It is essential to determine the reason the client is seeking help at this time. A clear focus on the immediate problem will prevent distracting issues from depleting the client’s needed coping energy.
Collect information that is relevant and aids in understanding the nature of the crisis, which often involves a theme of loss (loss of control, loss of nurturance, forced role adjustment, etc.). A mechanical or checklist approach is avoided as this is non-therapeutic. Rather, information is gathered in a coherent, caring manner, following the lead of the client as much as possible. Be client centered in your approach. (See Registered Nurses Association of Ontario (2002a) best practice guideline on “Client Centered Care”).
Clinical judgment and expertise are utilized to obtain relevant information to accurately assess the problem and crisis situation. Hoff (2001) suggests that assessment should focus on client functioning (emotional, cognitive, and behavioral), including a history of coping with stressful and traumatic life events. Do not challenge the client’s perception as this will only increase his/her frustration etc.
Help the client gain an understanding of the crisis and curtail any client self-blame through thoughtful reflection of the event or problem. This will facilitate a more realistic perception of the crisis by the client.
Be direct but not directive.
Negotiate and collaborate with the client to discover new ways to think about, perceive and reappraise the situation using positive reframing techniques, empowering statements, educational and normalizing comments, support statements, validation and reflection (see Appendix A for examples of how to frame questions).
Identifying perspective, subjective distress and current and previous functioning encompass most of this phase of the model. Impairments in behavioral, cognitive, social, academic and occupational functioning are assessed in relation to a client’s pre-crisis level of functioning. Formal and informal mental status exams for individuals with a previous history of mental illness are particularly important. Identify legal and ethical issues involving suicidal/homicidal risk, abuse of all types, substance abuse and organic or physiological precipitants.