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Section 3
Middle Stage of Interviewing

Question 3 | Answer Booklet | Table of Contents

In the last sections, we discussed two important concepts regarding the first stage of interviewing during a crisis intervention.  These two concepts are beginning preparation, and important questions.  We will also discuss two simple interviewing techniques.

In this section, we will discuss 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.

The Middle Phase of the Crisis Interview - 3 Factors

♦ 1. Strupp’s Conditions
A first important factor of the middle phase of the crisis interview, whether the first interview or a subsequent session, is Strupp’s conditions.  Of course, crisis counseling as a process concerns itself with both behavior change through public and external data, and the client’s inner world through private and internal feelings.  
Strupp outlined the following three conditions necessary for both behavior change and an understanding of the client’s inner world to take place.
Condition 1: The therapist creates and maintains a helping relationship characterized by respect, interest, understanding, tact, maturity, and a firm belief in her or his ability to help.
Condition 2: This first condition creates a power base from which the therapist may influence the client through one or more of the following: suggestions; encouragement for openness of communication; interpretations of self defeating strategies in interpersonal relations and distorted beliefs; setting an example of maturity and providing a model; contracts and rewards.
Condition 3: Both preceding conditions are crucially dependent on a client who has the capacity and willingness to profit from the experience.

♦ 2. Jacobson’s Guidelines
A second important factor in the middle phase of the crisis interview I find is Jacobson’s guidelines.  Jacobson, who writes from a psychoanalytic point of view, advocates the following six guidelines for the middle phase of the crisis interview.  As I read Jacobson’s six methodological guidelines, consider how similar or different these guidelines are to those you are currently using.

1. Active exploration of the current situation in order to identify the precipitating event in instances where the precipitating event is not obvious.
2. Listening for mention of situations in the client’s past even symbolically analogous to the current predicament.
3. Stating the client’s problem to her or him concisely and in language that she or he can understand in order to facilitate insight and integration of facts.
4. Supporting the client’s new efforts at solving her or his now defined problem and taking a more passive role so that the client can gain self-reliance
5. Avoidance of prolonged discussion of chronic problems
6. Anticipation of the fact that many clients will not require further professional help after the crisis is resolved.

♦ 3. Smooth-Focus 6 Phrases
In addition to Strupp’s conditions and Jacobson’s guidelines, I find a third important factor in the middle phase of the crisis interview is using a smooth-focus phrases technique.  There can be six components in the smooth focus technique, each of which is a questioning phrase intended to bring the client’s focus to an important issue while maintaining an open-ended questioning stance.

Here’s how I use this:

♦ Smooth-Focus Phrase #1: Is the "Earlier you said…" technique.  The phrase ‘earlier you said’ can be used by the therapist whenever she or he wishes to return to something the client mentioned previously.  The phrase, often used during a client’s long pause, can signal the therapist’s intentions to the client.  With minimal interference, the therapist is able to signal to the client that their talking together has a definite purpose. 

For example, Mary, 43, sought crisis counseling when a severe bout of depression had cost her her job and her apartment.  Early in the session, Mary had stated that she had experienced suicidal thoughts.  During a pause, I stated to Mary, "Earlier you said "I have had thoughts of suicide.’  Can you describe those to me?"  Mary stated, "I can remember times in my life I would have, but I always found an excuse not to… I don’t know.  The one time I really came close is when my father died and then the next week I found out my husband was cheating on me…"

♦ Smooth-Focus Phrase #2:  is "Earlier you talked about."  The phrase ‘earlier you talked about’ is very similar in intent and usage to ‘earlier you said,’ however this phrase offers a more open-ended invitation to explore context and feelings.  This phrasing can be used to examine a broader topic area, or in case you cannot recall specifically what phrasing the client used.  For example, after Mary came to a pause following describing previous suicidal thoughts, I stated, "Earlier you talked about your father.  What would you say your relationship was with him?"

♦ Smooth-Focus Phrase #3: is "Tell me about that."  This standard phrase clearly allows the therapist to focus on a vague or ambiguous statement, such as "They hate me."  By asking the client to "tell me about that," the therapist can gain a more specific definition of the emotions the client is describing.

♦ Smooth-Focus Phrase #4: is "What do you do when…"  As you know, this smooth-focus statement allows you to make an assessment of how the client deals with potentially upsetting material and stressful situations while making minimal interference.  This question assist in formulating an idea of the client’s behavioral repertoire, mental status, impulse control, perception of certain stimulus situations, and emotional reactions to these stimuli.

♦ Smooth-Focus Phrase #5: is "Can you summarize?"  I find that after a crisis interview has progressed over five or ten minutes, there is often a great deal of information facing me.  I find that asking the client to summarize is a good way to enable myself to review pertinent information without disrupting the client’s narrative too much.  In addition, asking the client to summarize can help her or him regain perspective that may have been lost during the rush of feeling and content discussed so far in the session.

♦ Smooth-Focus Phrase #6:  is Silence.  Although silence is not technically a phrase or question, I have found, like you, that silence can definitely be a communicative gesture that allows both therapist and client to organize and review thoughts, feelings, and information.  Conversely, I find when silence of more than five second is introduced by the client, I usually state, "I see," wait for a moment, and then follow my own pause with a questioning "and" or "but."  I also might say, "I see you’re finding it difficult to talk" or "I wonder why you are so silent."

Think of a client you are currently treating with a crisis interview therapy structure.  Would implementing the smooth focus phrases technique be conducive to a better flow of information in your client’s narrative during the middle phase of your crisis interviews?

In this section, we have 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.

In the next section, 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.
Reviewed 2023

Peer-Reviewed Journal Article References:
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.

Satin, G. E., & Fisher, R. P. (2019). Investigative utility of the Cognitive Interview: Describing and finding perpetrators. Law and Human Behavior, 43(5), 491–506.

Schneider, L. H., Pawluk, E. J., Milosevic, I., Shnaider, P., Rowa, K., Antony, M. M., Musielak, N., & McCabe, R. E. (2021). The Diagnostic Assessment Research Tool in action: A preliminary evaluation of a semistructured diagnostic interview for DSM-5 disorders. Psychological Assessment.

QUESTION 3
What are the six components of the smooth focus phrases technique? To select and enter your answer go to Answer Booklet.

Answer Booklet
Section 4
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