On the last track, we discussed three important factors of the middle phase of the crisis interview. These three factors are Strupp’s conditions, Jacobson’s guidelines, and the smooth focus phrases technique.
On this track, we will discuss five important components of the ending phase of the crisis interview. These five components are the 1-2-3 technique, success leads to success, the focusing technique, the time factor, and the ending phase in subsequent sessions.
The Ending Phase of the Crisis Interview - 5 Components
1. "1-2-3 Technique"
A first important component of the ending phase of the crisis interview is the 1-2-3 technique. I have found that in the first crisis interview, towards the end of the session the problem-identification process should be clearly stated and shared between therapist and client. To accomplish this, I often ask the client to state the first, second, and third most significant problems that offer the best possibility of solution.
I feel this approach has several advantages. Asking the client to state the three most significant problems says to the client that she or he is an active participant in the crisis resolution process. It also indicates to the client that she or her has something to say about countering the forces that brought her or him into crisis, and that she or he is responsible for seeking a solution. Clearly this technique is not always appropriate, depending on the client’s mental state and other factors. Clients whose ability to make coherent decisions are impaired, for example severely suicidal, homicidal, or psychotic clients, are not appropriate candidates for the 1-2-3 technique.
2. Success Leads to Success
A second important component of the ending phase of the crisis interview is success leads to success. As you know, some clients may choose to focus on a problem that has little or no possibility of immediate resolution. The client is then faced with the problem of feeling increasingly more helpless and frustrated. Sasha, 36, came in with multiple family problems. She defined her immediate problem as her four year old son’s temper tantrums. Sasha stated, "Brian provokes my anger so much that I’m afraid I’m going to lose control and beat him!"
Once I assessed Sasha for the risk of violence towards her son and found the risk of her actually losing control to be low, I introduced Sasha to some specific behavioral techniques and reading material that could have an immediate affect on her relationship with Brian, and consequently on his behavioral problems. The concrete, small successes that Sasha thus made with Brian helped Sasha remain optimistic about her progress and about the crisis intervention sessions. Reminding Sasha of her small successes with Brian’s behavior helped strengthen her adaptive responses to what had at first seemed to her an impossible situation of multiple family problems.
3. Focusing Technique
In addition to the 1-2-3 technique and success leading to success, a third important component of the ending phase of the crisis interview is the focusing technique. I have found that frequently a client in crisis will stop discussing a specific theme once she or he has broadly defined the problem and her or his feelings. Usually, this does not provide me with sufficient information. The open-ended focusing technique thus helps me return a client’s train of thought to the problem, so that I can gain more information and be more effective in developing a crisis resolution plan with the client.
In the focusing technique, I usually wait until the client has completed a sentence and begins to pause. However, I sometimes find it necessary to interrupt a rambling client as unobtrusively as possible when I hear a repetition of themes. Some examples of a focusing comment are "How does that strike you" or "Does that make sense." What focusing comments are you currently using with clients in crisis to encourage the discussion of specifics towards the end of a crisis interview?
4. Time Factor
A fourth important component of the ending phase of a crisis interview is the time factor. Clearly, the ending phase of the first interview should take as much time as the therapist and client feel is necessary. Often, running over the scheduled time for an initial interview is more important to the client’s safety than ending promptly. In subsequent sessions, I usually attempt to remain aware enough of time to allow a minimum of ten minutes for the ending phase and drawing out specific problems to be worked on in the next session.
If I have a full schedule and an unexpected crisis interview clearly needs to run outside of its allotted time, I often find that I feel guilty about keeping my next client waiting. I have found that asking the client in crisis to wait for a few moments while I excuse myself and inform the waiting client that it will be another few minutes, relieves me of guilt and any feelings of the need to hurry. This allows me to focus clearly on the ending phase of the crisis interview, which benefits both the client in crisis and myself.
5. Subsequent Sessions
A fifth important component of the ending phase is the ending phase in subsequent sessions. I have found that after the first crisis interview session, it is necessary for me to provide a much more structured ending phase. Although the structure I use remains consistent, the length of the ending phase fluctuates depending on the amount of material covered in the session. If a large amount of material has been covered, I attempt to begin the ending phase early to allow enough time to review what has been covered, and avoid the discussion of new material that may overwhelm the client.
Four Step Model
I use a four step model for summarizing the session in the ending phase and preparing the client for the next session.
First, I review with the client the current state of his or her crisis. Second, I review with the client the current status of the crisis intervention plan, paying specific attention to any adaptations that have occurred during the course of the current session. This step reinforces the main problems and themes being addressed by the crisis intervention interviews. Third, I assess whether there is any new material that needs to be discussed. Although I attempt to wrap up all loose ends that emerge in a session, this is obviously not always possible.
Making time in the ending phase to address any new material allows me to state to the client, "This is important material, but we will have to wait and get into that in the next session." I then record the new information so that I can review the loose ends before our next session. Frequently, I encourage clients to come to sessions with a notebook, so that they can also record information they wish to discuss in the next session. Finally, I take a few moments to discuss with the client our crisis intervention plan for the next session, so that she or he will know what to expect.
On this track, we have discussed five important components of the ending phase of the crisis interview. These five components are the 1-2-3 technique, success leads to success, the focusing technique, the time factor, and the ending phase in subsequent sessions.
On the next track, we will discuss a three-step model for telephone crisis counseling based on the three-step crisis interview model examined in tracks 2, 3, and 4. These three steps are the beginning, middle and ending phases.
Peer-Reviewed Journal Article References:
Beers, T. M., & Foreman, M. E. (1976). Intervention patterns in crisis interviews. Journal of Counseling Psychology, 23(2), 87–91.
Faubert, S. E. (2020). Review of Crisis intervention: Building resilience in troubled times [Review of the book Crisis intervention: Building resilience in troubled times, by L. G. Echterling, J. H. Presbury & J. E. McKee]. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 41(3), 237–238.
Kamen, D. G. (2009). How can we stop our children from hurting themselves? Stages of change, motivational interviewing, and exposure therapy applications for non-suicidal self-injury in children and adolescents. International Journal of Behavioral Consultation and Therapy, 5(1), 106–123.
Online Continuing Education QUESTION 4
What are five important components of the ending phase of the crisis interview?
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