[From Bill Powers (971212.1131 MST)]
I'm enclosing with permission a direct post from Mark Lazare, a former
student of Tom Bourbon's. I think what he describes is what you get from
really applying PCT.
Best,
Bill P.
···
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Subject: Re: Update on Mark to Bill P.
Some background on what I have been up to --- the last couple of years I have
spent as a crisis counselor. I was working for an agency called TERROS.
TERROS provided support for the community Crisis Phone lines in Phoenix. We
would go the person's house, Appt., or convenient store wherever the client
was
located. Also we had private contracts with local hospital ER's. When some
one would end up in the ER to be treated for an attempt the ER would call us
for a Face to Face intervention. Currently, I have struck out on my own and
have contracted with other local hospitals myself.
When I do an intervention with some one in the ER the approach is a little
different. For one thing the Client is not thinking about maybe committing
suicide --- they already tried. Candor is very important at this time and
letting the person tell you how they ended up in the ER is a good starting
point.
Secondly I got to keep in mind I am NOT doing long term counseling with these
clients. What I am doing is a brief crisis intervention. So it is very
important to keep the Client focused and in the present and help the person
develop future plans. The focus is not on what they did do, but what they can
do---
After introducing my self - the first question I ask is "Can you tell what
going on, and how you ended up here?" I am asking "Why?" with out using the
word, asking "why" at this point makes the person defensive, because there is
no rapport established yet.
This question usually goes to the person's problem-their Error Signals.
Often the person focuses on the depression or anxiety of not getting what they
want. The person is usually re-experiencing the emotional pain that got them
to this point.
If the person is evasive, vague, nonchalant, and/or aloof (s)he is not re-
experiencing the emotional pain. It is as if the person is saying, to you,
it's no big deal. If the person is not re-experiencing the emotional pain, I
will ask them a question something like this, "Why do you want to murder
yourself?" This question always turns the conversation to a much more serious
tone. The person will now begin to open up to you. You can tell the person
that most people don't really want to murder their selves they just want to
stop the pain inside.
It is important for the person to re-experiencing the emotional pain (error
signal), but I don't let them "stew" in this for too long. Just long enough
until they describe what they want to happen (Reference or Goal) and what they
are getting (input perception). The best way to pull them out of this
"emotional stew" is a little shock to their perceptions.
Make sure you have their attention. Say something like this using their first
name "Amy," . . . . . "Amy, I am going to tell you something that sounds
really
weird, something you have probably never heard before; OK?"
"Anxiety and Depression are good for you." Wait a few seconds until the look
of puzzlement or disgust is fully on the person's face. Now you just
interjected a Disturbance (to create an error signal) to the person's
perception. Undoubtedly you now have the person's full attention back in the
present.
You can now explain Anxiety and Depression are not situations or a thing by
it's self. Hold out one of your hands, say "On one hand this is what you
want,
and on the other hand this is what you're getting." "The further these things
are apart the more anxiety and depression you feel." Anxiety and Depression
are not bad. All they do is to tell you some thing is wrong. It is at this
point when you notice that you are "feeling" depressed or anxious that you
need
to find out where it is coming from.
Now is a good time to ask the question --- "Is what your doing getting you
what
you want?" The answer will be "No." Now go back and reference the story of
their situation, staying focused on "this is what you told me you wanted" and
"this is what has been going on."
Based on the interactions with my clients during the intervention, by now I
have found the main "level of conflict in the hierarchy" -- (referring to the
Method of Levels) and "chased the problem around the loop." A phrase I
made up
for myself, meaning - Looking the problem(s) of control the person is having.
They could reside in any of 3 location, Perceptual input, Reference signal, or
the output function.
1) Perceptual input, -- the person does know what Control Variables (CV) are
important to control for, or can not sense the CV.
2) Reference signal, -- person may not have a clear goal, need, want, desire,
intent or reference model of how things could or should be.
3) Output function. -- the knowledge of what to do and/or what order to do
them
in is not clear. The person has no future plans of significance.
At this point in the intervention I guide the person to the problem and have
them come up with several possible solutions.
Remind them of their own words -- that what they have been doing in the
past is
not working. So now, try something new --- Focus on doing something
regardless of the result, Right, Wrong or Indifferent. Tell them "The closer
you get to your goals, the less anxiety and depression you will feel." I
like
to remind them "most people don't learn how to do something the first time.
Usually, the first time they learn how NOT to do it. At times the best way to
find out what you do want, is by eliminating those things you don't want or
don't work.
Next I reaffirm the plans made with the client.
Some of the most common reactions to a suicide attempt are remorse, shame and
guilt. I like to talk to the client about "reframing" the perception towards
the future. I like to tell them "this is not a bad thing" I say pointing to
them in the hospital bed, referring to how they got here. Usually their eyes
get pretty big, and I follow up by saying, "it is not a good thing either, it
is just an event in your life, it is what you DO about it that determines
weather it is a good or bad event. The outcome of this event is within your
control, it will be your choices that determine the value of the event.
I hope this explains some of the ways PCT has been very helpful to me. I
would
appreciate any feedback, suggestion, or other techniques to use.
Thank you in advance
Mark Lazare