Key Elements of Therapy with Clients in Crisis
What is a ‘crisis’? Glenys Parry (1990), a well-respected British therapist and researcher, outlined eight defining features of a crisis. In listing them below, I will show how a therapist can help clients deal effectively with the crisis, encouraging them to identify and use their internal resources whenever possible.
1 A triggering stress event or long-term stress
Help the person to express in words the situation they have been facing. Such expression to an attentive, non-judgmental listener can be healing in itself, as the person may have spent much time trying to avoid thinking about the situation or internally ruminating about it.
2 The individual experiences distress
Helping the person express their distress and understand it will encourage them to stand back and think about the situation constructively.
3 There is loss, danger and humiliation
Asking the person how they have dealt with similar themes before can encourage them to reconnect with the part of themself as an effective personal problem-solver.
4 There is a sense of uncontrollability
Having the person focus on what they can and cannot control can encourage them to identify their internal resources concerning the former and to drop attempts to deal with the latter.
5 The events feel unexpected
Helping the person to see life as a complex mixture of the expected and the unexpected can lead them to draw on their experiences of accepting (but not liking) unanticipated adverse events.
6 There is disruption of routine
It is important to encourage the person to resume their routine in their own time.
7 There is uncertainty about the future
Helping the person tolerate such uncertainty and encouraging them to detail how they have responded well to such uncertainty in the past shows them that they have relevant internal resources they can draw upon in the present.
8 The distress continues over time (from about two to six weeks)
It is important that the person is offered help at their chosen moment and is not asked to join a lengthy waiting list. Services offering single-session therapy can provide a rapid response to a person in crisis (Dryden, 2021).
From the above, it follows that an effective therapeutic response to a client in crisis involves the following:
- Deal with the person as a unique individual.
- Provide a rapid response to the person in crisis.
- Offer the person an opportunity to talk about the crisis and express their feelings about it.
- Respond to their feeling-based narrative with attention and empathy.
- Wherever possible, encourage the person to identify internal resources they have used in similar situations. They may have lost sight of these, but you can reacquaint them with this part of themself and help them to see how they can use such resources in the present crisis.
- Target interventions where the person is struggling the most. Thus you may best help them to i) deal effectively with their distress; ii) develop healthy attitudes to the unexpected nature of life and the uncertainty of the future, and iii) focus on what they can control rather than on what they can’t control.
Windy Dryden is Emeritus Professor of Psychotherapeutic Studies at Goldsmiths University of London and is a Fellow of the British Psychological Society. He has authored or edited 233 books. His current interests are in single-session and very brief interventions within a therapy and coaching context. Relevant publications include: When Time is at a Premium (Rationality Publication, 2016), Single Session Integrated CBT: Distinctive Features (Routledge, 2017) and Very Brief Cognitive-Behavioural Coaching (Routledge, 2017). His book Very Brief Therapeutic Conversations (Routledge, 2018) is focused on work he has done conducting live demonstrations of therapy/coaching in front of an audience that lasts 30 minutes or less. He has done more than 380 such demonstrations all over the world. His latest books are Single Session Therapy: 100 Key Points and Techniques (Routledge, 2019) which outlines the theoretical underpinnings and practical applications of the single-session mindset, Single-Session One-At-A-Time Therapy: A Rational Emotive Behavioural Approach (Routledge, 2019) which presents an REBT perspective on SST/OAAT, Single-Session Therapy: Distinctive Features (Routledge, 2019), which outlines the theoretical and practical distinctive features of this way of working with clients and The Single-Session Counselling Primer: Principles and Practice, which is a comprehensive introduction to SST for counsellors. His goal is to disseminate SST/OAAT with the hope that it might help provide help at the point of need within the NHS, a form of IAPT where the “I” stands for “Immediate.”
Speaker Disclosures:
Financial: Windy Dryden maintains a private practice. He receives royalties as a published author. Windy Dryden receives a speaking honorarium from PESI, Inc. He has no relevant financial relationships with ineligible organizations.
Non-financial: Windy Dryden is a member of the British Psychological Society, the American Psychological Association, and the Psychology and Psychotherapy Association.
