Crisis Case Study 2 is about Mr. Jones, the "fragile adult." Recently, a neighbor has brought attention to a case involving Mr. Jones and has asked for a crisis worker to help. Mr. Jones is an elder who lives alone, but whose son has been seen occasionally visiting. The neighbor and Mr. Jones go have coffee together regularly, but Mr. Jones has not wanted to meet in two months and no longer invites the neighbor inside the house. The neighbor claims that there are new bruises on Mr. Jones's face. The crisis worker should employ the ABC model in this case.

The ABC method of crisis intervention is a three-stage process for a brief and focused procedure. Although there are three distinct steps, the text points out that it is sometimes necessary to use the interview components of each step at any time in order to achieve goals (p. 2). Thus, it is important to remember that the ABC model is not linear in nature, but more like a "tapestry" style intervention (p. 1). The first element of the ABC model is establishing rapport and initiating the therapeutic relationship. This entails maintaining contact with the client via active listening. Next, the problem is identified and focused so that appropriate interventions can be developed. Finally, coping mechanisms are introduced to help the client address the core elements of the crisis that were elucidated. The therapist helps the client to develop a long-term solution to the crisis once the therapeutic relationship has been terminated.

Establishing rapport is the first step in the ABC model. The crisis worker will attempt to contact Mr. Jones, which is an important and necessary step. Mr. Jones has withdrawn from his social life lately, which is why the neighbor has approached the social workers. Because of this, it could be difficult to establish rapport with Mr. Jones. Building rapport means engendering trust. The client, Mr. Jones, needs to know that the social worker is an objective and neutral party that can be trusted to maintain confidentiality. Moreover, the crisis worker is not there to give advice but to listen. Mr. Jones can therefore feel safe with the crisis worker, in a way that perhaps he does not with the neighbor. The neighbor may have prejudgments, or may use a tone of voice that only serves to help Mr. Jones withdraw. The crisis worker can help by using soothing tones of voice, which assuage Mr. Jones's fears (p. 3). Furthermore, the crisis worker uses the tools of active listening to encourage the establishment of rapport with Mr. Jones. Active listening involves paraphrasing what Mr. Jones has said, so that he knows the counselor is listening objectively and without judgment.

However, it is critical to understand cultural and ethnic variables that might impact the exact types of nonverbal and verbal communication styles to use that will help with rapport building. Mr. Jones is a senior white male, of northern European ancestry. This cultural variable will be taken into account. According to the text, "European-Americans tend to value a quiet, controlled vocal style; other groups may see this as manipulative or cold," (p. 4). The social worker must remember that European-Americans have certain expectations regarding signs of respect and authority, including the use of eye contact. Rapport depends on cultural sensitivity, which is why the crisis worker should do some background research to understand how to best approach Mr. Jones.

During the rapport building process, the crisis worker also begins the questioning that will help Mr. Jones. Some closed-ended questions are necessary for information gathering. For example, the crisis worker might ask, "Do you have any family members who see you regularly?" This would elicit a yes/no response from Mr. Jones. A follow-up question would be "who," if Mr. Jones did not volunteer that information himself. According to the text, open-ended questions are best for gathering the core information about the crisis because closed-ended questions tend to "bog down" the interview and result in a lack of flow (p. 4). Thus, open-ended questions are preferable. The open-ended questions encourage the client to do most of the talking. The crisis worker can then ask follow-up questions to clarify issues and facts. Questions that begin with "what" and "how" can be more effective than questions that begin with "why," simply because "why" questions may seem to imply judgment and therefore can easily make the client defensive (p. 4).

Open-ended...

Jones in this case include, "How did you get those bruises?" And "How are you feeling?" Asking Mr. Jones what he does during the day, and what he would like to do are also good questions to encourage him to trust the crisis worker as the sessions continue. When emotions are introduced to the conversation, the crisis worker must be careful to clarify exactly what the client means as opposed to assuming. For instance, if the crisis worker asks, "How do you feel about staying home all day?" Mr. Jones might respond, "My son wants it that way." The crisis worker can then ask, "What happens if you do not listen to your son?" Mr. Jones might then say, "He gets angry." The crisis worker would then ask, "How do you know, or how can you tell that your son is angry? What kinds of angry behaviors does he tend to exhibit?"
After effectively establishing rapport, and summarizing Mr. Jones's core issues, Part B can be developed. Identifying the problem is "the most crucial step" in the crisis intervention (p. 9). The emphasis should be placed on the client, and not on the external circumstances or situations. This is because it is easier and more effective to encourage the client to change his or her feelings, reactions, and behaviors than it is for the client to change other people or external situations over which the client might have no control. Thus, identifying the problem involves pinpointing the core issue that is impacting Mr. Jones. The precipitating event is that which caused the neighbor to seek help. Because of this, Mr. Jones might have been resistant to the intervention but if the rapport has already been established, then the precipitating event might be the bruises on Mr. Jones's face, coupled with the fact that Mr. Jones has not been leaving the house or maintaining social ties.

There may also be ancillary events that occurred without the neighbor knowing, which is why establishing rapport can clear up loose ends and unknown issues. The clients perceptions about what is going on in his life are the important thing. What does Mr. Jones see to be the problem, if anything? How does Mr. Jones's son treat him? What is scary about disobeying his son? Clearly there is a problem with Mr. Jones retreating into his home and not leaving the house, and not welcoming the neighbor that he used to be friends with. Thus, Mr. Jones perceives the world to be threatening at this time, and the counselor needs to ascertain what exactly is causing these perceptions, in order to help Mr. Jones change his behavior. Increased functioning can be considered a goal of the crisis intervention (p. 12).

According to the text, "usually, stress originates from one of four areas: loss of control, loss of self-esteem, loss of nurturance, or forced adjustment to a change in life or role," (p. 13). Pinpointing which source of stress applies to Mr. Jones will help the client to increase functioning. Questions like "What do you think about your son's approach in helping you?" And "What do you think about maybe seeing your neighbor who cares about you?" are possible open-ended questions that can help determine the source of Mr. Jones's stress. Ethical checks must also be made at this point, because Mr. Jones's case might be one of elder abuse.

The main part of the crisis intervention is the therapeutic interaction, which may include support or validation statements. Supportive statements should not be empty platitudes like, "Everything is going to be ok," (p. 17). Instead, the crisis worker offers more specific, realistic, and concrete support statements, like "You have pulled through tough times with your son before, and you have proven do have the power to extricate yourself from an uncomfortable situation." The crisis worker can also offer educational support statements, which may provide an appropriate segue way to the final part of the counseling process. Educational statements direct Mr. Jones to resources like books or groups that are related to the issues at stake, such as depression and elder care. Finally, empowering statements encourage Mr. Jones to consider alternatives to remaining a prisoner in his home. For example, Mr. Jones might be told that he has the power to make changes in his life, and that he has the choice of whether or not to listen to his son or to move into an assisted care facility. The crisis worker can also remind Mr. Jones of the power of social support, which he had taken advantage of in the past by having…