Crisis Intervention Verbatim

Nira Kfir

• Publisher: Taylor & Francis
• Year: 2014
• eBook ISBN: 9781317770503
• Topic: Psicologia
• Subtopic: Salute mentale in psicologia

First published in 1989. This volume intended primarily for professional people such as physicians, attorneys, ministers, psychologists, social workers, psychiatrists, and counsellors of all types, is certainly helpful even for people in crisis. Crises often result in suicide or other devastating consequences. A person in a crisis is in this state exactly because he or she does not know how to cope. Crisis Intervention Verbatim, with its two part approach of theory and practice (through case histories), is valuable text which can be of considerable help to professional people dealing with crisis situations through giving them an understanding of the basic mechanisms of crises and an appreciation of effective ways of handling such problems.

II

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CASE STUDIES

In the second part of the London workshop we worked with several people who were invited by their doctors and psychotherapists. These volunteers were in therapy or medical treatment, and their therapists believed them to be in crisis or imminently facing one.

These people knew ahead of the session that they were going to be counseled in front of a group of therapists and that the audience would be involved. This is the way we teach, with the client as part of the group rather than by being observed through a one-way mirror or being discussed in absentia. Live supervision offers three advantages—ones for the client, the therapist, and the learners or group.

CLIENT’S ADVANTAGE

The person who is counseled gets immediate support from the group. The group setting provides an opportunity to discuss values, taboos, and secrets. Through the group interaction, the client is informed and reassured that others in the room share his or her problems and concerns. This in itself is supportive. During our workshop, numerous people offered to share their own private logic about issues like masturbation, homosexuality, jealousy, going mad, hating one’s own child, and the fear of dying. We were able to discuss these issues, and in so doing give the client new information and legitimize certain feelings, which in itself relieves anxiety.

The power of the group extends beyond support. The concentrated thinking and concern of the group, the focused attention, and the greater accountability the client feels in front of a group add greatly to the impact of the session. In addition, the heightened awareness that words count, the time allowed for reflection, and the strong desire for the session to be useful within the time constraints posed contribute to the impact of the group.

THERAPIST’S ADVANTAGE

For therapists, live supervision may seem threatening in the beginning. Nevertheless, it offers several possibilities for a breakthrough in the therapy. First, there is the value gained by the variety of feedback about the client’s situation and alternative possibilities. Second, seeing the client through the eyes of one’s colleagues is a learning experience. Third, a self-exposure comes from sharing one’s ideas and asking for help and enlightenment.

Therapists are interveners, and in that role, they also need intervention. The therapist as well as the client gets encouragement and support, in addition to sympathy for the difficulty of the case and respect for the responsibility and exposure. In modeling and shaping the request for advice, the therapist makes the whole issue of therapy an equal project.

GROUP’S ADVANTAGE

For learners, future therapists, and those already in practice, the live supervision provides the opportunity to see how it is really done. Every learner in the session is not just an observer, but also a participant in the responsibility for what is taking place. Group members may interrupt, ask questions, and try out ideas.

It is important that the group never refers its questions or points directly to the counselee, but to the supervisor. The reason for this is to protect the person from those questions or hypotheses that might increase stress. The supervisor channels the group’s questions or comments to the counselee. Therapy, or intervention, is a process of constant decision making and assessment. Unless one has the opportunity to observe and be part of the process, it is difficult to learn.

The supervisor uses the group setting for co-counseling. Referring to the group gives the counselee a break and the opportunity to also be an observer. More than that, the therapist can confront the client through talking to the group and can raise ideas to which the client does not have to respond, only listen and assess.

In this workshop, there was a need to enlarge on topics that came up that were pertinent but not necessarily directly related to the client’s situation. Good examples would be the whole issue of normal and abnormal behavior, being in control versus being out of control (going mad). Generalized discussion takes the pressure off, enhances learning, and promotes changing attitudes toward the subject at hand. We tried with all the counselees at this workshop series to provide a new supply of information, general support, and some options in line with general actions and practical homework. Of course, these options varied depending on whether we were treating anxiety, problems in a relationship, bereavement, or psychological problems associated with terminal cancer.

Interveners are often hesitant when they meet people with terminal diseases. Much like friends and family, the intervener takes it on himself or herself to supply hope for life. If this cannot be done sincerely, it shouldn’t be done. Interveners must relate to the real situation, help the client realize whatever is available, not simply what is wished. In the session with Richard and Susan (Chapter 9), Richard said that he wanted to be happy and not worry all the time about his cancer spreading. We tried to deal with reality. Can a person be happy at that stage? We tried out other possibilities for him to consider like faith, friends, and writing. These are options that focus on what he can do for himself and by himself, rather than an outcome or byproduct such as happiness that cannot be reached directly.

Throughout the workshop, we used exercises to make certain points even stronger. Mostly, the exercises were offered to help persons feel their own strength, or locked up energy and unused power, and to experience using it.

The need of persons in crisis to repeat their story with detailed dates, places, and events is satisfied by the patient listening of the group, their feedback, and the limits set by the supervisor.

All the sessions in the following chapters would be classed as one-time interventions. Follow-up was provided by the patient’s doctor or therapist. Some of the sessions ended with a discussion, others didn’t need it, and a few left us beyond speech—with no words suitable to express the deep feelings that welled up in our hearts.

4

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Brian: Control in the Face of the Uncontrollable

INTRODUCTION

This section opens with Brian because he is the only person who used our workshop as a crisis intervention center. Brian reached a critical breaking point the previous evening and was anxious to get help because he was alarmed at what was happening to him. Since he was not in therapy, this session illustrates a one-time intervention, with possibly no follow-up and with no supportive therapist. We had to fulfill all intervention goals in one session. It began with an introduction of Brian to the group by a friend, who happened to be a therapist attending the workshop.

SESSION DIALOGUE

Therapist: Brian owns the gym where I work out. I went there this morning to lift some weights and was met by Brian’s business partner, whose first words were, “Hi, did you hear about Brian?” And, of course, I hadn’t. He explained what had taken place the previous Friday, and it became clear to me that Brian was in crisis. I asked him if he was prepared to come this evening, and this he agreed to do.

Nira: Brian, can you tell us about the situation you find yourself in?

Brian: On Friday evening, I was called by my mother, who was in a very distressed state. She is blind, diabetic, and in the past 4 months has had three serious heart attacks. She is 67 years old, very bright, and very dominant. My father, on the other hand, is introverted, tall, and deaf. Generally, they get on okay and have a pretty good time. At the age of 31, I am beginning to discover them and am building a friendship with them both. The reason for my mother’s distressed phone call was that a taxi had dropped my father at the end of the drive in a very inebriated state. The best thing my mother could do was let him sleep it off. I arrived home at about 12:30 A.M. to discover that he had in fact had a stroke. I called an ambulance, and within a short time he was in a hospital. My sister, who lives in the Midlands and has a 9-month-old baby, arrived on Saturday. Things were sorting themselves out pretty well until my mother suffered another heart attack and was taken to a different hospital.

I am finding it very hard to cope. The onus is on me to help as much as I can because my sister has a baby and lives about 100 miles away. At first I thought it was simply a matter of getting the house sorted out. I know that I appear to be concerned very much with organizational matters, but at the moment this is simply how I perceive things. I pride myself on being very calm and collected. But last night I simply went to pieces. I brought my mother’s guide dog up in my father’s car and my father, not liking dogs, had a go at me. I lost my temper, threw things and slammed doors. Afterward, I felt very foolish and now feel confused. I don’t know what to do or where to go. Much of the time, I am on the verge of tears. I am not used to feeling this way, and find it difficult. At the moment, any decision, either business or otherwise, has become almost impossible to make. I oscillated for the whole day on whether or not to come this evening.

Nira: I take it this is not the way you usually handle decisions.

Brian: I am normally decisive, and now I am lost.

Nira: Have you ever been in a situation that has any similarity with this one?

Brian: In all honesty, I haven’t … except perhaps when my mother started to have heart attacks and was taken to the hospital last November. However, in many ways, that was easier to cope with. It was only one parent, and the responsibility did not fall completely on...

Table of contents

• Cover Page
• Half Title Page
• Title Page
• Copyright Page
• Dedication
• Contents
• Foreword
• Preface
• Acknowledgements
• Introduction
• I Theory and Model of Crisis Intervention
• II Case Studies
• References and Bibliography
• Index