Crisis intervention, also known as crisis intervention, is a technology that provides effective help and psychological support to individuals in crisis. Its main fields include suicide, sexual assault, disaster, loss of loved ones and many other aspects.
three crisis intervention modes proposed by Belkin and others, namely
balanced mode;
cognitive model;
Psychosocial transformation model
provides a theoretical model for crisis intervention methods and strategies.
Gillinland and James and others put forward a six-step method of crisis intervention, that is,
determining the problem;
ensure safety;
give support;
propose and verify flexible corresponding methods;
make a plan;
get a promise.
in order to study how to apply the six-step method of crisis intervention in practice, this paper will analyze the six-step method of crisis intervention with specific cases.
1. Case introduction
A 2-year-old female, a freshman in a vocational college in Beijing, was introduced by the head teacher to the psychological counseling center of the school for psychological counseling.
The counselor learned from the class teacher that the mood of the helper was very unstable, and he told his dormitory classmates many times the night before the consultation that he didn't want to live.
The counselor observed that the client was slightly fat and walked slowly. When he sat down, his eyes always bowed forward, and he had no eye contact with the counselor. His body movements were very few, his facial expression was indifferent, his speech was calm and lifeless.
Upon inquiry from the counselor, I learned that the helper was extremely depressed and desperate the night before, and had written a suicide note. At 9 pm, he wandered around the lake on campus for a long time, trying to end his life by jumping into the lake, because there was always someone by the lake, but he didn't find the opportunity, and later he was found by his classmates and returned to his dormitory.
two, six-step intervention in cases with psychological crisis intervention
crisis intervention is a special psychological counseling process, and the basic skills of psychological counseling, such as listening, * * * emotion, questioning and emotional response, are completely needed.
The basic ideas of psychological crisis intervention are as follows:
Counselors keep listening and paying attention to provide psychological support for help seekers;
Provide opportunities for catharsis and encourage help-seekers to express their inner feelings;
The counselor explains the current situation of the help-seekers, so that the help-seekers can see hope and build their self-confidence;
Counselors guide clients to call various resources to effectively cope with the crisis.
Although there is no fixed procedure for psychological crisis intervention, the six-step intervention method can be used as a guiding step for psychological crisis intervention.
1. Determine the problem
In the initial stage of general psychological counseling, the counselor needs to keep a curiosity, that is, to actively explore what causes the help-seekers to come to the counseling room at this moment.
At the beginning of psychological crisis intervention, counselors also need to identify and understand the problems that the clients themselves know and understand the current psychological situation of the clients.
At the beginning of this case, the counselor used an open-ended question to determine the problems faced by the clients:
Counselor: "What happened yesterday that made you have suicidal thoughts and plans?"
Helper: "I don't know what's wrong with me. I've been like this every year since high school, that is, I feel particularly unhappy every spring, because there have been times like this before, so this time I know that if I can survive this spring, I will definitely get better, but it's really hard. I've worked very hard.
I live very tired, very tired. I try to be a kind person and be as good as possible to everyone, but they will never understand me, and they will always think that I have ulterior motives.
One night, when I was washing clothes, I helped to wash my roommate's clothes. I think people should help each other like this. This is not the first time for me to help my roommate wash clothes, but why do people say that I am deliberately trying to please my roommate? I am trying to be nice to everyone around me. Why do they treat me like that? "
In this conversation, the counselor identified two main problems faced by the clients at present: one is the depression that comes with spring, and the other is the difficult interpersonal relationship.
2. Ensuring the safety of those seeking help
Life first is the first principle to be observed in psychological crisis intervention.
In the process of crisis intervention, counselors should always pay close attention to the safety of clients and minimize their physical and psychological risks.
For this reason, after determining the main problems faced by the help-seekers, the counselor should evaluate the impulse of self-mutilation, suicide or hurting others, and take measures to ensure the safety of the help-seekers when necessary. The evaluation process of this case is as follows: < P > Counselor: If you give yourself a score for this suicidal impulse, is that there is no impulse, and 1 is that the impulse is extremely strong and completely out of your control. What was your impulse when you thought of suicide by the lake last night?
helper: 95 points.
Counselor: At that time, the impulse was already very strong, but even then, I didn't completely give up my desire to live. I wonder what the remaining 5 points are that I don't want to give up my life?
Helper: I think of my parents. I can't imagine what they will do when they know this.
counselor: at that time, you thought of your parents, and you didn't want them to be sad.
Helper: Yes.
Counselor: I want to know, at this moment, in our consulting room, what would it be if you were given another score on your suicidal impulse?
Helper: 5 points, I feel relatively calm at the moment.
In psychological counseling and therapy, it is a very intuitive and effective psychological evaluation skill to let the clients rate their emotions or impulses.
In this case, through the evaluation, we know that the psychological condition of the client is basically controllable at this time, and it is less likely that the client will choose to commit suicide again during the consultation.
With this conviction, the counselor can relax himself to some extent, and can continue to understand and pay attention to the deeper psychological situation of the clients.
3. Give support
This step mainly emphasizes that the consultant should establish a good relationship between consultation and visiting through communication and exchange with the clients, so that the clients can feel that the consultant is completely trustworthy and can give them care and help.
In this case, after confirming that the suicide impulse of the client is under control, the counselor continued to care and listen to the client, and asked the client about his recent main experience and psychological difficulties with open questions, which made the client have the desire to talk.
? Help-seekers are willing to talk, indicating that their situation is improving, and talking is also a process of emotional healing. Help-seekers showed strong trust in the counselor and told the counselor a lot of confusion when interacting with roommates.
? The helper has said many times that he wants to be a kind person and try to be good to everyone. The counselor affirmed and recognized this wish of the helper, and also expressed his feelings of injustice and helplessness in interpersonal communication.
? The helper also tells that he can't be understood by his classmates and friends around him, and he can only find a confidant through reading. His favorite is a Japanese writer, who has many unspeakable feelings that others can't understand, and finds a particularly expressive expression in his works.
? The helper also talked about his desire to learn Japanese and to live in Japan.
Through listening and communication, counselors and help seekers gradually establish and deepen the trust relationship between consultation and visiting, making them feel that someone really cares and is willing to understand themselves, which is difficult for them to experience in their daily life.
4. Propose and verify alternative coping styles
Individuals in psychological crisis are narrow-minded and can't see that there are actually many ways to deal with every problem. Counselors should let clients know that there are many alternative coping styles to choose from, some of which are more suitable than what they know at present.
In this case, the counselor learned that the client had a lot of depression through her facial expressions, speech intonation, body movements and other information, and preliminarily judged that she had the possibility of depression.
Clinically, depression is mainly manifested as significant and lasting emotional depression, accompanied by cognitive impairment and physical symptoms, and serious suicide attempts or behaviors. The help-seekers accepted the consultant's advice and tested themselves with the Self-Rating Depression Scale (SDS). The results showed that they were currently in a state of severe depression.
Counselors then provide depression information to clients:
(1) The current suicidal impulse is a manifestation of severe depression, and depression can be cured as a psychological problem;
(2) There are many depressed patients in the world. In order to cure them, scientists have found many treatments, including psychotherapy and drug therapy.
(3) There are many excellent psychological counselors in Beijing who can help. If you choose medication, there are many kinds to choose from.
In the process of psychological counseling, it is generally emphasized that the counselor should try to avoid "labeling" the psychological problems of the clients. However, in this case, the diagnosis of "depression" is obviously conducive to guiding the help-seekers to focus on the solution of depression from suicide.
Before that, the help-seeker didn't clearly attribute her pain and despair, and she "didn't know what happened to herself", so there was no way to solve this psychological situation. It seemed that suicide was the only way out.
When it is known that she has "depression", it seems that an enemy who can fight with her has appeared in front of her eyes, and at the same time, she has an imagination after victory, which is hope.
The counselor learned that the client had never sought help from a professional psychological hospital before. According to the current severity, the counselor suggested that she go to a psychological hospital for treatment
Mainly taking medication, supplemented by psychological counseling. Asking for help, the counselor asked whether there would be any side effects if the drug was selected, and what the expected effects would be if the drug was taken. The counselor then provided more information on the efficacy of antidepressants.
here, we can see that the help-seekers have shown more hope to get out of the current psychological predicament, and we can also be sure that the help-seekers have understood that there are other ways to get out of the current psychological predicament more rationally than suicide.
5. Make a plan
At this stage, the counselor and the client should work out action steps to correct the emotional imbalance of the client.
In this case, the help-seekers need the support and cooperation of their parents for professional diagnosis and treatment.
after consulting with the helpers, the school contacted the parents through the class teacher. The counselor communicated with the parents about the current situation and the next arrangement of the helper, and got the parents' active cooperation.
The counselor emphasized to the clients that the most important thing now is to ease their depression and return to normal as soon as possible, and made clear the following arrangements:
(1) Take a week off and go to a psychological hospital for treatment;
(2) according to the doctor's diagnosis, medication or psychological treatment;
(3) If the helper can return to school normally after the situation improves, he can also voluntarily come to the psychological counseling center of the school for psychological counseling.
The situation of the helper is obviously beyond the scope of work of the psychological counseling center of the university, so it is necessary to refer to the psychological hospital, and the third item of the above arrangement is also indispensable, which will make the helper feel that referral is a responsible and better arrangement, rather than abandoning her, which is low.
6. Get a guarantee
That is, let the helper repeat the plan made and get a guarantee from the helper that he will definitely follow the plan. This link is relatively simple. In this case, the helper assured the counselor that he would not commit suicide lightly and followed his parents to the psychological hospital for treatment.
III. Reflections on this case
The six-step method of psychological crisis intervention is a highly operational method, but the counselor's mind can't be completely stylized in specific application.
Although the author did not set the intervention procedure according to these six steps in advance, the process of crisis intervention is basically consistent with the steps of the six-step method.
Just like all psychological intervention techniques, the so-called methods point out a breakthrough point and a reminder for us, and we can't rigidly apply them to the psychological intervention process full of fluidity and unknowns.
Some scholars have aptly compared psychological crisis intervention to the emergency room of a hospital, which reveals that timeliness is an important principle of psychological crisis intervention.
There are generally four outcomes when encountering psychological crisis.
That is, getting through it smoothly and getting growth;
survive the crisis but leave a wound;
fall into crisis and form neurosis or psychosis;
End the crisis by suicide
In this case, the main goal of timely psychological crisis intervention is to stop suicidal behavior, while in more cases, the crisis intervention is to prevent help seekers from forming mental illness due to falling into crisis.
In the daily psychological counseling practice, we often find that the psychological diseases of the clients are generally not formed in a short time, and the psychological problems of many cases are due to a serious crisis during their growth. Because of the long time, the traumatic experience caused by the psychological crisis has spread to their personality state, and it is particularly difficult to completely cure the psychological problems at this time.
If help seekers can get timely professional help when the psychological crisis first occurs, they will have more opportunities to spend the most difficult time with the help of psychological counselors, and get out of the psychological crisis smoothly and grow.
this article comes from the internet.