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In the last section, 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.
♦ 1. Strupp’s Conditions
♦ 2. Jacobson’s Guidelines
♦ 3. Smooth-Focus 6 Phrases
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.