Registered Nurses´ Association of Ontario
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An Application of A Model Of Crisis Intervention
The ABC Model of Crisis Intervention
Note: Numerous examples (in italics) have been cited to provide choices for clinicians, in framing questions. It is not intended that all questions should be posed to all clients in question.
A: BASIC ATTENDING SKILLS
Introduce yourself and your role in a respectful, friendly and CALM manner. Use icebreakers as needed to relieve the tension. Extend your hand if possible in a handshake.
I can see that you are very distressed/ upset. I am concerned about you. Can you tell me what is upsetting /bothering you? I´d like to understand your situation from your point of view. Have you had an opportunity to talk to anyone about this? Please tell me what is happening with you. Can I help you get started by asking you…??? (Listen actively, and paraphrase in the client´s own words re his/her description of the current situation).
How can I help you today,Mr. or Mrs ___? You seem to be having a little trouble getting started. Can I help by ____? (Offer a drink of water, or whatever may be needed). I am so pleased you could meet with me today, as I can see it must have been very difficult for you to make it in today.
B: IDENTIFYING THE PROBLEM AND THERAPEUTIC INTERACTION
- Identify the precipitating event.
What specifically brings you here today? Is what is happening unusual or different from the way you normally think (behave or feel)? How is this different from your usual norm? I know you have had problems with this in the past, so something must be different about what is happening now. Can you try and put your finger on what is different, for you now? Did something happen recently, something different? Try and recall to the best of your ability. It will make it easier for you and I to tackle the problem together. - Explore meanings, cognitions, and perceptions.
What do you think about all this? (may have already been provided by the client, so may not be necessary to ask). What does it mean to you? What thoughts go through your mind when you picture or relive the event/experience? How do you make sense of all of this? What specifically do you mean? Can you tell me more about this, so I can better understand? I appreciate your ability to try to help me understand this further. Take a couple of deep breaths - it may help you to collect your thoughts. - Identify subjective distress (emotional distress).
Am I correct in understanding that you feel really (sad, anxious, afraid, angry, guilty, helpless, depressed etc.?). Have you ever felt this badly before? Under similar or different circumstances? What other feelings are going on inside you? You seem sad, angry, ambivalent, in pain. How have you been feeling since this occurred (the precipitating event)? Have these feelings worsened since the event? - Identify impairments in functioning in the following areas:
- Behavioural
How has this been affecting your life? For example, How are you sleeping? How is your appetite? Have you been carrying on with your normal activities? Kindly elaborate. How is this different from before the event occurred? - Social
Are your relationships with your friends and family different since this happened? How would your friends or family describe the change in your relationships with them? Are you still able to maintain your usual social contacts with the important people in your life? Please explain. How do you usually feel or act around people? Would you describe yourself as a sociable person normally? Is this different for you now? - Academic
Are you going to school? How are your grades lately? Is this a change from normal? Have you been able to study and concentrate in classes? How are you getting along with classmates? Are you more withdrawn, irritable, or absent from class? - Occupational
How are you coping or functioning at work? Has your work performance changed since (the precipitating event)? Have you been able to function adequately at work? Have co-workers observed a change in you. If so, in what way?
- Behavioural
Identify pre-crisis level of functioning in 1-4 above. If not already employed as above, ensure that current assessment is compared with a person´s normal functioning.
How has your ability to function socially, at school, and at work changed since (the precipitating event)? What was it like for you before (the precipitating event)? What were your relationships like before and after (the precipitating event)?
- Identify any ethical concerns:
- Suicide/homicide assessment
Do you ever think that life is no longer worth living? Have these feelings intensified lately? Do you think of joining loved ones who have passed on? Are you more preoccupied with thoughts of death lately? Do you ever think of taking loved ones with you? Have you been thinking about hurting yourself or others? Do you have a specific plan? Can you tell me about it? Do you have the means to follow through with your plan? Is there anything or anyone stopping you from killing yourself or others? Are your children/wife/husband or others in imminent danger? Are you in imminent danger? Although I realize this is painful to talk about, I am grateful that you are able to share these thoughts with me. It took a lot of strength and courage for you to ask for help today, and I (we) are here to help. I can better understand why you are feeling the way you are (validate and state the specific emotion being communicated by the client).You are coping with a great deal now. Together we can work on establishing a different course. Would you be willing to work with me on this? Despite your intense feelings now, I have helped others like you AND I KNOW there are other solutions/options/choices for you to lessen your distress. I´d like to work with you on this. Are these feelings interfering with your everyday functioning? Can you tell me more about this? - Organic or other medical concerns
How is your physical health status? What treatments or conditions are you coping with? How are these conditions affecting your everyday functioning (i.e. sleep, appetite, work or school attendance, relationship with others)? Do you know the medications you are currently on?
Are you able to get up in the morning and feed yourself? Are you independent in your ability to carry on your activities of daily living? Please elaborate if you can. (How many hours do you sleep? Can you dress yourself every day?)
Do you ever hear voices/sounds that others cannot hear? Does it ever feel like the phone wires are talking to you? Do you ever believe you have special powers? Can people read your mind or put thoughts into your head? Do you think people are out to harm you in anyway? Do you ever smell, taste, feel or see things that are unusual or that others don´t understand? Over what period of time have you been experiencing these sensations? Often people experiencing high degrees of stress report these unusual sensations.
- Suicide/homicide assessment
- Identify substance use/abuse issues.
Are you currently using any non-prescription drugs? Have you used these in the past? For what period of time? Has alcohol consumption been a problem for you lately? How much alcohol do you normally drink per week/month/day? Has this changed since the precipitating event (use the patient´s own words here re his/her description of the crisis event)? What if any drugs do you use recreationally? Is your drinking/drug use a problem in your view? - Use therapeutic interactions
- Educational comments:
Although you feel as though you are the only woman who stays in a battering relationship, it is estimated that about 30% of women in the United States and Canada live in ongoing battering relationships for a variety of reasons.
Going through a period of intense anger is quite normal and to be expected after the death of a loved one.
Actually, it is not uncommon to be raped by someone you know. Date rape is extremely common for women ages 15 to 24.
Studies to date do not show that one can catch HIV by shaking hands.
It is not uncommon for the spouse of an alcoholic to be highly anxious about the spouse´s drinking. - Empowerment statements:
It is true that you did not have a choice about being raped, but you do have choices now, including whether to press charges, get a medical exam, or drop the whole matter.
Unfortunately, you cannot control your wife´s drug use, but you can control your own behaviour, or responses to/ with her.
True, you are HIV infected and cannot change that.You can, however, choose how to live the rest of your life in a way that is most meaningful for you. - Support statements:
This is an extremely difficult situation, and I don´t take it lightly. I can only imagine the pain you are going through. I am so sorry this happened to you. Please, let me be there for you: I do care. It must feel pretty terrible if you want to kill yourself. These kinds of traumas often make people feel like giving up. - Positive Reframes
I think it takes a lot of strength to cry, and I don´t see crying as a sign of weakness.
While painful emotionally, this crisis will help you become a stronger, more insightful person.
Have you ever considered that perhaps your children /wife were trying to help you rather than harm you when they …? I can´t see how anything you may have done would have prevented your friend´s death. From what you have described, you were there for your friend every step of the way.
- Educational comments:
C: COPING
- Identify client’s current coping attempts.
What have you done in the past to cope with similar feelings or behaviours? Did this work for you? Why or why not? What have you done recently to try to feel better? What else have you done? Anything else? Why do you think this is not working for you now? Do you have any ideas on what might be more helpful for you at present? Perhaps together we can explore some alternatives that might be worth trying to help you feel more in control of the situation. You seem to be doing a good job of the situation, but perhaps there are other things that you haven’t considered, that you might find more helpful. I would like to work on this with you. What do you think? Would you be willing to give it a try over the next couple of visits? (Specify how many). People in crisis often learn more about themselves and think of ways to overcome their distress. This is my hope for you. In the process of exploring your own solutions to this crisis you will become stronger and healthier. Crises are often a normal part of life.We all experience crises at some point in our lives.You, more than anyone, know yourself best and what may or may not work for you. I will follow your lead and provide encouragement for you along the way. - Encourage client to think of other creative coping strategies.
What else can you think of to try to get through this? What have you done in the past to get through difficult times? What would you tell a friend to do in this case?
- Present alternative coping idea/ Develop a Plan.
Contract to come in for additional sessions with yourself. Negotiate the number of sessions. Set up the next appointment - time, date, location. Offer homework as needed for the next session. Our focus will be…….. I’d like you to bring in your ideas on what solutions we may consider to help you solve the problem.Would you find this helpful? I am looking forward to our next session. Thank you for helping me understand this with you. I know it took a lot of courage on your part and I know that strength will carry you through this difficult period. - Refer to a lawyer
I would recommend you get legal advice from an attorney. These matters are beyond my scope of clinical expertise. A visit with a public defender, justice of the peace or lawyer will help you consider or exercise your legal options. I will set this up for you before you leave today, as I can see that you are coping with a great deal right now. Are you aware of restraining orders? This legal appointment will offer you additional information and options that I feel you need to address to maintain your safety or the safety of your family. Would you agree to this? I would like to meet with you again following the visit with the lawyer if you are in agreement. Shall we set this up now? - Refer to a shelter or other community other agency
How would you feel about going to a battered woman’s or homeless shelter in the meantime? Particularly since you do not feel safe in returning home tonight. You will be safe there and it will give you some time to explore your options. I will continue to maintain contact with you until this crisis is resolved even though there might be other agencies and people involved. - Recommend books
Do you like to read? I know some really good books that help explain more about what you are going through. Here are some suggestions that might make it easier for you to talk about and understand your situation. - Obtain commitment; do follow-up
When can you make another appointment with me? Call me when you set up your appointment with Dr. Jones. I am going to call you tomorrow at 9 am.Will you promise not to act impulsively or harm yourself until then? Do you give me your word? Let’s shake on it. Can you have a friend stay with you tonight just so you are not alone? Let me call this person on your behalf. I will also leave you my card. If you need to call at any time of the night or day, there is always a person at this number 24 hours per day. I will return your call as soon as I possibly can. I am looking forward to seeing you or speaking with you on our next visit (or phone call). Has talking about this helped you in some way? Can you describe this for me?
