The Six Step Model of Crisis Intervention

In order to develop basic crisis intervention skills it is necessary to have a model on which one can work from, allowing you to understand the situations that bring a person into crisis (chiefly things that overwhelm a person’s coping strategies, where they find themselves unable to take further positive action), and the tasks that must be completed to help them successfully navigate such a crisis.

The Six Stage Model of Crisis Intervention

This model of crisis intervention is from James (2008) who has adapted it from Gilliland (1982). These steps form the foundation of intervening with an individual to help give them a sense of control and help to restore basic coping skills.

Step 1. Defining the Problem

The first step in crisis intervention process is to determine exactly what the problem is. This part of the process helps establish a connection between yourself and the client. The active listening process is important here: open-ended questions and the core factors of empathy, genuineness and positive regard.

Step 2. Ensuring Client Safety

The next step is to ensure the safety of the client. This involves suicide risk assessment, as well as checking homicide risk. Removing access to lethal means of suicide as well as other items that can be used to hurt yourself and the client are important. For instance, in an average office, scissors, paper cutters, staplers and three-hole punches can all be used to injure self or others.

Step 3. Providing Support

After the client is physically safe and the problem has been adequately defined, the next step is for the crisis worker to accept the client as a person of value and communicate that they care about them. This can involve simply talking to the client about what’s going on in their life, taking care of basic needs (e.g. food and shelter.)

Once the client has their basic needs met, the next part of providing support is ensuring the client has enough information to understand their available options for dealing with their situation.

Step 4. Examining Alternatives

In step 4, Examining Alternatives, the client is encouraged to explore potential solutions to what they’re dealing with. A client whose coping skills are suspended will have difficulty coming up with options and this is where the crisis worker comes in.

James identifies three categories of potential alternatives:

1. Situational Supports – individuals around the client who “might care about what happens to the client”
2. Coping mechanisms – “Actions, behaviours or environmental resources” the client can draw on to help get through their situation. Assessing coping skills is a key part of telephone crisis intervention, which should explore what they did in the past, present, and then future
3. Positive and constructive thinking patterns – New ways of thinking about the client’s situation that can help them reframe

Step 5. Making Plans

Now that the client trusts the crisis worker, they have provided immediate safety and met basic needs, explored alternatives, it’s time to make a plan. The goal of this step is to focus on concrete steps that can help restore control in the client’s life, and identify other referral resources that can help provide the client additional support.

Making sure the plans are realistic and not overwhelming is a key part of step 5. Clients must feel empowered by the plan in order for them to proceed with it, therefore working collaboratively is extremely important. Many clients have been disempowered or oppressed before seeking (or being forced into) treatment, and continuing this pattern will lead to poor outcomes.

Step 6. Obtaining Commitment

The final step of the process, is obtaining commitment. If you’ve worked together with your client, obtaining commitment should be easy. You may need to write down the plan for the particularly overwhelmed client to keep track of it, and follow up with them to ensure that they have followed through with the plan.

Moving Through the Model

Although the model is presented in a linear fashion, in actuality a client may move between these steps, moving forward and then regressing back as their situation changes. It is important for the worker to be at least somewhat certain of the stage his client is in so that he can respond appropriately.

Bibliography

Gilliland, B.E. (1982) Steps in crisis counseling. Memphis: Memphis State University, Department of Counseling and Personnel Services. (Mimeographed handout for crisis intervention courses and workshops on crisis intervention.)

James, R.K. (2008) Crisis Intervention Strategies. Brooks/Cole: Belmont, CA.