Conflict & crisis communication: the behavioral influence stairway model and suicide intervention.
Health counseling (Management)
Communication in medicine (Management)
Suicidal behavior (Care and treatment)
|Author:||Vecchi, Gregory M.|
|Publication:||Name: Annals of the American Psychotherapy Association Publisher: American Psychotherapy Association Audience: Academic; Professional Format: Magazine/Journal Subject: Psychology and mental health Copyright: COPYRIGHT 2009 American Psychotherapy Association ISSN: 1535-4075|
|Issue:||Date: Summer, 2009 Source Volume: 12 Source Issue: 2|
|Topic:||Event Code: 200 Management dynamics Canadian Subject Form: Health counselling; Health counselling; Suicidal behaviour Computer Subject: Company business management|
|Geographic:||Geographic Scope: United States Geographic Code: 1USA United States|
Previously, the overall concepts of conflict and crisis communication were examined as a methodology for influencing and persuading behavioral change (Vecchi, 2009b). This article will build upon that foundation by examining and detailing the critical task of putting conflict and crisis communication theory into practice through the application of specific strategies and tactics. Specifically, the Behavioral Influence Stairway Model (BISM) (NCNC, 2003; Vecchi, Van Hasselt, & Romano, 2005; Vecchi, 2009a) will serve as the basis of the overall strategy to be employed in conflict and crisis situations in developing a "relationship" by which the communicator influences the person in crisis to comply. Several communication approaches will also be covered, which will serve as the tactics by which the communicator can apply the BISM strategy to various situations. Finally, suicide intervention methodology will be examined to illustrate strategies and tactics derived from the BISM.
Determining Communication Approaches in Conflict and Crisis Situations
People communicate to satisfy needs, whether they are instrumental or expressive. Wilmot & Hocker (1998) categorize needs as falling into one of four general categories: 1) content, 2) relational, 3) identity, and 4) process. Content needs are substantive, such as food, money, or transportation. Relational needs have to do with the way people treat one another; if someone feels disrespected or patronized, then this need would be lacking. Identity needs have to do with feelings of security, saving face, and recognition. Process needs relate to the structure or forum of the dialogue--mediation versus court hearings or formal versus informal. People also communicate on two levels: content and emotion. These levels vary. depending on the degree of conflict or crisis that a person is experiencing (Vecchi, 2009a, 2009b).
Although both conflict and crisis situations can have both substantive and expressive components, it is the focus that distinguishes between them. In conflict situations such as hostage-taking, kidnapping, divorce, or high stakes mediation, the focus is on substantive or content needs, such as trading hostages for money or obtaining custody of children. Conflict situations are rational and require problem-solving approaches (Dattilio & Freeman, 2000; Fisher, Ury, & Patton, 2001; Mullins, 2002; Rogan, Hammer, & Van Zandt, 1997; Slatkin, 2005; Ury, 1991). Conversely, in crisis situations such as suicide, the focus is on expressive or identity needs, such as ventilating emotions, saving face, or recognition (Booth, Vecchi, Finney, Van Hasselt, & Romano, 2009; Daniels, Royster, & Vecchi, 2007; Greenstone & Leviton, 2002; McMains & Lanceley, 2003; Rogan, Hammer, & Van Zandt, 1997; Rosenbluh, 2001; Slatkin, 2005; Van Hasselt, Flood, Romano, Vecchi, de Fabrique, & Regini, 2005). Crisis situations have the additional element of the person having exceeded his or her ability to cope; these situations are irrational and require crisis intervention approaches (Vecchi, 2009a, 2009b). A litmus test that can be used to assist the communicator in determining whether the situation calls for crisis intervention or problem-solving is to ask two questions:
1. Is the person rational and goal-oriented?
2. Does the person want to talk to the communicator?
If the answer is yes to both questions, then the situation is most likely one of conflict, which necessitates the use of problem-solving techniques. If the person exhibits irrational thinking, unclear goals, and resistance to speaking with the communicator, then the situation is most likely one of crisis, which requires the use of crisis intervention techniques (Vecchi, 2009a, 2009b).
Keep in mind that there are rarely "pure" conflict or crisis situations, as most situations have elements of both. Take for example the classic case of the crime-gone-wrong scenario. A person holds up a bank, expecting to escape with loads of cash. Instead, the silent alarm is activated and the police surround the bank, all before the person can escape. This puts the person in crisis and, as a result, he takes two tellers hostage at gunpoint and retreats to the vault. He then demands money and transportation or else he will kill the hostages. In analyzing this situation, we find that the person is initially in a crisis state as a result of being caught in the act. During this initial chaos, crisis intervention techniques would be appropriate. As the situation stabilizes, the negotiator would move on to problem-solving techniques in furtherance of eliminating demands, releasing hostages, and influencing the person to surrender. It should be noted that at anytime the person could get emotional again, which would require the communicator to use crisis intervention techniques again. This back-and-forth dynamic is what separates the "art" from the "science" in applying the methodology of conflict and crisis communication.
At the heart of conflict and crisis communication is the ability of the communicator to build a relationship with the person in crisis, via verbal skills. This relationship can be tenuous at times; however, it is one of necessity if communication is to be successful. Remember that with any intervention, the job of the communicator is to influence the person to change their behavior in order to end the crisis. Notice that the emphasis is on influencing the person to change their behavior rather than making them change. This point is critical because, unless you have physical control over a person, you cannot stop them from hurting themselves or others if they are inclined to do so; therefore, the only real safe alternative is to influence them to voluntarily do as you suggest. This, of course, is not easy because people in crisis are usually highly emotional and oftentimes unreasonable; thus, if a course of action is prematurely suggested before a positive relationship is established and before the person is ready to accept the suggestions of the communicator, then the chances of positively overcoming the crisis are greatly diminished (Vecchi, 2009a, 2009b).
Behavioral Influence Stairway Model
In conflict and crisis situations, the Behavioral Influence Stairway Model (BISM) can be employed as the method for resolving these incidents without the use of violence. The BISM graphically depicts and explains the process of developing a relationship between the communicator and the person in crisis that results in ultimately influencing the person to accept and act upon the suggestions of the communicator. The model moves the communicator from "no relationship" with the person in crisis to a "relationship" that allows for the communicator to influence and ultimately persuade the person in crisis to do as the communicator suggests. This is accomplished in four stages as a product of time and includes 1) active listening (the foundation), 2) empathy, 3) rapport, and 4) influence. The upward arrow depicts the movement from "no relationship" to "relationship" and the downward arrow represents mistakes made by the communicator ("falling down the stairs") that require the communicator to return to the active listening stage and begin again. Law enforcement negotiators have honed this process over the past 30 years to be effective even in the most volatile of situations, and this model has proved to be highly effective in resolving crises without injury and within a relatively short period of time (NCNC, 2003; Vecchi, 2009a, 2009b; Vecchi, Van Hasselt, & Romano, 2005) (See Figure 1).
The BISM is comprised of four stages, which occur in a specified order:
STAGE 1: Active listening
STAGE 2: Empathy
STAGE 3: Rapport
STAGE 4: Influence
It is important to note that these stages occur in order and one stage cannot be skipped in order to get to the next stage faster. For example, a communicator cannot skip from STAGE 1 (active listening) to STAGE 4 (influence) without first having developed empathy and rapport (STAGE 2 and STAGE 3) with the person in crisis. The most important thing to remember is that if the communicator is not making progress, it is best to go back to the foundation (STAGE 1) and start over again and to stay focused on the process of developing a relationship with the person rather than on the outcome of ending the crisis (NCNC, 2003; Vecchi, 2003, 2004, 2009a, 2009b; Vecchi, Van Hasselt, & Romano, 2005).
[FIGURE 1 OMITTED]
STAGE 1: Active Listening
People in crisis have a universal need to be heard and understood and they all have their own unique story to tell. Active listening attends to these needs from the standpoint of the person in crisis and it is the first step in developing a relationship that will ultimately lead to behavioral change and an end to the crisis (Booth, Vecchi, Finney, Van Hasselt, & Romano, 2009; Daniels, Royster, & Vecchi, 2007; Greenstone & Leviton, 2002; McMains & Lanceley, 2003; Rogan, Hammer, & Van Zandt, 1997; Rosenbluh, 2001; Slatkin, 2005; Van Hasselt, Flood, Romano, Vecchi, de Fabrique, & Regini, 2005). Active listening skills (ALS) form the bedrock of the BISM and are comprised of core and supplemental groupings. The core group elements are Mirroring, Paraphrasing, Emotion Labeling, and Summarizing. The supplemental group consists of Effective Pauses (silence), Minimal Encouragers, Open-ended Questions, and "I" Messages. Although there are no hard or fast rules, supplemental ALS should be used when necessary to enhance the effectiveness of core ALS (NCNC, 2003; Vecchi, 2003, 2004, 200% 2009b; Vecchi, Van Hasselt, & Romano, 2005).
Core Active Listening Skills
Mirroring refers to repeating the last few words or gist of the person in crisis. It demonstrates to the person that the communicator is attentive and it also serves as a method by which to draw out specific concerns and problems for use in furthering the interaction. In this way, the communicator ensures that the discussion content is provided solely by the person in crisis rather than by the communicator, thereby remaining in that person's frame of reference. It is also a good way to get "new" material to talk about that is relevant to the person in crisis (NCNC, 2003; Vecchi, 2003, 2004, 2009a, 2009b; Vecchi, Van Hasselt, & Romano, 2005).
Paraphrasing refers to putting the content of what the person in crisis said into the communicator's own words. This demonstrates to the person that the communicator is trying to understand his or her specific situation from a cognitive or content perspective (NCNC, 2003; Vecchi, 2003, 2004, 2009a, 2009b; Vecchi, Van Hasselt, & Romano, 2005).
Emotion Labeling refers to identifying the emotion(s) that the person in crisis is feeling. This gets at the heart of what the person is experiencing because most content is surrounded by emotion(s) (NCNC, 2003; Vecchi, 2003, 2004, 2009a, 2009b; Vecchi, Van Hasselt, & Romano, 2005) (see Figure 2).
Even if the communicator misidentifies the emotion, it still demonstrates to the person in crisis that the communicator is trying to understand the situation, which tends to de-escalate highly volatile emotions. An example of emotion labeling would be: "you sound angry," "you seem frustrated," or "I hear disgust in your voice."
[FIGURE 2 OMITTED]
Summarizing combines the content of the paraphrase with the emotion identified by emotion labeling into the communicator's own words. This process is a final clarification to the communicator of what the person in crisis is experiencing and it assures the person that the communicator understands the situation from the perspective of the person in crisis (NCNC, 2003; Vecchi, 2003, 2004, 2009a, 2009b; Vecchi, Van Hasselt, & Romano, 2005). An example of summarizing would be: "Let me make sure I understand what you're saying, you lost your job for no apparent reason (paraphrase) and this makes you angry (labeled emotion)."
Supplemental Active Listening Skills
Effective pauses equate to deliberate silence before or after meaningful comments by the communicator. This provides the person in crisis with the ability to focus on what the communicator is saying. Pausing just before or after saying something important tends to cause a person to listen to the content of the message because the pause breeds anticipation (if done before the meaningful comment) and reflection (if done after the meaningful comment) (NCNC, 2003; Vecchi, 2003, 2004, 2009a, 2009b; Vecchi, Van Hasselt, & Romano, 2005). For example, the communicator could use an effective pause in this way: "Tell me if I have this right ... (pause) ... you are angry with your mother because she never showed you love" or "you sound angry about the loss of your father ... (pause) ... tell me more about that."
Minimal encouragers are verbal and nonverbal cues to the person in crisis that the communicator is being attentive to what he or she is saying and experiencing. They also demonstrate that the communicator is psychologically present with the person and that he or she is genuinely trying to understand his/her perspective (NCNC, 2003; Vecchi, 2003, 2004, 2009a, 2009b; Vecchi, Van Hasselt, & Romano, 2005). Minimal encouragers are used while the communicator is listening. Verbal encouragers are comments such as "uh-huh," "yes," "right," and "okay." Nonverbal encouragers are actions such as nodding the head, tilting the head, leaning forward, watching the person's eyes or mouth as they speak, or mirroring the nonverbal behavior of the person in crisis.
Open-ended questions prompt the person in crisis to expand on his or her concerns and perspective and encourages clarification--which is used by the communicator in employing more primary active listening strategies (mirroring, paraphrasing, emotion labeling, and summarizing)--all in an effort to bring the person to a more rational level (NCNC, 2003; Vecchi, 2003, 2004, 2009a, 2009b; Vecchi, Van Hasselt, & Romano, 2005). Open-ended questions do not limit the responses to either-or or yes-no answers, but require elaboration and detail on the part of the person in crisis. Open-ended questions may include questions that start with "what" or "when" or statements such as "tell me more about ..."
"I" messages are used sparingly by the communicator when it is appropriate to make a personal disclosure in furtherance of developing the relationship or when the person in crisis is verbally attacking the communicator. A communicator uses a personal disclosure to connect an emotion or experience within the context of what the person in crisis is describing (NCNC, 2003; Vecchi, 2003, 2004, 2009a, 2009b; Vecchi, Van Hasselt, & Romano, 2005). For example, the communicator may say: "I am a father too, but I can only imagine what it must be like to lose a son. It must be terrible." When being verbally attacked, the communicator can use the "I" message in this way: "When you say that I don't care, it frustrates me because I really am trying to understand your situation and I really want to help you. I am here because I want to be, not because I have to be."
In many cases, the communicator is the only one in the life of the person in crisis who has made an effort to understand and respond to the crisis situation in his or her frame of reference. Active listening is the starting point of effective crisis intervention and the first stage toward influencing behavioral change (NCNC, 2003; Vecchi, 2003, 2004, 2009a, 2009b; Vecchi, Van Hasselt, & Romano, 2005). In addition, active listening is always the fallback position when communication begins to deteriorate.
STAGE 2: Empathy
Empathy is a natural by-product of effective active listening. Empathy implies an identification with and understanding of another's situation, feelings, and motives (Vecchi, 2009a). The communicator uses empathy to see through the eyes of the person in crisis and to absorb tension. Being right is not the issue; making the attempt to get it right on the part of the communicator is what counts (NCNC, 2003). An example of an empathetic statement would be: "It is understandable how you would be angry over that."
Empathy should not be confused with sympathy, which indicates pity (NCNC, 2003). In crisis intervention, the goal is not to feel sorry for the person in crisis, but to establish a relationship through effective communication whereby positive steps can be taken toward resolving the crisis in a collaborative fashion.
A crucial consideration with regards to developing empathy is the importance of tone. Whether or not the perception is based in reality, tone influences how the person in crisis perceives the meaning of what the communicator is saying and it is this perception of meaning that counts the most in effective crisis intervention. Therefore, all strategies and tactics must be based on their impact upon the person in crisis. Tone indicates attitude and genuineness through inflection and pitch and it expresses emotion, demeanor, and projected sincerity. Remember that the way a communicator says something is far more important than the content alone (NCNC, 2003). Empathy seeks to first understand and then to be understood on the part of the communicator, which form the building blocks of rapport.
STAGE 3: Rapport
Up to this point on the BISM, the relationship has been one-sided in that the person in crisis has been talking and the communicator has been actively and empathetically listening (NCNC, 2003; Vecchi, 2003, 2004, 2009a, 2009b; Vecchi, Van Hasselt, & Romano, 2005). Once empathy has been established from the standpoint of the person in crisis, rapport develops, which is a relationship characterized by trust and mutual affinity (Vecchi, 2009a). Once rapport has been developed, the person in crisis is poised and ready to listen to what the communicator has to say. At this stage, the communicator, in collaboration with the person, begins to build themes, defense mechanisms, minimizations, or blending concepts that serve as precursors to ending the crisis (Dattilio & Freeman, 2000; Fisher, Ury, & Patton, 2001; Mullins, 2002; Rogan, Hammer, & Van Zandt, 1997; Slatkin, 2005; Ury, 1991). Themes comprise reasons that would explain, justify, mitigate, or excuse the crisis and address distorted thinking by putting a "different spin" on the situation. Defense mechanisms use rationalization and projection of blame to reduce volatile emotions, whereas minimization downplays any negative behavior exhibited by the person in crisis. Blending is where the communicator and person in crisis agree where they can without conceding, reduce real or perceived differences, and find common ground. At this point, the person in crisis is ready to both be influenced and persuaded to act by the communicator.
STAGE 4: Influence
Influence is the act or power of producing an effect without apparent force or direct authority (Vecchi, 2009a). At this stage, the relationship has now grown to the point where the person in crisis is ready to accept the suggestions of the communicator as a prelude to behavioral change (Vecchi, 2003, 2004, 2009a, 2009b; Vecchi, Van Hasselt, & Romano, 2005). In other words, the communicator has earned the right to suggest a course of action to the person in crisis as a result of collaborative problem-solving (NCNC, 2003). At this point, the communicator and person in crisis work together to identify solutions and alternatives that are suitable to both.
Behavioral change will occur only if the previous four stages have been successfully completed and a relationship has been formed between the communicator and the person in crisis. The difficulty of successfully reaching this stage is often the result of the communicator moving too quickly through the stages or skipping stages in a misguided effort to solve the crisis through premature problem-solving (NCNC, 2003; Vecchi, 2003, 2004, 2009a, 2009b; Vecchi, Van Hasselt, & Romano, 2005). It cannot be stressed enough that the key to behavioral change and successful conflict and crisis communication in particular is a positive relationship between the communicator and the person in crisis, via the implementation of active listening, empathy, rapport, and influence strategies and tactics. At this point, the person in crisis will do as the communicator suggests for no other reason than the fact that the communicator asked the person to do so.
Making Contact and Introductions
One thing to keep in mind is the importance of contacting the person in crisis as soon as possible and keeping him or her engaged. This process buys time and is called verbal containment (NCNC, 2003). Verbal containment is established for several reasons:
Occupies the person in order to reduce the likelihood of the person hurting himself/herself or others
* Puts pressure on the person to keep talking
* Permits for better decision-making through the gathering of information (interviews of family and friends, medical records, psychological records, etc.)
* Assists in assessing the needs of the person
* Reduces stress and anxiety
* Allows for a positive relationship to develop between the communicator and the person in crisis
* Person's expectations are reduced
When first speaking with persons in crisis, communicators should introduce themselves by stating their name and agency or organization for which they work (NCNC, 2003). For example: "My name is Greg. I am with the FBI and I would like to help. Are you okay?" Notice that there is no mention of any sort of rank, which keeps the message on a more personal level, yet it is clear that the communicator is a professional. In furtherance of this, the communicator should also attempt to refer to the person by his or her name and ask permission to use their first name, if possible.
Among the first things to determine is lethality and injury (NCNC, 2003). In assessing this, the communicator should first ask the person if he or she is okay. This approach oftentimes places the person off-balance because he or she is unlikely to have expected that the communicator would even care about his or her particular situation. This approach goes a long way toward setting the stage for developing a positive relationship between the communicator and the person in crisis. The communicator should also ask if anyone else is hurt and if medical attention is necessary. This question serves not only to assess medical needs, but it goes towards personalizing the captives and lessoning their perception of being viewed as objects by the person in crisis.
One thing to make clear is the fact that the communicator is not going away and that he or she is there to help the person in crisis, as oftentimes the person in crisis does not want the communicator present and simply asks the communicator to "go away" (NCNC, 2003). In response, the communicator may say: "I'm not going away; I'm here to help you." The person in crisis may respond: "You don't care about me, you don't know me!" In response, the communicator may say: "You're right, I don't know you, but I am here because I really care about you and how you're feeling."
One common concern of persons in crisis is the perceived threat that they will be overrun, thereby losing control of a situation that they are so desperately trying to control (NCNC, 2003). In barricaded situations, a tactic for reducing this concern is for the communicator to say: "You have things under control in there and we have things under control out here. Let's keep things under control together because I am really interested in helping you." This approach puts the impetus of stabilization on the person in crisis.
Responsibility and accountability of action is an important ground rule to make up-front (NCNC, 2003). In furtherance of this, the person in crisis may say: "If you come in here, I will kill the girl and it will be your fault!" The communicator should say: "I'm not coming in there, but if you hurt her it will be your responsibility and not anyone else's, so let's get back to what we were talking about ... you sound angry, what happened?" With this response, the communicator makes it clear that the person in crisis is solely responsible for his or her actions; this leads to employing the first step of the BISM, which is active listening.
Active Listening Methodology
Active listening aims to allow the person to ventilate his or her concerns and to identify and discuss the person's feelings and emotions as the foundation for moving toward influencing the person to voluntarily listen to and act upon the suggestions of the communicator. Therefore, upon making contact and introductions, the communicator's job is to figure out the needs and concerns of the person in crisis from the perspective of that person and empathetically echo these needs and concerns back to the person in their frame of reference (Booth, Vecchi, Finney, Van Hasselt, & Romano, 2009; Daniels, Royster, & Vecchi, 2007; Greenstone & Leviton, 2002; McMains & Lanceley, 2003; Rogan, Hammer, & Van Zandt, 1997; Rosenbluh, 2001 ; Slatkin, 2005; Van Hasselt, Flood, Romano, Vecchi, de Fabrique, & Regini, 2005).
In order to root out the core needs and concerns of the person in crisis, the communicator must do so by "drawing" out these elements without directly asking. This amounts to staying in the person's frame of reference and ensuring that it is "all about the person" and not about the communicator. For example, if the communicator simply states: "I know you're hurt because your wife left you." The response from the person in crisis may be: "You don't know anything, just go away." In this example, the communicator left the frame of the person in crisis and spoke from his/her own point of view, which is an obstacle to negotiation. If, for example, the communicator says: "you sound really hurt about your wife leaving you," this keeps the interaction in the person's frame of reference; thus, the person may say: "I am hurt, because I really love her." In this example, the communicator stayed in the person's frame, which furthered the communication in a positive manner (Vecchi, 2003, 2004).
Employing Core Active Listening Skills
It is suggested that the core active listening skills of mirroring, paraphrasing, emotion labeling, and summarization be used in a specified order to maximize the perception to the person in crisis that the communicator is staying in their frame and trying to understand the situation from their perspective. This is because, upon making first contact, the communicator does not know the concerns and needs from the perspective of the person in crisis; the communicator must employ active listening in order to "draw out" the concerns and needs of the person to make an informed assessment for eventually introducing problem-solving strategies that are acceptable to the person in crisis (Vecchi, 2003, 2004; Vecchi, Van Hasselt, & Romano, 2005).
Mirroring should be the first active listening skill employed because it "draws" out elements of what is important to the person in crisis, which can then be used to determine and develop their most important concerns and needs. By repeating the last few words of the person in crisis, the communicator encourages the person to keep on talking, which results in drawing out more material for the communicator to use (Vecchi, 2003, 2004; Vecchi, Van Hasselt, & Romano, 2005). Here is an example of a mirroring exchange between the person in crisis (P) and the communicator (C):
P: "They just don't care."
C: "They don't care?"
P: "Yeah, that's why I got fired."
C: "You were fired?"
P: "Yeah, I got fired because management doesn't care about me."
C: "Management fired you?"
P: "Yes, my supervisor and his boss decided to fire me."
C: "Your supervisor and her boss?"
P: "Yeah, my supervisor, Monica, and her boss, Janice."
Notice that the communicator has successfully hit on some of what the crisis entails by simply mirroring the last few words of the person in crisis. The next step is to flesh out more of the content of what is going on through paraphrasing.
Paraphrasing is used to restate the content of what the person in crisis said in order to ensure that the communicator understands his or her perspective, which also demonstrates to the person in crisis that the communicator cares and is listening. In doing so, the communicator restates what has been said in his or her own words (Vecchi, 2003, 2004; Vecchi, Van Hasselt, & Romano, 2005). The following is an example of paraphrasing:
C: "You were fired because Monica and Janice decided to let you go because they don't care about you."
P: "That's right. No one cares."
The next step is to probe the emotions of the person in crisis, as this is the key to reestablishing a sense of rationality to him or her, which must be present before problem-solving can begin. Emotion labeling gets at the heart of the crisis by unveiling how the person feels about his or her situation with respect to himself/herself and others. It also provides insight into the precipitating event(s) that led to the crisis, which sets the direction for problem-solving (Vecchi, 2003, 2004; Vecchi, Van Hasselt, & Romano, 2005). To do this, the communicator listens for emotions and simply relays them to the person:
C: "You sound angry about losing your job."
P: "Your damn right I'm angry, I've worked hard for that company for 22 years and now I'm going to lose my pension!"
Interestingly, when it comes to labeling emotions, it is the attempt by the communicator to get the emotion right that counts. Even if the emotion is labeled wrong, this will not negatively impact the developing relationship between the communicator and the person in crisis because the person believes that the communicator is trying to understand (Vecchi, 2003, 2004; Vecchi, Van Hasselt, & Romano, 2005). Here's an example:
C: "You sound angry about losing your job."
P: "I'm not angry, I'm frustrated. I've worked hard for the company for 22 years and now I'm going to lose my pension."
Now that the communicator has determined the content and emotional elements of the story, it is necessary to put the pieces together by summarizing. Summarizing combines the facts obtained during paraphrasing and the stated emotions discerned during emotion labeling and combines them into one statement that the communicator relays back to the person in crisis to demonstrate an understanding of the situation (Vecchi, 2003, 2004; Vecchi, Van Hasselt, & Romano, 2005). The following is an example of summarization:
C: "Let me make sure I understand what you're telling me. You were fired from your job by Monica and Janice for no apparent reason and this makes you very angry because, not only have you worked hard for the company for 22 years, you're now going to lose your pension."
P: "That's right."
Employing Supplemental Active Listening Skills
Unlike the core active listening skills, the supplemental active listening skills (effective pauses, minimal encouragers, open ended questions, and "I" messages) are not used in any specified order, but interlaced as necessary to enhance the effectiveness of the core active listening skills (Vecchi, 2003, 2004; Vecchi, Van Hasselt, & Romano, 2005). Here are some examples using the same scenario:
C: "Let me make sure I understand ... (pause) ... you are angry because you were fired."
P: "I've been working for the company for 22 years ..."
P: "... so my pension is pretty good."
P: "But now, I'm going to lose everything because I was fired."
C: "Tell me more about Monica, your supervisor."
P: "I always thought she was a nice lady, but I guess when the bottom line is the most important thing, anyone is expendable."
P: "Why should I listen to you, you're just a stupid therapist who wants to get inside my head! You don't care about me; leave me alone!"
C: "When you say I don't care and you call me stupid, it really frustrates me because I am trying to understand your situation so that I can help. I don't have to be here ... I am here because I want to be."
Through the proper application of active listening skills, the communicator has now developed a fundamental theme to develop with the person in crisis, which can eventually be used in problem-solving. The important thing to keep in mind is that throughout the crisis intervention process, the person in crisis must maintain a sense of ownership over the outcome of the crisis, which can only be accomplished via the perception and within the frame of that person (Vecchi, 2003, 2004; Vecchi, Van Hasselt, & Romano, 2005).
Suicide is a major problem in the United States. According to the FBI (2002), nearly 30% of all law enforcement barricaded incidents in the United States involve suicidal situations. In 2004, suicide was the eleventh leading cause of death in the United States, accounting for 32,439 deaths. Moreover, an estimated 8 to 25 attempted suicides occur per every suicide death (NIMH, 2009).
Suicide is an intentional self-inflicted death that has many psychological, sociological, and biological aspects (Connor, 2009). Suicide is a form of behavior that is designed to deal with a problem. It is a goal-oriented coping method--a way to take control--and it can be the ultimate form of revenge from the standpoint of the suicidal person (Lancely, 2003; McMains & Mullins, 2006; Strentz, 2006). One sure point is that if someone really wants to kill himself/herself, regardless of the reason or cause, there is very little a communicator, or anyone else for that matter, can do about it. Fortunately, most suicide-related incidents involve people who are looking for help and who haven't made the final decision to kill themselves.
There are several widely-held myths about suicide that need to be understood so they don't unnecessarily interfere with effective crisis intervention (Connor, 2009: NIMH, 2009):
* If you ask a person about his/her suicidal intentions, you'll encourage that person to kill himself or herself
* Suicidal persons rarely seek medical attention
* Professional people don't kill themselves
* When the depression lifts, there is no longer any danger of suicide
* Suicide is a spontaneous activity that occurs without warning
Of all the myths, the first one has the most impact on the communicator. Asking the suicidal person if he or she intends to committ suicide actually encourages him/her to talk about the problem. Talking buys time, which reduces tension. Ignoring the question of suicide altogether can actually increase the likeliness of it occurring because by ignoring it, the communicator fails to probe the concerns and needs of the suicidal person, which can be viewed as being insensitive to a cry for help (Lancely, 2003; McMains & Mullins, 2006; Strentz, 2006).
Suicidal Risk Factors
The following are some characteristics that are often associated with suicide (Lancely, 2003; McMains & Mullins, 2006; NCNC, 2003; NIMH, 2009; Strentz, 2006):
* Feelings of hopelessness, helplessness, low self-esteem, and guilt
* Previous suicide attempts
* Talking about death and suicide
* Planning for suicide
* Mental illness
* Alcoholism and substance abuse
* Social isolation
Of all these risk factors, hopelessness and helplessness are the two greatest predictors of suicide (NCNC, 2003).
For the communicator, there are several behavioral and verbal clues that indicate potential suicide. Some behavioral clues include (Lancely, 2003; McMains & Mullins, 2006; NCNC, 2003; NIMH, 2009; Strentz, 2006):
* Giving personal items away
* Putting affairs in order
* Writing a note
* Test-firing a weapon
* Slowed thinking or indecisiveness
* Mood changes, crying spells, and/or sudden elation-hyperventilation
* Reckless or impulsive behavior
Some direct and indirect verbal clues include (Lancely, 2003; McMains & Mullins, 2006; NCNC, 2003; NIMH, 2009; Strentz, 2006):
* "You won't have to put up with me any longer."
* "I can't go on."
* "I will resolve my problem my own way."
* "I'll make--suffer."
* "They'll be better off without me."
* "All of my problems will end soon."
* "I just wish it was over/would all end."
* "I wish I were dead."
* Communicating in the past tense
* Verbal will
Communication Techniques for Suicide Intervention
As mentioned earlier, when the communicator suspects that a person may be suicidal, the most important thing to do is to focus on getting the person to express his/her emotions (as most suicidal persons are willing to discuss their thoughts) via active listening (Lancely, 2003; McMains & Mullins, 2006; NCNC, 2003; NIMH, 2009; Strentz, 2006). Suicidal individuals are often fearful and even feel guilty about having suicidal thoughts; it is important to remember to be empathetic, nonjudgmental, and open-minded, and to focus on the specific situation that caused the person to feel suicidal. The following are some specific questions that a communicator may ask:
* "Are you having thoughts about killing yourself?"
* "Do you have a plan for committing suicide?"
* "What are you planning to do?"
* "How long have you been planning it?"
* "Have you ever had thoughts about killing yourself before?" "When?"
"What stopped you before?"
* "Have you ever tried to kill yourself?" "What happened?"
* "Have you been drinking or using drugs?"
When speaking to a suicidal person, the communicator should encourage talking openly about the finality of death. Efforts should be made to find out what is meaningful and valuable to the person and these "hooks" should be used to identify other options and alternatives (Lancely, 2003; McMains & Mullins, 2006; NCNC, 2003; NIMH, 2009; Strentz, 2006). The communicator should emphasize reasons against suicide (Connor, 2009; NCNC, 2003; NIMH, 2009):
* The belief that the person in crisis can eventually cope with and survive the crisis or loss
* The grief or hardship on his/her family
* Concerns about the effects of suicide on his/her children (if appropriate)
* Pain of dying and unknown consequences about the finality of death
* Social disapproval
* Moral, religious, and ethical reservations
* Suicide is a permanent solution to a temporary problem
Conflict situations such as hostage situations, kidnappings, divorce, and high stakes mediation require a content-focused, problem-solving approach, which gives each party in the communication ownership in its outcome. Crisis situations such as suicide and domestic violence situations require a crisis intervention approach, which includes dealing with emotions and empathetic understanding. The BISM is the method by which communicators can develop a relationship with the person in crisis so that crisis intervention or problem-solving techniques can be successfully employed.
Suicide can be the result of change, choice, control, self-punishment, punishment of others, or mental illness. Suicidal feelings, thoughts, and behavior are almost always associated with the perception of helpless and hopelessness and with symptoms of depression, anxiety, or the result of medical problems involving chemical imbalances (Connor, 2009). Communicators should always be concerned and relay compassion when the possibility of suicide is raised and it is most important to take immediate steps to address it.
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The views expressed in this article do not necessarily represent the views of the FBI.
Gregory M. Vecchi, PhD, CFC, CHS-V, is the Unit Chief of the Behavioral Science Unit (BSU), Federal Bureau of Investigation (FBI). Dr. Vecchi was assigned to the BSU in January 2006, where he conducts research, training, and consultation activities in behavioral-based conflict analysis and resolution, crisis management, conflict and crisis communication, and global hostage-taking.
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