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Framework of a Crisis Intervention

I still use PCT every day (it is just like the law of gravity, you really
don't have the option of not using it, unless you are not from this
universe).  If you allow me to blow my own horn, I am very good at it.
Although for the true believers of PCT, you can pick it apart and pontificate
on it. But, one thing remains (knock on wood, say a prayer, whatever works)
In five years, no one has committed suicide after talking to me.  For me, and
anyone who does this work, it is the biggest fear.

You want control over that event, knowing that it is really not under your
control, you can only act as if it is, or you could not act at all.  I
realize, the only thing I have is a short term influence, and a hopefully a
good sells pitch on life and how to effectively help the person regain
control without being dependent on you or any one else.

(I know, I know I used the phrase "sells pitch."  I will apologize in advance
to those who, are offended by any reference to selling PCT)



Off the top of my head, here are common points I use.

Establish Rapport.  (Clark & McPhail's work --- their papers on openings and
establishing cooperation are awesome --- rapport can not be understated.)

Have the person give a narrative --- avoid "how did that make you feel" crap.
You are trying to pull them out of that emotional stew.

Draw out WHAT happened VS. what they WANTED to happen.

The emotion is a byproduct of these two.  Clearly explain, anxiety and
depression, are NOT the problem they are a byproduct.  (In PCT terms it is
the error signal, screaming at you-saying what you are doing is not working)

Then assess what/how much control would anyone have over the EVENT(s) or the
DESIRED STATE(s).

I use the word EVENT a lot during the intervention ---- after you explain the
term as---- anything that happens to you or anyone else is --- only an EVENT
--- with NO moral attachment to it ---- and no value attached to it  --- An
Event is neither GOOD nor BAD...  The value of an EVENT is ONLY determined by
what the person does and or how they react to it -- either way outcomes ARE
WITHIN THE PERSON'S CONTROL.

Most of the people will express regret, and/or feel stupid for just having
attempted suicide.  Also, they may say they can't do anything right, not even
suicide.  Others may say they did it because they ran out of options (coping
skills), they just wanted the pain to end.  I rephrase it this way - So it
was not so much, that you wanted to murder yourself, but that you wanted the
emotional pain to end.  (Usually their eyes get real big when they hear the
phrase "murder yourself" (That is a little test - for a controlled variable).
 If I don't get a reaction, I assume one of 2 intentions-the person has done
this for drama, spite, or some other secondary gain.  Or the person is still
suicidal and has made peace with their self-demise.  If you do get a reaction
of surprise or shock - after saying "murder yourself" you may assume the
person is truthful in saying, they were out of coping skill and their insight
was or is limited.
Now, I help them reframe their perception of ending up in the bed of an
Emergency Room as an EVENT.  I tell them it is not a bad thing.  (I Pause and
wait for a reaction, as another test - for a controlled variable).  If they
seem to agree with me, they probably have a secondary gain.  If their
reaction is more like "what the F______ do you mean, it is not a bad thing
trying to kill yourself.  (You may again assume the person is truthful in
saying they were out of coping skill and their insight was or is limited)

Next, I should have their full attention, to explain it as ONLY AN EVENT the
value of which will be determined at a later date. This is done by the
choices the person makes, to more effectively cope and control for their
desires.  I will explain the reorganization process, like this;  Is what you
have been doing, working for you; getting you what you want?  Their answer
will be, No.

So, you can now tell them about how all people work, what we ALL have in
common.  If what you are doing is not getting you what you what, CHANGE.  DO
SOMETHING different.  Whether it is right, wrong or indifferent, you do know
what you have been doing, is not working.

I see suicide as an attempt to reorganize, and reduce the error signals, when
the person's current coping skills fail.  "I have tried everything, and
nothing works" is a common, explanation of this attempt at reorganization,
and sometimes the last attempt they ever make to reorganize.  Due to limited
or failed coping skills and limited insight.

Also, in this framework I explain in great detail of how important Purpose is
to all of us.  I tell the person, to look around the room at all the Nurses
and Doctors.  I tell them to imagine if you could take away their purposes.
Prevent them for practicing medicine, being a parent, friend, take away all
their roles, and they will be suicidal also.  If you have no purpose, desire,
or goal, why get out of bed in the morning?


What do you want to happen?

If that happened and you were getting what you wanted, would you be
depressed?

How much control do you have over it?

This is the time I get on the PCT soapbox:

What do you have 100% control over?

Three things, and only three things.

I am sure you have been told the first one; it is BEHAVIOR, you can choose to
do this or that, drink alcohol, or not drink, go to work or not, say yes, or
say no, the choice is yours.

You probably also have hear the second, GOALS.  But GOALS are also needs,
wants, intentions, desires, and purposes.

But the last one is elusive and sometimes only with counseling do you realize
the tremendous power of it; that you DO, have control over your perceptions.
You can CHOOSE to LOOK at anything as an EVENT.  An event can be anyone, or
anything that happens to you, or anyone else, it has NO moral attachment to
it, and no value attached to it.  An Event is neither GOOD nor BAD.  You can
CHOOSE to look at it positively, negatively, or apathetically.

Apathy is my personal favorite; it takes the least amount of energy.  If you
love or hate an event or person,  you will be spending a lot of time and
energy doing so, especially if you don't have any control over the event or
the person.  You will be spending all your time and energy on something you
don't have control over, and wont have any time or energy left over to
control for the things you do need, want and desire.

Now back to the problem at hand;

Develop a future plan based on outcomes the person does have control over.
Remember:
The value of an EVENT is ONLY determined by what the person does and or how
they react to it -- either way outcomes ARE WITHIN THE PERSON'S CONTROL.


Wrapping up, REFRAME their stressors -- (the difference of what was wanted
and what they got) and the future plans and employment of new coping skills.

I like to call this "Reframing their Perceptions," taking the focus off the
emotion --- get them to ID the emotion as a byproduct, of their BEHAVIOR,
PERCEPTIONS AND GOALS.

FOR THESE ARE THE ONLY 3 THINGS THEY WILL EVER HAVE 100% CONTROL OVER.

That is framework of a Crisis Intervention ......

There is still more -- but the above are common to every intervention I do.


Mark Lazare