Therapy Skills: How to Handle A Crisis in Session

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As therapists, we often don’t know what to expect when a client walks through our door, even if we’ve seen that person before. Our job requires that we be ready for anything, and, unlike many occupations that allow professionals to respond after having time to think, we are expected to do our best in the moment.

One moment that is particularly hard to respond to, is when a client comes to our office in crisis.

What can we do to help?

How can we make sure that we don’t make it worse?

In what way can we de-escalate the situation?

Therapist Mark Tyrell wrote a wonderful blog post about a scary situation that he encountered with one of his clients. You can read about it by clicking the link above, but, here, we wanted to pull from, and expand upon, Mark’s 5 tips for healing and preventing crises.

Ascertain Safety

In this step, we make sure that our client is able to maintain his or her physical safety. We check for signs of suicidal and/or homicidal ideation, and we alert authorities if necessary. This is also a time to check whether your client has ingested any drugs or alcohol, and whether they have a firearm on their person. Finally, it’s a good time to find out (if you haven’t already), who else your client can call in a crisis. Is there a family member, friend, or another professional that you can enlist to help your client maintain safety?

Some therapists also find it helpful to employ a Safety Plan, which is not to be confused with a Contract For Safety. (Contracts for safety, although widely used, have proven to be less effective than other methods).

Calm Your Client

Once you know that your client is physically safe, you can proceed to calming him down with supportive listening, relaxation techniques, breathing exercises, etc. This might require grounding exercises, such as getting fresh air, putting bare feet on the ground, or mindfully noticing his surroundings. Once your client has calmed down, you can move on to the other steps.

Engage Resources  

Help your clients identify people, places, and things that are helpful to them when things get hard. Have them write these things down, so that they don’t have to think when their emotions are too high.

Work With Cognitions  

Similar to what you might do on a “non-crisis day,” work with your client to help him understand that his thoughts during a crisis are not representative of who he is as a person. Teach your client about how his brain changes during a crisis, and help him to reframe his disaster thoughts into more helpful ones.

Make An Action Plan  

The final step is to help your client make a plan for how to prevent future crises. This will make both of you feel more safe and secure moving forward.

Want to learn more about Crisis Intervention? Therapy Hive is hosting a professional development event on Connections and Crisis, October 13th from 11:30-2pm. Contact us at 972-674-8270 or Therapy Hive for more details!

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