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In the last section, we 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.
In this section, we will discuss a three-step model for telephone crisis counseling based on the three-step crisis interview model examined in sections 2, 3, and 4. These three steps are the beginning, middle and ending phases.
Regina, 32, had been seen previously for general depression related to events in her early adulthood that had culminated in a suicide attempt at the end of her last year of college. Regina called in one Friday just as the office was closing, and stated to the receptionist that she had ‘had a black period’ and suddenly it came to herself that she realized she was standing in the kitchen with a knife to her wrist.
I have found that whether the crisis involves a client’s suicidality (sue-i-si-DAL-i-tee) or not, crisis interviews over the phone can be structured to fit the same beginning, middle, and end model as practiced in face to face crisis counseling.
♦ Step #1: Crisis Call: Beginning Phase
I often find crisis calls like Regina’s highly stressful for me in the beginning stage, because all of the visual cues I usually receive in face to face crisis counseling are absent, and I am forced to rely on vocal and nonvocal sounds, often difficult to pick out, to assess the client. I try to focus on voice inflections, background noises, and the like in order to reduce this handicap. In Regina’s case, as she began to talk to me, I heard the sound of the knife dropping onto the floor. I was able to confirm with Regina that she had dropped the knife, and through this observation and other vocal cues, was able to determine that her level of distress was decreasing.
As in any face to face crisis interview, I offered Regina only as much structure as she required. Since Regina immediately became very talkative, I refrained from interfering as much as possible, and let Regina guide the direction of our discussion in the beginning stage of her crisis call.
♦ Step #2: Middle Phase
I feel that a telephone crisis call should focus upon rapid resolution of the crisis situation, and that it is not necessarily productive to discuss chronic situations. While in face-to-face counseling I would certainly give more focus to these issues. When I am conducting a telephone crisis call, I am mindful of the fact that I may have only one opportunity to deal with the caller, who may be referred to a different therapist for long-term care. I feel it is my duty in a telephone crisis call to focus all my attention on the immediate resolution of the prominent issue of the crisis.
♦ Step #3: Ending Phase
I also feel that the ending stage of a telephone crisis call should involve letting the client know that I will be making a follow-up call in the near future. During the follow-up call, I can see how the client is doing, determine whether she or he has followed up on the referral, and review the client’s current status.
♦ Technique: Benjamin’s Self-Assessment
How does the current self assessment technique you are using for your telephone crisis calls compare to Benjamin’s technique.
In this section, we have discussed a three-step model for telephone crisis counseling based on the three-step crisis interview model examined in sections 2, 3, and 4. These three steps are the beginning, middle and ending phases.
Peer-Reviewed Journal Article References: