Awake At Sunrise

“I just don’t know what to do.” That’s what a person often says when they find they find themselves plunged into a crisis situation. In order to help individuals and families deal effectively with a crisis they are facing, we need to help them evaluation the crisis, mobilize resources and develop a plan of action. That is the ultimate goal of crisis counseling.

Thus far, we talked about the need to establish a relationship of care and concern with the individual in crisis. Next it is important to boil down the problem to its basic elements. These are essential phases in helping someone handle a crisis. Nevertheless, we need to help them come to a point where they can deal effectively with the crisis in order to arrive at a resolution of the crisis.

The action that a person takes may be to simply make a decision, accept a loss, learn a new skill or find a new job. Taking decisive action that has been thought through carefully is what can lead to personal growth.

Establishing Goals

Once a pastor or other church minister has established a relationship, facilitated the expression of feelings, and helped a person boil down and define the problem, the next task is to establish goals. Since crisis counseling only aims at alleviating symptoms and helping the individual to return to at least their previous level of functioning, setting goals is often relatively simple task.

The aim in crisis counseling is to shift the focus from negative to positive, from problems to goals. Once some overall goals are established, it is important to develop some easy-to-achieve objectives that will move the individual toward problem-solving. If possible, it is good before the first contact ends, to help the person choose at least one specific action that he or she can take. It needs to be something simple such as making an appointment with a doctor for a physical or attending an Al-anon meeting. Having something they can do in order to start moving toward a resolution, can give people a sense of hope.

Taking An Inventory Of Resources

Frequently, people in crisis have difficulty recognizing both the internal and external resources that are available to them to help them deal with a crisis. A pastor can ask individuals what has helped them cope with a crisis in the past? What have they learned from previous experience that they could put to use in the present situation?

External resources can also be helpful to a person in crisis. These include family, friends, church, and community groups. Often people in crisis pull away from those relationships that could give them needed support. There may also be other persons and groups that can provide needed help. It may be necessary to help mobilize people who can provide care for someone in trouble. On many occasions, an individual in crisis may be reluctant to ask others for help or to believe that others would be willing to provide assistance. The person counseling the individual in crisis may need to offer encouragement in this regard.

Formulating Alternatives

Once goals are developed and resources are identified, the minister and the individual or family in crisis can brainstorm alternative ways to deal with the crisis. These alternatives will be geared to achieve the goals that have been established. This process needs to begin with the person, but often the minister will need to suggest actions the person has never considered. Being outside the crisis often enables us to see alternatives that the person in crisis won’t see.

When a list of alternatives has been formulated, its time to weigh each course of action. At this point, it might even be helpful to have a prayer asking for God’s guidance. Actions that are irrelevant or unworkable need to be crossed off the list. Each action is evaluated in terms of it potential effectiveness. After the person has considered the effectiveness of an alternative, the minister might want to offer information from his or her own experience or the experience of others who have faced similar circumstances.

Once the list of alternatives is reviewed, it is important for the person to choose one or two things that will be tried. It is good to press for a commitment to begin doing what has been chosen before the next visit takes place.

Commitment To Action

After a commitment to a course of action is made, it is crucial that the individual or family follows through on that commitment. This is vital to prevent increased dependency on the helper. Action counters the sense of immobilization that persons in crisis often experience.

A pastor or minister needs to be ready to confront with patience and firmness the resistance that often occurs at this point . Excuses such as “forgetting” or “not having time” are commonly offered. When such resistance is encountered, it must be identified and addressed as soon as it appears. People often need to be reminded that they are free to do something about their problem or not. The counselor can provide assistance in achieving goals, but he or she can’t do it for them.

Evaluating

Rather than being kept to the end, evaluation that reviews and refines goals and action plans is an ongoing process. In the final sessions of crisis counseling it can be very helpful to review what has been learned from dealing with the crisis. Individuals and families can be encouraged to put to use newly-discovered strengths and coping skills when future crises occur.

Follow Up

It is important to follow up on a person or family in crisis. This has the effect of deepening the relationship between the minister and those in crisis and reaffirms the helper’s concern for them. Such follow up can provide an opportunity to deal with the fallout from a crisis. The crisis event may reveal problems that need longer term counseling. Many pastors will use that as an occasion to refer people to someone who offers more long term counseling.

Referral

There are three aspects of a situation that may prompt a pastor or other minister to refer someone in crisis right away. They include:

• Time—The care giver may not have adequate time to deal with a particular person’s crises. For instance, if someone in crises comes to us that day before we are leaving on vacation, we may need to hand them off to someone who can help them while we are gone. Waiting until we return may not provide the immediate response that is required.
• Skill—We may find ourselves confronted with a situational crisis that goes beyond our level of skill and experience. For instance, dealing with a meth-addict requires an approach that most pastors won’t be able to effectively offer.
• Emotional Objectivity—We need to honestly access our own emotional objectivity. Our personal experiences may get in the way of our being able to provide that objectivity. If that’s the case, it is best for us to refer the individual or family to someone who can be more objective.

When making a referral, there are several things to remember:

• Not everyone will accept the suggestion of referral.
• Referrals need to be offered in a tactful and concrete way.
• When uncertain where to refer, contact a mental health professional, a local crisis line or a referral agency.
• Suggest several referral sources if possible.
• Except in an emergency, don’t make a referral call on behalf of the person in crisis. It is important that the individual needs to initiate the call.
• Remember that referral isn’t the first step. First, establish the relationship, listen carefully and then gently and slowly nudge the person toward doing something, including contacting a suggested referral resource.
• After referring, follow up.

Helping individuals who find themselves overwhelmed by a personal crisis can be a challenging, but rewarding effort. Having a framework to use when dealing with a situational crisis can give us the confidence to offer help to someone who comes to us and can make that chances of successfully negotiating a path through a crisis more likely. When this happens, individuals and families can come out of a crisis stronger that they were before. That’s the hope and the promise of crisis counseling.

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The previous post explored what is necessary as we begin to deal with a situational crisis in someone else’s life. It is important make that initial contact where we are able to establish rapport with someone who is seeking help.

The second phase in helping someone deal with a situational crisis is to reduce the problem to its essential elements. We do this by responding and focusing.

Responding

In his book, Crisis Counseling, Howard Stone lists several types of response to a crisis that aren’t helpful. Anyone with experience in counseling will recognize these. They include’:

• Giving Quick Advice—We need to establish a relationship and make sure that we have a good idea of the problem. Furthermore, the individual needs to feel that we have heard them before we begin to even suggest new ways to cope. Most quick advice will go unheeded.
• Offering False Assurance—Telling people that things will be just fine when we don’t really know that will be the case is not helpful. We want to reassure people, but we need to make sure our reassurances are realistic.
• Questions—Since questions tend to put people on the spot and can narrow the range of expression, they need to be kept to a minimum. Open-ended questions are normally more helpful than close-ended questions.
• Judgmental pronouncements—Judgment can often overlook the complexity of a person’s problems. It is only after considerable listening and the establishment of relationship with someone that we may chose to voice our understanding of the ethics of a situation. Even then, what we say needs to be phrased in a tentative manner that communicates gentleness and caring for the person we address.
• Psychoanalysis—This is best left to those who have that sort of training.
• Debating Or Arguing—When a person is in crisis, we need to respect their views even when they differ from our own. Getting into an argument will only create distance and will make it unlikely that we can be of help.

Effective responses usually involve active listening. Most pastors have been trained in the skill of offering the simple mirroring response in which the listener tries to put into their own words what they have heard the other person saying. This involves identifying feelings as well as reflecting the content of what has been communicated. This simple skill helps the other person know that we have heard them and that we understand what they are saying. It is also a way to make sure that our understandings are indeed correct. If we have misinterpreted, the person will hear that and will usually give us a needed correction. We need to listen for that as well.

There are several features of an effective response that Stone identifies. They include:

• Specificity—Avoid being vague or general. Telling someone that they are too emotional isn’t as helpful as to say, “You constant weeping gets in the way of your ability to communicate clearly.”
• Use Open-ended Questions. Try to frame questions that will require more that a yes or no answer. For instance, “Can you tell me more about what’s been happening in your life lately?”
• Describe Rather Than Evaluate—Instead of labeling something as “stupid” or “stubborn” for instance, simply stick to describing the feeling that person has expressed.
• Respond With Immediacy–Try to give immediate feedback, rather than waiting to summarize everything at conclusion of the conversation. Look for openings to offer responses as the conversation unfolds.
• Brevity—Even as you look for the chance to respond often, keep responses brief. A sentence or two is usually enough.
• Check For Understanding—By rephrasing what the other person has said, we can let them know we have heard them and allow them to confirm our understanding or correct it if necessary.
• Pauses—Pauses in the conversation need to be respected. We shouldn’t feel what we need to make sure the conversation flows on without interruptions. A pause can allow a person to reflect on what has been said and allows time to formulate an effective response.

Focus

Frequently, individuals will not grasp the impact that the precipitating incident has had on them or others. For this reason the counseling conversation involves an exploration and identification of the threat. Focusing includes: 1) identifying the precipitating event; 2) determining the loss that has occurred or is threatened; 3) becoming aware of the methods and resources the individual has used to try to cope; and 4) recognizing new factors that may have lead to the failure of traditional methods of coping.

As these four elements are explored, the goal is to set aside extraneous data and to work with the person in crisis to  put into words an understanding of what has happened. The crisis is examined from all angles to help the individual grasp the important aspects of the crisis. Once this understanding has developed the person will be ready to move on to the next phase which is to examine alternative methods of dealing with the crisis and choosing one to pursue. In the next post, we look at that phase in more detail.

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As a pastor or a worker in the church, we often have some kind of relationship with those who come to us for help in a time of crisis. Usually the person who approaches us at the church or when they meet us in another setting is already a member of our congregation and we have at least met. On other occasions, though, the individual who is seeking help may be someone we’ve never met before. They may show up at the church or approach us out in the community because they expect that the church or a member of a church staff  might be able to provide them with the help they need.

Whether the counselor knows the person who comes for help quite well or this is the first time that they have met , the first task when someone in a crisis situation comes for help is to achieve contact with this person.

Establishing a relationship of trust and demonstrating empathy are essential in many counseling situations and this is certainly true for crisis intervention. Since a person in crisis is normally less defensive, establishing a relationship of trust and empathy can happen rather quickly. In his book, Crisis Counseling, Howard Stone notes that two basic skills are needed to build this kind of relationship: offering attending behaviors and listening.

Attending Behaviors

Stone describes attending behaviors as the “physical, nonverbal acts that communicate interest and concern and help produce a relaxed and comfortable environment for people.” These behaviors communicate care and concern for the person in crisis. One of the basic ways we demonstrate care for another is by attending to their physical needs. Providing food or drink for others is symbolic as well as meeting real needs for others. When someone drops off a meal or a plate of cookies for a bereaved family they attend to more than physical needs. Offering a cup of coffee or a glass of water and providing a comfortable place to sit in a relaxed setting are important ways to demonstrate concern for others.

Body language can also communicate concern. We face the person we are talking to, we lean toward them slightly as they talk, we look them in the eye. Touch can be another effective way to show care for another person when we place a hand upon the arm, put an arm around someone who is deeply distressed or even offer something as simple as a handshake.

The room where the conversation takes place can communicate calm, confidence and openness. It is best if both the caregiver and the person in crisis can sit in comfortable chairs that are similar in height, facing each other. A closed door to shut out distractions and interruptions, a room that features comfortable temperature and lighting, a space that offers a opportunity for confidential communication and an area that is reasonably orderly all help to create an environment of care and concern. Recognizing the importance of setting means that we will seek the best place we can find to carry on a conversation with someone in crisis. It also influences how we arrange our office space. Whenever I have moved into a new office, I think about how I want the furniture arranged. for instance, I look for a way that I’ll be able to sit facing the individual who comes into talk without a desk or some other barrier between us.

Listening

The second skill that Stone finds to be essential for establishing a relationship of trust is the act of listening. When we give another person our undivided attention, we are demonstrating care and concern. In order to give such attention to a person in crisis, it is necessary to remove both the outer and inner distractions that can hinder us from careful listening.

As we listen, it is necessary to discover two things: the presenting problem and the precipitating event. The presenting problem is what the individual names as the reason for seeking help in the first place. We can get at the problem by simply asking something like: “Why did you want to talk?” Sometimes, such points of entry are not needed because the person simply starts to pour out their problems.

It can often be the case that the individual can identify the symptoms that something is wrong, but they haven’t made a connection to the event that has precipitated the crisis. A good line is inquiry is to ask whether something significant has happened in the last couple of weeks. If a precipitating event can be identified, the pastor or counselor can be reasonably certain that this is a situational crisis that should respond to the approach being described. If on the other hand, if the distress that the person is experiencing is the result of recurring, persistent, long-standing causes, other kinds of resources will be needed to deal with the person’s circumstances.

Frequently, the source of stress lies in a relationship that is falling apart or failing to meet the needs of the person in crisis. Questions regarding significant relationships in the person’s life can help identify this stress.

The initial contact with an individual is an opportunity for them to experience some emotional catharsis. A pastor or other church worker can help the individual recognize and express strong negative emotions, including: anger, hostility, guilt, anxiety and grief. These emotion can distort the individual’s perception of himself or herself.

Before the first contact is finish, it is very important to build a sense of hope. This can be communicated both verbally and nonverbally. It is important to move as quickly as possible when dealing with a crisis situation. It is in the first days and weeks that change is most easily achieved. We want the person in crisis to feel that resources can be brought to bear to help deal with the crisis situation.

Even though the conversation might end at this point, it doesn’t need to. If there is time, the elements that we will look at in the next posts, namely boiling down the problem and coping with it, can be pursued. What we are describing is a process that unfolds in its own way, not a series of steps. Sometimes it will require several sessions to move through the process, but on occasion most of it can be handle at one time with just a follow up to make sure that the methods of coping with the problem are working out for the person.

The key in the first session is establishing rapport so that an atmosphere of empathy and trust develops. By the end of the session we want the person to leave with a word of hope from us that they will be able to deal with the situation effectively. If we can to that, we have begun the process of dealing with a situational crisis.

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A patient arrives at the doctor’s office, hacking, sneezing complaining of congestion in the head and chest. The physician can see that the patient suffers from a terrible cold.  In years past, many such sufferers expected the doctor to prescribe an antibiotic to help them get over their misery. Yet many of us have learned that antibiotics aren’t effective in treating a cold, since the cold is brought on by a virus, not a bacteria that would be respond to antibiotic treatment. It is important to fit the treatment to to diagnosis.

When considering whether to use a crisis counseling approach to a problem that a person may present, it is crucial to establish whether the person is involved in a situational crisis or not. If they are, crisis counseling can offer very effective help because the individual is open to influence during a time of crisis. On the other hand, if the problem that the individual has encountered is something other than a situational crisis, another approach, include the possibility of referral, needs to be employed. So how can we identify whether we are dealing with a situational crisis?

In his classic book, The Minister As Crisis Counselor, David Switzer asks a series of questions that can help a pastor or other worker in the church determine whether a person or family is facing a situational crisis.

Has there been a recent onset of troublesome feelings and/or behavior?

A crisis is something that is recent in origin. It has begun in the last few weeks. It isn’t something that has been going on for a long time although it may be related to ongoing problems. For instance, addictive behavior usually develops over a number of years. Nevertheless, if something new happens—the addict gets picked up for DWI, that may trigger a crisis.

Have the feelings and/or behaviors been getting progressively worse?

A crisis develops when a person realizes that his or her attempts at coping are not working and they aren’t sure what else to do. Persons in crisis experience a breakdown in thinking as a result of physical or psychological overload.

Can the onset of these feelings and/or behaviors be linked to a specific external event?

Something has happened, some event has occurred that has made a sudden and dramatic change in the person’s life. Their situation in life has changed in some significant way.

If the answer to these three questions is “yes,” then a crisis most likely has occurred. The most helpful response will be to employ a crisis counseling response. Indeed, a person is usually more open to change and readjustment during a time of crisis.

People in crisis rarely face them alone. Often they are surrounded by family members, friends, coworkers and many times a community of faith. The response that pastors and other church workers or members make to a crisis can open the person or family to significant change. Such a response has three essential elements:

1. Achieving contact with the person in crisis
2. Boiling the problem down to its essentials
3. Coping actively with the problem

In the next posts, we will look at  this ABC response  in more detail.

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Most pastors and many other church workers will inevitably find themselves facing a crisis in someone else’s life. People in crisis often show up at the church looking for help. At other times, we simply run into them as we go about our daily lives. As we prepare ourselves to help others deal with situational crises, we need to be aware of the personal issues that we may encounter when we try to provide care to someone in crisis.

Be Alert To Our Limitations

Sometimes we may inadvertently find ourselves getting in the way of our own efforts to help. This can happen when someone else’s crisis is similar to one that I have recently experienced myself or haven’t completely resolved in my own life. At that point it may be important for me to consult with someone else or refer the person to someone who will be better suited to provide the needed care.

Be Prepared To Accept Failure

The efforts to define success and failure can be illusive. Yet there are times that we feel we have failed no matter how we try to explain what happened to ourselves. This can happen because we have made mistakes, but it can also take place when someone refuses the help that they truly need. Dealing with crisis means change and some people will resist making the changes they need to make in order to resolve their crisis in a healthy manner.

Be Aware Of The Expectations Of Others

Many people my not know how to act in counseling. They may also transfer experiences they have had in their family of origin, especially with their parents. Perhaps they expect that you can give them a simple prescription to solve all their problems. In many ways, people can have unrealistic expectations of those from whom they seek help.

Prepare To Deal With Negative Feelings

It isn’t surprising that a crisis can generate plenty of negative feelings. Sometimes those feelings are directed at others, but it common for those feelings of anger and contempt get focused on the pastor or other person who has been asked to help. Sometimes can can be a matter of needing to vent the powerful emotions that are generated by a crisis. If we can accept those emotions without reacting emotionally ourselves, that venting can lead to some emotional cleansing. That said, it is also the case that a helper can extend themselves in many ways and yet receive no gratitude or even hostility from those for whom the offer care.

Watch Out For Our Own Crisis

Caring for others can be so taxing that it can plunge us into our own crisis. A typical example is the person who tries to provide care for many persons that have be effected by a disaster in the community. If a flood or a storm strikes, the needs for care may be more than any caregiver can handle. The care giver may lose the ability to respond in a calm and relaxed manner. When we feel ourselves entering into crisis ourselves, it is time to pull back and to find someone else who can help share the burden.

Genuinely Care For The Other Person

One of the requirements of providing help for others, especially in times of crisis, is that we need to genuinely care for the person we are trying to help. If we don’t find that in ourselves, we aren’t going to offer effective care. We can get so caught up in techniques of care that we forget about the person we are trying to help. Or we may find that we dislike the kind of life the person in crisis has led. If this happens, we need to reexamine how we feel about the person in crisis and change our attitude if we can or find someone else to minister in our place.

In the next post, we’ll begin exploring the ABC’s of crisis intervention.

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I was busy working in my office when I heard a knock at my door. When I said, “Come in,” a young mother from my congregation stuck her head in the door.

“Are you busy?” she asked.

“I was working on my sermon,” I said, “but I can take some time to talk. Come in and have a seat.”

She sat down in the chair across from me. “I just don’t know where to turn,” she said.

“What’s wrong?” I asked.

Shaking her head slowly, she said, “I am so embarrassed. I’ve never had to come to anyone like this before, but we just don’t have any food left in our house. There is absolutely nothing in our refrigerator. All I have is a couple of boxes of macaroni in our cupboard. That’s it. I don’t know what to do.”

In the conversation that followed, we talked about how this woman had gotten into this predicament. It was evident that eventually she would have to deal with some of the long-term problems in her life that had led to this situation. But right now she simply needed something for her and her two kids to eat.

It didn’t take long for me to to put her in touch with a local food bank. When she went there, they could help her deal with her immediate crisis. Once that situation was handled, she could step back and take a look at her life to discover why she found herself in this situation in the first place. The crisis created an opportunity for personal growth.

Advantages Of Crisis Intervention

Methods of crisis intervention can have some distinct advantages over traditional, more long term counseling. In his book, Crisis Counseling, Howard Stone points out five such advantages.

Dealing With The Crisis

Crisis intervention focuses on dealing with the crisis itself, not on other problems. In the situation of the woman who found herself without food for herself and her children, the immediate need was to help her deal with this situation. Once the need for food was addressed, she was ready to work with someone else to help her avoid that kind of situation again.

Avoiding Backlash

Pastors can find themselves meeting with backlash from people with whom they attempt to do long-term, in-depth counseling. Because crisis intervention is by nature short term, congregational members don’t worry that the pastor will become privy to all their deep, dark secrets. They will be less likely to resent a pastor or leave the church out of embarrassment.

Crisis Intervention Can Work With Many Types Of People

Crisis intervention has been used effectively with people from a wide variety of ethnic and socio-economic backgrounds. This is true even with poorer individuals who may be looking for immediate relief rather than deferred gratification.

Effective Use Of Time

By its very nature, crisis intervention is short-term. Most crises have run their course in six weeks or less. This brief form of pastoral care and counseling consumes less of a pastor’s time.

Many People Can Learn To Do It

Crisis intervention is a type of care that not only pastors, but many lay persons can learn to do effectively. Even though it may be helpful for lay persons to receive training and supervision as they engage in crisis intervention, it is not necessary to engage in extensive study in counseling and psychological analysis in order to effectively intervene in a crisis.

With these advantages in mind, crisis intervention is a skill that most pastors as well as other leaders in the church will find it helpful to learn. In the next post, we look at ways to prepare ourselves for that time when we have the opportunity to provide care for someone in crisis.

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