Thoughts on crisis and crisis intervention

There are countless notions for the analysis of crisis theory. The expression ‘crisis’ is of Greek origin.
Its meaning is equivalent with the sense of “turn” in medication, which is often experienced during
the course of physical diseases. It was observed during serious epidemics, that the patients’
worsening state seemed to be suddenly changing from the nadir of their irreversible state. Perhaps
the other meaning of this word is also interesting because it can be expressed as trauma. This
modern use of the word denotes mental, economic, social and natural situations where turning
points appear. General psychology, sociology, psychiatry and economy deal with crisis situations.

Psychical symptoms and the possibilities for assistance to the physically and mentally traumatized
started to be concerned more intensively in the second half of the past century. Lindeman dealt with
people (with grief reaction and the processing of loss) whose relatives were involved in a fire in
Boston in 1944, and it turned out, that the ability of families to process trauma had improved. The
psychological background was founded by Ericson (1950) with his dynamic model of development
including the phases of adulthood. He was the first who explained the notion of the developmental
crisis – and he did not restrict his analysis to childhood as his predecessor, Sigmund Freud did, but
considered the adult way of life as a constantly changing, developing, and shaping period.

The other electrophysiological, psychological researcher, János Selye claimed that the human
organism similarly reacts to the non-specific damaging effects with an adaptation syndrome in stress
theory. Its first phase is the alarm (an emergency reaction), followed by the phase of resistance, and
finally the period of exhaustion. Cannon, whose research experiences can also be traced in the
background of this theory, analyzed emergency reaction in detail. By this time it was obvious, that a
certain amount of stress is necessary for development. The author referred to his own research
results with the phrase: “stress is the quintessence of life.” Controlled and overcome difficulties, as
well as the undercurrent excitement can sustain one’s personality and self-esteem.

Cumming (1962) differentiates three groups of crises: there are biologically founded ones, which
cannot be avoided, for instance puberty. The second one is evoked by environmental and social
factors. These can be partly avoided, for example crises evoked by migration. Finally, unintentional
accidents or catastrophic situations belong to the third group of crises.

Lasarus (1966) called those adaptation attempts confrontation or coping that aim to overcome the above
mentioned stress situations. Problem-centered and emotion-centered approaches are differentiated. If the
person focuses on the solution and the change instead of the problem, we call it a problem-centered
approach. When the person’s aim is mainly levelled at reducing the emotional reaction connected to
the crisis or stress situation -­ including anxiety, fear, or depression-, and does not want to solve, or
change the situation itself because it is beyond his/her power, or he/she is unable to do so, then it is an
emotion-centered approach.

The purpose of emotion-centered strategies is to protect the person from destructive impulses,
emotions, or to reduce negative emotions in uncontrollable or similarly qualified situations, so they
can help adaptation, and the reduction of stress.

Attila Oláh (1966) talks about so called coping potential dimensions, which indicate those personality
factors that contribute to the individual’s coping ability through influencing primary and secondary
evaluations. Such features are controllability, learned inventiveness, or the complex notion of
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psychical hardiness, which includes the appropriate self-confidence, frustration tolerance,
commitment, active reaction to challenges, and controllability. Positive thinking or optimism is
necessary for the individual to engage in a task and to be able to imagine and fantasize about its
fortunate outcome. The other thing is the sense of coherence which provides the efficiency of
solutions by promoting rationality and the understanding of coherence. One of the most important
factors in self-efficiency is proper self-knowledge, psychological knowledge, and the ability to learn a
lesson from something in the course of coping. The application of particular coping methods depends
on both the individual’s current physical and psychological states. These can be acquired on the first
and second levels of socialization.

Finding stress management mechanisms continually generate a broader scale of knowledge. The
definition of stress management mechanisms is the following: series of activities menacing our safety and
initiated by situations threatening our self-esteem. For example:

1. Defensive techniques: we try not to notice something, or we start a danger-seeking behavior

anticipating the solution.
2. Preventive techniques: we mainly apply avoidance and delay, and try to solve the situation
by passive acceptance, by blaming the circumstances, or by accusation.
3. Autoplastic restoration techniques: when we try to find a solution by ourselves from our self-
supporting powers. Apprehension, desertion, rephrasing of the situation, relabeling and
acknowledgement of dangerous situations belong here. Recognition of necessity serves the
initiation of self-supporting powers to get into motion.
4. Alloplastic transplantation techniques: when an individual tries to draw mainly from external
and partner-supporting forces. It can be a knowledge broadening activity, information
extension, learning, affiliation, reinforcement, or direct activities. The main goal is to develop
proper behavior methods from the existing behavioral repertoire.

Individual directions and choices can be highly influenced and defined by the supportive relationship.
It is required to help orient the individual toward data-fact solutions during support, and it holds for
telephone operated work, as well.

Based on client analysis after the above mentioned fire catastrophe, E. Lindeman emphasizes the
following as the criterion for the course of normal mourning reaction:

1. independence from death

2. readjustment of those situations, circumstances where the deceased person is missing from
3. the individual is able to establish new relationships which satisfy him/her

It is apparent, that familiarity with the stages of mourning is necessary for the supportive relationship
in crisis.

War crisis situations discussed by several authors (Pinker, Spiegel, Rado, Holdstein, Glass), appear in
refugee sustenance situations, in terror attacks, and in the large scale migration in Europe nowadays.

According to Lindeman, in case of crisis – connected to grief and the loss of a relative –, the most
important points to be applied in supportive communication are the following:
1. A somatic physical distress syndrome evolves. In today’s sense, it is similar to the vegetative
symptoms of panic disorder.

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Project QuaLiS: Best practice in Qualifying Listening Skills to promote Emotional Health, 2013-2015
 2. With the help of fantasy connected to the lost relative, the mourner tries to fill this loss with
hallucination.
3. Sense of guilt – regarding the mourner –, that is especially expressed when ambivalent,
controversial emotions and failure are connected to the lost relative. This can also cause a
pathological mourning reaction.
4. Hostile feelings emerge toward the deceased, when similarly ambivalent sides, signs or guilt
motivate the mourner.
5. The individual experiences that he/she loses control over events, if they happen
independently and beyond his/her control.

Gerard Caplan further develops crisis theory in the 1970s. He tries to summarize its tenets, the
psychological situation, crises and attempts to put down its major points in the supportive model. Its
formerly mentioned features are the following:

1. The person is unable to face events and circumstances menacing his/her psychical state;
2. Closeness of the problem is the central question of his/her life and it becomes more
important than anything else;
3. The evolved situation cannot be avoided, or solved with the usual method;
4. He/she cannot control problem solving, stress managing methods that formerly proved to be
efficient in behavioral therapy, so he/she requires external support.

In fact, there are three criteria which are very important. Individual solution capacity is insufficient,
thus external support becomes a central question. Many authors, including Sifne Boss (1972) and
others emphasize the feeling of intense threat, which in a psychological sense stand for concurrent
hopelessness, disorientation and a painful psychic state. Choice and decision are experienced as a
possibility to move to good and bad directions, thereby the capacity of problem solving is
overcharged and a sense of deficiency is experienced. Most of the negative life events, which trigger
crisis, are oftentimes family related experiences, close to emotional states (Holmes’s colleagues
1967). The course of crises and their stages are stirring in regard to the supporter, including
telephone work.

Sifne Boss created the notion of emotional crisis in 1972 in view of the Caplanian crisis theory. It is
such a tense and painful state of mind, in which the possibility for development, for the right to a
more harmonic existence – rather than relapse, that is to get into a strict, narrowed, disharmonic
state – is given. It emerges after a dangerous life event happens to the individual but it does not
necessarily turn into a crisis situation in each case. Jacobson’s (1979) crisis matrix theory developed
from these ideas: he merged accidental and developmental crises. In his words, the crisis matrix is a
longer period (lasting for months, or years) – generally a transition between life phases –, when the
individual experiences many emotionally disturbing, critical situations, thus he/she becomes more
receptive, more vulnerable to the emergence of crises.

Turning back to the idea of those events that evoked crisis, we can conclude, that they are often
unexpected, and characterized by the traits of failure, loss, and danger. Emotionally they are
considerably stressed for the individual in a given moment, and they reach the person through a
system of relations, which emphasize defenselessness, restraint, provocation of distress and
helplessness. Their common feature is that events – or so called experiences of loss – frequently
appear collectively. Events are structured in layers and it causes the existing conflict solving

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techniques to be paralyzed, and the individual wants to destroy himself/herself instead of the
problem. In 1949 the psychiatrist, T.H. Holmes started to examine if there was a connection between
the individual’s significant life events and his/her serious illnesses that occurred during this period.
He created the social readjustment rating scale, listing 43 remarkable events, including joyful and
static ones. Numbers denote the extent of crisis situations connected to life events, which determine
stages to the risk of illness: events above 50 points are all critical but it is not sure if they provoke a
psychic state.

Due to the deficiencies of socializing processes, several inclinations to crisis originate from
unprocessed failures and experiences of loss. There are intergenerational crises, where mysteriously
returning traumas cause the same problems in the families from generation to generation. However,
returning crises are when the same life situations, breaking of relationships, experiences of loss return in
the person’s life. Life turning crises are also well-known phenomena of crisis literature. Crisis states
can be divided into specific phases. In the first period of the crisis state – returning to stress theory –
there is an alarm reaction, an emergency state, then comes the period of coping, and the third period is
panic. This is an emotion-controlled, non-rationally operating state. It tries several techniques but
uneasiness, anger, upset emotions characterize this state. If strained efforts do not solve the crisis, the
phase of breakdown follows in the fourth period. In this case affectivity, emotions, impulses take
over the control. Momentary flow of ideas and impulses define activities. Narrowing could become
dangerous because destructive behavioral patterns may appear. It can also bear the risk of suicide.

Models describing crisis states illustrate triggering factors and the procession of crises. Causes for
such situations could emerge during crisis hours. Dread and unease last for a few days, then
adaptation develops in some weeks. This theory is Hirschowitz’s crisis model (1973). Crisis situations
force the individual to change in all cases. Differentiation of personality and emergence of empathy
are appropriate for the growth of commiseration that evolves in critical situations.

The outcome of a crisis situation can be seen as the possibility for reaching a developed balance
state: more developed coping techniques come into prominence, learning to handle losses, gaining
new self-expressive techniques, while the differentiation of personality begins, self-confidence
increases. These are creative or positive crises. The other direction is finding balance through
dysfunctional operation. Appearance of adaptation disorder, symptoms of anxiety, posttraumatic
stress – frequently present on wartime areas nowadays –, depressive symptoms, emergence of
addictions (alcohol, medicine, drugs), emergence of toxicomania, or psychosomatic disorder,
psychotic state, suicidal crisis may be the outcome.

Nothing is going to be the same after crisis situations. There is a possibility for development and
differentiation as a result of individual suffering. In a less fortunate case, balance is restored through
dysfunctional operation. Psychic illnesses may evolve as it was mentioned above. From this point of
view, coping strategies are very important in supportive work.

From the mid-twentieth century Lasarus (1960) and his colleagues introduced a new notion, coping, as
it was mentioned before. Coping means confrontation, management and domination over
difficulties. In contrast with instincts, it is not a spontaneous, not an instinctive but a conscious
strategy resolution construction. It is worthwhile to mention catastrophes, where accumulated and
condense crises take place. Not only individuals but communities and masses can also be involved. In
other words, catastrophes are special crisis situations which affect communities, not only an

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individual. There is opportunity for reliance, cooperation and sharing one’s burdens with others.
These emergency cases must be thwarted, in order to avoid the emergence of post-traumatic stress
preventively. Catastrophes can be divided into different phases according to the order and time of
events, and the participants’ behavior.

1. The first phase is the period of the burst of emergency. 15-25% of affected individuals show
intense anxiety, panic, depression. Just a small proportion (one quarter) of the community is
capable of keeping real control and facing the situation.
2. The second phase follows right after the emergency period has ceased. When the situation
starts to get back to normal, and it is rearranged, subjects start to react to events and the
early period of processing the problem begins but the trauma still remains in the center. This
phase could last for weeks.
3. The third phase is the post-traumatic period. Everyday life returns to its usual routine but
sleeping disorder, nightmares, anxiety, sense of fear, depression, and incapability of breaking
with the trauma characterize this state.

Pataki (1998) divides panic situations into four phases.

1. The first is the pre-critical phase, when perception and awareness of the crisis happens. e.g.:
flood or earthquake
2. The second is the critical phase. Perception and apprehension of actions characterize it.
Escape and activity attempts come up. Old strategies are reinforced. Informal leaders are
chosen.
3. The third is the post-critical phase. Rational activities dominate. Cooperation is more intensive
and the restoration of regular behavioral patterns begins.
4. The fourth phase is the return to the state before the panic occurred. Assimilation of new
adaptation techniques.

Averill differentiates three stages based on his research: the state of shock, the period of loss of
object and the phase of recovery. It was emphasized in the introduction, that crisis states are very
similar to mourning reactions, or accumulated crises, and chaotic states. The supporter must
advocate even adolescent realignment, the possibility for broadening of repertoire, and have to find
a way out of crises, for which several solutions are offered. Any stress decreasing mechanism is
appropriate. One of these solutions in psychoanalytic thinking is sublimation, where release of
unconscious powers and contents can be satisfied through any activity or creation (several creative
techniques are welcome to be applied in work and in arts).

Teréz Virág (1993) compared the role of Winnicottian transitional objects to the function of
compensational activity, and she found many similarities and resemblances. Suffering and trauma
are transformed into active thinking and creativity. It is important during the processing of traumatic
experiences that events of trauma appear in an acceptable, verbalized form in the continuity of
personality development. They should be conveyable and communicable to the external world. It is
very important, that the above mentioned traumatic experience should appropriately become the
part of self-development, and it should not turn into a self-estranged process. It can become
separated with its emotions and contents if it does not fit and integrate into the personality as a
whole.

Crisis processing is characterized by extremities of duality and ambivalence: despair and search for
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Project QuaLiS: Best practice in Qualifying Listening Skills to promote Emotional Health, 2013-2015
resolution, hopelessness and hope, acceptance and objection. Creative creation has reward and
integrational function during processing. It tries to reintegrate the traumatizing part of the self
through activity and creativity, and carries the maintenance of double consciousness and
ambivalence.

Lindemann’s idea of grief and loss, Caplan’s concept of crisis, Ericson’s crisis theory regarding life-phase
turning points, and Rappaport’s emphasis on role change considered the core of crisis in different
ways. Cullberg thoroughly analyzed trauma induced crises. There are also biological, somatic crises but it
is difficult to separate accumulated crises. The merger of bio-, psycho- and social dimensions may
appear during telephone work, in the dimensions of crisis. Biologically difficult life phases (hormonal
changes in puberty, menopause, pregnancy, and aging) raise critical changes, causing imbalance. They
are highly important in supportive work and telephone work.

Distinctive phases can be differentiated in Cullberg’s ideas about trauma induced crisis. He
emphasizes the phase of shock, the reaction to shock and its chronic turn, where danger of suicide is
remarkable. It is followed by the processing of the experience, then rearrangement and
reorganization of the situation.

If we examine the course of crises, the following factors must be considered extensively: in what age,
which life period did the crisis emerge? What is the individual’s problem solving capacity and the
repertoire of behavior like in this life phase? How far is this crisis from the necessary stages of
resolution?

The other situation for examination is when we focus on the quality of the individual’s problem
solving capacity, what kind of working methods he/she uses, to what extent he/she is able to apply
systematic methods, how can he/she tolerate chaos and uncertainty.

Conclusion: it is necessary to define the minimal purpose of general crisis therapy, which aims at the
psychological resolution of the crisis. Only this point must be focused on and be discussed during the
conversation.

However, the ultimate aim is to improve the psychological and mental levels before the crisis, so we
arrive at the barriers and limits of assistance, and the extreme edges of telecommunication.

Purposes aimed at the resolution of the crisis state, which intend to help the individual in the
achievement of ordinate psychic state, is called crisis intervention. In a medical sense, an emergency
event is one which requires immediate intervention. The laical environment can also help with crisis
intervention. The person in crisis is especially responsive to intervention, he/she is strongly
suggestible, emotion controlled, volatile, troubled and narrowed to the provoking event. Not only is
the person’s suggestibility strong, but his/her motivation to be supported, and to talk about his/her
feelings, thoughts and fantasies.

Rapport skill must be established by turning to the subject. Mental breaks of the person in crisis will
ease; he/she is prone to impulse directed solutions. The task of the supporter is to recognize danger,
to try to save the subject from actions that he/she would regret later on, what he/she does not take
willingly, or what is also dangerous for his/her environment.

Decision is especially important in our work – including phone service –, whether the extent of the
client’s inordinateness and narrowed consciousness affect the control of reality, or if he/she has a
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psychic illness, which require medical treatment. In this case direct efforts must be made to forward
him/her to a specialist. Direct client delivery-reception technique must be applied in this case, and the
time of contact making should be as short as possible. The environment must be involved but
carefully and thoughtfully, in order to avoid distrust.

Steps of crisis intervention:

1. Mapping the causes, finding relief, building an accepted, strong relationship. (Building
rapport)
2. Offering support, following, listening, intensive emotional attention, unconditional
acceptance.
3. Reservation of certain emotional reality.
4. Careful expansion of narrowness, involving other aspects and merits.
5. Reduction of tension and impulsiveness, reality control, representation of multiple
perspective thinking, protection of the subject from ill-advised acts.
6. Upholding hope, focusing on the problem at hand, self--­strengthening, gradual restoration of
self--­e steem, positive attitude.
7. Active intervention if auto-­ or hetero--­destructive tendencies are observed.
8. Support and motivation in turning to a specialist, evoking the need for personal intervention,
or hospitalization.
9. If it is necessary, trauma treatment in the family and in the close environment.
10. Involvement of those people who can help to ease narrowness and offer support and
acceptance: involvement of the environment and authorization of the appropriate client,
proceeding tactfully.
11. The subject’s dependence should be avoided; analysis of deeper dynamic correlations and
the transition into psychotherapy are not recommended. They should be offered later.

All in all it is obvious, that in crisis situation management it is important to close the steps of crisis
intervention as soon as possible. It could be followed by psychological consultation, tracking, or
psychotherapy. There are some specialists, who simplify crisis intervention and crisis therapy and
they differentiate only four phases:

1. Judgment of the individual and the problem

2. Construction of therapeutic intervention
3. Realization of intervention (bringing emotion to the surface, re-starting and re-opening the
world)
4. Anticipatory planning (accomplishment, elaboration of small details of fantasies of action)

If the crisis is not solved, if these phases of crisis therapy cannot be implemented, then
hospitalization or redirection to special crises ambulances is necessary.

Comparison of the Freudian psychosexual development theory and the Ericsonian ideas of
psychosocial development theory is a stirring question – even in telephone work –, where identity or
confusion of roles are remarkably emphasized. In fact, it generated James Marcia’s (1980) identity
status examination, which analyses, whether identity crisis happened, or if commitment was
established (identity becomes a considerably central question, which is going to be the greatest
problem of the 21st century later on). Laufer’s emergency signals, the adolescent breakdown signals
are even more emphasized from this aspect. The most frequently occurring crises during the period

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of puberty in 1975 were identity crises, achievement crisis, authority crisis, eating and sleeping
disorders, drug-addiction, and suicidal problems. All of them bear accumulative crises.

Personally, I think that the problem of suicide should have had high priority in telephone work.
Professor Ringel from Vienna has reached the greatest breakthrough in the field of suicide in his
research. He analyzed the common symptoms through psychological dissection after saving 146
patients, who tried to commit suicide. He recognized three groups of symptoms. One of them is the
phenomenon of narrowness, which consists of emotional, mood, dynamic and affective narrowing:
thinking, movement and communication are narrowed. This may last for weeks, or months. The next
group is the appearance of suicidal fantasies, which characterized the examined population for
weeks. The third group is the conscious intention for death. We analyze the presence of these three
groups of symptoms or phenomena on a time axis in the pre-suicidal period. In case of psychotic
individuals in old age or patients who suffer from dementia, the phenomenon of pre-suicidal syndrome
can hardly be discovered preceding the suicide.

The phenomenon of “cry for help” is a stirring question. The person tries to ask for help through
indirect signs and the question is, whether these signs can be decoded, whether we will be able to
recognize them, or help them. Communication through the channel of telephone provides
possibilities for transmission: the speaker’s tone, the person’s speech characteristics, and emotions
influence it, while anxiety and internal tension signal change. Tone and speed are influenced by
psychic properties and temper; an emotionally high-spirited person is faster, while a depressed person
produces slower speed in communication. Transmission and function of emotional charge is the
highest during pauses, so the dynamic of silence must be well known in telephone work. Tone and
volume must be considered as the release of tension, from which we can draw conclusions to the
extent of emotional influence. Intonation must be interpreted as a phenomenon generated by
emotional changes. In vocal communication seven basic emotions (love, anger, boredom, happiness,
impatience, anxiety, satisfaction) can be perceived with certainty based on four acoustic variants
(volume, pitch, speed, rhythm). The vocal channel itself is the most sensitive factor in the dysfunction
of psychic processes. They speak about signs of confusion, while incorrect pronunciation, verbal
mistake, too long pauses, incorrect word order, omission or repetition of words, or unfinished
sentences allude to serious disorders. There are signs of communicational disorder, which can
exclude the partner, for example: absence of linguistic socialization (it is hard for the person to form
words about his/her feelings), or the use of jargon. The flow of words may cause tension in
communication; generalization and the use of clichés can stand for sleaziness or disrespect. Barriers
of transmission thwart communication. These are order, command, warning, threat, preaching,
polarization, advice-giving, listing advices for solution, logical argumentation, persuasion, judgment,
critique, qualification, accusation, praise, understanding, dishonor, travesty, and condemnation. All
of these are capable of evoking a block in communication which is important in the course of
supportive conversation. “Who takes the time and is able to keep up the conversation saves a life” –
as we usually phrase it.
Montun’s idea of four ears: communication operates on four stages, it consists of four types of
messages, so “four ears are present in communication”. One statement can have more messages and
it can lead to inner conflict. The four aspects are theoretically equal. The layers are:

1. Matter layer: informational side of the message based on criterion (true or false,
appropriateness, relevance, importance, sufficiency, adequacy).
2. Information about us, revelation of personality, mood, orientation, the level of our relation
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 to the role.
3. Relationship layer, where the message reveals the relation between the two speakers. It is a
sign, how the speaker relates to the listener.
4. Appeal: the speaker’s intention is revealed, what he/she wants to achieve.

Listening is a complex phenomenon in a communicational supportive relationship. It is two-directional,

the aim is to listen to the calling person, reinforce and help him/her to find a solution to the problem.
The timeframe is limited and controlled by the caller. Methodologically the conversation is controlled
by the approving person. The directed, guided phase in the course of supportive conversation, or
stimulation of self-revelation in crisis intervention shall be concerned. Active listening and
comprehensive attention contain both of them.

As Alfred Vanes said, “listening with the ears of another” is the hardest part of our work. The point is,
how we can give feedback to the appropriate type and intensity of feeling, how comprehensive
attention can be developed (discreetness is a very important part of reaction to emotions). Here are
some sentences which are typical to our work:

-­ You feel/believe/think, that…

-­ It seems to you, that…
-­ From your point of view…
-­ I suppose from your words, that …
-­ It seems to me that you …
-­ Perhaps you …
-­ If I understand it correctly, you feel/believe/think, that

All of them signal that we represent a comprehensive attention. Admitting but not initiative, freely
floating attention and interest are required in a good supportive relation. The supporter listens to the
speaker’s experiences, he/she is curious and capable of waiting without judgment. He/she is
committed, authentic, tolerant, objective, takes responsibility for the relationship, respects the
supported person, facilitates disclosure and uses silence. The supporter makes himself/herself
understood by the supported through his/her own language, he/she uses the caller’s terms, regards
both his/her own and the caller’s reactions; the supporter is free from pressure, he/she is controlled,
emotionally stable; he/she manages and guides the conversation, keeps the limits, gives an
opportunity for the supported to decide what and how much he/she wants to share about
himself/herself. The supporter tries to ease resistance, listens acceptably, highlights important
feelings that the caller has disclosed. He/she is authentic and if it is necessary, he/she reveals his/her
feelings regarding the relation. He/she creates an accepting, reliable atmosphere.

All of these complex communicational phenomena are present in the context of support. Regarding
these situations, we collected training exercises based on more than a decade of training, supervisor
and telephone supporting work experience, for which we try to make our newly employed
supporters more affected and trained.

With the help of Rogers’s triad, the supporter has to learn and acquire constant communicational
presence, and the significant messages of the sanctuary of humanistic psychology. The supporter acquires
the method of sequencing, layering the pre-history of crises according to age, and the disclosure of life
crises through timeline technique. This technique gives such a foundation of self-knowledge, where
supporters can help others to clear turning points in their lives and to get rid of blind spots in their self-
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image.

With the help of self-exploration scales we try to acquire the discreteness of helices of self-revelation
and the importance of sequences, and that these stages must not be arbitrarily violated by pulling
back the individual, or forcing him/her to a faster progress.

The Asist model is a very practical sensitizing program for beginners. It is vital to prepare as much
amateur supporters, volunteer communities, community protecting guards in our environment as
possible, with the help of these methods.

The risk of suicide is greater if:

-­ somebody loses a close person or an intimate relationship breaks up
-­ when health or circumstances change to the worse, or presumably will change, for example:
retirement, financial problems
-­ painful and/or disability--­causing disease occurs
-­ in case of alcohol abuse, or alcohol or drug addiction
-­ the person has had suicidal attempts before
-­ there has been a suicide in the family
-­ in case of depression

People usually indicate their suicidal feelings if:

-­ they withdraw and they are unable to build any relationship
-­ they have an imagination about how to commit suicide
-­ perhaps they talk about arranging their issues, or show any other signs that they are
preparing for suicide
-­ they talk about that they feel lonely and isolated
-­ they express that they are useless, unsuccessful, and they feel desperate and hopeless, they
lose self-esteem
-­ they constantly reflect on problems, for which there is no resolution
-­ they express the absence of positive life philosophy, e.g.: lack of religious belief

In practice we decide on the possibility of suicide with the help of the following scale:
-­ 0: the person does not have any thoughts about the intention of suicide
-­ 1: the person has had thoughts about suicide but he/she has not imagined how and when to
commit it: “I can’t take it anymore,” or “I wish I would die”
-­ 2: the person has thoughts and a plan for suicide but he/she says he/she is not going to
commit it right now. “I have my sleeping pills with me and if the situation won’t get better …”
-­­ 3: the person is preparing for suicide (a knife or pills are behind him/her) or he/she has
already committed it (has used the knife or has taken the pills) before he/she connected the
supporter.

The turnover of above mentioned ideas into practice is a really complicated endeavor but from the
point of view of training, supportive relation and attendant supervision, unified case treatment and
crisis management techniques can emerge, which make our work safer. We tried to help this work
with the mentioned methods.

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Project QuaLiS: Best practice in Qualifying Listening Skills to promote Emotional Health, 2013-2015
 HELPING CONVERSATION

1. What will you achieve with this exercise?

The individual person standing amidst the challenges of life often feels that these challenges are
problems. The aim is to treat the problem as a situation that can be examined and responded to…

A helping conversation consists of three phases:

 following
 emphatic reflections
 guided conversation.

2. How does it work?

First phase: FOLLOWING

Duration: 8--10 minutes.

The client tells an average of 4-5, or at most 6-7 sentences as a part of the whole story, trying to stay on
the same line. At the end of this phase his/her motivation for speaking gets slower, the power of
communication looses strength.

Should we interrupt the client too early, we’ll hear: “But I haven’t told you, that...”

In case we take the first step too late, we’ll get: “What do You think about it?”. This means, that we
are passive listeners and do not notice that it’s time for stepping into the next phase.

Second phase: EMPHATIC REFLECTIONS

This phase is a very important, central part of the helping conversation, which is very difficult to be
executed professionally.

Duration: 1--2 minutes.

It has got two functions:

transmitting empathy: “I understand You”, “I can imagine myself in your situation”

reflecting: “For me it’s clear that...” “This situation reflects that...”, “It has a message that...”

Similar sentences can be delivered to the client aiming to summarize what has heard. Do not use foreign
words, because these key-sentences will be the starting point of the conversation hereafter.

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Project QuaLiS: Best practice in Qualifying Listening Skills to promote Emotional Health, 2013-2015
 You should say something even in the most blocking situations as well, like “For me the facts are...”,
“The problem is that...”, “The situation is that...” or anything else you may feel.

Afterwards, this phase is to be closed by a fix sentence like “And what do you think about it?”, by
which you confidently make the client keep on speaking, without generating any conflicts or disputes.
This behaviour indicates that it’s time to evolve the details and dimensions of the problem.

Third phase: GUIDED CONVERSATION

Duration: 25--30 minutes

The issues to be cleared are as follows:

Why did you called right NOW?

Why did you called US?

Have you ever turned to any other helpline services? What happened then? What

do you expect from us? What can we offer?

Who are your supporters/resources? Who are your enemies? What

are the difficulties? How can you overcome?

What are your strongest fears?

What is the worst thing that could happen?

So our aim is to create an action plan. During this work, we have to proceed according to the scale of self-
exploration by Tringer & Pintér. We have to go ahead strictly step by step as people often feel fear and
anxiety for intimacy and self-exploration. Sometimes we have to apply the brakes, sometimes we have to
speed up the process.

Braking question: “How would you specify...?”, “Let’s try to think it over together...”

Speed-up question: “How would you describe the next step?”

3. What do you need?

40 minutes for role-play. We need 3 participants acting as observer, client and helper.

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Project QuaLiS: Best practice in Qualifying Listening Skills to promote Emotional Health, 2013-2015
4. Reflection
At the end we have to explore whether there is anything important left from the story that hides the
substance. The crisis is usually defined by this time, for which the helping conversation is no more
suitable, it is beyond its efficiency. Now focal crisis therapy or crisis intervention is necessary.

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Project QuaLiS: Best practice in Qualifying Listening Skills to promote Emotional Health, 2013-2015
 SELF-­­EXPLORATION SCALE BY TRINGER & PINTÉR

1. What will you achieve with this exercise?

Self--­exploration happens consequently in a row of circles of intimacy. It is very important to
strictly observe these stages not to generate distress or shame during self--­exploration.

2. How does it work?

You have to adjust the rhythm of your questions
to the client’s self-exploration’s level. Keep the
optimal time for the conversation in order to
avoid that the client feels pressed or fails to reach
the honest thoughts of actions or the deepest
emotions of intimacy.

For the above, Tringer & Pintér has worked up a

self-exploration scale. Communication units shall
be recorded in a thematic way, then replayed to
the group who will give points for such units (a
unit can consist of one or more sentence joint
together by a same message).

3. What do you need?

30 minutes roleplay. Printed sheets of Self--­exploration scale (Tringer & Pintér).

4. Reflection
The group will learn to analyse, evaluate, and classify the units according to the following rules:

Do not step from the general line directly up to the higher level of intimacy!
Do not turn from the zone of intimacy back to the general level! Do not
be afraid of the whirl of self-­ exploration! It would slow down the effective communication as
well as the process of self-­ exploitation.

The above rules of this spiral method can make the communication with clients more effective.

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Project QuaLiS: Best practice in Qualifying Listening Skills to promote Emotional Health, 2013-2015
 Self--exploration scale (Tringer & Pintér)

7 The client – in possession of the new knowledge about him/herself – aims to change
his/her behaviour or adopt new attitudes.

6 The client intensively deals with his/her emotions and observes new relations that
give him/her a more realistic and wider range of knowledge about him/herself.

5 The client mostly talks about his/her emotions, evaluating him/herself.

4 The client mostly talks about his/her emotions.

3 The client’s emotions come up in references or can be suspected.

2 The client speaks about his/her own behaviour, without emotions.

1 The client complains all the time about his/her physical or mental status.

0 The client does not talk about him/herself, rather describes events or other people.

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Project QuaLiS: Best practice in Qualifying Listening Skills to promote Emotional Health, 2013-2015
 THE TRIAD GAME BY ROGERS

1. What will you achieve with this exercise?

In Rogers’ triad model a real encounter (meeting) consists of three main components: the empathy,
the unconditional acceptance and the congruency (credibility).

The helper will live through the importance of their sequence and parallelism in different phases, and
learn how to use and synchronise these three functions.

2. How does it work?

The three main component as above will be the base of the following game, where the helper has to
choose three performers representing the PARTS OF THE SELF, as follows:

a person acting as EMPATHY

a person acting as UNCONDITIONAL ACCEPTANCE
a person acting as CONGRUENCY.

The helper is sitting facing to the selected three persons and listening to the client (caller). The

performers’ task is to give reactions to the client’s sentences according to their role.

Afterwards the group commonly analyze the sentences or the communicational units of empathy,
unconditional acceptance and congruency.

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Project QuaLiS: Best practice in Qualifying Listening Skills to promote Emotional Health, 2013-2015
3. What do you need?
30 minutes for role-play. A pen and a sheet of paper with the following content, on which the
participants can record their thoughts:

Typical sentences of empathy:

Typical sentences of unconditional acceptance:

Typical sentences of congruency:

4. Reflection

Processing:

Sharing

The key sentence: „Have you ever gone through such a situation in your life?” “Have you ever had any
experience that raised similar emotions in you? “
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Project QuaLiS: Best practice in Qualifying Listening Skills to promote Emotional Health, 2013-2015
Role feedback

„What did you feel in that role?” “What kind of thoughts did you have in that particular period of
life?”

Identification feedback

The question is not only for the performers bust for the whole group as well; anyone who feels being
equal to any of the performers: „What kind of thoughts grew up in your mind?” “Did you feel
empathy?”

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Project QuaLiS: Best practice in Qualifying Listening Skills to promote Emotional Health, 2013-2015
 TIMELINE TECHNIQUE WITH PSYCHODRAMA METHOD
1. What will you achieve with this exercise?
This method helps to explore effectively any and all important stages of life, as well as the tendencies
and the breaking- or turning points. It is like making a soul inventory. The emotions, experiences
and blockings can be processed by a flash or the aha-experience according to the method of Mihály
Bálint.

2. How does it work?

The helper (protagonist) gets a piece of paper with the instruction to put the most important
events of his/her life onto the timeline.

The helper indicates the dates of these events, and links some thoughts, messages, experiences,
which were significant and influenced the future.

When ready, the group will have to imagine the long timeline in the room. Their task is to choose
some persons who will represent the important resources or thoughts. These persons will get and
memorize the key sentences and repeat them step by step.

Changing roles may enrich and deepen the game, combining with the protagonist centred
psychodrama model of Jacob-Lewy-Moreno.

At the end of this game, the important messages and governing thoughts will be emphasized and
repeated while moving forward on timeline.

3. What do you need?

30 minutes for role-play. A pen and a sheet of paper with TIMELINE.

4. Reflection
At the end, the group and the protagonist will be asked to evaluate the task in three steps
according to the processing model of psychodrama:

Sharing
The key sentence: „Have you ever gone through such a situation in your life?” “Have you ever had
any experience that raised similar emotions in you? “

Role feedback
„What did you feel in that role?” “What kind of thoughts did you have in that particular period of
life?”

Identification feedback
The question is not only for the performers bust for the whole group as well; anyone who feels
being equal to any of the performers: „What kind of thoughts grew up in your mind?” “Did you
feel empathy?”

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Project QuaLiS: Best practice in Qualifying Listening Skills to promote Emotional Health, 2013-2015