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[From Bill Powers (990423.1407 MDT)]

Mark Lazare (990423) --

Framework of a Crisis Intervention

Mark, thanks for that passionate and lucid picture of how you apply PCT to
crisis intervention. It is a beautiful example of what happens when you
simply apply an undertstanding of PCT to a problem without any intermediate
steps: just you, the other person, and PCT. Understanding is what does the
trick, not techniques or methods or procedures. I count you as one of Tom
Bourbon's success stories (not to mention your own success story).

Best,

Bill P.


>
>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
>
>