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So, the psychiatric boundaries of an urgent consultation are outlined. The person is sitting in front of you. You figured an emergency consultation was indicated, you accepted the challenge, and you know, let’s say… six things:
- Something happened to this person.
- He came to you for the first and last time
- This person needs help immediately.
- Time is limited
- Most likely, it will be impossible to correct or complete today’s work
- He needs specifics, otherwise at a difficult moment he would not waste time and money on you
If you are used to working slowly, you may be puzzled by the situation in which a trusting but business contact needs to be created not just quickly, but immediately. The following points will help you if you think about them beforehand.
Don’t go deep into feelings
Deep emotional contact with a person who has had something bad and comes to you to «pick him up» is bad for your work. Do not prevent him from crying if he cries, but do not ask about the subject of tears (this is usually clear anyway). I often hear from students the question “what should I do if he sobs and I can’t stop him.” In fact, ordinary people, unless they are natives from a distant island with a difficult name, find it difficult to open up to a stranger, and they are perfectly able to slam back. I don’t know anyone who, having started crying, is still crying. The longest sobs in my line of work didn’t last longer than 20 minutes, and it took me years of upfront work to do so.
Track the countertransference
That is, the sign, quality and intensity of one’s own feelings in relation to the person who has come. Frankly, no one needs your countertransference even in long-term therapy, and even more so here. If, in a short-term consultation, you offer a person the wrong degree of self-disclosure (provoking him with inappropriately intimate self-presentation), you risk not having time to do what is necessary. A person filled with feelings finds it difficult to switch to a task, remembers details worse, formulates a goal more slowly. In a word, do not say: “Oh, when my hamster died, I also cried for two weeks!”. Instead, say, «I see this is not easy for you to talk about, but let’s try to understand what would be important for you to do right now, at this meeting.»
Dose empathy
Advice coming in a «set» with the previous two. There is no need to support the experience, encourage to talk about the intricacies of mental anguish, and get bogged down in the details. It is important for you to accurately define the main conflict dichotomy in a joint dialogue (as a rule, this is always a dichotomy): run or stay / put up or sue / save yourself or wait and have fun &
There is nothing more important than diagnosis
Being a pro, you probably know a lot of tricks, exercises and techniques for a variety of occasions. The Jogari Window, the Dunning-Kruger Effect, the Yerkes-Dodson Law, the Karpman Triangle, Occam’s Razor (and, of course, Hanlon’s) are probably only a small part of the knowledge that your head is full of. This I mean that you will find what to recommend to the client. The problem of a short-term consultation is completely different: you need to have time to understand exactly what the matter is. That is, your main task is diagnostics. Therefore, I recommend 70-80% of the time to study the situation, and only 20-30% to recommendations.
About details
A detailed plot is not needed. Details and emotional involvement tend to exacerbate each other. In fact, never, to anyone and nowhere has it been and will not be important what kind of thong the husband’s mistress was in at the moment when the wife returned from the dacha a day earlier. The essence of the matter is different: the wife is traumatized, experiencing betrayal. The essence of her appeal is that she cannot cope with her feelings in order to meet her husband tomorrow without a knife in her hand. The longer you ask her about the appearance of the thong, the longer she then sobs (it seems you didn’t want this?) And the harder it will be for you to switch the client from revenge plans to constructive. Start immediately with a constructive: “The situation is extremely unpleasant. Let’s figure out what’s the best thing to do now.» This is directly related to the diagnostic point: you only care about those details that clarify the essence of the matter for you without triggering an emotional reaction. However, clarify until it becomes clear to you what exactly torments the person.
How to understand what’s the matter?
As an apologist for Gestalt therapy, I cannot (and do not want to) offer anything better for diagnosing a situation than the classic cycle of contact from Gestalt therapy. For those who do not know at all what it is about, it is better to read something on this topic. For those who are in the subject, I will explain in a nutshell what I mean. We contact the world through the sensitivity at the boundary between us and the world and the needs within us. Our idea of what we need is born gradually from vague sensations, through the first verbalizations, to a formalized desire and further to its satisfaction/frustration. Then a new cycle begins.
In an urgent counseling situation, you work the same way with the contact cycle. Only you have time pressure. Gathering information about the situation of a person, asking and offering your own versions of what happened, you (more directive than in long-term therapy) contribute to the rapid formation of a new need. Simply put, when you ask questions, you check the situation from time to time by asking, “What would be best for you?” or “What would you like today?”. If the answers sound unclear or inadequate, “I don’t know,” “Cut my mistress to pieces,” “I’m in shock,” “Find out why I need this?”, then you continue to ask and structure. The beauty of working with the cycle of contact is that clarity at some point comes by itself. The wording is born, and you just have to get the consent of the interlocutor: “Do I understand correctly that your choice now is to leave everything as it is or take a break in the relationship?”.
As a rule, the third quarter of an urgent consultation ends with the emergence of some kind of dichotomy. If you miss the wording, you will have to look for others, but the very appearance of dichotomous wording means that you are on target. In a minute, the client will look at you with a suddenly cleared look and say yes. You have 15 minutes left, and that’s just enough.
Do you have a plan?
A person in a difficult situation always has difficulty concentrating and planning. For three reasons: he is stressed, he has no pattern of action, and he has time pressure. Fifteen minutes before the end, you need to move on to debriefing and recommendations. The recommendation should be constructive, unambiguous, not containing conflicting choices. If it contains paragraphs, number them out loud. Describe in detail where to start, because getting started is the hardest thing, and the start will start right at your door. So say: “Marina, it means that now you are looking for a lawyer first of all, right? Lots of lawyers.» Leave the last five minutes for questions and closing.
Decatastrophization
Even if a person came to you for advice, he secretly hopes that after meeting with you he will feel better at heart. In part, he will become: he spoke out, and even received recommendations for action. However, sometimes people tend to ruin their lives by fantasizing the bleakest future. If a person, after listening to you, says something like: “No, everything will be terrible and I will not succeed,” a technique called “decatastrophization” will come in handy. “Tell me the worst,” you say. Do not be afraid of atomic arguments: usually people draw as irreparable, completely ordinary subjects. Using the already existing plan, break this plot.
Plan b»
For a highly anxious person, develop a «Plan B» right away. Usually «Plan B» is obvious, you just need to say it out loud. The maximum structuring of the proposed future is reassuring. Usually plan B goes something like this: “You are almost sure that your husband is cheating on you, and even planned to leave him. But what’s stopping you from talking to him first? — I’m afraid of gu.e.stey and rejecting behavior on his part. — But, you see, there is an obvious plus in this: clarity. If talking doesn’t solve anything, you’re looking for a lawyer.»
Be mindful of the time
Boundaries are additional support for a person in a difficult situation. Feeling that his situation is so problematic that even the psychologist is sweating while sitting with him for double the time is not supportive at all! Keep in mind that the consultation time is always delayed by the consultant, and not by the client at all. Take care of the person who comes to you: show him that despite the chaos in his life, there is will, order and structure in the world. Fifteen minutes before the end, you should move on to the recommendations. Ten minutes before the end, listen to catastrophic ideas and come up with a plan B. With five minutes left, you should jump to conclusions.
open end
The desire to take an urgent consultation with a psychologist usually indicates that the person is anxious, upset, or in crisis. The very idea that there will certainly be one consultation suggests that he thinks catastrophically: he expects imminent trouble, and in his dramatic fantasies he can only see you once, and then the sky will fall to earth. Therefore, your calm notice to him that, if he wishes, he can still turn to you, will additionally calm him down. Do not say «Call me even in the middle of the night, I will certainly save you!» is a hint that his affairs are very bad. Just say that you are open to continue working. This will make it clear that in your picture of the world, the story goes further. And that you are someone you can rely on.
If there was no consultation
You may be surprised, but statistically the most likely outcome of an urgent consultation is not the thousand troubles described above. More often than not, an emergency consultation… just doesn’t happen. You are sitting, but the client has not come. And he never answers your phone again. Below are just hints without explanation. They must be remembered in order to reduce such a probability to zero.
1. Never record from third parties. Correct answer: «Let your friend call himself.» He will never come anyway.
2. If the time/day doesn’t suit the person and you’ve already offered two options, don’t offer a third. There will still be no consultation.
3. Appoint a «same day» consultation only after reading the clinical part of this article three times.
4. Don’t schedule a consultation after any critical comments about your boundaries (place, day, time, price). She still won’t.
5. Do not schedule a second consultation with an unknown person if the first was canceled for any reason. She still won’t.