Helping A Student or Resident
in Crisis - Basic Counselling
Skills for Faculty
Developed for The Faculty Development Office,
Schulich School of Medicine & Dentistry, The University of Western Ontario.
Supported by a faculty development grant from the
Royal College of Physicians and Surgeons of Canada.
Developed by
Dr. Jack Russel
Student Development Centre
The University of Western Ontario
jack@sdc.uwo.ca (519- 661-3031)
GOALS AND NEEDS
Basic Counselling Skills
Crisis Interventions
Resources
By the completion of this module
participants will:
be able to exercise counselling intervention skills &
strategies depending on the presenting problem
be able to sort out those student problems which
require referral to a professional counsellor
understand some of the pitfalls and errors that are
easily made in one‑on‑one counselling situations
be aware of other campus and community support
systems available for students
The PowerPoint presentation will give you
some ideas to consider when students or
residents in crisis come to you for help.
The described techniques are demonstrated
with a video clip of a simulated interview.
Finally, we provide several references for
anyone who wishes to learn more.
The Video Example
Dan sits before you upset. He is a resident in
Orthopedics. A six foot six former university football
tackle, he passed up a CFL career to come into
Medicine and has never regretted his decision. Up
to now he has shown lots of promise but his
girlfriend has recently split up with him and moved
out of the apartment. He has contacted her
repeatedly to try to reconcile but has not been
successful. He is distraught and wants to drop out
of his program to get his relationship back on track.
What to watch for:
Attending
Paraphrasing and summarizing
Reflecting feelings
Getting concrete
Referral
To see this 13 minute interaction, click this
link: VIDEO
The video will open in a separate window. To
return here, close the window with the video.
CREATING A CARING
COMMUNITY
Develop an ethos of
care
Repeatedly let students
know they can come to
you
Be an agent of change
OPENING PANDORA’S BOX
“Do I dare?”
“What do I do if they follow up?”
“I’ve stopped asking people how they are –
because they tell me!”
“Once they tell me, I have to solve it.”
WHAT DO I SAY AFTER SAYING
HELLO?
Give your undivided
attention
Show you are
interested in them
Ask questions
THE POWER OF LISTENING
“Listening is a magnetic and strange thing, a
creative force – the friends that listen to us are
the ones we move towards and want to sit in
their radius as though it did us good.”
Clark Moustakas
LISTENING
“If I can listen to what s/he tells me, if I can
understand how it seems, if I can sense the
emotional flavour which it has, then I will be
releasing potent forces of change from within.”
Carl Rogers
THE BASIC OF BASICS -
ATTENDING BEHAVIOUR
Verbal following
Eye contact
Body posture
PROMPTS AND VERBAL
FOLLOWING
Can you expand on that?
Uh, huh and then?
Please continue.
Was there more you
wished to say on that?
Tell me more.
TANGENTIAL – NOT FOLLOWING
CLIENT: My mother’s new boyfriend moved in
with us last week – I don’t like him very much.”
COUNSELLOR: “What day did he move in?”
VERBAL FOLLOWING OR
TANGENTIAL
CLIENT: “I’ve had the hardest day! We’re
putting out a new computer program
and everybody was so stressed out.”
COUNSELLOR: “What kind of computer
program is it?”
EXPLORING AND
ELABORATING ON WHAT IS
SAID
Questions and questioning – reliable
technique to gather info, deepen discussion,
or broaden focus.
Ask about – thoughts, feelings, behaviours,
relationships
TYPES OF QUESTIONS
Closed ended – more focal and answered with
one or two word
You ask – They answer
Do you? Are you? Have you?
TYPES OF QUESTIONS?
Open ended – provide
flexibility in responding
What? How?
CHANGING CLOSED TO OPEN
Are you having troubles
with your partner?
What is your
relationship with your
partner like?
CHANGING CLOSED TO OPEN
Are you feeling
stressed now?
How are you feeling
right now?
WHEN CLOSED QUESTIONS
ARE GOOD
You need to intervene in a crisis situation -
e.g. Do you have a plan to kill yourself?
When you require specific information –
e.g. Are you going to hurt your girlfriend
because she broke up with you?
THE PROBLEM WITH WHY?
They put people on the spot
Pressure the individual to provide an
explanation when they don’t know
WHY VS. OPEN ENDED
QUESTIONS
Why are you failing that course?
Could you tell me about the difficulties you are having
with your course?
What are some of the things that trouble you about
your coursework?
TRIED AND TRUE QUESTIONS
What brings you here to see me?
What prompts you to come now to talk?
How did you think I might help?
Where would you like to begin?
Can you tell me more about your situation?
Can you elaborate some on what you just said?
Can you say more about it?
Could you put that in other words so I can understand
better?
Does what I am saying make any sense?
PARAPHRASING
Conveys you are trying to understand
Clarifies client’s statement by repeating more
concisely
Checks your perceptions to confirm you really do
understand
Emphasizes the cognitive/objective content of the
message
PARAPHRASING SAMPLES
CLIENT: “He can’t help me with my
relationship troubles – his degree is from an
non-accredited school – he’s had very little
training – and on top of that I hear he is
unkind to his partner.”
YOU: “You question his competency and
character.”
PARAPHRASING SAMPLES
CLIENT: “I’m not sure about the Prof – one
moment she is really nice and willing to help
me and the next moment she seems unkind
and distant.”
YOU: “You are troubled by her inconsistency.”
SUMMARIZING STATEMENTS
Crystallizes more coherently and integrates
what has been presented – puts the facts
together
Serves as a stimulus for further exploration –
what next?
Functions as a perception check
Brings some order to rambling
REFLECTING FEELINGS
Emphasizes
emotional/feeling
aspect of the client’s
message
You communicate you
recognize their feelings
HOW TO REFLECT FEELINGS
Listen intently to feeling words
Notice the tone of voice
Put yourself in their shoes
Suspend how you see things
Think how this person is feeling - what are they
trying to tell me
WORKING WITH FEELINGS
IDENTIFY THE
FEELING
How do you feel about
that?
What feelings does it
bring up in you?
How does it make you
feel when…..?
WORKING WITH FEELINGS -
CONTINUED
DEFINE AND CLARIFY
FEELINGS
What does it mean to
you when you say you
feel______?
What else might you be
feeling when you feel
down?
3. WORKING WITH FEELINGS
ACKNOWLEDGE THE
FEELINGS
Encourage
responsibility for the
feeling
State feelings in a
direct and personal
way. “I feel” vs. “one
should feel”
GETTING CONCRETE
Facilitates closer relationship by increasing
understanding of the client’s concerns
Facilitates problem identification and goal
setting
Determine interventions to deal with the
problem
CONCRETE EXAMPLES
CLIENT: “I’m flunking out of school, losing my
boyfriend, fighting with my parents – I am
really depressed”
Poor – “Tell me more about it.”
Good – “Can you help me understand what it
means to be depressed for you?”
CONCRETE HELP
“Could it be that……
“I wonder if……
“Could this be what is going on…
“You appear to be feeling….
“Perhaps you are feeling…..
“I’m not sure i understand - are you saying…...
CONCRETE HELP (2)
“I get the impression you…..
“As I hear it you are saying…..
“This is what I think I am hearing…..
“Perhaps you are feeling…..
PITFALLS IN HELPING
Preaching – moralizing
Evaluating and criticizing –
Sympathizing
Not paying attention
Kidding/teasing
Continuing with why
questions
PITFALLS TO HELPING
Looking away
Watching the clock
Fidgeting and restless
Walking away
Being harried
Not caring
RESPONDING TO CRISIS
Determine and assess
severity
Risk to self and others?
Method, means,
manner (the 3 h’s),
and motive
Sad persons
RESPONDING TO CRISIS (2)
Hospitalization
Community agency
Campus resource
Assist in arranging the
referral
REFERRAL RESOURCES
Student development centre - psychological
services - 661-3031
Student health services - counselling –
661-3771
Mental health crisis line –
South street -
HELPFUL WEB SITES
www.udayton.edu/~cc/facstaff.htm
