The ABC Model of Crisis Intervention

The ABC model of crisis intervention refers to the conduction of very brief mental health interviews with clients whose functioning level has decreased following a psychosocial stressor also known as a crisis (Kanel, 2007). This method was first introduced by Gerald Caplan and Eric Lindemann in the 1940s, other variations of this model have developed over the years. The ABC model is a 3 step problem-focused approach used to provide temporary and immediate relief that has been known to work best when applied within 4 to 6 weeks of the precipitating event (Kaplan, 2007). The focus of the ABC model is to identify the aspects of a crisis or precipitating event/crisis, the client’s perceptions about the event, personal anguish, failed internal coping mechanisms, and the inability to function (Kanel, 2007). The first phase or the A phase of this interviewing process is creating contact with the client. This is accomplished by establishing an informational, trusting and mutually respectful relationship between the clinician and the client.

This is established through attending behaviors such as maintaining focus on the client and active listening to the client. This helps the clinician gain a clear understanding of how the client perceives the crisis. Lacking this understanding the clinician is unable to assist the client in changing their perception of the event and therefor unable to help the client improve their level of functioning. Without building this basis, foundation or rapport the client may not feel as though the clinician is trusting, empathic, accepting or non-judgmental and will not move into the B or C phase of the model (Kanel, 2007). The B phase of the model is identifying the problem, this is known as the most critical part of the process. During this stage there is a number of specific items that the clinician needs to identify: precipitating events, perceptions, subjective distress, and prior and current functioning levels.

Since crisis intervention is brief and time limited the clinician must quickly identify these objectives. Asking the client relevant questions is an invitation for the client to “open up” allowing them to express their “real” selves (Kanel, 2007). According to Kanel soon after the interview begins, the clinician should begin to ask about the precipitating event by using open ended questions. An appropriate question to begin with is “What happened that made you call for an appointment?” (Kanel, 2007). After identifying the event the clinician needs to explore the client’s cognitions of the event. It is the client’s perceptions of the event that causes them to be in a crisis state as well as losing their ability to cope. Affective questioning for this is asking the client “What do you think about…?” or “What does this mean to you?” (Kanel, 2007). The clinician needs to identify emotional distress: what is their emotional level of functioning? This can be done by asking “How is all of this making you feel?”(Kanel, 2007).

Next the clinician needs to identify the client’s impairments in functioning. A good question for the clinician to ask to gain insight for this is “What else is going on in your life that you feel is being affected by this problem”? (Kanel, 2007). This form of questioning can also be broken down into categories such as Behavioral, Social, Academic or Occupational. These questions can be specific to the category such as “How are you doing in school or at work”? Or “How have you been sleeping or eating”? (Kanel, 2007). The clinician needs to explore the client’s previous level of functioning in order to compare the two to get an accurate account of lowered levels of functioning. The clinician can do this by asking the client “What was your life like before this event”? (Kanel, 2007). This will allow the client to talk about their life prior to the event that caused the crisis. There are also some ethical considerations to be aware of in the second stage of the ABC model. These ethical concerns must be addressed with every client.

This is where closed ended questions may be considered, the best approach is to intertwine these questions into the normal flow of conversation so that the client does not feel like they are being judged. One of the ethical concerns the clinician needs to address is suicide, since those dealing with the crisis have no ability to cope and are vulnerable and overwhelmed, suicide may feel like their only option to end the crisis (Kanel, 2007). The clinician needs this information to keep the client safe. Another ethical concern the clinician must address is the possibility of abuse towards a child or the elderly or any harm to others. It is always a counselor or mental health workers’ duty to report any suspicion of this kind of activity to the proper authorities (Kanel, 2007). Organic or medical concerns are one of the other ethical considerations which must be addressed in the second stage.

This includes making evaluations about any mental health or behavioral disorders as well as making any necessary referrals (Kanel, 2007). Substance abuse is another ethical concern that must be addressed by the clinician. Since substance abuse is commonly used to treat stress for those in crisis the clinician must be assertive in gathering information about drug use (Kanel, 2007). This information will direct the clinician in the proper direction to provide referrals to the client to help him/her overcome the substance abuse. The third and final stage of the ABC model is the C phase, which includes coping, resolution, referrals and support. During the third stage of the ABC model the counselor or crisis intervention specialist will help the client cope with the situation. In the beginning of this stage, the counselor should sum up the problem and ask the client how they have coped with it up to this point.

Finding out what the client has done to cope with the crisis up to this point will give the clinician and the client insight about what has been effective and what has not. Next the clinician will encourage the development of new coping behaviors. This is the opportunity for the clinician and the client to work together and create problem solving ideas and ways to cope. This also will allow the client to learn problem solving skills that they may use in the future. As a clinician, I would present my client with preventive techniques such as becoming involved with activities such as journaling, bibliothearpy and “reel” therapy. I would help my client learn to cope with the use of support groups, 12 step program or long term therapy. As A clinician, I may make medical or legal referrals depending on the situation. Finally, I would obtain a commitment from the client to follow through as well as a plan for a time to follow up on the coping strategies (Kanel, 2007).

There are many important skills one must have to be an affective crisis interventionist. One must have attending behaviors this includes eye contact, attentive listening, body posture, overall empathy and warmth. In order to be a successful counselor when using the ABC model, it is important to have knowledge of cultural sensitivity (Kanel, 2007). According to Kanel crisis workers must remember that the attending behavior of different cultural and ethnic groups may vary in style, and as a clinician one may need to adapt when working with certain cultures (Kanel, 2007). Another important skill a clinician must possess is the skill ask questions properly without seeming judgmental. Most often in this model, it is important to use open ended questions in order to learn more information about the precipitating event. Questions beginning with “what” or “how” are most effective in this case. The ability to paraphrase is also important, which is the clinician’s ability to restate what they thought they heard in their own words or clarify what was said in a questioning manner.

When this is done properly, the client knows that the counselor is listening and it helps build good rapport. Reflection of feelings is another technique to let the client know the counselor is listening, as well as summarization (Kanel, 2007). A counselor should maintain self-awareness. Speaking to clients who may have similar life experiences to the counselor could trigger events from the clinician’s own past. It is important that the counselor empathize without letting it affect them on a personal or emotional level (Ray, 2015). A good crisis intervention counselor must be nonreactive.

Being nonreactive means that when they witness strong emotion or outbursts from the client they can remain in control of the situation and maintain support of the client without the emotional escalation of the client. Escalation may cause an unstable environment and therefore cause the client to shut down and not reveal any further helpful information (Ray, 2015). A crisis intervention counselor should have a high tolerance for chaotic situation. Crisis intervention counseling is a highly tense and stressful field. It is highly vital that you are able to be able to handle the high level of stress that is handed to you daily while in that field (Ray, 2015).

References

Kanel, Kristi. A Guide to Crisis Intervention, 3e, 3rd Edition. Cengage Learning, 02/2006. VitalBook file. Ray, L. (2015). Characteristics of a Good Crisis Counselor. The Houston Chronicle, pp. http://work.chron.com/characteristics-good-crisis-counselor-7007.html.