normal…more about that later. Take risks…It is the best way to learn and if you follow rules 1 and 2 it is easy to do. Ask questions…ask enough questions and maybe they won’t make us do role plays…NOT!!! Ask more questions…there may be a prize for the best one. Relax…John’s bark is worse than his bite…and his bark isn’t all that impressive anyway. Have fun…Yes we are here to learn, but it also a time away from work. If John says he’ll get back to something and he dosen’t...remind him…he forgets

What are we going to do today?
The workshop intends to provide I&R workers an understanding of crisis intervention that will enable them to: Understand what crisis is and the continuum of crisis De-escalate and stabilize callers Enable the caller to talk about and work through their feelings to facilitate assessment, problem-solving, and appropriate referral Maintain contact with the caller pending referral or rescue Prepare the caller to follow through with any referrals given

We plan to explain the... Reasons for knowing the basics of crisis intervention Definition of crisis and the nature of the continuum of crisis as it relates to the normal state and coping Basic tenets, elements, and listening skills of client centered crisis intervention Basic crisis intervention Model Do's and Don'ts of crisis intervention

“Do it because we said so!”
Wow!! Seems like a lot. Why so much theory? Why? Why? Why? I’m Stressed!! We are doing it this way because too often we are taught the “How” without being given a thorough understanding of the “Why”. Once we understand the “Why” it becomes easier to understand and implement the “How”. Besides, who likes being told, “Do it because we said so!”

I do I&R. Why should I learn about Crisis Intervention?
Poll the group for their take on the possible reasons. Note them on flipchart then go to next slide and compare. Note any viable additions the group may have for inclusion in future presentations. Let’s ask the group what they think.

I do I&R. Why should I learn about Crisis Intervention?
It is, perhaps the only commonality you have with your Callers. To a degree you already do it. You call it Active Listening People contacting you don’t differentiate between an I&R Service and a Crisis Service It facilitates making “contact” with your Callers It can help you make better referrals to your Callers It helps your Callers better accept the services of the offered referrals AIRS Standards have been amended to require basic crisis intervention skills (see page 18 of handout).

Ok. If you say so. Where do we start?
Let’s begin by talking about assumptions we can make about the person who is not in “Crisis”. They are relatively “normal”. They have basic coping skills. They have ways to cope with day to day problems. Remember normal has several contexts. As it relates to Crisis Intervention people are a product of three affects. Their: Thoughts Feelings Behaviors

And? In our “normal” lives what we think, feel, and the way we behave are in a homeostatic balance which is referred to as the “Normal State”. In the normal state there is a homeostatic balance between a person’s thoughts, feelings and behaviors. In the crisis state there is imbalance between a person’s thoughts, feeling and behaviors. “Homeostatic Balance”? That sounds gnarly to me. And “Normal”? I thought Normal was:

“The Don’t Worry Be Happy State”?
Sorry. If we didn’t throw in some big words we couldn’t call it a workshop. OK so instead of using “Homeostatic Balance” and “Normal State” what if we call it “The Don’t Worry Be Happy State”? Even though this is the state we prefer we also know that there is always stuff that makes us worried and not happy. It is this stuff and the unbalance it creates between our desire to be happy and the thoughts, feelings, and behaviors the stuff generates that can lead to crisis. The Homeostatic Balance is upset and we are no longer living in our Normal State.

So group…How would you define “Crisis”?

So just what is “crisis”?
Crisis is: “A state of acute emotional upset in which an individual or group of individuals experience a temporary inability to cope with a given situation by means of usual problem-solving devices.” Or in other words Crisis is: “A period of psychological disequilibrium, experienced as a result of a hazardous event or situation that constitutes a significant problem that can not be remedied by using familiar coping strategies.”

C’mon, that’s mystifying me. In simple language…what is “crisis” ?
OK in even simpler words. Crisis is when stuff happens that we can’t control or fix on our own and we end up feeling crummy and stuck. Oh, that I understand.

Actually crisis is all about stress.
Stress is a response to a stimulus characterized by heightened physical and psychological arousal response. Stress is a disruption of the homeostatic balance which may be triggered by alarming experiences, real or imaginary. The body reacts releasing epinephrine (adrenaline), norepinephrine, cortisol and cortisone. This leaves the lower brain functions in control inducing three possible responses to the stressor.

Stressor induces one of three responses
Fight Flight Freeze

There are what we will term Autonomic Coping Defenses.
Autonomic Coping Defenses protect the individual from consciously experiencing anxiety and engage automatically when the homeostatic balance

Autonomic Coping Defenses include but are not limited to:
Avoidance Delusions Denial Displacement Dissociation Hallucinations Intellectualization Isolation Projection Rationalization Reaction Formation Repression Somatization Splitting Suppression

Hmmm...So a crisis is like a problem or an emergency.
Not really... A problem may create stress and be difficult to solve but we are able to find a solution without outside intervention. An emergency is a sudden, pressing necessity, such as when a life is in danger requiring immediate attention by a trained professional. It does not require action by the individual.

Tertiary (AKA Adaptive/Maladaptive Resources)
OK, fine. Now you said something about “problem-solving devices” and “coping strategies”. What’s that about? See I’m paying attention. Do I get a prize? As individuals, when things go wrong, we each have our own ways of problem-solving or coping. While we may not actually think about it, we have three levels of resources we use to respond to stress and fix stuff. They are: Primary Resources Secondary Resources Tertiary (AKA Adaptive/Maladaptive Resources) Actually, problem-solving devices and coping strategies are two ways to say pretty much the same thing. As individuals, when things go wrong, we each have our own ways of problem-solving or coping. While we may not actually think about it, we have three levels of resources we use to fix stuff. They are: Primary Resources Secondary Resources Adaptive/Maladaptive Resources (AKA. Tertiary)

So what are “Primary Resources”?
Primary Resources include the individual’s own interpersonal, mechanical skills, and experiences that they use daily to negotiate their lives. They can include immediate family members and close friends with whom they are comfortable interacting. Primary Resources also include the individual’s belief, ethical, and moral systems. Can you suggest other Primary Resources?

Hmm...And “Secondary Resources”?
Secondary Resources are those resources that are less familiar to the individual. They may include relatives, clergy, teachers, and school counselors. What do you think some other Secondary Resources may be?

Ok so far…Now ”Adaptive/Maladaptive Resources”?
Adaptive/Maladaptive Resources are resources the individual turns to when they feel their Primary and Secondary Resources have not been helpful in resolving their situation. Adaptive Resources are those that will assist the individual in addressing their needs. They might include counseling, calling a hotline, going to a crisis center, substance abuse counseling, or hospitalization.

Maladaptive Resources?
Maladaptive Resources are what people use to mask the effect of the precipitating crisis and ultimately harm the individual. Turning to substance abuse or contemplating suicide would be examples of a Maladaptive Resource as they are inherently damaging to the individual. Some other Tertiary Resources?

So how does crisis happen?
Normal state :-). Precipitating event disrupts normal state. The person reacts to event using primary and/or secondary coping skills. Existing coping skills (primary and secondary) are temporarily ineffective or lost. Tertiary resources are called upon. Crisis will resolve or not. Post-crisis functioning. · Baseline functioning: Person is able to balance inner tensions and outer stresses and maintain self without too great an expenditure of energy (normal state). · Precipitating event disrupts normal state. · Person reacts to event using primary and or secondary coping skills. · Existing coping skills (primary and secondary) are temporarily ineffective or lost. · Tertiary resources are called upon. · Crisis will resolve or not. · Post-crisis functioning.

So how does all this help me understand Crisis Intervention and how it works?
Let’s draw a picture. Imagine the line below represents the “Road of Life” (Normal/Homeostatic State). The road is flat and easily negotiated. Natural History of a Crisis · Baseline functioning: Person is able to balance inner tensions and outer stresses and maintain self without too great an expenditure of energy.

Okay…so…? Now, say something upsets the Normal State and “crisis” happens. We get a road like this... Natural History of a Crisis · Precipitating event disrupts normal state. · Person reacts to event. · Existing coping skills are temporarily lost.

Okay…so…and? Now, if Primary and/or Secondary Resources are used, a bridge is built over the crisis and the road is smooth again….the crisis disappears (is resolved). Natural History of a Crisis · Precipitating event disrupts normal state. · Person reacts to event. · Existing coping skills are temporarily lost. · Primary or tertiary resources are called upon. · Crisis will resolve. · Post-crisis functioning…life goes on as before.

Okay…so…and that’s it? Not really. If Primary and/or Secondary Resources don’t work and Adaptive Resources are used. A new bridge is built to a higher level of coping….the crisis disappears and the ability to face similar crises is enhanced. Natural History of a Crisis · Precipitating event disrupts normal state. · Person reacts to event. · Existing coping skills are temporarily lost. · Adaptive resources are called upon. · Crisis will resolve. · Post-crisis functioning…life goes on at a higher level of functioning.

What if nothing is done or Maladaptive Resources are attempted?
Then the Caller is trapped in a state of crisis that continues until they opt to use Adaptive Resources. If the decision is made to not attempt Adaptive Coping the crisis becomes chronic. Natural History of a Crisis · Precipitating event disrupts normal state. · Person reacts to event. · Existing coping skills are temporarily lost. · No resources are called upon or Maladaptive Resources are enjoined. · Crisis does not resolve. · Post-crisis functioning…life goes on at a lower level of coping. Which brings us to….

John you said you were not going to do that!
Well I lied…Besides its tradition.

The Chinese Symbol for Crisis consists of 2 glyphs representing Danger and Opportunity.
The Caller in crisis is in danger of remaining stuck in the crisis but, with effective intervention, has the opportunity to transcend the crisis and develop new levels of functioning and coping.

So it seems crisis is about change. Right?
It is all about change. Changes that happen. Things that can be changed Things that can’t be changed. Crisis is precipitated by life changes. Crisis is resolved by changes in how we address the new situation. We can not change who or what Caller is physically. We can not change the situation or past activities that have created the situation that bought the Caller to us. We can help the Caller change how they react to the crisis. Yes. It is all about change. The crisis is precipitated by life changes and resolved by changes in how we address the new situation. When someone calls or comes to us for help they are using us as an Adaptive Resource. In working with the Caller we need to understand and accept that there are limitations to what we can do to help them. We can not change who or what they are physically. We can not change the situation or past activities that have created the situation that bought them to us. Neither we nor our Callers have control over these matters.

The Good News About Change.
We can help the Caller to effect change by addressing that which they can control, change, or adapt…their Thoughts, Feelings, and Behaviors. As we have said in the Normal State there is a homeostatic balance among the three. In the “Crisis” state there is imbalance. To help the Caller restore balance among the three parts we engage in the Crisis Intervention Process.

AUTOBIOGRAPHY IN FIVE SHORT CHAPTERS By Portia Nelson
I walk, down the street. There is a deep hole in the sidewalk. I fall in I am lost.... I am helpless It isn't my fault. It takes forever to find a way out. II I walk down the same street. I pretend I don't see it. I fall in again I can't believe I am in the same place but it isn't my fault. It still takes a long time to get out. III I walk down the same street There is a deep hole in the sidewalk. I see it there.' I still fall in.... it's a habit, my eyes are open. I know where I am. It is my fault. I get out immediately. IV I walk down the same street. I walk around it. V I walk down another street.

So what does Crisis Intervention do?
Crisis Intervention is a short-term helping process that focuses on resolving the immediate problem by using personal, social, and environmental resources in an effort to mitigate an individual’s response to the situation precipitating the crisis. Crisis Intervention is not psychotherapy or a substitute for psychotherapy. It offers immediate, short term, person centric, focused assistance to help individuals in crisis cope and return to a previous level functioning without endangering themselves or others. Attempts to deal with the immediate crisis or problem. Encourages the development of new coping skills to help the individual function more effectively.

And Crisis Intervention does this how?
Crisis Intervention accomplishes crisis resolution through a focused communication process based on Three Basic Rules Four Fundamentals Seven Active Listening Skills This allows us to create a five step Model to guide the crisis intervention process. .

The Three Tenets (ahem, Rules) of Crisis Intervention are:
Just like anything else in life, the Crisis Intervention Process has rules. The Three Tenets (ahem, Rules) of Crisis Intervention are: The worker and Caller are equals. The Caller determines the pace of the interaction and can make their own choices and decisions. The worker “mirrors” the Caller through Active Listening The three basic rules governing our interactions with people in crisis are borrowed from Carl Rogers Client Centered Treatment Theory. They are: 1. The Counselor and Client are equals. This discounts the concept of the high and mighty counselor enlightening the lesser, powerless Client. It provides that counselor and Client work together, on an equal level, to help the Client better understand themselves, their situation, and their resources. 2. The Client determines the pace of the interaction and can make their own choices and decisions. This says that the worker accepts the Client is a capable, competent person who knows their life, situation, experiences, and abilities better than anyone else. In accepting this we conclude the Client is best equipped to make the decisions that will affect their lives. It also says the Client best knows the rate at which they can explore and resolve their presenting situation. 3. The worker "mirrors" the Client through Active Listening. This rule refers to the "reflective" Active Listening techniques used by the worker to help the Client better hear themselves and, therefore, gain greater objectivity in making the decisions regarding their situation.

Whoa! The worker and Caller are equals? Isn’t that kind of radical?
Not really. The equality of the two participants: Discounts the concept of the high and mighty, all knowing worker Empowers the Caller who is feeling powerless as the result of the their crisis. Allows the worker and Caller work together on an equal level. Not really. The equality of the two participants in the intervention discounts the concept of the high and mighty, all knowing worker while serving to empower the individual who is feeling powerless as the result of the their crisis. It allows the worker and individual work together, on an equal level, to help the individual better understand themselves, their situation, and their resources. Discounts the concept of the high and mighty, all knowing worker…this helps 2 ways. The Caller does not feel subservient to the worker and the responsibility of making the Caller better is removed. The other 2 oare pretty self-explanatory. It helps to facilitate the interaction if we remember that the Caller still has their own resources.

They set the pace and make choices and decisions
They set the pace and make choices and decisions. How does anything ever get done? We have phones to answer! What are you saying! This says that the worker accepts the Caller: Is a capable, competent person who knows their life, situation, experiences, and abilities better than anyone else. Is best equipped to make the decisions that will affect their lives. Best knows the rate at which they can explore and resolve their presenting situation. In the Model we’ll introduce later you will see that it is direct, focused, and not particularly time consuming process. This says that the worker accepts the Caller is a capable, competent person who knows their life, situation, experiences, and abilities better than anyone else. In accepting this we conclude the Caller is best equipped to make the decisions that will affect their lives. It also says the Caller best knows the rate at which they can explore and resolve their presenting situation. When we practice the process later on you will see that it is direct, focused, and not particularly time consuming.

The worker “mirrors” the Client through Active Listening
The worker “mirrors” the Client through Active Listening. Is that like me using my mirror to look fabulous? Actually, this is the part of Crisis Intervention you learned about in “The ABC’s of I&R”. This rule refers to the “reflective” Active Listening techniques used by the worker to help the Client better hear themselves and gain greater objectivity in making the decisions regarding their situation.

Aren’t listening and hearing the same thing? I hear, therefore I listen.
Hearing is the physical act of perceiving sound by the ear. If you are not hearing-impaired, hearing happens. If that weren’t the case there would be no use for alarm clocks. Listening, however, is something you consciously choose to do. Listening requires concentration so that your brain processes meaning from words and sentences. Listening leads to understanding. Most people tend to be "hard of listening" rather than "hard of hearing." When it comes to the similarities between listening and hearing, the only one is you use your ears for both. We generally listen passively, as one does in a lecture. We are distracted by personal thoughts or surroundings. We “listen” while thinking about what to say next. . .our related personal experiences . . .the temperature of the room. . .the Client’s demeanor. . .what we will order for lunch. . .can we rap this up and get home early. What the Client is saying is only a piece of this serendipitous process and the depth of their message is often lost. Because of this, we do not “hear”, much less understand, all that the Client is relating. Important information that we can help them use to resolve their crisis is not explored. Additionally, since the Client feels they are not actively engaged in the problem-solving process our message is not always made clear to the person with whom we are communicating. The seeds of miscommunication and misunderstanding are sown.

Gee. That wasn’t so bad was it
Gee! That wasn’t so bad was it. Now for the four Fundamentals of Crisis Intervention Acceptance Respect Empathy Hope

Acceptance is…? Acceptance is the “non-judgmental” piece of Crisis Intervention we hear so much about. This fundamental says: Regardless of what we think or feel about the Caller we will not judge them, their situation, their actions, or their ability. That people, situations, actions, and abilities are things to be acknowledged, not judged. Without the risk of judgment, people feel safe and become able to communicate freely. This enables the Caller, in concert with the worker, to address the crisis and begin working toward resolution.

Respect is...? Once we accept the need to be non-judgmental we can then embrace the idea of respect. This means: We will respect each person's unique individuality and ability. The worker will respect the Caller enough to accept that they can resolve the crisis at hand. Which brings us to empathy. The worker will respect the Caller enough to accept that they can, with appropriate facilitation, resolve the crisis at hand.

Ahem…This is important. Please try to remember empathy is not sympathy.
Empathy is our attempt to understand what the Caller is feeling and the communication of that understanding to the Caller. In this sense, empathy is a “shared” experience. Sympathy is our attempt to remove the Caller from their feelings so they (we?) will feel better. Sympathy is something we “extend” to them. When we do the “Poor baby, poor baby” of sympathy we are denying the strength of their feelings.

Hmm…Empathy…Wasn’t that an original Star Trek episode?
Empathy is the most powerful fundamental because we seldom, if ever, communicate with others on an empathic level. Once a person experiences communication on this level the novelty of the “reflective” experience a bond is produced which permits open interaction and effective problem solving. Emapthy is the most powerful fundamental because we seldom, if ever, communicate with others on an empathic level. When we are accepting and respectful of the Caller we can communicate with them on a basic feeling level. Once a person experiences communication on this level the novelty of the “reflective” experience, within the perceived safety of the accepting, respectful environment, a bond is produced which permits open interaction and effective problem solving. The Star Trek episode in question was “The Empath” and was aired 12/6/1968 during the 3rd season of the show.

Then what about “Hope”? “Hope you get over this”, doesn’t sound too empathic to me.
The fundamental of hope has it’s basis in the concept that each person has, within themselves, the power to: Change Survive Thrive Regain control of their situation The power and strength of the accepting, respectful, empathic interaction can empower the individual to see that they can develop the skills to move out of the situation they find themselves in an attain higher levels of coping and functioning.

Worker/Caller Equals - check Caller Decides – yep, got that Mirroring/Active Listening – can do Then there’s Acceptance/No Judging – cool Respect – we like that Empathy Good/Sympathy Not – OK Hope – Sounds Good Gotcha…We’re good to go. What’s next? Bring it on!

Okay. You’re getting there
Okay! You’re getting there. We are almost finished with the basic technical stuff. Let’s look at the 7 listening skills then we will have some real fun. We are going to let you do some of the talking. Isn’t that exciting? Rats! Letting us talk…sounds like role-plays to me. Let’s run and hide!

7 Active Listening Skills…Oy! Sounds Like too many!
Don’t worry. As we said, you already do them. The only change is that we are going to try and help you understand why you do them. Chill. This will be a breeze. The Listening Skills are: Silence Encouragment (Minimal and Standard) Reflection Paraphrasing Summarizing Restatement Clarification Let’s run through them real quick. Then a break!

Silence Silence is a simple, yet effective, skill to use if we keep in mind that while it is a lack of sound it is also in indication of inner stillness. Silence allows the client room to think. Silence demonstrates respect for the client’s work in the interaction. Silence passively pressures the Caller to say more. Silence is a skill used throughout the call. Silence can be an important form of communication. The difficulty with silences is that it is often hard to understand exactly what the client is “saying” when they are silent. Possibilities include: They may be thinking and reflecting on the implications of the conversation. The discussion may have released powerful emotions that are struggling to surface. They may be at the critical point of experiencing suppressed and painful feelings. Silence can indicate a moment of ambivalence as the client pauses, trying to decide whether or not to plunge headlong into a difficult area of work. The conversation deals with an area generally experienced as taboo in our society. Silence may also be a signal that the worker’s preceding response was “off base” in relation to the client’s expressed concern. The worker has “missed” the client and the silence is the client’s polite way of saying so. The client may be angry with the worker. Frequent silence in an interview may reflect a systematic attempt to express this anger passively by withholding involvement. Problems can be created if the worker extends the silence over a period of time. Silence can be particularly troublesome if it is used to communicate either a negative reaction or passive resistance. In such cases, the client may experience the silence as a battle of wills. In the face of a very silent client, workers are encouraged to explore the meaning of the silence and/or the feelings behind it. A final point about silence: Tolerance of silence varies from culture to culture. What a Northeasterner might feel is too much silence might feel very comfortable for someone from the South, who might talk much more slowly and allow for more gaps in the conversation. Native Americans typically experience the constant “nattering” of Caucasian people as unproductive and alienating.

And more about Silence Silence lets important points hang in the air for greatest impact. The “Pregnant Pause”. Silence allows the worker to formulate their thoughts into clear and concise messages. Silence expresses feelings. Silence is a skill used throughout the call. Silence can be an important form of communication. The difficulty with silences is that it is often hard to understand exactly what the client is “saying” when they are silent. Possibilities include: They may be thinking and reflecting on the implications of the conversation. The discussion may have released powerful emotions that are struggling to surface. They may be at the critical point of experiencing suppressed and painful feelings. Silence can indicate a moment of ambivalence as the client pauses, trying to decide whether or not to plunge headlong into a difficult area of work. The conversation deals with an area generally experienced as taboo in our society. Silence may also be a signal that the worker’s preceding response was “off base” in relation to the client’s expressed concern. The worker has “missed” the client and the silence is the client’s polite way of saying so. The client may be angry with the worker. Frequent silence in an interview may reflect a systematic attempt to express this anger passively by withholding involvement. Problems can be created if the worker extends the silence over a period of time. Silence can be particularly troublesome if it is used to communicate either a negative reaction or passive resistance. In such cases, the client may experience the silence as a battle of wills. In the face of a very silent client, workers are encouraged to explore the meaning of the silence and/or the feelings behind it. A final point about silence: Tolerance of silence varies from culture to culture. What a Northeasterner might feel is too much silence might feel very comfortable for someone from the South, who might talk much more slowly and allow for more gaps in the conversation. Native Americans typically experience the constant “nattering” of Caucasian people as unproductive and alienating. Can somebody tell us how “silence” expresses feelings?

Encouragement?

Umm…Not exactly. Encouragement is the skill of getting the Client to elaborate on stated points or feelings. In essence we are “encouraging” them to say more. Minimal Encouragers are the nodding head, “Mm-hmm”, “And then”, or the “Go on” we are familiar with. Standard Encouragers are statements much like, “What did you do then?”, or “Can we talk some more about." “Encouragement” is the skill of getting callers to elaborate on stated points or feelings; we’re encouraging them to say more. The distinction between standard encouragers and minimal encouragers is as follows: Encouragers are complete sentences that ask for the caller to elaborate, such as “Tell me more about that.” Minimal encouragers are brief murmurs or statements that do the same, such as “Mm-hm,” “Go on,” and the like. “Operant conditioning” of verbal behavior is possible in a relationship. In studies of operant conditioning, if the experimenter says “Mm-hm” or “Good”, or nods after certain types of words or statements, those classes of words tend to occur more frequently because of being reinforced. Using such procedures could bring about increases in such diverse verbal categories as plural nouns, hostile words, and statements of opinion. In these studies, as on the phones, the person is completely unaware of being influenced in any way by these reinforcements. The implication is that we can inspire callers to use whatever kinds of words and make whatever kinds of statements we have decided to reinforce by using minimal encouragers. This makes it especially important that we not allow our personal biases and opinions to come through in our use of minimal encouragers. We could lead a caller to select a focus or move in a direction that he or she might not have chosen otherwise. Psst…For the Jargon Junkies in the group…think “Operant Conditioning”.

Reflection Reflection is the verbal interpretation of the verbal and non-verbal expressions of the Caller’s emotions. It establishes an empathic relationship with the Caller that permits them to feel understood by and connected to the worker. It also creates an emotional mirror that lets them see an objective view of their situation and their relationship to it. Reflection of feeling is the communication of an understanding of clients’ verbal and nonverbal expressions of emotion related to the problem or situation they’re presenting. Some reasons for reflecting feelings are: The tension induced by crises calls for relief, and reflecting and exploring feelings help to alleviate that tension. Stress stands in the way of an objective assessment of a crisis, inhibiting its resolution. Once calmed, a caller can see more clearly and think more rationally. Reflecting feelings also shows the callers that you understand how they feel, which validates them. Reflection of feelings normalizes callers’ emotional reactions, stressing that they’re understandable. Reflecting feelings gets callers to pay attention to their own feelings and helps them to put their feelings into words to relieve that tension. Reflecting feelings fosters a relationship and builds trust, as callers are more likely to invest in a conversation with someone who seems to understand and see things from their point of view. Reflecting feelings helps workers cultivate empathy for callers with whom we don’t automatically empathize, as when we are talking to callers we do not like, such as perpetrators of crime or abuse. During instances where a caller might be someone we’re struggling to have acceptance or respect for, such as perpetrators, focusing on that person’s feelings might help us view him or her as “human.” Note that merely reflecting feelings isn’t generally enough to convey empathy. It needs to be accompanied by an empathic tone, by a willingness not only to acknowledge but also to focus on feelings, by accepting silences when the caller needs to be silent, and through empathic murmur. Psst! This is the biggie do this right and there are big time brownie points from the Big Guy.

Ahem! Reflection sounds real important. Can You tell us how to do it?
You bet. You do it just like this... Use a stem statement, such as: “Sounds like you feel” Then add a feeling, such as: “sad” Then add context, such as: “that you lost your job after so many years”

Examples of Stem Statements
I wonder if…. I'm not sure if I'm with you but... Correct me if I'm wrong, but...... You appear to be feeling...... Perhaps you're feeling..... It seems that you.... As I hear it, you...... What you mean... What I think I'm hearing is..... Let me see if we are together.... I get the impression that… The message I'm getting is that.... You felt that Sometimes you think ... Tell me .... Let’s talk about ... If I'm hearing you correctly...... What we are talking about is.... So, you are feeling So, as you see it, you feel It sounds as though you are saying...... Is it possible you are saying..... So, from where you sit Right now you're feeling...... You must have felt...

INFORMATION ABOUT YOUR FEELINGS
Examples of Feelings INFORMATION ABOUT YOUR FEELINGS There is no such thing as "controlling" your feelings. You can't control them by ignoring them or denying them. You can't deal with (heal) what you refuse to recognize or respect. Even though you cannot control your feelings, you can control your behaviors and actions. All feelings are positive. They are neutral and true. They supply data and information about what is going on inside you. Use this information. Do not suppress it. You can study these feelings. Feelings inform you of how you are interpreting a person or event. They are telling you the significance you have attached to a particular circumstance. Feelings themselves are non-rational, but they arise for a reason that you have decided is either positive or negative. Feelings are not logical, but they do have a logical base. There is a reason somewhere why you feel the way you do. It is possible that the reason behind the feeling is unconscious. Feelings are experiential and as such can't be reasoned away. You have a right to your feelings. To ignore them is to be an incomplete person. Your body is your ally. It is to your advantage always to respect and listen to what it is saying. Your feelings will never lie to you; your mind will. Maintain contact with your feelings so they can reveal information you need to know about personality. When you have a feeling, study it. It usually says something about your connections with others and yourself. Your feelings do not make choices for you. They simply remind you of the choices you made in the past, which now have been translated into emotional responses. You can't change your feelings without changing your interpretation of people and events. Getting upset at the way you feel is like getting mad at a tree because you don't like the color green. Your eyes are simply telling you what you see. How you interpret what you see is your decision, and your feelings will flow from that choice. (Notes continued on next page)

It’s hard to remember all those
It’s hard to remember all those. Isn’t there an easier way to remember all those feeling words? You really don’t have to remember them because you all ready know them. You experience feelings day in and out. It does make it easier though if you think of it as a game…”Connect the Feelings” to get the whole picture of the person’s situation. For example: You "lose touch" with your feelings when you disguise them or cover them up with other emotions you think more appropriate. When you feel like crying because you are sad, but you pretend to be strong and hold back your legitimate emotions, you do yourself an injustice, which in the long run can do more harm than good. It is beneficial to notice your feelings and just be with them. It is very easy to avoid or deny negative feelings; but they too can reveal useful information to and about you. It is possible to have "mixed" or contradictory emotions. This is especially true when you are dealing with significant people or events in your life. When this happens it is best to acknowledge both emotions so you can deal with (heal) the conflict they represent within you. Do not accept one and deny the other. Use both of them. You can have feelings, as well as thoughts, about your feelings. This complicates the healing process, because you have now compounded the original emotion by feeling something else about that emotion. These additional feelings usually arise from religious, cultural, or educational conditioning that taught you that certain feelings are right. Is it wrong to feel angry with a parent who makes many sacrifices for you? Is it wrong to feel jealous of a sibling? Is it wrong to feel happy that you got something you wanted because of someone else’s misfortune? Feelings are never wrong. The choices you make based on those feelings can sometimes be counterproductive. But remember: you always make the best decision you can at a given moment based on the resources you have at the time. To judge yourself because you have a particular feeling is to give feelings a responsibility they do not have of themselves. Feelings are signals that are calling out from the margin of our attention to be considered. Even if you try to force them back to the periphery, they will not simply "go away." They must be dealt with. They can either "save you or slave you." The choice is always yours! You can pay attention to feelings and your thinking in utilizing the crisis model. Some feelings occur based on your own history, culture, family, and experiences. These are subjective feelings. Feelings that you experience based on the caller’s history, family dynamics, and the like are called objective feelings. These feelings can be used to help the caller. It is important for you to be able to identify which are your subjective feelings and which are the caller’s feelings (objective).

Do you remember “Connect the Dots”?
Start of with a feeling…then when I feel that feeling I feel…and point to someone in the audience…and when I feel…audience and so on. Let’s do a “Connect the Feelings” exercise.

A Few Thoughts About Feelings
There is no such thing as "controlling" your feelings. However, you can you can control your behaviors and actions. All feelings are positive, true, and provide information about what is going on inside you. Feelings themselves are non-rational, but they arise for a reason that you have decided is either positive or negative. You have a right to your feelings. Your feelings will never lie to you; your mind will. There is no such thing as "controlling" your feelings. You can't control them by ignoring them or denying them. You can't deal with (heal) what you refuse to recognize or re-spect. Even though you cannot control your feelings, you can control your behaviors and actions. All feelings are positive. They are neutral and true. They supply data and information about what is going on inside you. Use this information. Do not suppress it. You can study these feelings. Feelings inform you of how you are interpreting a person or event. They are telling you the significance you have attached to a particular circumstance. Feelings themselves are non-rational, but they arise for a reason that you have decided is either positive or negative. Feelings are not logical, but they do have a logical base. There is a reason somewhere why you feel the way you do. It is possible that the reason behind the feeling is unconscious. Feelings are experiential and as such can't be reasoned away. You have a right to your feelings. To ignore them is to be an incomplete person. Your body is your ally. It is to your advantage always to respect and listen to what it is saying. Your feelings will never lie to you; your mind will. Maintain contact with your feelings so they can reveal information you need to know about personality. When you have a feeling, study it. It usually says something about your connections with others and yourself.

A Few More Thoughts About Feelings
Your feelings do not make choices for you. They remind you of past choices, which are now translated into emotional responses. You "lose touch" with your feelings when you disguise them or cover them up with other emotions you think more appropriate. It is possible to have "mixed" or contradictory feelings. You can have feelings, as well as thoughts, about your feelings. Your feelings do not make choices for you. They simply remind you of the choices you made in the past, which now have been translated into emotional responses. You can't change your feelings without changing your interpretation of people and events. Getting upset at the way you feel is like getting mad at a tree because you don't like the color green. Your eyes are simply telling you what you see. How you interpret what you see is your decision, and your feelings will flow from that choice. You "lose touch" with your feelings when you disguise them or cover them up with other emotions you think more appropriate. When you feel like crying because you are sad, but you pretend to be strong and hold back your legitimate emotions, you do yourself an injustice, which in the long run can do more harm than good. It is beneficial to notice your feelings and just be with them. It is very easy to avoid or deny negative feelings; but they too can reveal useful information to and about you. It is possible to have "mixed" or contradictory emotions. This is especially true when you are dealing with significant people or events in your life. When this happens it is best to acknowledge both emotions so you can deal with (heal) the conflict they represent within you. Do not accept one and deny the other. Use both of them. You can have feelings, as well as thoughts, about your feelings. This complicates the healing process, because you have now compounded the original emotion by feeling something else about that emotion. These additional feelings usually arise from religious, cultural, or educational conditioning that taught you that certain feelings are right. Is it wrong to feel angry with a parent who makes many sacrifices for you? Is it wrong to feel jealous of a sibling? Is it wrong to feel happy that you got something you wanted because of someone else's misfortune? Feelings are never wrong. The choices you make based on those feelings can sometimes be counterproductive. But remember: you always make the best decision you can at a given moment based on the resources you have at the time. To judge yourself because you have a particular feeling is to give feelings a responsibility they do not have of themselves. Feelings are signals that are calling out from the margin of our attention to be considered. Even if you try to force them back to the periphery, they will not simply "go away." They must be dealt with. They can either "save you or slave you." The choice is always yours! You can pay attention to feelings and your thinking in utilizing the crisis model. Some feelings occur based on your own history, culture, family, and experiences. These are subjective feelings. Feelings that you experience based on the caller's history, family dynamics, and the like are called objective feelings. These feelings can be used to help the caller. It is important for you to be able to identify which are your subjective feelings and which are the caller's feelings (objective).

How about “Paraphrasing”?
Paraphrasing takes a long, detailed message and feeds it back to the Caller in a condensed version. Let’s practice by paraphrasing the following: When I come back from vacation there is a pile of work that people didn’t do while I was away. Then there is the line of people with problems that need to be solved. Going away doesn’t seem worth all the aggravation but I feel so burnt out. Paraphrasing Paraphrasing refers to the attempt to concentrate on a specific part of the client's message in order to make the theme stand out. It takes a long and detailed message and feeds it back in a short, concise way that focuses on the point of the message. Reasons for paraphrasing include: · People in crisis often experience an internal panic. Long, windy statements frequently are indicators of what's going on inside the mind of the person speaking. · Paraphrasing helps to simplify jumbled messages and makes them more manageable, ad-dressable, and understandable. · Paraphrasing also helps the caller move along more expediently, keeping the focus on point, and freeing the conversation from unnecessary detail that bogs down the process. · Paraphrasing also helps the worker to track the caller's story without having to slow things down in order to feed back every nuance (just what's important). Summarizing Summarizing refers to verbally collecting all the facts and feelings that the caller has shared to this point. Reasons for summarizing are: · Summarization serves as a check to see that we're following the caller up to that point in the conversation. · Summarization is the marker as we prepare to move from step to step within the model. · Summarization can help callers grasp what was learned during the call, making it especially useful to summarize before terminating the call. · Summarization helps us to make sure we're following the story.

And what about “Summarizing”?
Summarizing refers to verbally collecting all the facts and feelings that the Caller has shared with and concisely restating them. Let’s practice by summarizing the same scenario: When I come back from vacation there is a pile of work that people didn’t do while I was away. Then there is the line of people with problems that need to be solved. Going away doesn’t seem worth all the aggravation but I feel so burnt out. Paraphrasing Paraphrasing refers to the attempt to concentrate on a specific part of the client's message in order to make the theme stand out. It takes a long and detailed message and feeds it back in a short, concise way that focuses on the point of the message. Reasons for paraphrasing include: · People in crisis often experience an internal panic. Long, windy statements frequently are indicators of what's going on inside the mind of the person speaking. · Paraphrasing helps to simplify jumbled messages and makes them more manageable, ad-dressable, and understandable. · Paraphrasing also helps the caller move along more expediently, keeping the focus on point, and freeing the conversation from unnecessary detail that bogs down the process. · Paraphrasing also helps the worker to track the caller's story without having to slow things down in order to feed back every nuance (just what's important). Summarizing Summarizing refers to verbally collecting all the facts and feelings that the caller has shared to this point. Reasons for summarizing are: · Summarization serves as a check to see that we're following the caller up to that point in the conversation. · Summarization is the marker as we prepare to move from step to step within the model. · Summarization can help callers grasp what was learned during the call, making it especially useful to summarize before terminating the call. · Summarization helps us to make sure we're following the story.

Gotcha! “Restatement”? Restatement refers to the reflection of a Caller's thinking, meanings, and facts as they perceive them. We put what they've said into our own words. Let’s practice using restatement. You know the scenario: When I come back from vacation there is a pile of work that people didn’t do while I was away. Then there is the line of people with problems that need to be solved. Going away doesn’t seem worth all the aggravation but I feel so burnt out. Restatement Restatement refers to the reflection of a caller's thinking, meanings, and facts as They perceive them. This requires us to show understanding of what clients have shared with us, so we don't parrot (i.e., feed back exactly what the client has said in the exact words); we put what they've said into our own words. Reasons for restating are as follows: · Even though the caller is thinking and saying what they are sharing, that doesn't mean that the caller is listening to himself or herself. Restating helps the caller to finally listen to the facts of his or her situation, thereby gaining greater objectivity. · We can also reframe the way the caller is looking at the problem by restating it. For example, restating to a woman who is reporting that her boyfriend hits her that "It sounds like you're being abused" puts her situation in clearer perspective. Clarification Clarification refers to the search for connections that aren't immediately apparent. It ensures that the counselor and the client are as clear on the issue at hand as possible. Often what isn't clear to us isn't clear to the caller, either.

Yep! And “Clarification” Dude?
Clarification refers to the search for connections that aren't immediately apparent. You know the drill. Let’s practice clarification: When I come back from vacation there is a pile of work that people didn’t do while I was away. Then there is the line of people with problems that need to be solved. Going away doesn’t seem worth all the aggravation but I feel so burnt out. Restatement Restatement refers to the reflection of a caller's thinking, meanings, and facts as They perceive them. This requires us to show understanding of what clients have shared with us, so we don't parrot (i.e., feed back exactly what the client has said in the exact words); we put what they've said into our own words. Reasons for restating are as follows: · Even though the caller is thinking and saying what they are sharing, that doesn't mean that the caller is listening to himself or herself. Restating helps the caller to finally listen to the facts of his or her situation, thereby gaining greater objectivity. · We can also reframe the way the caller is looking at the problem by restating it. For example, restating to a woman who is reporting that her boyfriend hits her that "It sounds like you're being abused" puts her situation in clearer perspective. Clarification Clarification refers to the search for connections that aren't immediately apparent. It ensures that the counselor and the client are as clear on the issue at hand as possible. Often what isn't clear to us isn't clear to the caller, either.

Okay…7 active listening skills
Silence Encouragement (Minimal and Standard) Reflection Paraphrasing Summarizing Restatement Clarification Break Time!?!

Almost, but not quite yet
Almost, but not quite yet! Let’s take a look at what the Active Listening Skills aren’t. Then we will demonstrate how they work. I dunno…On reflection, it sounds like they are hungry and getting cranky. But let’s take a quick look at what active listening isn’t.

Active Listening Skills are not:
Asking questions Self-disclosure Making promises Giving advice Defining right and wrong Asking questions is not listed as a skill because questions serve to create an inequality between the worker and the Client. Questions can also be non-accepting (judgmental), directive, and intrusive. Questions that can be answered in one word serve to stifle the exchange of thoughts and feelings necessary to the Crisis Intervention Process. However we do recognize there are times when we do need specific information to assist the Client. In these instances it is most effective if we phrase the question as a Reflective statement. Another effective way to ask questions is to be sure the question is "open ended". This means the question is constructed in such manner that it has to be answered by a thought not a single word. This serves to open the issue at hand to further exploration. Also notable for its omission is self-disclosure. There will be times when we are working with a Client who is addressing a situation we either have had experience with or been in ourselves. At these times we will feel we need to use our experience to help the Client through their crisis. This is not an acceptable practice for several reasons. Primarily, we need to recognize that each Client's crisis is unique to themselves. Even though we had the identical crisis our experience and resolution is unique to us alone. Our resolution has no place being introduced as a solution for the Client. Self-disclosure also upsets the balance of equality in the interaction as the focus is shifted to the worker. The worker becomes an authority as opposed to being an equal. Making promises is also not listed among the listening skills. The worker may assume the Client will be comforted by promises of what can be done to help them. The reality is that we have no way at all to ensure a specific outcome of any intervention. To do so risks disillusioning a person who is already sensitive to disillusionment and such a risk is indefensible. Advice giving is similar to self-disclosure. However a way to deal with it is to use the stem statement “Some people in your situation may consider….” There is no right or wrong in crisis but rather the negative feelings experienced making on think that something is wrong.

Walking on Down Virginia Avenue: Crisis Intervention for I&R”
AIRS 31st Annual I&R Training and Education Conference “Mining for I&R Excellence” Reno, NV Tuesday June 2, 2009 Part 1 – 10:30 AM – Noon Part 2 – 2:15 – 3:45 PM John Plonski Database Coordinator Covenant House Nineline President NYS AIRS Voice: (212) Fax: (212)

First a poetic interlude. Listen
When I ask you to listen to me and you start giving advice, you have not done what I asked. and you begin to tell me why I shouldn’t feel that way, you are trampling on my feelings. and you feel you have to do something to solve my problem, you have failed me, strange as that may seem. Listen! All I asked was that you listen; not to talk or do – just hear me. Advice is cheap; ten cents will get both Dear Abby and Billy Graham in the same newspaper. And I can do for myself; I’m not helpless. But, when you accept as a simple fact that I do feel what I feel, no matter how irrational, then I can quite trying to convince you and get about the business of understanding what’s behind this irrational feeling. And when that’s clear, the answers are obvious and I don’t need advice. Irrational feelings make sense when we understand what is behind them. Perhaps that’s why prayer works, sometimes, for some people. Because God is mute, and he doesn’t give advice or try to fix things. He just listens and let’s you work it out for yourself. So please, listen and just hear me. And, if you want to talk, wait a minute for your turn; And I’ll listen to you.

A Crisis Intervention Model
Defining The Problem Exploring Goals Generating Alternatives Planning Closure

Why a Model? · Views a person in terms of their ability to cope, their strengths and problem-solving abilities · Uses the person's environment and social structure · Assumes the Caller can make the right choices · Emphasizes active, direct role of crisis worker

Why a Model? (continued)
· Is active and cognitively oriented · Worker focuses on assisting the Caller to identify the problem, develop a reasonable goal, generate alternatives, and make a plan. · Deals with the situation in the present. · Assists the Caller in identifying and using personal and social resources

Let’s look at each step of the model.
Defining The Problem Use silence, listen carefully Reflect and identify feelings; make contact on a feeling level Build on feelings and points, using encouragers Identify the problem. Why is the Caller calling right now? Track the Caller by restating, paraphrasing, and summarizing Clarify what is unclear

Exploring Goals Determine to what end the effort will be directed What are the Caller's immediate goals? Today? Tomorrow? What are the Caller's long-term goals? Facilitate the Caller to make their own decisions Remember: The Caller may not want to do what you want them to do Set some realistic goals for the specific areas you have agreed upon Be sure that goals can be reached by immediate action

Generating Alternatives
Acknowledge the Caller's personal strengths Explore past coping strategies Identify personal resources: family, friends, loved ones To whom has the Caller spoken already? What advice was offered? Have the Caller generate his or her own options, consider alternatives, costs Offer additional options for consideration Provide information and referral when needed Determine the means by which the Caller will reach his or her goals

Planning Facilitate the Caller in selecting the best option(s) Make the plan manageable. Break it down into steps Prioritize goals and planned steps Get the Caller to offer a prognosis. How confident are they in the plan? Offer your prognosis based on Caller’s confidence Encourage the Caller to take action; assign tasks Remind the Caller about available resources Reinforce the benefits of following up on referrals

Closure Summarize the call and plan, emphasizing strengths and progress Monitor for dial-tone disclosures Avoid farewell party syndrome Offer a few words of encouragement

What is the worker’s role in the Model?
LISTEN Actively!! Mobilize resources within and around the Caller. Learn your limits and know when to ask for help. Recognize that you are not responsible for the outcome…You are responsible for using your intervention skills to the best of your ability. Be involved with your agency. Share experience and feedback with staff and supervision. Let the Model, not your personal feelings guide you. Establish Trust (Offer Sanctuary, Value Communication) 1. Recognize the feelings of the caller. 2. Discuss the abuse directly; do not avoid the issue. 3. Communicate concern and care by: a) speaking empathetically b) avoiding questions c) using active listening skills d) being nonjudgmental e) identifying the problem and the feelings Help the Caller Identify Goals (Choice) 1. Acknowledge the caller's desire for help 2. Validate the caller's willingness to talk about abuse: "You sound like a really brave person because you have told me about those things that are troubling you." 3. Present the possibility of child abuse report or other viable resources 4. Help with the report when possible Recognize the Limitations of the Crisis Worker 1. Assess and accept what the caller tells us 2. Avoid power struggles with callers 3. Advocate with agencies Report the Abuse Crisis workers are mandated reporters of child abuse. The caller should be made aware that if we are given enough information to make a report and we suspect child abuse, we are mandated to report the abuse, even if we do not have the "permission" of the caller.

Helpful Hints Take your time…Think about what has
been said and what you plan to say. The personal pronoun “I”…avoid. Direct questions back to the Caller. Involve the Caller in the resolution…don’t problem solve for them. Your “Style” “Normal” Responsibility No sermons Dare to expand your skills Use Parallel Process Just as we need to refrain from judging things normal or not normal we need to realize that anytime we use the personal pronoun "I" we present a judgmental, exclusionary stance to our callers. While it may not be possible to eliminate this particular pronoun from our vocabulary, it is desirable we attempt to communicate with our callers on a generalized, inclusive level. This is a difficult yet extremely powerful concept to master. Think about it a bit. As a suggestion you may want to think of "I" in terms of "you" or the inclusive "people". As an example: Instead of, "I think you need to talk to your worker", we might say, "In a situation like this some people might think about talking to their worker.” Each of us will develop our own styles of Crisis Intervention because each of us is different in personality, values, abilities, and experience. We bring these differences to our interactions with our Callers and thus our STYLE is created. Our diversity in styles means our Callers can tap into many different insights regarding their situations. BUT we must remember effective Crisis Intervention demands we interact with Callers as equals and we must use the Active Listening Skills at all times. We cannot allow STYLE to become an excuse or reason for avoiding the basic tenets of Crisis Intervention. The style of the truly effective Crisis Listener balances their own individuality with the needs, ability, and functionality of the Caller. As your own STYLE develops keep in mind the person who will be most affected and helped by it. . .Your Callers. In reality your style becomes the product of your individuality as it interacts with the individual needs and persona of the Caller. When asked about normal we need to answer with the caller's viewpoint in mind. If the caller thought their situation normal they probably would not be on the phone with us. Their calling indicates the situation feels less than normal to them. This means we would not judge their sense of normalcy by saying something is or is not "normal". More appropriately, we could reply their call indicates they feel the situation does not feel normal for them and they feel uncomfortable being in the situation. In short, nothing is normal. . . situations are either comfortable or uncomfortable. Another thought about normalcy stems from our tendency to judge a caller's behavior during the call as being normal. This is exemplified when we tell a caller who cries during a call it is normal to cry. We must remember that while we, as crisis workers, may see tears as normal in a given situation the caller may not feel the same way. A more appropriate response would be to observe that people sometimes cry when in situations such as the caller's. We would then reflect the sadness or isolation the tears represent. Parallel Process is a fancy way of saying, “Go with your gut”.

Okay…Now it is time to practice what we have learned
Okay…Now it is time to practice what we have learned. This will be a ton of fun! Oh no...I knew it...role plays…and too late to hide!!!

See its not so bad. Homer is practicing already!

Role Play Ground Rules Have fun!
Don’t be afraid to make mistakes. You are learning something new. Participate in feedback. Track your progress through the Model. Vary the Active Listening Skills you use.

Feedback Ground Rules The person receiving feedback should be in charge. Corrective feedback should be balanced and address specifics while offering alternatives. The person receiving the feedback should summarize. Guidelines for Effective Feedback Feedback is a way of improving our performance, by finding out how our behavior affects others. Like all tools of communication, feedback can be clear and useful and facilitate a constructive communication. It can also be unclear and frustrating and serve as a block to effective communication. Below are some guidelines for effective feedback: ·The person receiving feedback should be in charge. Let the Crisis Worker in practice sessions determine how much or how little feedback is provided. · Feedback should focus on strengths, particularly in the early phases of the program. If negative feedback is given, there should be an equal amount of positive feedback. People grow from strength, not from weakness. Feedback should be helpful, not harmful. · Feedback should be concrete and specific. "You said "Uh-huh" in a way that clearly indicated that you were listening." is more helpful than "Your attending skills were good." Make your feedback factual, specific, and observable. · Feedback should be relatively non-judgmental. Feedback can be very threatening because the receiver often hears it as a personal evaluation. Stick to the facts and specifics. The word "relatively" recognizes that judgments will inevitably appear in many types of feedback. Care must be taken to share an observation in a manner that is kind and supportive. Avoid the words "good" and "bad" and their variations. · Feedback should be lean and precise. It does little good to suggest that a person change 15 things. Select one to three things the Crisis Worker might actually be able to change in a short time. You'll have opportunities to make other suggestions later. · The person receiving the feedback should summarize what each observer has said and check for accuracy before moving on to the next observer.

Feedback Ground Rules Feedback should: Focus on strengths.
Be helpful, not harmful. Be concrete and specific. Be non-judgmental. Be focused and precise. Guidelines for Effective Feedback Feedback is a way of improving our performance, by finding out how our behavior affects others. Like all tools of communication, feedback can be clear and useful and facilitate a constructive communication. It can also be unclear and frustrating and serve as a block to effective communication. Below are some guidelines for effective feedback: ·The person receiving feedback should be in charge. Let the Crisis Worker in practice sessions determine how much or how little feedback is provided. · Feedback should focus on strengths, particularly in the early phases of the program. If negative feedback is given, there should be an equal amount of positive feedback. People grow from strength, not from weakness. Feedback should be helpful, not harmful. · Feedback should be concrete and specific. "You said "Uh-huh" in a way that clearly indicated that you were listening." is more helpful than "Your attending skills were good." Make your feedback factual, specific, and observable. · Feedback should be relatively non-judgmental. Feedback can be very threatening because the receiver often hears it as a personal evaluation. Stick to the facts and specifics. The word "relatively" recognizes that judgments will inevitably appear in many types of feedback. Care must be taken to share an observation in a manner that is kind and supportive. Avoid the words "good" and "bad" and their variations. · Feedback should be lean and precise. It does little good to suggest that a person change 15 things. Select one to three things the Crisis Worker might actually be able to change in a short time. You'll have opportunities to make other suggestions later. · The person receiving the feedback should summarize what each observer has said and check for accuracy before moving on to the next observer.

Let’s look at how we are doing in achieving our goals and review what we have covered.
Reasons for knowing the basics of crisis intervention…Check! Definition of crisis and the nature of the continuum of crisis as it relates to the normal state and coping…Did that! Basic tenets, elements, and listening skills of client centered crisis intervention…Yep! Basic crisis intervention model…You bet! Do's and Don'ts of crisis intervention…Yep!

Crisis Intervention demystified. Let’s review.
And so there you have it. Crisis Intervention demystified Let’s review. People are a product of their thoughts, feelings, and behaviors. They are relatively “normal”, have basic coping skills, and have ways to cope with day to day problems. A problem may create stress and be difficult to solve but we are able to find a solution without outside intervention. An emergency is a sudden, pressing necessity, such as when a life is in danger requiring immediate attention by a trained professional. It does not require action by the individual.

And…? Crisis is: “A state of acute emotional upset in which an
individual or group of individuals experience a temporary inability to cope with a given situation by means of usual problem-solving devices.” Or more simply: Crisis is when stuff happens that we can’t control or fix on our own and we end up feeling crummy and stuck. We have three levels of coping resources which are Primary, Secondary, Adaptive/Maladaptive Resources. Crisis Intervention is a short-term helping process that focuses on resolving the immediate problem by using personal, social, and environmental resources.

And…? The 3 Tenets of Crisis Intervention are: The worker and Caller are equals; The Caller determines the pace of the interaction and can make their own choices and decisions; the worker “mirrors” the Caller through Active Listening. The 4 Fundamentals of Crisis Intervention are Acceptance, Respect; Empathy; and Hope. The 7 Active Listening Skills are: Silence; Encouragment; Reflection; Paraphrasing; Summarizing; Restatement; and Clarification

And…? Well that sums it all up. Any questions?
The Active Listening Skills are not: Asking questions; Self-disclosure; Making promises; Giving advice; Defining right and wrong. The 5 steps of the Crisis Intervention Model are: Defining The Problem; Exploring Goals; Generating Alternatives; Planning; Closure. Well that sums it all up. Any questions? Psst! Just one question. What makes John so cool?

Well, then on behalf of everyone who made this presentation possible we would thank you for your attendance. You were a really great group to work with. Thank you for sharing your time with us.

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