A MODEL OF CRISIS COUNSELING Dr. Allan R. Dionisio Dr. Maria Ciedelle Rogacion Dr. Milagros F. Neri

You are already counselors. We all have our own models that work. No one can argue with success. We want to offer you additional ammunition to the ones that you already have, so that you will have greater flexibility. “If the only tool you have is a hammer, you will treat every problem like a nail.”

SOME CRISIS SITUATIONS Family member with ESRD Father is hospitalized for heart attack 17 year old daughter attempts suicide because of unwanted pregnancy Woman runs away from abusive husband Couple is informed that newborn son has Down’s syndrome Families are displaced by landslide during a typhoon Community is destroyed by raging flood

What is CRISIS? State of acute emotional upset that includes temporary inability to cope through usual problem-solving devices Does not last long and is self-limiting

CRISIS INTERVENTION Focuses on resolution of immediate problem through use of personal, social and environmental resources.

Myths: Myth: People in crisis suffer from a form of mental illness. Fact: People in crisis may have had chronic emotional or mental disturbance before the crisis. Likewise, a negative resolution of crisis may result in emotional or mental breakdown. BUT most people are NOT mentally ill.

Myths: Myth: People in crisis cannot help themselves. Fact: There is basic human need for self-mastery. Actively helping people to take control on their own is needed for positive crisis resolution.

Myths: Myth: Only psychiatrists or highly trained professionals can effectively help people in crisis. Fact: Crisis work has been done by lay volunteers, police officers, ministers and other front-line workers.

Myths: Myth: Crisis intervention is a mere band aid, a necessary preliminary, but trivial in comparison to real treatment carried out by professional psychotherapists. Fact: The effectiveness and economy of the crisis approach to helping distressed people is being recognized by health professionals.

Myths: Myth: Crisis intervention is a form of psychotherapy. Fact: Techniques such as active listening are used by crisis intervention workers, but it is not the same as psychotherapy. Crisis intervention avoids probing into deep-seated psychological problems.

Basic Steps of Crisis Management Psychosocial assessment of individual or family in crisis, including evaluation of risk of suicide or assault on others Development of plan with person or family in crisis Implementation of plan, drawing on personal, social and material resources Follow-up and evaluation of crisis management process and crisis resolution

The Attitudes of a Counselor Allan R. Dionisio, MD

Review of Active Listening Attitudes: Empathy Unconditional positive regard Congruence Attending Skills: LOVERS

Review of Active Listening Leading Skills Direct lead Indirect lead Reflecting Content Paraphrasing Perception checking Focusing

Review of Active Listening Reflecting Feeling Probing Not “objective type” Should be open-ended HDTMYF? TMMATF. Summarizing

P F B R P = R

P iF iB R C P = R

The ABCDE Model of Crisis Counseling. Allan R. Dionisio, MD Maria Ciedelle Rogacion, MD Milagros F. Neri, MD

Pastor Howard J. Clinebell, Jr. , Ch. 8 Crisis Care and Counseling Pastor Howard J. Clinebell, Jr., Ch.8 Crisis Care and Counseling. “Basic Types of Pastoral Care and Counseling.”

Critical Incident Stress Debriefing (Mitchell et al.)

Context of Crisis Counseling NOT during the acute disaster. The intervention takes place AFTER the basic survival needs have been attended to already. There is still a crisis, but one of getting on with life rather than just surviving.

Objective : to get some control of a difficult situation

ABCDE A- Achieve a relationship of trust and caring. B- Boil down the problem to its major parts. C- Challenge the individual to action. D- Develop an ongoing action plan. E- Evaluate the results

Table event feelings physio rxns thoughts actions Break up Devas-tated insomnia No one will love me. Slash wrist

A- Achieve a relationship of trust and caring. Develop rapport. Use the active listening skills to ventilate emotions and diagnose perceptions. What happened? What did you feel (emotions/physiologic rxns)? What did you think? What did you do? Tabulate above (key words only/large font) and show it to the counselee. Show the connections. Normalize the feelings and thoughts.

Table event feelings physio rxns thoughts actions Break up Devas-tated insomnia No one will love me. Slash wrist

B- Boil down the problem to its major parts. List down on paper the problems identified by the patient and show it to the patient. “Is this list complete? Would you want to add to the list?” “Which problems are within your control? Which are not? Start with what you can control.” “Which would you like to handle first? Which are priority?” (focus on what is immediately actionable)

C- Challenge the individual to action. What solutions have you tried and what happened? (some may have already been mentioned) What other things can you try? Suggest solutions if necessary. Examine each option: What might happen if you did this? Prioritize which to do: Which one would you want to try now? Reflect the strengths: What are the things going for you right now?

D- Develop and on-going action plan Make a plan with small achievable goals: How do you want to accomplish this? Explore obstacles: What is stopping you from carrying out this option? What can you do about these obstacles? When do you want to start? Provide assurance of availability and support. Connect them with resources. Set up regular appointments and phone contacts.

About giving advice It is better if the solutions come from them. Limit your advice to where you are expert. Time the advice: AFTER they feel listened to. AFTER you have gone through their sol’ns

E- Evaluate the Results Review Evaluate Revise Encourage

Exercise Think of a problematic situation for you. Take turns practicing the model on each other.