5 Schedule December 30-31, 2003 & January 2-3, 2004 1.Tuesday: Basic Didactic Understanding 2.Wednesday: AM: teaching, PM: cases 3.Thursday: New Year Holiday: off 4.Friday: AM: teaching, PM: cases 5.Saturday: AM: teaching, PM: cases
6 Daily Schedule 09:00 to 10:30 AMInstruction session 1 10:30 to 10:45 AMBreak 1 10:45 to 12:00 PMInstruction session 2 12:00 to 01:00 PMLunch 01:00 to 02:30 PMInstruction 3 (Cases) 02:30 to 02:45 PMBreak 2 02:45 to 05:00 PMInstruction session 4 05:00 to 05:30 PMQ/A Individual Time
7 教牧輔導與危機應變基本技巧 1.Since this is a new course designed specifically for the pastoral staff of Hong Kong, there is no text book available in the market for a course of this nature 2.PowerPoint slides available for reference: www.ChristianMentalHealth.com and a compilation of these materials and resources as hand-outs to be provided by the instructor
8 教牧輔導與危機應變基本技巧 預期中的同學輪廓 1.This is a non-clinical, non-technical course primarily for the MPC program 2.Non-MPC program students are also welcome to register for credit and audit purposes 3.A larger audience will also be welcome to audit this course 4.Participants on this basis are busy pastors, lay-leaders or mental health professionals
9 教牧輔導與危機應變基本技巧 同學必須有的基本輔導技巧基礎 1.General personal maturity Spiritual maturity: Driven by Biblical principles Emotional maturity-stability: Empathy Ability to make good judgment and decisions 2.Basic counseling skills Do not give insensitive-simplistic responses 3.Basic communication skills Can practice “Active Listening”
10 教牧輔導與危機應變基本技巧 課程目標 1.What makes the difference between an urgent situation versus a crisis situation? 2.What are some key guiding principles a pastor has to work with during a crisis? 3.What skills can be used to de-escalate a crisis versus escalating it? 4.What are some typical and unavoidable crises in the ministry of an effective church?
11 教牧輔導與危機應變基本技巧 課程目標 5.What to do after a crisis has struck? 6.Are crises preventable and if so how? 7.Where is God when a crisis is un- avoidable? 8.What can a pastor do to help himself or herself after confronting a crisis?
12 Course Requirements 1 (20%) Students are required to present a two- page reading report of a recent newspaper-magazine article on any crisis issue of his or her selection
13 Course Requirements 1 (20%) This report is to be presented in class orally for more interactive learning with the instructor (Extra Credit Available: +10%) Either the original newspaper article or a photocopy of the same is to be stapled in the back of this report (Sign Up Sheet)
14 Course Requirements 2 (80%) Each student is expected to complete a Term Paper A case study on ONE aspect of following eight content areas to write a paper on
15 教牧輔導與危機應變基本技巧 教牧輔導與危機應變基本技巧 Course Requirements 2 (80%) Accidental or sudden death of a loved one Self-harm crisis: Suicide threat Harm-to-others: Homicide threat Sexual Abuse: Molestations and rapes Relationships in crises Financial crises Gender-Identity Workplace crises Spiritual crises
16 教牧輔導與危機應變基本技巧 教牧輔導與危機應變基本技巧 Course Requirements 2 (80%) Students are required to present a sample crisis situation experienced before (someone that you have counseled over a crisis, someone that you know as a friend or relative) will suffice.
17 教牧輔導與危機應變基本技巧 教牧輔導與危機應變基本技巧 Course Requirements 2 (80%) Give an introduction, a family history with a genogram A description of the crisis or events leading up to the manifestation of the crisis A formulation of the spiritual-moral- cultural correlations and some suggestions for a brief crisis intervention strategy will be required
18 教牧輔導與危機應變基本技巧 教牧輔導與危機應變基本技巧 Course Requirements 2 (80%) If a case is used from a newspaper or magazine The original story or stories in original or photo-copy format must accompany the report
19 教牧輔導與危機應變基本技巧 教牧輔導與危機應變基本技巧 Course Requirements 2 (80%) There is an option if the students do not have a sample crisis case. The student may use a case reported by the media, usually a newspaper article or magazine to use it as a case for study in a report.
20 教牧輔導與危機應變基本技巧 教牧輔導與危機應變基本技巧 Course Requirements 2 (80%) A BRIEF written summary (3,500 to 4,000 words) is to be presented to the instructor by the time- line delineated by the seminary.
21 教牧輔導與危機應變基本技巧 教牧輔導與危機應變基本技巧 Course Requirements 2 (80%) Term Paper Deadline By Friday, January 30th, 2004 (Submit to registrar’s office) Within three weeks from the end of class Must have your hard copy mailed Do not just email your work to me!
22 Session One Introduction Orientation Schedule and Time Table Time-Content Assignment Evaluation-Expectation ******** Didactic Instruction 1.
23 Job receives bad news that his herds were stolen and his workers killed
24 The walls of the home collapse from the strong desert winds, killing Job's children Credit: Gustave Doré
25 Job is Tested (1:1–2:13) (credit: Life Application Bible) Job, a wealthy and upright man, lost his possessions, his children, and his health. Job did not understand why he was suffering. Why does God allow his children to suffer? Although there is an explanation, we may not know it while we are here on earth. In the meantime, we must always be ready for testing in our lives
26 Three Friends Answer Job (3:1–31:40) (credit: Life Application Bible) Job’s friends wrongly assumed that suffering always came as a result of sin. With this in mind, they tried to persuade Job to repent of his sin. But the three friends were wrong. Suffering is not always a direct result of personal sin. When we experience severe suffering, it may not be our fault, so we don’t have to add to our pain by feeling guilty that some hidden sin is causing our trouble
27 A Young Man Answers Job (32:1–37:24) (credit: Life Application Bible) A young man named Elihu, who had been listening to the entire conversation, criticized the three friends for being unable to answer Job. He said that although Job was a good man, he had allowed himself to become proud, and God was punishing him in order to humble him. This answer was partially true because suffering does purify our faith. But God is beyond our comprehension, and we cannot know why he allows each instance of suffering to come into our lives. Our part is simply to remain faithful
28 God Answers Job (38:1–41:34) (credit: Life Application Bible) God himself finally answered Job. God is in control of the world, and only he understands why the good are allowed to suffer This only becomes clear to us when we see God for who he is. We must courageously accept what God allows to happen in our lives and remain firmly committed to him
29 Job is Restored (42:1-17) (credit: Life Application Bible) Job finally learned that when nothing else was left, he had God, and that was enough. Through suffering, we learn that God is enough for our lives and our future. We must love God regardless of whether he allows blessing or suffering to come to us. Testing is difficult, but the result is often a deeper relationship with God. Those who endure the testing of their faith will experience God’s great rewards in the end
30 List Price: $29.99 Price: $20.99 Hardcover 460 pages ; 1.15 x 9.46 x 6.36 Publisher: Regal Books; (May 2003) ISBN: 0830732411
31 教牧輔導與危機應變基本技巧 教牧輔導與危機應變基本技巧 Webster's collegiate dictionary crisis \krī-səs\ noun plural crises \krī-sēz\ [Middle English, from Latin, from Greek krisis, literally, decision, from krinein to decide — more at certain] (15th century) 1 a : the turning point for better or worse in an acute disease or fever b : a paroxysmal attack of pain, distress, or disordered function c : an emotionally significant event or radical change of status in a person’s life 〈 a midlife crisis 〉
32 教牧輔導與危機應變基本技巧 教牧輔導與危機應變基本技巧 Webster's collegiate dictionary 2 : the decisive moment (as in a literary plot) 3 a : an unstable or crucial time or state of affairs in which a decisive change is impending; especially : one with the distinct possibility of a highly undesirable outcome 〈 a financial crisis 〉 b : a situation that has reached a critical phase 〈 the environmental crisis 〉
33 危機 Crisis 危險危難 Danger Disaster 機會 O pportunities 危難裡面的機會 Paradigm Shifts in Crises: Growth Emotional-Spiritual Growth: Faith
34 Anatomy of a Crisis William Ury and Richard Smoke William Ury and Richard Smoke, "Anatomy of a Crisis," in Negotiation Theory and Practice, eds. J. William Breslin and Jeffery Z. Rubin, (Cambridge: The Program on Negotiation at Harvard Law School, 1991), pp.47-54.
35 Anatomy of a Crisis William Ury and Richard Smoke 1.The stakes are high in a crisis environment 2.There is little time available to deliberate 3.It is characterized by great uncertainty 4.It involves a sense of narrowed options
36 Anatomy of a Crisis William Ury and Richard Smoke Crisis Escalation As a crisis intensifies, each of these elements also intensifies. Time runs out. The stakes go up and this increases uncertainty. Options become further polarized in the face of increasing uncertainty and not enough time to deliberate effectively. These factors also contribute to a growing sense of hostility.
37 Anatomy of a Crisis William Ury and Richard Smoke Defusing Crises The key to defusing a crisis is to enable high-quality decision-making. Enabling better decision-making during a crisis requires control of the four basic crisis elements.
38 Anatomy of a Crisis William Ury and Richard Smoke Defusing Crises First, parties seek to control the perceived stakes. Second, they must slow the rate of action and reaction to allow sufficient time for the sides to consult with each other, and to deliberate. Third, accurate and trustworthy information must be made available about the other side's intentions and the situation. Fourth, the parties must remain flexible and generate a range of options.
39 教牧輔導與危機應變基本技巧 1.E ffective Crisis Evaluation 2.D e-escalation Skills in Crisis Management 3.C ommon Crises in Pastoral Care Ministries
42 教牧輔導與危機應變基本技巧 2. De-escalation Skills in Crisis Management
43 教牧輔導與危機應變基本技巧 2. De-escalation Skills in Crisis Management Understanding dichotomized thinking in the presence of an emotional crisis 1.Emotional flooding causes emotional exhaustion Emotional instability: Lack of regulation-control 2.Brain tries to simplify perceptions: To make sense Details-nuances are lost: “Big picture” preserved “Good or Bad” “Black or White” “Friend or Foe” People with traumatized childhoods: Fear driven 3.Rigidity & dogmatism ensues: Inflexibility
44 教牧輔導與危機應變基本技巧 2. De-escalation Skills in Crisis Management 1.Keeping calm and rational in the middle of a stressful-catastrophic situation? 2.Self-understanding 3.Developing emotional self-modulation 4.“Talking Down” techniques in the way you talk
45 教牧輔導與危機應變基本技巧 2. De-escalation Skills in Crisis Management 5.Taking temporary control of a crisis by making short-term decisions 6.“Blame-free” and “Guilt-free” speech in reducing emotional volatility
46 教牧輔導與危機應變基本技巧 2. De-escalation Skills in Crisis Management 1.Keeping calm and rational in the middle of a stressful-catastrophic situation? Your emotional-safety needs are provided for Expect crisis all the time: “Going to work” Prepare, prepare and prepare Practice, practice and practice
47 教牧輔導與危機應變基本技巧 2. De-escalation Skills in Crisis Management 2.Self-understanding Not everyone is best suited to do crisis work It does not mean that you are weak if you can’t It takes ability to deal with ambiguity Are you an optimist or pessimist? Faithfulness? Know what you can do best “Do one small part” Knowing when to “bow out” (exit) is wisdom Practice your “routine”: Regularity helps
48 教牧輔導與危機應變基本技巧 2. De-escalation Skills in Crisis Management 3.Developing emotional self-modulation How do you know you are stressed? –P–Pulse rate, Blood pressure, Face-flushed –S–Stomachache, Indigestion, Heart-Racing –C–Can’t concentrate, Irritability, Emotions unstable –T–Take deep breaths, Deep breathing exercise, –D–Depend on policy & a routine “Physician Heal Thyself”: Can’t heal self Depend on your peers (spouse & staff) for support, encouragement & guidance
49 教牧輔導與危機應變基本技巧 2. De-escalation Skills in Crisis Management 4.“Talking Down” Technique Engage: Visually (eye contact), Verbally (speech) Preparing to Listen: Get as much background & history of this situation as possible Start to listen: As much as speaker ready to share Listening to control: As clarifying questions? –D–Don’t ask why? Say “The reason for…?” Use soft voice, talk below the position of speaker
50 教牧輔導與危機應變基本技巧 2. De-escalation Skills in Crisis Management 4.“Talking Down” Technique Nod your head “approvingly” Start to empathize: Find something true to agree –B–Begin “emotional catharsis” –“–“I can understand why you are so mad!” –“–“I can understand why you are so sad!” Start to manage the crisis: “Take a break?” –O–Offer something concrete: Soda, Tea, Food
51 教牧輔導與危機應變基本技巧 2. De-escalation Skills in Crisis Management 4.“Talking Down” Technique Clarify feelings after a “coffee break” –“–“How are you doing?” –“–“How are you feeling now?” When “Talking Down” Technique Fails Suspect substance abuse: Drug & alcohol Serious mental illness: Schizophrenia Spiritual influence & demon possession
52 教牧輔導與危機應變基本技巧 2. De-escalation Skills in Crisis Management 5.Take temporary control: By making short-term decisions It is okay to make some short-term decisions –W–Where to spend the night after “wife-battering” –E–Encourage victim to make a police report –E–Encourage victim to call a crisis line for help Principle: To assist person in crisis to decide Provide a “break” away from the crisis to restore personal judgment skill after emotional flooding
53 教牧輔導與危機應變基本技巧 2. De-escalation Skills in Crisis Management 6.“Blame-free” and “Guilt-free” speech in reducing emotional volatility Saying the right thing is important in crisis Avoid “loaded” speech: “Shame & Blame” Principle of “Trauma & Drama” Principle: To reduce victim’s emotional stress Victim is most emotionally vulnerable: Avoid sensitive-personal issues (for now)
54 教牧輔導與危機應變基本技巧 3.Common Crises in Pastoral Care
55 教牧輔導與危機應變基本技巧 3.Common Crises in Pastoral Care 1.Accidental or sudden death of a loved one 2.Self-harm crisis: Suicide threat 3.Harm-to-others: Homicide threat 4.Sexual Abuse: Molestations and rapes 5.Relationships in crises: Break-up & Pregnancy 6.Financial crises 7.Gender-Identity, Spiritual crises 8.Workplace crises
56 教牧輔導與危機應變基本技巧 3.Common Crises in Pastoral Care 1.Accidental or sudden death of a loved one Unavoidable with aging: Increases Unanticipated: Accidents: Most difficult Anticipated : Prolonged illnesses: Treatment Relationship with deceased critical to recovery –G–Good: Easier to resolve with closure: Goodbye –B–Bad: Unresolved issues with closure: Goodbye Christians vs. Non-Christians: Issue of hope
57 教牧輔導與危機應變基本技巧 3.Common Crises in Pastoral Care 1.Accidental or sudden death of a loved one Stages of Coping 1.Shock : Emotional Instability: Needs Structure 2.Denial: Emotional Numbness: Frozen 3.Bargaining : “Why?” Rationalizes: Wants Control 4.Anxiety-Depression : “How?” Fear-Insomnia 5.Resolution-Acceptance: Emotions return
58 教牧輔導與危機應變基本技巧 3.Common Crises in Pastoral Care 2. Self-harm crisis: Suicide threat 1.Evaluate lethality of suicide threat by doing a good suicide assessment
60 教牧輔導與危機應變基本技巧 3.Common Crises in Pastoral Care 2. Self-harm crisis: Suicide threat 2.What to do if the threat exists? First Priority: Preserve safety of person Even against the “best judgment” of patient Voluntary hospitalization: By family, clergy Less stigmatizing Involuntary hospitalization: Evaluation Can be shameful: Social Workers, Nurses, Police
61 教牧輔導與危機應變基本技巧 教牧輔導與危機應變基本技巧 5150 Emergency Hospitalization Show Probable Cause “Imminent Threat of Bodily Danger-Harm” 1.Danger to Self: Suicide Threat Suicide Assessment: Duty to Protect 2.Danger to Others: Homicidal Threat Tarasoff Warning: Duty to Warn 3.Grave Disability: Unable to Self-Care Food, Shelter, Money-Management
62 教牧輔導與危機應變基本技巧 教牧輔導與危機應變基本技巧 California Standards for Crisis Intervention 5150 Welfare and Institution Code “72-Hour Hold” “5150 Advisement” “For Mental Evaluation” “Probable Cause” 1.Harm to Self 2.Harm to Others 3.Grave Disability
63 教牧輔導與危機應變基本技巧 教牧輔導與危機應變基本技巧 5150 Emergency Hospitalization 5150. When any person, as a result of mental disorder, is a danger to others, or to himself or herself, or gravely disabled, a peace officer, member of the attending staff, as defined by regulation, of an evaluation facility designated by the county, designated members of a mobile crisis team provided by Section 5651.7, or other professional person designated by the county may, upon probable cause, take, or cause to be taken, the person into custody and place him or her in a facility designated by the county and approved by the State Department of Mental Health as a facility for 72-hour treatment and evaluation. Such facility shall require an application in writing stating the circumstances under which the person's condition was called to the attention of the officer, member of the attending staff, or professional person, and stating that the officer, member of the attending staff, or professional person has probable cause to believe that the person is, as a result of mental disorder, a danger to others, or to himself or herself, or gravely disabled. If the probable cause is based on the statement of a person other than the officer, member of the attending staff, or professional person, such person shall be liable in a civil action for intentionally giving a statement which he or she knows to be false.
64 教牧輔導與危機應變基本技巧 教牧輔導與危機應變基本技巧 5150 Emergency Hospitalization 5157. (a) Each person, at the time he or she is first taken into custody under provisions of Section 5150, shall be provided, by the person who takes such other person into custody, the following information orally. The information shall be in substantially the following form: My name is ____________________________________________. I am a ________________________________________________. (peace officer, mental health professional) with __________________________________________________. (name of agency) You are not under criminal arrest, but I am taking you for examination by mental health professionals at _____ _______________________________________________________. (name of facility) You will be told your rights by the mental health staff. If taken into custody at his or her residence, the person shall also be told the following information in substantially the following form: You may bring a few personal items with you which I will have to approve. You can make a phone call and/or leave a note to tell your friends and/or family where you have been taken.
65 教牧輔導與危機應變基本技巧 3.Common Crises in Pastoral Care 3. Harm-to-others: Homicide threat 1.Usually in the suicide plan of causing endangerment to the lives of family members and loved ones 2.Aggressive homicidal threat to others Male: Avenge perceived injustice, wrong Female: Avenge a relationship: “Borderlines”
66 教牧輔導與危機應變基本技巧 3.Common Crises in Pastoral Care 3. Harm-to-others: Homicide threat 3.If “probable cause” exists: “Duty to warn”: “Do a Tarasoff” warning Notify the patient this is taking place: Intake Not notify the patient this is taking place Written record of “completing the Tarasoff” “Chart notes” (A written record): Discharge duty Police record: Take the case number
67 教牧輔導與危機應變基本技巧 3.Common Crises in Pastoral Care 4. Sexual Abuse: Molestations and rapes 1.What is “worse than” rape? “It is your loved one does not believe you!” 2.The injury is physical and emotional 3.Always take “rape claims” seriously Gender differences: female vs. males claims “Borderline-histrionic” females claims
68 教牧輔導與危機應變基本技巧 3.Common Crises in Pastoral Care 4. Sexual Abuse: Molestations and rapes 4.Practical-concrete aspects of rape reporting Age of the victim: Minors vs. adults Adults: Encourage self-report to authorities Children: Encourage report to parents first Encourage parents-guardians to do reporting “Duty to report” on authority figures: Ethical-legal Age differences between victim and aggressor Issue of consent: (Canada: 14 year-old, USA: 18) Record keeping
69 教牧輔導與危機應變基本技巧 3.Common Crises in Pastoral Care 4. Sexual Abuse: Molestations and rapes 5.Psychological-emotional aspects of rape “My fault”: Rationalization of powerlessness “Dirty, unclean”: Self-image-esteem injured “No one will love me anymore” “Damaged goods” “I can’t try men any more!” “Men-hating” Ego self-repair: Protection Multiple layer of clothes, short hair, “Why did God let this happen to me?” “Not care?”
70 教牧輔導與危機應變基本技巧 3.Common Crises in Pastoral Care 5. Relationships in crises 1.Marital discord: Threats of separation & divorce 2.Extramarital affairs 3.Affairs of the mind: After discovering that your spouse is a pornography addict 4.Breaking-up of a dating relationship: Being “left behind” and abandoned 5.Parent-child conflicts: Physical and sexual abuse 6.Crisis pregnancies: Break-ups: No-Abortion options?
84 教牧輔導與危機應變基本技巧 Common Crises in Pastoral Care Financial crises 1.“Negative-equity” of property owners Urgent but not a crisis by itself Guard against it becoming a precipitant 2.Gambling debts: Always urgent Repayment of debt burden: A Crisis Buy time vs. more money loans
85 教牧輔導與危機應變基本技巧 Common Crises in Pastoral Care Gender-Identity, spiritual crises 1.Discovered that sexual attraction is toward the same sex 2.Generally around the age of 12-14: Males 3.Females: Later age but more subtle “Liking for a teacher, coach” Older female 1 st 4.Myth of “inborn-gay”: Genetics vs. Parenting 5.Support groups: Exodus, Living Waters, Books
86 教牧輔導與危機應變基本技巧 Common Crises in Pastoral Care Workplace crises 1.Less common in Hong Kong 2.Concerns: Loss of job & status 3.More an urgent than a crisis 4.Can be a precipitant but not a cause 5.Problem with work stress: Volume 6.Problem with work fit: Personality-Style
87 教牧輔導與危機應變基本 Crises prevention strategies Most crises are preventable 1.“Prevention is better than the cure?” 2.Is “Crises Prevention” an oxymoron, thus a mutually exclusive concept? 3.What you can learn from a crisis to prevent it from happening again? 4.Re-designing or adding a topic to enrich Christian education in your church to make it more comprehensive? Prevention oriented?
88 教牧輔導與危機應變基本技巧 The presence of God in a crisis 1.Can you answer the question: “Where is God when it hurts?”
92 教牧輔導與危機應變基本技巧 The presence of God in a crisis 1.Can you answer the question: “Where is God when it hurts?” 2.While sin is mostly associated with suffering, there are exceptions: “Job” 3.Suffering is related to Spiritual “Refining” 4.Furnish option of “Meaning in the Suffering” 5.“The Wounded Healer” Concept: Give back
93 教牧輔導與危機應變基本技巧 Need for debriefing after a crisis 1.What are the key elements for a closure? 2.How can a pastor and leaders do self-care 3.While waiting for the next crisis, what are some coping strategies a pastor can have?
94 教牧輔導與危機應變基本技巧 Self-Care for the Pastor 1.The need to “process” after a crisis 2.The need for reflection & insight What could have been done in a better way? How was God’s name been glorified? 3.Need support from spouse and peers Talk to a counselor, consult your mentor: Advice & accountability 4.“Re-entry stress”: Family life after a crisis 5.Outcome: More faithful, More dependent on God and His Will: Just do the “right” thing
95 How To Contact Us? ChristianMentalHealth.com (510) 794-8898 Internet Search Engine Google, Alta Vista, Yahoo “ Dr. Melvin Wong ” “Melvin Wong Psychologist”