CRISIS MANAGEMENT DURING "LIVE" SUPERVISION: CLINICAL AND INSTRUCTIONAL MATTERS

Journal of Marital and Family Therapy, Jul 2005 by Charl�s, Laurie L, Ticheli-Kallikas, Michele, Tyner, Kelly, Barber-Stephens, Brandi

With this information in hand, the therapists worked with Susan on a plan for what she could do in those moments she felt like hurting herself. Their increasingly skillful questioning elicited important information-Susan preferred calling an anonymous help line to calling someone she knew. She also said she felt comfortable calling the therapists or our MFT clinic. This encouraged us. In addition, as Susan talked, she said that she knew she would never hurt herself on the bathroom floor, because she was a coward-she couldn't do it. Quickly, I phoned in to BBS and MTK to tell the client that on the contrary, her refraining from harming herself was an act of bravery, not cowardice. What she was doing was the brave thing-for it took courage to go on when she felt so much pain and isolation. Susan looked up, for what seemed like the first time that session, and said "Yes, I guess that's true." By the end of the session, we all felt Susan was depressed and in need of help as she said, but we felt certain she was not in danger of harming herself or anyone else.

I called in one last intervention to MTK, who was nearest to the phone and who seemed to have had the most trouble focusing on the client's scary comments. I asked her to find a way to get the client to tell her she would follow through on a plan to talk to others when she felt the urge to hurt herself. I remember telling MTK to "make sure [the client] looks you in the eye" when she said it. I asked MTK, "Can you do that?" "Yes, I can," MTK said. And she did.

After the session, I talked with BBS and MTK. Although they had started out hesitantly, feeling around new ground, by the end of the session, they were doing an excellent job getting information. In fact, by the end, they were fearless about asking hard questions, those to do with Susan's desire to cut her wrists, to sit alone on the bathroom floor and talk to her dead mother. By the end of the session, BBS and MTK could hear those comments and respond sensitively to them, without trying to persuade Susan that she need not feel what she did. BBS and MTK did a superb job, and I told them so. MTK then told me, "Once I got over worrying so much about me and what I was asking . . . and just asked her about her, it worked. It clicked."

Case Example Two: The Angry Mother (KT, Doctoral Student)

Case overview. This case involved a mother and father who brought their 10-year-old daughter in for problems with lying, urinating on herself, and poor hygiene. It also appeared that the parents were concerned about their daughter's motivation in school; however, the daughter's overall grades were not bad. The mother reported being "at the end of her rope" with the fighting and bickering between the 10-year-old daughter and her older brother (12 years old). She reported that the two would scream at each other and that the mother could actually feel her blood pressure rise during these fights. The mother was concerned that "normal siblings" did not scream at each other this way; however, the father found nothing unusual about the behavior.