Updated for 2018! See below.
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. You can see a video of this post here.
Table of Contents
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 they also developed the ABC Model of Crisis Intervention dictated below.
Achieving rapport describes the emotional and physical aspects used to establish a connection with the suicidal person you’re working with. This involved physical safety, emotional connection and good rapport.
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, you can establish safety and comfort through the following:
- 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.
- Use a calm, even voice-tone – don’t speak too quickly and don’t cut off the other person
- Avoid judgement such as “why” questions. Instead ask “How come?”
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.
For example, a student who has never failed a test before could become suicidal over a perceived threat to their Ivy League college hopes based on failing a test, while another student may have had many ups and downs and therefore has learned to cope with this loss.
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.
Contracting for action means developing plans with the client that they can do within the next 24 hours (or another short period) in order to ensure their safety.
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.
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.
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.
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.