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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