Unit 3: Developing Positive Relationships, Crisis Intervention & Handling Difficult Cases Thursday, February 17, 2011

Unit 3 Assignments  Discussion  Written Assignment (You are required to cite your research. Please see APA announcement on the course homepage.)

Crisis Case Handling  Handling Crisis vs. Long-term Cases  Case Handling at Walk-In Facilities  Police & Crisis Intervention  Transcrisis Handling in Long-term Therapy  Counseling Difficult Clients  Confidentiality

Developing Positive Relationships Starting from the Inside

 Positive Relationships- A connection or bonding of one or more people that is anchored in trust, understanding, kindness, and respect.  Why the need for Positive Relationships: 1. To feel safe and comfortable with others. 2. To develop a sense of belonging. 3. To lay the framework that allows individuals to become more confident, interdependent, and engaged in their world. Introduction

Laying the Foundation  Safety- Many of us and those we serve are burdened with memories of distrust and fear. To feel safe we must experience unconditional love, acceptance, and the physical and emotional space that we’re comfortable with.  Security- The feeling that I’m safe, I won’t be hurt, and everything is going to be okay.  Love- The warmth of feeling cared for. Its trust and faith that you unconditionally honor, accept, and understand me.  Attachment- I belong. I’m accepted. Stay with me even when I’m being difficult.

The Ingredients: I Will Be….  Genuine: Be real. Don’t fake it…everyone catches on. Your credibility and your chances of developing a positive relationships starts with your being genuine and real in your actions.  Consistent: We need to be predictable and reliable in our interactions with others. We can’t be loving, caring, supportive one day and be distant and aloof the next.  Supportive: The old saying, “Be here now!” applies. Be in the moment when interacting with someone. Show caring by using your eyes, face, body, voice and touch.

We must use our: 1. Eyes- The eyes are often referred to as the window to the soul. To build relationships, we must embrace others with our eyes. Your gaze into others eyes should be soft, slow, loving and warm. Picture your eyes as hands and arms reaching out to people. Many people see a look as fists. Look gently and softly at the person, moving your gaze into the persons eyes with out piercing them.

We must use our: 2. Face- Our facial expression tells more about how we feel about someone than our words. Our faces should be calm, relaxed, and gentle. Smile Even if you don’t feel like it sometimes….smile till your heart catches up!

We must use our: 3. Body- Remember body kinesics and proxemics. Where and how you stand in relation to a person is critical in how they perceive your presence. Avoid squaring up and/or standing over someone while talking with them. When communicating with children come down to their eye level. When standing and engaging someone, stand with an open stance with relaxed body posture and open hands facing towards the person.

We must use our: 4. Voice- Even if the people we are talking to don’t understand what we are saying, they’ll feel what we are saying by our tone, volume, warmth and rhythm. Use gentle, calming words. If your talking causes escalation, go the other direction with your voice. People need to feel warmth, tenderness, and unconditional love from your voice.

We must use our: 5. Touch/ hugs- Use as a sign of friendship and caring. Touch should be done softly, slowly, predictably, and you should be ready to back off at any moment if discomfort is being shown. Knowledgeable touching is key. Know the individuals life-story, experiences, and comfort levels. Touch should be used for the hands, forearms, shoulders, side and back of the head and upper back. If touch/hugs are not appropriate to the situation then use your voice, body, face and eyes to communicate safety, security and love.

Understanding Awareness Road Blocks Putting it all together

Role of the Direct Service provider  Assist and support the individual to make informed choices, follow through on responsibilities and take risks  Promote the individual participating in the design of support services  Provide opportunities for self-advocacy by increasing awareness of self-advocacy techniques, encouraging the individual to speak on his/her own behalf

More on Roles  Promote community connections, friendships and other valued relationships  Assist the individual to meet his/her physical needs by teaching skills, providing supports and building on strengths and capabilities  Ensure the health and safety of the individual

Understanding: “ Walk in my shoes”  Know your audience. Learn about the person you’re developing a relationship with.  Put yourself in their life experiences and begin to understand where they are coming from.  Focus and start with what's inside, then work your way out.  Accept everyone where they are. Build on that starting place.

Awareness: “Be in the moment”  Give your time and attention.  Notice the tears, smiles, anxiousness, and comfort and respond accordingly.

Road Blocks: “What's keeping you from Developing Positive Relationships?”  We bring our own “stuff’ into relationships. Sometimes our stuff gets in the way of Developing Positive Relationships.  Keep yourself healthy. Go on an ‘ego’ diet. Eat, drink, think, sleep, and do positive things. Get supports for those areas in life that need TLC.  Love or learn to love yourself. Be kind and gentle to yourself and you’ll be able to give the same in return.

1. Training 2. Practice 3. Patience 4. Openness Making it work

1. Training  When working with individuals with disabilities, learn all you can about them. Use the library, computer, seminars, co-workers, etc. as resources.  Learn beyond this power point presentation on how to develop and maintain positive relationships in your life. Resource websites:

2. Practice  If loving, caring, and supporting doesn’t come naturally to you…practice.  Volunteer at a senior center, or Special Olympics event. Join the Big Brothers Big Sisters organization.  If your heart is vested in developing positive relationships all these concepts will fall into place and it’ll become a part of who you are.

3. Patience  Take a deep breath.  You may not succeed in developing a positive relationship the first, second, hundredth time. If your heart is genuine it will happen!!  Give it time, don’t personalize setbacks, and always see the potential. The greatness that sits on the horizon needs to be visualized and realized by you!

4. Openness  It is very difficult to see through a cloudy window or a closed door.  To be successful in developing relationships, you have to open up yourself.  You must be willing to take the risk of love, trust, care and support.  You can’t give, what you don’t have!

A Commitment If you are willing to unconditionally…  Love  Support  Care  Understand …what commitment can you make today?

What to do if a crisis occurs.

Purpose of Crisis intervention To maintain: Care Welfare Safety Security

Physiological impact of a crisis  Increased Heart Rate.  Dilation of bronchioles for easier breathing.  Constriction of arterioles in skin, digestive system, and non- exercising muscles.  Inhibition of digestive functions.  Widening of pupils.

 Crisis development/Behavior levels Anxiety: a noticeable increase or change in behavior. Examples: pacing, finger drumming, wringing of the hands, staring  Staff attitudes/approaches Supportive: an empathic, non- judgmental approach attempting to alleviate anxiety

 Crisis Development/Behavior levels Defensive: Beginning of the loss of rationality. Person may become belligerent and challenge authority.  Staff attitudes/approaches Directive: An approach in which a staff member takes control of a potentially escalating situation by setting limits.

 Acting out person Total loss of control which often results in acting out episode.  Nonviolent Physical Crisis Intervention Safe non-harmful control and restraint techniques used to control an individual until they can regain their behavior. Techniques should be utilized as a last resort, when an individual presents a danger to self or others

 Tension Reduction: Decrease in physical and emotional energy which occurs after a person has acted out, characterized by the regaining of rationality.  Therapeutic rapport An attempt to re- establish communication with an individual who is experiencing Tension Reduction.

Nonverbal behavior  Personal Space Factors that influence personal space include: gender, size, cultural differences, familiarity, and situation occurring.  Body positioning: Body posture and motion which include facial expression

Paraverbal Communication  Definition: the vocal part of speech, excluding the actual words one uses. A. Tone B. Volume C. Cadence  Suggested approaches  Try to avoid inflections of impatience, condescension, inattention, etc.  Keep the volume appropriate for the distance and situation.  Deliver your message using even rate and rhythm

Tension ReductionQuestioning Release Refusal Intimidation

Tips for verbal intervention  Do Remain calm Isolate the situation Enforce limits Listen Be aware of non- verbals Be consistent  Don’t Over-react Get in a power struggle Make false promises Be threatening Use jargon

Empathetic listening  Be non-judgmental  Give undivided attention  Listen carefully to what is being said (not just the facts)  Allow silence for reflection  Use restatement to clarify messages

Compartmentalization of feelings  Definition:Separation of ones feelings from the crisis situation. A professional attitude must be maintained so that we can control the situation. Outlets are needed for negative energy absorbed during the crisis An open discussion about the events may be needed.

A very human experience  Individual’s behavior level Anxiety (-) Defensive (-) Act out person (-) Tension reduction (-)  Staff attitude/approach A. Supportive B. Directive C. Therapeutic rapport Individuals do not operate in a vacuum. Staff and individuals effect each other.

After the incident  Make sure everyone is safe  Identify concerns and brainstorm ways to address those concerns.  Look for patterns among crisis situations.  Provide support and praise to your team members.

Finally:  Remember: “Everybody is safe and tomorrow is another day.”

Any questions?  Any final questions?  See you next week at the Unit 4 seminar on Thursday, 2/24/11 at 10 pm ET.