Counselling is a type of oral therapy involving an expert and a patient discussing the emotional problems and difficulties of the latter. In turn, crisis counselling is a more action-oriented type of counselling that typically deals with patients with severe levels of stress, trauma, depressive episodes, etc. Crisis counselling, as does any other theory of counselling, requires a wide range of microskills related to the therapist’s abilities to listen to patients’ issues, reflect on their underlying problems and propel the discussion. This paper will cover the theory and basic steps of crisis counselling, highlight the necessary microskills and suggest a list of general sample questions that can potentially be used in a counselling session.
To begin with, crisis counselling may refer to various types of crises that a person might be experiencing. Ivey et al. (2018) outline two distinct types of crises that can be categorized as immediate crises and more casual crises. The former can encompass radical and earthshattering changes in a patient’s life including experiencing natural disasters, threats to one’s life or going through a terminal disease and that requires immediate actions. The latter may refer to less dramatic but, nevertheless, significant events such as a loss of a close person, harassment or a particularly harsh breakup and can be dealt with in a less urgent manner. Regardless of the type of crisis the patient might be experiencing, crisis counselling often consists of two basic steps: “(1) working through the initial trauma and (2) appropriate follow-up and further counselling” (Ivey et al., 2018, p. 320). The authors add that one has to be especially sensitive and careful when it comes to dealing with patients who have intrusive thoughts about or have already tried taking their own lives. In conclusion, crisis counselling targets patients experiencing significant turmoil in their lives, and usually boils down to dissection of the patient’s problem and consecutive professional therapeutic help.
When it comes to counselling sessions, there is no universal approach to helping patients deal with their trauma as every person has their distinct problems, character traits and attitudes to their misfortunes. However, there are particular microskills that can be applied to the vast majority of crisis counselling cases. Specifically, Beck and Kulzer (2018) list the ability to actively listen, convey empathy and decode patients’ nonverbal communication as powerful tools when dealing with crises situations. Furthermore, Ivey et al. (2018) emphasize the importance of therapeutic confrontation and, in particular, highlighting and focusing on the patients’ main issues and paying particular attention to the cultural and environmental context of a given situation. With regard to sample questions, here are some general phrases that can be used in a crisis counselling session:
- Please tell me how this particular situation made you feel?
- What was your family/friends/loved one’s response to this event?
- Can you recall when you first felt that it was affecting your mental health?
- Let’s focus on your immediate feelings, what are you experiencing right now?
- Let’s break down the problem into smaller pieces and try to figure out how to solve them one by one?
Lastly, despite there being a large variety of crises situations that require counselling, there is a general pool of tools and techniques, more precisely microskills and opening questions, that a counsellor can use regardless of the specifics. I believe that due to patients in crises situations being particularly sensitive to any external stimuli, it is paramount to exercise the skills of active listening and conveying empathy to gain the patient’s trust. Moreover, it is vital to pay attention to the patient’s nonverbal communication as there can be particular signals a person might be sending without ever telling it out loud. Finally, the opening questions should avoid direct details and be aimed at trying to get the patient to talk as too specific questions about their experience and trauma might scare them and prevent them from sharing.
Beck, K. and Kulzer, J. (2018). Teaching counseling microskills to audiology students: Recommendations from professional counseling educators. Semin Hear, 39(1), 91-106.
Ivey, A. E., Ivey, M. B. and Zalaquett, C. P. (2018). Counseling theory and practice: How to integrate the microskills with multiple approaches. In P. Tropp (Ed.), Intentional interviewing and counseling: Facilitating client development in a multicultural society (9th ed, pp. 318-343). Cengage Learning.