Building Communication Skills

In the helping professions, including both client-facing roles (like therapy or case management) and other roles, the importance of being able to talk constructively with people is key.

Particularly in areas like nursing or case management where both physical/medical issues need to be taken care of, patients can feel overlooked or like they’re not taken care of, even when they’re instrumental issues (e.g. their medical problems or what brought them into the service) are being handled.

Empathy Statements

The core to making a person feel heard is to use empathy statements. These are statements that allow you to communicate in a way that makes the other person feel heard or understood.

An empathy statement has the following structure: an opening statement (often that references what the person has said), followed by an emotion, and sometimes a statement closer.

For instance, “When you say that nobody cares about you, it sounds like you’re feeling really alone.” The person may say, “Yeah, I do really feel alone, I might talk to one person a week”, that further explores the problem.

On the other hand, they might say “No, I’m not feeling alone at all, I’m more angry than anything”; this is okay! Now you know exactly what emotion they are experiencing.

DESC Model for Assertive Communication / WIN Statements

The DESC Model is one way to communicate assertively when you need something from someone, or you need them to know what you’re feeling. They also have the name “WIN” statement as a short way to remember them.

DESC stands for Describe, Express, Specify and Consequences:

  • Describe the Situation – Say what behaviour the person is doing you wish to change
  • Express Your Feelings – I feel ___________.
  • Specify what you want – I want/prefer/need you to ___________.
  • Consequences – Indicate what you and the person will gain if they give you what you’ve asked for

WIN Statements are a shorter version of this:

  • When you ___________ I feel ___________; I need you to ___________.

 

Active Listening Training Resources

For more indepth training on active listening, you have a number of options: most crisis lines offer basic training sessions (linked here is the ContactUSA helpline accreditation standards) that cover emotional support and active listening, I have an article on building helpline skills that covers active listening, and most counselling courses cover this as well.

There are also private seminars that go over this, such as those offered by the Helplines Partnership in the UK.

Active Listening Barriers

There are some things that you want to avoid in active listening, things that get in the way of providing emotional support.

Interrupting

Interrupting can sometimes be because someone is speaking slowly, they’re speaking too quietly for you to hear them, because you need to get more information from them, or because you’re not sure if the sentence has ended due to a language barrier.

Unfortunately when you interrupt, this gives the person the perception that you don’t care, and that can be very invalidating – even if you knew what they were going to say. Simply practice waiting until the person has finished talking completely or asking them to speak up if you can’t hear them.

“Why” Questions

Why questions are common in our everyday speech, but their use in emotional support conversations can be very judgemental. Instead of saying “Why do you think nobody likes you”, say something like, “Tell me more about that” or “What makes you think that nobody likes you?”

Fixing / Offering Advice

Fixing, or offering advice is a very natural gesture that takes a lot of work to undo. Giving advice promotes dependence on you, which means if you tell them to do something and things go wrong, you’ll be blamed for it, and the person will be unable to make their own decisions.

We want to promote independence and empowerment by helping people to make their own decisions. Rather than making the decision for them, you can explore options with them, by asking “Have you thought about xyz?”, “Tell me how you’ve coped with this situation in the past”, and avoiding use of the word “should.”



Cite this article as: MacDonald, D.K., (2015), "Building Communication Skills," retrieved on April 24, 2018 from http://dustinkmacdonald.com/building-communication-skills/.

Facebooktwittergoogle_plusredditmailby feather

ABC Model of Crisis Intervention

A simple model of crisis intervention is the ABC Model. A number of crisis intervention models use this same three step process. Essentially, it involves establishing a relationship (A), understanding the problem (B), and taking action (C).

This model uses Achieving Rapport, Boiling down the Problem and Contracting for Action.

Brief History of the ABC Model

In the 1980s, the Alberta Model was designed by a team of suicidologists who were responding to a spike in the suicide rate caused by a bottoming out in the economy. In addition to developing the CPR Risk Assessment and the ABC Model of Crisis Intervention dictated below.

Achieving Rapport

Achieving rapport describes the emotional and physical aspects used to establish a connection with the suicidal person you’re working with. Physical ways that you can establish rapport include:

  • Ensuring there is no obstacles between yourself and the suicidal person (e.g. chairs, tables); rapport is improved when there is nothing between you
  • Solid eye contact; when you look at someone rather than looking away it establishes that you’re able to talk openly about suicide
  • Orienting your body towards someone; this is a subconscious cue that you think positively of that person
  • Keeping your arms uncrossed and legs open; Crossed-arms and legs pressed together are signs of anxiety or dislike

Emotionally, it’s important to remember to validate what the person is saying. Use empathy statements, which are statements that highlight an emotion while responding. For instance, if someone says that they’ve had a fight with their wife, and that it keeps happening you might say “It sounds like you’re feeling really frustrated.” This captures the emotion underlying the experience and is an important part of helping someone feel understood.

Using a calm, even voice-tone, not speaking too quickly, and not cutting off the other person as they speak all communicate respect and support. When rapport is established, the suicidal person will be comfortable and able to express themselves.

Boiling Down the Problem

The next step in the ABC Model of Crisis Intervention is boiling down the problem. This involves a careful mix of open and closed questions to make sure that you fully understand what is making the person suicidal. You can start by asking them what they think is the source of their suicidal pain.

Suicidal thoughts are often the result of events that overwhelm a person’s personal coping methods. These methods can be different for every person and so it is unwise to assume that something isn’t an issue for the suicidal person unless you’ve spoken to them about it.

Contracting for Action

When you feel that you have a good understanding of the suicidal person’s problems, it’s important to work with them to implement some long-term changes. If you think back to the CPR Model, we need to assess whether the person is Low Risk, Medium Risk or High Risk.

Suicide Intervention

Low Risk

When the suicidal person is low risk, your role should be to help with any practical referrals and building up their support network. For instance, someone who is having financial issues, referral to debt counselling would be helpful. Exploring the person’s resources to see if there are those they can rely on who they may not be seeing will also be helpful.

Emotional support is most important at this stage so that the person feels comfortable expressing themselves without feeling judged or stigmatized.

Medium Risk

When the suicidal person is medium risk, it’s important to work collaboratively. Getting the suicidal person to agree to more comprehensive support will be easier if they know that you care. Taking steps to reduce risk by encouraging the person to remove access to suicide methods is also important.

Ensure that you follow up with the person to make certain that they’ve taken advantage of the referrals. By checking in with them frequently and continuing to assess their suicide risk (even on a simple 1-10 scale) will help you tell if their suicidal risk is being reduced.

High Risk

When the suicidal person is high risk, it’s important to take immediate steps to reduce that risk. You should be directive with the person, taking immediate steps to guarantee their safety. This will involve checking for suicide attempts in progress, referrals that you make with the suicidal person and possible hospitalization if they don’t think they can remain safe throughout the night.

In order to assess for immediate risk, you should ask questions like, “Are you in danger?”, “Have you taken anything tonight?”, “Have you done anything tonight to hurt or kill yourself?” If the person admits that yes, they have, than it’s important to get details and make the call to 911 if necessary.

If not, you should explore what they can do to ensure their safety. This may involve calling a crisis line if they don’t feel safe, calling 911 or going to a hospital emergency room or staying with you (or someone else they can rely on) to keep them safe.

Further Reading

The book Crisis Intervention Strategies, 7th Edition provides a review of the ABC Model of Crisis Intervention and other basic and advanced crisis intervention skills. I also provide a number of crisis intervention articles in this area.

Cite this article as: MacDonald, D.K., (2015), "ABC Model of Crisis Intervention," retrieved on April 24, 2018 from http://dustinkmacdonald.com/abc-model-of-crisis-intervention/.

Facebooktwittergoogle_plusredditmailby feather