Exercise 1. the Case of Rita

Chapter 4: Tools of the Trade

Exercise 1. The Case of Rita

The case of Rita, based on a real situation in our counseling practice, is presented here for you to consider because it clearly demonstrates and emphasizes the tasks to be performed in crisis intervention. We suggest that you make notes as you read and reread it. Read this as if you were the crisis worker to whom Rita had come, in person, for help. As an exercise to demonstrate how well you have learned the Hybrid task crisis intervention model, write a personal narrative description of how you might use the model to help Rita during the initial session you have scheduled with her; then, compare your crisis intervention strategies with the narrative we have prepared. Remember that in crisis intervention, there is no one best way. Yours may be as effective as the sample’s.

Rita is a 35-year-old businesswoman. She is a graduate of high school and a post–high school vocational-technical institute. She holds a certificate in auto mechanics. She has never been to a counselor before, and has come to the crisis worker at the suggestion of a close friend who is a school counselor. Rita owns and operates an automobile tune-up and service shop. She employs and supervises a crew of mechanics, tune-up specialists, and helpers. She works very hard and keeps long hours but maintains some flexibility by employing a manager. Rita’s husband, Jake, is a college-educated accountant. They have two children: a daughter who is 13, and a son who is 8. The family rarely attends church, and they don’t consider themselves religious, but they are church members. Their close friends are neither from their church nor from their work. Rita’s problem is complex. She constantly feels depressed and unfulfilled. She craves attention but has difficulty getting it in appropriate ways. For diversion, she participates in a dance group that practices three nights a week and performs on many Friday and Saturday evenings. Rita, Jake, and their children spend most Sundays at their lake cottage, which is an hour-long drive from their home. Their circle of friends is mainly their neighbors at the lake. Rita’s marriage has been going downhill for several years. She has become sexually involved with Sam, a wealthy wholesaler of used automobiles. She met him through a business deal in which she contracted to do the tune-up and service work on a large number of cars for Sam’s company. Sam’s contracts enable Rita’s business to be very successful. Rita states that the “chemistry” between her and Sam is unique and electrifying. She says she and Sam are “head over heels in love with each other.” While she still lives with Jake, she no longer feels any love for him. According to Rita, Sam is also unhappily married, and Sam and his current wife have two small children. Rita states that she and Sam want to get married, but she doesn’t want to subject her two children to a divorce right now. She is very fearful of her own mother’s wrath if she files for a divorce. Sam fears his wife will “take him to the cleaners” if he leaves her for Rita right now. Lately, Sam has been providing Rita with expensive automobiles, clothing, jewelry, and trips out of town. Also, Sam has been greatly overpaying Rita’s service contracts, making her business flourish. Jake doesn’t know the details of Rita’s business dealings with Sam, but he is puzzled, jealous, frustrated, impulsive, and violent. Jake used to slap Rita occasionally. In the last few months, he has beaten Rita several times. Last night he beat her worse than he ever has. Rita has no broken bones, but she has several bruises on her body, legs, and arms. The bruises do not show as long as she wears pantsuits. Rita has told her problems only to her school counselor friend. She fears that her boyfriend would kill her husband if he found out about the beatings. Rita is frustrated because she cannot participate with the dance group until her bruises go away. Rita is feeling very guilty and depressed. She is not particularly suicidal, however. She is feeling a great deal of anger and hatred toward Jake, and she suffers from very low self-esteem. She is feeling stress and pressure from her children, from her mother, from Jake, and even from Sam, who wants to spend more and more time with her. Recently, Rita and Sam have been taking more and more risks in their meetings. Rita’s depression is getting to the point where she doesn’t care. She has come to the crisis worker in a state of lethargy—almost in a state of emotional immobility. Rita has decided to share her entire story with the worker because she feels she is at her “wit’s end,” and she wouldn’t dare talk with her minister, her physician, or other acquaintances. Rita has never met the crisis worker, and she feels this is the best approach, even though she is uncomfortable sharing all of this with a stranger.

I. A Crisis Worker’s Narrative

Write your own narrative describing how you would use the Hybrid Task model of crisis intervention with Rita. If you are participating in a class, workshop, or other study group, get together with others (preferably in small groups of five to seven people) to share descriptions of your particular method of crisis intervention. Read the sample narrative from your instructor only after you have written your own and met in small groups to discuss your and others’ narratives.

Exercise 2. Basic leads and responses

Restatement and Reflection

Communication is often not a simple matter. Sometimes, words come so fast and easily that we have responses formulated in our heads before we hear the client’s full message. Most of us would like to improve the odds that we really do accurately interpret clients’ messages when they talk to us. There are many hints to aid us in listening to clients. We will deal with two methods in this exercise.

1. Restatement of ideas. Make a simple statement in your own words telling the client what you heard him or her say. This helps to be sure that you and the client are talking about the same thing.

Example:

Client: I don’t think I can go back home tonight—just too many heavy problems for me to handle. Worker: You don’t think you can face what’s at home.

2. Reflection of feelings. Reflecting feelings means sending the client a message that confirms your understanding of what the client must be feeling. In that way you let the client know you heard him or her and give the client a chance to correct or clarify (you may have received half the message but not all of it). Reflective listening also helps the client see the basis for his or her behavior.

Example:

Client: My boss really chewed me out in front of my friends last night. Worker: Sounds like it really embarrassed you.

To help you learn to make appropriate responses that contain both restatement and reflection, do the following practice sheet. Do the exercise as directed on the sheet without consulting anyone else. Then obtain feedback from others as the directions indicate.

DIRECTIONS: In your own words, write a restatement and a reflection of the client’s statement. In small groups, give one another feedback on whether you are on target. Client’s Statement 1. When he says those hateful things to me, I wish I could die. Worker’s Restatement

Worker’s Reflection Client’s Statement 2. I don’t need her, and I frankly I don’t think I need counseling. She’s the one with problems. Worker’s Restatement

Worker’s Reflection

Client’s Statement 3. You’re so wonderful. Nobody else understands me, but you do. I think I love you. Worker’s Restatement

Client’s Statement 4. Life is like a box of chocolates you never know what you are going to get. Isn’t that kind of the way it is with you? Worker’s Restatement

Open-Ended Questions Asking open-ended questions does not guarantee that every client will respond with full statements. The purpose of this exercise is to help you become aware of how you state your questions so that you can get fuller, deeper levels of response. Decide whether the following counselor questions are closed- or open-ended. Fill in the responses below.

1. Do you have a girlfriend? 2. Tell me about your family. 3. How old are you? 4. How did that happen? 5. When will you go? 6. Tell me about school. 7. What happened next? 8. Isn’t that a silly choice?

Change the following closed-ended questions to open-ended questions. 1. How long have you been out of work? 2. Can I help? 3. Did you like that? 4. Are you angry with me? 5. Do you have to hit Sally every time you get drunk?

Closed questions also have their place in crisis intervention. Change the following leads to ones that are targeted and look for specific, concrete responses. Client statement I’m a loser in love. Loser on the job. Loser in life. I just wonder whether it’s worth it to keep on going.

Lead So right now you aren’t sure whether to go on. All those things have piled up and really got you down on yourself. Targeted

Client statement It’s just so hard. This is the third time I’ve been divorced and when I try to start dating again I’m only attracted to the same losers. Lead You are sorta wondering what is wrong with you Targeted

Client statement I’ve tried everything to get off booze I tell you. Nothing has worked. Once and addict always an addict Lead Your really seem down on yourself Targeted

Client statement You’re not much of a caring counselor if you won’t write that excuse for me for missing classes for two weeks. You know how depressed I have been. I could flunk out of school no thanks to your help. Lead So you are angry with me and think I haven’t done very much as far as supporting you is concerned Targeted

Owning Feelings Owned Message Practice

The following exercise is designed to let you try out owning your own feelings and expressing them in responses that indicate that you are doing so. We call such messages “I” messages. When we disown a feeling, we usually give someone else the responsibility for it and begin statements with words that refer outside ourselves, such as they, you, people, the experts, the police chief, the principal, your mother, and God. Fill in the worksheet below.

DIRECTIONS: Read the client situation in the first statement. Examine the disowned message in the second statement. Then write an “I” message that indicates you take responsibility for your feelings. The purpose is not to resolve the problem but rather to communicate that you are aware of your feelings and are being honest about them at this moment. In small groups, give each other feedback, making checkmarks under Yes or No to indicate whether the message indicates owning one’s own feelings. If, after you have shared your responses, others feel that most of your responses are not “I” messages, please elicit help in restating your message.

Situation Client has been sulking and acting sad all session. Disowned Message Come on, now. Stop moping around. Life isn’t that bad.

Owned Message

Situation Macho man brags about beating wife. He has just responded, “Women need to be kept in control.” Disowned Message Well, I wonder if you’d do that to the Raider linebackers.

Owned Message

Situation People complain about client’s body odor. Client’s underarm deodorant has failed miserably (it’s bothering you, too). Disowned Message James, have you ever, ah, considered that it might be something more than what you believe is your dull personality that’s keeping people away from you? Owned Message

Situation Cynthia has a reputation for being promiscuous and has talked at some length about it. Disowned Message We crisis workers feel that kind of sexual bragging only leads to acting out behavior. You could get a social disease or even AIDS you know. Owned Message

Situation John is extremely overweight. He wants to lose weight but doesn’t seem to be able to stick to a plan. Disowned Message Face it, John. You’re fat. I’m sorry, but that’s it. Why not try jogging? Owned Message

Situation Linda is verbally abusive, swearing and threatening the worker. Disowned Message I can call the cops and get your probation revoked, you know. Owned Message

Situation Ralph has tried really hard but had two drinking slips in the last week. Disowned Message You know the program, you are just going to have to suck it up and try harder. Owned Message

Situation Alisha has been successful in stopping a playground bully from harassing her. Disowned Message Well finally! It’s about time you stood up to him. Owned Message

Exercise 3. Total Listening Practice DIRECTIONS: Read the client’s statement. Then write the following: -a restatement of the message -a reflection of the message -an “I” message that owns your feelings but communicates acceptance -an open-ended question that elicits more information -a closed question that targets a specific behavior

Break into dyads (pairs) and role-play the client and the worker in dialogue to one of the statements. This activity is designed to help you practice (1) attentive listening and (2) formulating responses that communicate acceptance of the feeling behind the message as well as awareness of the message’s content. An accepting response combines (1) restatement, (2) reflection, (3) owning one’s feelings, (4) an open-ended question designed to get to the fuller meaning, and (5) information on a specific behavior. Thus, this activity is a culmination of the communications skills you’ve been practicing.

1. I used to like him as a boss. But he chewed me out today. I hate his guts.

2. He beat the daylights out of me last night.

3. Well, I really wonder what life’s all about—love, too, for that matter.

4. You’re just like all the rest. You don’t really care about me. I think I’ll kill myself. 5. It isn’t just this plan that has failed. It’s me!