Marathon Handouts (MESFEOCA, MRPISS, Feelings, Questions, Known Callers)

BASIC CRISIS THEORY

Crisis is the inner state of a person reacting to stress when normal coping methods have broken down.

Stress is the demands and tensions placed on the client constantly by his environment.

Coping methods are the normative way we the client handles stress. They may be adaptive or maladaptive.

A crisis is different from an emergency in that an emergency requires immediate external action on the part of someone to prevent in jury or death.

DEVELOPMENT OF A CRISIS:

One or more hazardous events.
Client is in a vulnerable state.
Precipitating event.
Rising emotions, cognitive and perceptual confusion.
Failure of coping mechanisms.
Full crisis.

CRISIS IS CHARACTERIZED BY:

A rise in emotional energy; emotional turmoil and confusion.
Cognitive disturbance.
Perceptual disturbance.
Time-limited in nature.
Push toward resolution.

RESOLUTION OF A CRISIS (Usually resolves within six weeks maximum):

Restoration of former coping methods.
Development of new coping methods.
Flight.
Psychosis.
Death – Suicide.

CLASSIFICATION OF CRISES:

Developmental.
Situational.
Deprivational.
Integrational.

OUTLINE OF CRISIS INTERVENTION COUNSELING (MESFEOCA)

Make contact at a feeling level rather than a factual level. Identify the client’s feelings. Accept the client’s right to feel that way. Verbally reflect to the client his or her feelings. Use statements rather than questions.
Explore the problem in the here and now. Focus on the last six weeks at the most. Try to identify hazardous events and precipitating incident. Sometimes it helps to ask, “What happened today that made you call?”
Summarize the problem with the client so that you both agree on the definition of the problem and the main elements.
Focus. Come to an agreement with the client on the specific area or problem to be considered. Two criteria are important; a) area selected should be causing client great pain and b) area selected should be susceptible to some immediate action with likelihood of results.
Explore their resources. Direct the client to tell you what they have done so far. Some good questions to ask are:

“What have you done in the past when you’ve felt this way?”

“What have you already tried to do?”

“What else do you think you can try?”

“What’s stopping you from ________?”

“Who do you think would be able to help you in this situation?”

“Who would you like to be able to turn to for help?”

If appropriate, offer additional resources such as counseling clinics, support

groups, etc.

6. Offer additional resources such as counseling clinics, support groups, etc.

7. Contract with the client. Agree on a plan of action. Specify what the next step is going to be, what they will do. Make sure they have a clear method of what to do if the next step is not successful.

8. Anticipate what might happen.

THE USE OF QUESTIONS IN CRISIS INTERVENTION

Skillful questioning helps the client provide honest and relevant information about his or her problem or situation. If asked correctly, a question also helps the client avoid responding as he or she thinks you want them to respond.

Open-ended questions promote better rapport. They are non-leading and elicit more information. They do not require a “yes” or “no” answer and do not require agreement with a point of view. They are not intended to make the speaker think that you already have the answer or that you want them to see something as you see it. They invite information rather than demand an answer. For example, “What other feelings did you have?” Open questions begin with words such as how, what, where, and when.

Closed-ended questions are direct and call for a “yes” or “no” answer or very limited but specific information. They ask for simple, clear answers but limit the scope of the speaker’s response. Closed-ended questions should be used carefully, sparingly and with a specific purpose in mind. For example, “Does your job call for your being away from your family very often?”

When asking questions to gather information during crisis intervention, there are several guidelines that should be followed:

Ask only one question at a time.
Keep questions simple. Use understandable language and avoid “lingo.”
Keep questions brief. The general rule is that a question be no longer than one sentence, with not more than one sentence preceding it.
Be specific. State the time, place or context you want the speaker to consider.
Ask “what” or “how” questions rather than “why” questions. “What made you decide to…” sounds better than “Why did you …” “Why” tends to put the person on the defensive and makes them feel like they have to justify their decision.
Don’t ask question after question – that can make the client feel more like they are being interrogated than counseled. After you ask a question, reflect a feeling, restate, paraphrase or use one of the other active listening skills. It is much more effective to use the other skills in conjunction with questioning.

Sample Open Questions to be used in Crisis Intervention Counseling

What’s going on?

What would you like to tell me about the problem?

What have you tried to do?, What else have you tried?

What would you like to see happen?

What do you think you could do next?

What do you think you can do to change the situation?, What else do you think you can do?

What do you think would happen if . . . ?
What’s the worst thing that could happen if . . .?

What’s the best thing that could happen if . . .?

How does that make you feel?

How do you feel about that?

What were you feeling when . . . ?

What does being ____ feel like to you?

How do you normally react when you feel _____ ?

What do you think you can do when you feel ____ ?

THE USE OF FEELINGS IN CRISIS INTERVENTION

By using the skill of reflecting feelings, the counselor communicates to the client in clear and simple language what he or she senses the client is feeling. The counselor attends to the client’s verbal and nonverbal communication in order to develop a sense about their feelings. When the counselor senses what the client feels and states their perception, the client can move closer to understanding what they want or need.

For example, the client says:

“My boyfriend and I just got in a fight. Sometimes he can be such a jerk.”

Counselor says:

“It sounds like you’re feeling confused.” Or “It sounds like you’re feeling angry.”

Sometimes verbal communications seem to contradict nonverbal ones. For example, the client might say, “I’m very happy” in a slow and heavy voice with a sad facial expression. When the counselor senses these contradictions, they can ask for clarification from the client by saying something like: “I’m not clear about what you’re feeling. I hear you say that you’re happy but at the same time you look sad.”

Reflecting feelings sometimes seems commonplace to the beginning counselor who assumes that this is a simple way of communicating that provides little challenge for him or herself or the client. However, the reverse is really true. Upon hearing their feelings reflected back, the client is challenged in several ways. A client’s statement that they feel something does not mean that they really hear what they are saying or that they fully acknowledge the feeling. Particularly when they feel pain or conflict, they may utilize talk as a way of denying their feelings. When this occurs, the counselor’s restatement of feelings challenges the client to acknowledge them or to begin integrating them.

Feelings should always be addressed as they relate to the decision or conflict that the client is exploring. Ultimately, the counselor will help the client utilize their feelings to make a decision or to provide further clarification of conflict.

Sample Feeling Statements to be used in Crisis Intervention Counseling

Because mixed messages may be given, such as a person saying they’re angry but sounding calm, it is important to preface an empathic response with a tentafying word, which allows the reflection to be made provisionally. It is then the speaker’s turn to confirm or deny your perception.

Below is a list of “tentafiers” which can be used to start a statement to identify or reflect a feeling. This list is by no means exhaustive. It is a starting point. It takes practice to make these statements become a natural part of our vocabulary. It is also necessary to use a variety of statements to avoid sounding rehearsed or repetitious.

It sounds like you feel . . . .

It seems as though you’re feeling . . .

So you’re feeling . . .

You appear to be feeling . . .

From what you’re telling me, it sounds like you feel . . .

And that made you feel . . .

What you’re saying is you felt . . .

****It is important to use a variety of statements to avoid sounding rehearsed or repetitious.****

Stay away from saying:

You must be feeling….

That had to be…

You should have felt…

You shouldn’t feel . . .

ATTENDING/ACTIVE LISTENING SKILLS

Minimal Encouragers – The least amount of verbalization to encourage a client to talk. Examples include “uh huh” “mm mm” “so” “go on” “and then.”
Restatement – Mirroring or echoing what the client has said. Saying back verbatim what the client has said. The client says “I was raped last night.” You say “You were raped last night.” Can be powerful for the client to hear their own words exactly as they said them. Can make what they said seem more real.
Paraphrasing – Giving back the essence of what the client has said but in your own words. Similar to restatement but you are putting into your own words rather than repeating back exactly what they said. Helps client see that you are listening to and understanding what they are saying.
Interpretation – Counselor makes a link or connection the client hasn’t made based on what they’ve heard in the call. An example would be if the client says something like “My boyfriend broke up with me last night. I knew this was going to happen.” You might say “It sounds like things weren’t going well in your relationship.”
Summary – Recapping the major points of the conversation thus far. Summary gives structure and helps clarify any inconsistencies. Summary can be used to focus the client on what’s causing them the most pain. It is also a great tool to use to end the counseling session.
Silence – Silence allows the client to think about what has been said.

Known Callers and Difficult Callers

What is a Known Caller?

Known callers, or frequent callers, are callers that repeatedly calls crisis centers. They appear to be dealing with the same problem, or set of problems, on every call and appear to be making no clinical progress.
They do not appear to be in a state of crisis that is responsive to telephone crisis intervention and are unwilling to make change (as opposed to unable).
There is a cost to callers when we engage frequent callers: it creates barriers of access to legitimate callers in crisis.
Engaging with frequent callers can create “learned helplessness”: feeling a lack of mastery over any situation. It also compromises self-determination, which is the heart of LICC’s counseling philosophy!
The frequent caller’s mindset becomes, “I can’t do it. Only you can do it for me. I will keep calling”. Therefore, we are really doing the frequent caller a disservice when engaging with them.

Helpful Phrases/Questions When Talking To A Known Caller (Frequent Caller)

We have standard statements that we put out to Known Callers which tend to work. However, the following is a list of more statements and questions that can be utilized to create structure to the call. What the Known Caller needs more than anything is “structure” and direction. Feel free to use any or all of them, depending on the nature of the call and the profile guidelines.

Stages of the helping process Structured listening with the caller

Establish rapport “What is new and different since you last called?”

Clarifying the problem “Tell me something that you could change about your situation” OR “What would you like to be different?”

Exploring resources “Who, other than the crisis center, can you put on your support list?”

Developing a plan “What is something you will change before you call again?”

Wrapping up the call “Tell me what you plan to do before you call here again.”

Commending the caller “It sounds like you have the ability to make change.” (or a variation)

More tips on how to respond to known/frequent and/or abusive callers (in no particular order). Feel free to adapt these statements to language that suits you:

Directly ask if there is an emergency (“Are you in any danger right now?”)
Explain our short-term nature (“Since we reviewed the options this hotline can offer you, and you are not in need of immediate assistance right now, I will be ending the call.”)
Address inappropriate language immediately (“We would like to help you but are unable to do so if you continue to speak in such a manner.”)
If caller sounds under the influence, ask directly (“Have you been drinking or using any drugs today/tonight?”)
Do not raise your voice if the caller is raising theirs. Stay calm and say very little.
If a caller becomes threatening, take all necessary steps to protect fellow volunteers by alerting them and paid staff of appropriate details.

Difficult Callers/Non Known Callers

Yes Butters:

Occasionally, you will get a call from someone known as a “yes butter”. These are clients who, no matter what options you come up with, have an excuse as to why it will not help them.

For example, a counselor may say “How would you feel about speaking to your mother” and a client may respond “I could but she will yell at me”. The counselor may respond with, “How would you feel about writing a letter to your mother telling her how you feel?”, and the client responds “Yeah but it takes a lot of time to write a letter and I’m not even sure what I’d say”.

It can take a lot of patience to counsel a yes butter and it can be frustrating to feel like nothing you say is getting the client to some sort of resolution, even if you’ve spent a lot of time exploring options. It’s important to remember that we cannot solve clients’ problems- we can only empower them to come up with a resolution and implement it on their own. If they are unwilling to take referrals or any type of idea you put out to them, do not be discouraged. Some helpful things to say to a yes butter when the conversation is going nowhere are “What did you hope to get out of calling here today?”, “The only person who can change your situation is you”, “How would you feel about calling back when you’re ready to make a change/take referrals”, “What do you think YOU can do”, “What would you like to see happen”. These questions should be asked after all options have been exhausted, and in a gentle affect.

Motor Mouths/Clients Who Need to be Focused:

It takes a lot of strength for someone to get up the courage to call and speak to someone about what’s going on in their lives, especially if they have spent a long time bottling everything up. Sometimes, when a counselor picks up the phone, a client can unload years of crises on them in a very short amount of time. Since we are short term counseling, it’s important to focus the caller and get to the root of what made them call today (what was the straw that broke the camel’s back). We can only work with what is currently happening, not with what happened in the past that is over and done with.

In instances of “motor mouths”, it can be very beneficial to get the persons first name, as it can be a tool to interject while they are speaking. It’s very hard to learn how to cut someone off, however it’s for both you and the clients benefit that you do. While in training, your mentor may feed you certain lines that could help you better focus the client. It’s important that you repeat the line as your mentor feeds it to you, even if you are cutting the client off, as unnatural as it may feel.

Abusive Callers

We are not here to be verbally abused!! If a client feels they need to take their anger or frustration out on you by either cursing or putting you down, it’s okay to calmly let the client know that we are here to listen and explore options with them, not to be abused. You can let them know that if it continues, you will have to end the call. Keep in mind that the caller may be in a lot of pain so try to use your active listening/feeling skills to clarify what they are so angry about or what’s causing them to speak to you in such an abusive manner rather than hanging up on them. If the abuse continues, it is ok to end the call. It’s important not to let your own anger at the situation come out in your affect. Do not fight anger with anger and do not abuse the client back. Sometimes a calm voice is all you need to help the client calm down as well.

Clients Who Will Find No Resolution

You will get clients that we cannot come up with a resolution or a resource for. As discouraging as it may feel to both you and the client, we cannot give referrals that do not exist. While it would be amazing to have a separate database full of housing referrals, or a separate database full of referrals that offer financial assistance, that amount of resources just do not exist. So while we may not be able to offer them the perfect referral, what we can offer them is a supportive, non judgmental conversation. Sometimes that is enough to help a client keep pressing on in their daily lives. While you may feel as if you did nothing for the client, just being a voice on the other end of the phone can sometimes be enough.