The crisis process Stages of Crisis Stages Recognition

The crisis process

Stages of Crisis • Stages: • Recognition: The person realizes that they are not coping well • The person struggles to solve the problem and may ask others for help • Not being able to solve the crisis the person is overwhelmed by emotions including fear, anger, confusion, and inadequacy.

Deal with the feelings • The emotions are blocking the persons ability to think and cope • Help the person look for their own solutions rather them telling them a solution • Needing to have answers provided all of the time lowers the person’s self esteem • Appear calm and in control, and be flexible with your approach. Individualize

Diagnosis and Intervention • Person with Schizophrenia • Impaired thoughts, distorted perceptions • Delusions, hallucinations • Mood presentation may not fit the situation • Withdrawal • Refrain from laughing or making casual responses • DO NOT attempt to correct their misperceptions or convince them that the delusions are wrong or the hallucinations are imaginary • Attempts to use logic makes the person more defensive • Empathize with their feelings • Be calm, patient, and treat the person with respect

Person with Mania • Multiple simultaneous activities • Intrusive, inappropriate, demanding • Elevated mood, emotional lability • Grandiose delusions • Possible hallucinations • Impaired ability to function normally • Calm matter of fact approach • Avoid showing negative reactions to the person’s behavior • Do not argue with the person • Be clear and directive • Do not personalize

Person with Paranoia • Suspicious, anxious, frightened • Believes that others are out to get him • Capable of threatening behavior, typically out of fear • Easily humiliated • Remain confident and maintain eye contact • Try to conceal personal feelings, as the person may sense discomfort and become more frightened • Do not challenge beliefs or question distorted notions

Person with Depression • Persistent sadness, slow body movements • Can become agitated. Thin line between anger and depression • Recurring thoughts of death or suicide possible • Poor concentration, short term memory problems • Feelings of hopelessness • Can have delusions or become psychotic • Instill hope • Point out options available to person • Treat person with empathy, understanding and optimism • Maintain objectivity • Provide activities when available • If possible place them with a cell mate or inmate worker so they are not alone

Person that is Anxious • Fear develops without any logical purpose • May experience fear of dying, of going crazy, and feel panicky • Overwhelming need to feel safe and avoid places they see as unsafe • May experience irrational fear, intrusive anxiety producing thoughts (obsessions), repetitive behaviors (compulsions), or intrusive memories (PTSD) • Reassure person that they are not going crazy • Allow the person an opportunity to express their fear and confusion • Reassure person that they are safe. • Treat person in a calm and matter of fact approach

Active Listening

Active Listening • Active listening is listening not only to the content but also the emotions being communicated to you • It is the emotions behind the content that tell us the most about the person • It is an opportunity to display understanding

Active Listening • Is important because it provides feedback to demonstrate that you are understanding the story and the feelings that are being told to you • You are restating the other person’s position and emotions in a way that the other person hears as non-judgmental and accurate.

Feedback to Demonstrate Understanding

Feedback • Brief Statements of Observations – Generally not questions • Questions are more intrusive • Can create pressure and provoke defensiveness • Can diminish rapport • May prompt denials which can create barriers

Feedback • Brief Statements – Encourage them to go on – Make them feel listened to and respected – Can help diffuse negative feelings and create positive ones – Appears non-judgmental to the person

Active Listening Skills • • Emotional Labeling Paraphrasing Mirroring/Reflecting Summary Open-Ended Questions Minimal Encouragers Effective Phrases “I” Messages

Listening Skills • Emotional Labeling – Stated observation of the emotion heard, “you sound…” “you seem. . ”, “I hear…. ” – Excellent way to begin and very effective – Easy to back off from: – “I didn’t say you were angry, I said that you sound angry. ” – If possible label a lot of feelings it helps someone to feel understood.

Nonjudgmental Attitude is the Key • Feelings are Universal, Experiences are not • It is possible to demonstrate understanding of feelings without having gone through the same experience • You can ask clarifying questions such as “What I think I hear you saying is …. . Is that what you mean? ” • Even if you are wrong the person will know that you are trying

Listening Skills • Paraphrasing – Put the meaning into your own words – Restatement – Example: Inmate: He doesn’t pay attention to what I say and it makes me angry Officer: He doesn’t listen to you

Listening Skills • Mirroring/Reflecting – Brief follow along, the “gist” of the statement, repeating the last few words – Example: Inmate: He doesn’t pay attention to what I say to him and it makes me angry Officer: It makes you angry

Listening Skills • Summary – Periodically covering the main points – HIS STORY + HIS FEELINGS • In your words Example: O. K. what you’ve told me so far is this … and as a result you feel … Do I understand this correctly? ”

Listening Skills • Open Ended Questions or Sentences – “What else? ”, “How? ”, “When? ” – “Tell me more about …” – “I’d like to hear more…” – Benefits: • Conveys your interest in listening • Gives more freedom of response • Limits feelings of interrogation

Listening Skills • Minimal Encouragers – Indicate your presence… “Uh-huh”, “O. K. ” etc. – Best used when the person is talking for an extended period of time or telling a longer story – Best used in combination with another skill such as paraphrasing or mirroring/reflecting

Listening Skills • Effective Pauses – Immediately before or after saying something meaningful – The “Effect” desired is to help focus thought and interaction

Listening Skills • “I” Messages – Used to confront subject about a behavior that is counterproductive, without being accusatory – Examples: “When you yell, I feel frustrated because it stops me from listening to you. ” “I can’t hear you when you yell at me. ”

Phrases that Damage Rapport • “You should” “You shouldn’t” – These are advice giving statements that create feelings of being “put down” • “I understand” – This is a phrase used to silence people – You may not completely understand their experience • “Calm Down” – This may be perceived as an order statement which can provoke intense anger – Instead speak calmly and slowly

Empathy • Identification/Understanding of another’s situation, feelings, and thoughts • It is neither Opposition or Agreement • It is not necessary to actually feel what they feel to provide empathy • Empathy is not Sympathy – Sympathy is an expression of pity or sorrow for the distress of others – Pity and sorrow are not productive here