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Cards In This Set
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Four Steps in Brief
Counseling:
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1
Define the problem,
using open-ended questions, listening, paraphrasing, summarizing (What
brings
you here? What would be useful for me
to know to understand the situation? How does your behavior create a
problem
for you? Describe to me in one sentence
what you have told me.)
2
Examine attempted
solutions and exceptions: Explore
past solutions, get an idea of client’s resources and support network,
find out
what worked/didn’t work in past to help client generate new ideas.
3
Define a goal: goal
needs to be reasonable, meaningful, positive, specific, manageable,
socially
sound, and within client’s control.
Instill motivation by asking client to imagine desired outcome of
the
goal. Ask client to describe how it
will be when problem is resolved.
4
Assign a task:
homework. Tasks are assigned to clarify
goals (if vague); self-monitor behavior (e.g., pay attention to how they
deal
with depression); suggest trying a new behavior.
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Contraindications to Brief Counseling:
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Not appropriate for suicidal clients, SA
clients, psychotic clients, potentially violent clients, or clients with severe
personality disorders.
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MAIN IDEAS to BRIEF COUNSELING:
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Brief Counseling:
1) Brief counseling is lower-cost, action-oriented
approach for clients with specific, concrete problems.
2) It is pragmatic, structured, and directive. May consist of as few as one or as many as six sessions. 3) Involves leading client to take action by choosing among available alternatives for resolving specific problems. 4)Strengths-based, focusing on client’s strengths, resources, and goals. |
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Eclectic Suicide
Prevention:
Techniques used only to stabilize client so you can get
appropriate help. For crisis
intervention only; these are not treatment or counseling techniques.
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1) Counselor tries to assess lethality:
is client an attempter (“Two-thirds of all suicide attempts are actually pleas for attention…intended to end in rescue rather than death”) or a completer (eighth leading cause of death in America; second among youth; more suicides than homicides; 20% of attempters will eventually succeed; depression and suicidal ideation more frequent among adults, but depressed adolescents more likely to attempt suicide; high risk clients are male, over 40, socially alienated, OCD, chronic disease, substance abusers). Primary means of assessing risk is client’s verbal communication (I wish I were dead; I’m a complete loser; etc.). 2) Counselor’s goal is to instill hope and reduce anxiety. |
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Suicide risk factors: (8) ....and rationale:
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1) Family
history of suicide
4) Recent or impending loss (death, separation or divorce, rejection) 5) Self-destructive behaviors 6) Self Isolation 7) Self-mutilationSocial isolation
Among adolescents: divorce in family, communication barriers between parents and children; substance abuse; pressure from school, parents, friends; highly mobile families; personal relationship problem. Adolescents may also be more impulsive, attempts more spontaneous. Counselor needs to be aware of symptoms and risk factors in order to buy time for a professional referral. |
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Four Steps of
Eclectic Verbal Intervention:
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1.
Stay calm. Achieved
mainly via silent self-talk. Remaining calm and in control can diffuse
situation.
2.
Be aware of non-verbals: non-verbal communication
12.5 times
more powerful than verbal. Both clients
and counselors send messages via posture, tone, pitch, facial
expression.
a.
anxiety: increased gestures, red face, sweating,
fidgeting,
pacing, tapping.
b.
Anger: frowning, tensing lips, clenching teeth,
widening eyes,
thrusting chin. May erupt into physical
violence.
c.
Coldness: unsmiling, reduced eye contact, crossed
arms, closed
posture.
Watch proxemics.
3A. Begin verbal
intervention, using empathy and active listening:
d.
It’s not what you say, but how you say it (voice,
speed,
volume)
e.
Avoid rhetorical questions
f.
Stick with facts, avoid personal opinions
Active listening
skills:
·
Observe and read client’s nonverbals
·
Hear and understand client’s verbal message. Reflect feelings or thoughts to demonstrate
empathy and interest
·
Develop trust. Client feels heard and
understood.
3B.
Try using questions (“What are you shooting for?”)
If client is
unresponsive, try
turning questions into statements (e.g., “What do you want?” becomes “I
need to
you [calm down, etc.]”)
Questions give
client time to cool down, reflect, may move client out of emotion
and into
thinking (“cognitive bump”).
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Eclectic Verbal Intervention:
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Verbal intervention skills can prevent escalation
of a
crisis and decrease counselor job stress.
Crisis intervention important in three ways:
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Proxemics:
Intimate Distance:
Personal Distance:
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Personal space—way in which people use space
to communicate. Varies from individual
to individual, culture to culture.
Skin contact to about 18 inches. Sign of trust when people allow others into this space. May be perceived as threat if someone enters/invades this space without permission. If client feels threatened, may withdraw. 18 inches to four feet. Counselor should be 3 to 4 feet from client. If client begins to act out, lengthen the space. Be aware of cultural differences. In North America, 3 feet is accepted social distance. |
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Three Characteristics
of Crises:
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Six-Step Model of
Crisis Intervention:
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6) Obtain commitment: have client commit to definite, positive actions and be responsible for following through. Maybe a verbal contract, after review of plan. Written contract may be required in suiicide prevention. |
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Triage Assessment
Model:
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Allows a quick assessment of client’s current level
of
functioning in affective, cognitive, and behavioral domains, so
counselor can
decide on how directive she needs to be to move client out of crisis.
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