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As we evaluate the effectiveness of our intervention, we should ask ourselves, “Are the critical symptoms going away?  Are things getting better?”  If our answer is Yes, then we need only follow our hypothesis; our understanding of what is happening, what happened, and what might happen; and our understanding of the individual and his total situation.  If our intervention is not working, then either our definition of the crisis or our intervention hypothesis is wrong.  We need to develop either a better definition of the crisis or consider alternative intervention hypotheses.  The result of this rethinking should be the development of a new or modified intervention hypothesis.  That new hypothesis is then reevaluated in terms of its effectiveness.

Mr. H contacts us with what seems to be a fairly concrete problem.  He and his wife live on Social Security, and their check is a few days late.  He is very worried about how they are going to pay their bills and is concerned because they will not have any money to buy food.  You ask him if he has called the Social Security office to ask about his check.  Your initial hypothesis is that Mr. H needs some specific suggestions.  He says that he has called the Social Security office and in the next breath asks if you will take him to keep an appointment at his doctor’s the next afternoon.  You tell him that you will not be able to take him; you suggest that he call someone in his church.  Maybe they will give him a ride.  Your hypothesis suggests that you should try to help him think of a way to get to his doctor’s office to keep the appointment.  Instead of responding to your suggestion, he tells you that his wife is sick and may have to go to the hospital.  At that point, you reevaluate your initial hypothesis, which said that Mr. H wanted information and suggestions, and try a new hypothesis that Mr. H wants to talk with someone about his wife.  As you continue talking with Mr. H, developing and testing out various intervention hypotheses, you finally come to the conclusion that Mr. H is lonely and simply wants someone to talk with.  You say to him, “You seem rather lonely and sound as if it is good to have someone to talk with.”  He responds to this in a positive way, confirming your new intervention hypothesis.

Cathy, age fourteen, comes into your office and seems to be very interested in you, your family, the kinds of things you do, your education, and so on.  Your initial hypothesis is that Cathy is interested in becoming a crisis intervention worker and wants to know more about it.  As you begin to talk about crisis intervention, you notice that Cathy is focusing most of her questioning around teenagers.  You begin to suspect that Cathy is having some kind of problem herself and is interested in talking about “what is normal.”  You follow this new intervention hypothesis for a while, and Cathy relaxes a little and becomes very chatty.  She tells you about a friend who has been shoplifting.  She goes on to ask what you might do if the friend were to come to talk with you.  You develop a new intervention hypothesis while wondering if Cathy is talking about a friend or if she is really talking about herself.  As the discussion goes on, you learn that Cathy really does have a friend who has been shoplifting and who wants to talk with you.  The friend has talked Cathy into bringing up the subject with you to see what kind of reaction the friend would get were she to come to talk with you.  Your intervention hypothesis finally focuses on Cathy’s real concern: Would you be willing to talk with her friend without turning her in to the authorities?  You assure Cathy that you are very willing to talk with her friend and that you will not turn her in.  Cathy leaves and comes back in about fifteen minutes with her friend.

As we can see from these two cases, it is important for us to develop an initial intervention hypothesis.  We need to have some idea of what may help.  As mentioned earlier, help is only to avoid premature adoption of our initial hypothesis.  In these two cases we become helpful only after evaluating our intervention hypothesis and developing a new one as the discussion progresses.

People who come to us always want something.  The point needs emphasis.  People who contact crisis intervention services always have some reason, goal, purpose, or need.  Even if they are cranks and are contacting us “just for kicks,” they do have some purpose.  They think they will get some kind of thrill from calling us or coming to our drop-in center.  It is worth a moment’s thought to consider an individual who would contact a crisis service “just for kicks.”   Most of the time, he is fairly lonely, has some kind of social or emotional problem, or has been put up to it by friends.  In any event, talking to us does make him feel better.  If we keep this in mind, it may be a little easier to deal with the next “crank” situation we come in contact with.  In the vast majority of situations, however, people who contact crisis services have a good and serious reason for doing so.  We must start at the very outset of our contact with them by trying to understand their reasons for contacting us.  We develop an initial understanding of why they contacted us and some initial ideas about how we might help.  As our contact with them continues, our understanding of their reasons for contacting us and our ideas about what we can do will usually shift and may sometimes change quite drastically.  Our picture of the crisis and our intervention hypothesis must remain quite flexible and open to change and modification.  We must be alert to the individual’s thoughts, messages, and feelings.  This alertness will enable us to develop and evaluate an intervention strategy responsive to the individual’s special needs.

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