Chapter 5A: DEVELOPING AND MAINTAINING RAPPORTQuestioningSlide 4PARAPHRASINGREFLECTION OF FEELINGSSUMMARIZATIONB: IDENTIFYING THE PROBLEMETHICAL ISSUESCOGNITIVE EXPLORATIONTHERAPUETIC INTERACTION STATEMENTSSlide 12Slide 13Slide 14C: COPINGSlide 16Chapter 6SUICIDEFacts and statisticsSlide 20Slide 21Clues and symptomsSlide 23Suicide Assessment, Risk Level and StrategySlide 25MANAGING CLIENTS WHO ARE A DANGER TO OTHERSAssessmentInterventionChapter 5THE ABC MODEL OF CRISIS INTERVENTIONA: DEVELOPING AND MAINTAINING RAPPORT•Basic attending skills•1. Attending behaviors: good eye contact, attentive body language, verbal following, soothing calm voice, warmthQuestioning•Open-ended questions allow for exploration of what the client just said•Begin with “how” and “what”•Attach the question with something the client just said•Don’t ask “why” questions•Avoid “have you” questions, they are usually forms of hidden advice•Close-ended questions such as “do you”, “does it”, and “are you” lead to answers such as “yes” and “no” which go nowhere. Change them into what and how questions.•Be specific and direct.•Avoid “would you mind”, “could you tell me more”. Direct the client about what to explorePARAPHRASING•Help client and HS worker know that each understands the other.•Restatement: saying back to client in the HS worker’s own words what s/he heard the client just say. Mostly facts and ideas.•Clarification questions: The HS worker repeats something the client just said in a questioning tone to clarify the whole thing or part of what was said.REFLECTION OF FEELINGS•KISS (keep it simple student)•The best reflections are short, and focus just on the emotion expressed either verbally or nonverbally.SUMMARIZATION•This helps move the interview along and into other areas, such as the C section.•Useful when the HS worker is not sure where to lead the client.•Includes emotions, facts, cognitions disclosed throughout the entire sessionB: IDENTIFYING THE PROBLEM•Human Service workers need to identify the nature of the crisis:•1. precipitating events•2. cognitions about these events•3. emotional distress•4. how the client is functioning socially, academically, occupationally, and behaviorally since the crisis.ETHICAL ISSUES•HS worker must assess for the following:•1. suicide•2. child abuse•3. elder and disabled adult abuse•4. danger to others•5. medical or organic illness, substance abuseCOGNITIVE EXPLORATION•HS worker climbs the cognitive tree with client to understand the inner world, the cognitive schema that has created the crisis.•HS worker must understand client’s frame of reference in order to begin altering these perceptionsTHERAPUETIC INTERACTION STATEMENTS•1. Validation and support statements: these make clients feel that their point of view and subjective experiencing is valid and that the HS worker empathizes with their plight. HS worker lets clients know that their feelings are normal and difficult.•2. Educational statements: HS worker offers information based on HS worker knowledge about various aspects of the client’s crisis. This helps normalize the experience or corrects false ideas the client might hold.•Empowering statements: these comments help the client feel more powerful and in control. HS worker points out choices available and how client can overcome feelings of helplessness.•4. Reframing statements: HS worker helps the client view the situation from a slightly different point of view using the client’s frame of reference. Sometimes a positive perspective is changed into a negative one, sometimes a negative perspective is changed into a positive one.C: COPING•Have client explore their own attempts at coping and think of what they would like to do now.•HS worker then offers alternative coping ideas such as referrals to support groups, 12 step groups,long term, family, or marital therapy, shelters and other agencies, physicians & lawyers•Sometimes HS workers might recommend that clients journal, or read books, view films or participate in assertive training or stress management courses.Chapter 6When crisis is a dangerSUICIDE•Myths:•Discussing suicide will make client more likely to attempt•Suicide threats don’t need to be taken seriously•Suicide is an irrational act•Suicide tendencies are inherited•Once someone thinks of suicide, it never goes away•Suicide is always impulsiveFacts and statistics•1 out of 59 individuals in the U. S. has been affected by the suicide of someone close to them•Rates have remained stable over the past 40 years•About 40,000 people commit suicide and almost 800,000 attempt•Males more likely than females to successfully complete suicide•Females more likely to attempt, but not be successful•Psychiatrists have the highest rate of all professions•Suicide occurs within the first 3 months of improvement from an episode of depression•15-19 year olds: 2nd highest cause of death, car accidents are the main cause•25-30% of alcoholics will attempt suicide•25% of schizophrenics will attempt•25% of dysthymic disorders will attempt, 12 out of 100,000 will succeedClues and symptoms•Giving things away and putting things in order•Writing a will•Withdrawing from usual activities•Preoccupation with death•The recent death of a friend or relative•Feeling hopeless, helpless, and worthless•Increased substance abuse•Displaying psychotic behaviors•Verbal hints, “I’m no use to anyone, what’s the point?”•Agitated depression•Living aloneSuicide Assessment,Risk Level and StrategyFactor: Response: Risk: Strategy:Ideation:NO LOW Supportive Crisis Intervention.YES Go to next factor to decidePlan:NO LOW Crisis Intervention Verbal No-Suicide ContractYES Go to next factor to decideFactor: Response: Risk: Strategy:Means:NO LOW Regular Contact, C.I.YES MIDDLE Written no-suicide contract, increase contact, family watch, turn in the means to HS worker.Can anything stop You?YES MIDDLE Encourage clients to live for the reasons given; help them find meaning in lifeNO HIGH Possible involuntary hospitalization.Severe DepressionNO MIDDLE Refer to physician for a physical and possible medication.YES HIGH Possible voluntary hospitalization.Suicide Assessment,Risk Level and StrategyMANAGING CLIENTS WHO ARE A DANGER TO OTHERS•Must keep in mind the Tarasoff decision and duty to