Crisis Intervention in Social Work – Psychosocial Crises and Suicidality
4. Module 3 · Conducting conversations in acute crises: contact, relief, focus
A phone call in the late afternoon, a client standing distraught in the corridor, a young person who has stopped speaking after an argument: crises rarely announce themselves, and they require social work professionals to find the right word at the right moment. This module applies the basic principles of crisis intervention to the situation in which they have to prove their worth – the conversation. It shows how you make contact when a person has been thrown off emotional balance, how you make relief possible without losing yourself in the flood of feelings, and how you find, together with the person affected, a focus that allows small, workable next steps. This is not about a technique that you ‘apply’, but about a professional stance expressed in language, pace and structure.
- You describe the three movements of a conversation – contact, relief and focus – and place them within the course of a crisis conversation.
- You explain how conversation can be adapted to the shock phase and the reaction phase of a traumatic crisis.
- You distinguish helpful from less helpful responses in conversation and explain the difference in professional terms.
- You close a conversation with concrete agreements and accessible points of contact as a lead-in to safety planning.
- You reflect on conversations under difficult conditions and on the importance of self-protection, team agreements and clarity of role.
PART 1 – Introduction: what makes a crisis conversation
The conversation as the central tool
In most fields of social work there are neither medicines nor equipment for acute crises – there is the conversation. Whether in family counselling, hospital social services, homelessness services or a residential group in child and youth welfare: professionals often meet people in crisis first, frequently unprepared and without the chance to plan the situation calmly. For exactly this reason it is worth seeing conversation in a crisis as a professional task in its own right. The National Suicide Prevention Strategy stresses that members of professions who come into contact with people in suicidal crises should be made even more aware and trained in dealing with people at risk (Bundesministerium für Gesundheit [BMG], 2024). Safe conversation is one building block of this awareness – but it replaces neither medical nor psychotherapeutic help, and it is always carried out within the procedures of your own organisation and in a team.
Definition: crisis and crisis conversation
The starting point is the concept of crisis covered in detail in Module 1. Sonneck and colleagues describe the psychosocial crisis, in essence, as the loss of emotional balance that a person experiences when confronted with events or life circumstances that they cannot cope with at the moment (Sonneck et al., 2016). The decisive phrase is ‘at the moment’: a crisis is neither an illness nor a character trait but a state in which the usual coping resources are temporarily not enough. A distinction is made between traumatic crises, triggered by sudden, painful events, and crises of change, which arise from transitions and upheavals in the course of life (Sonneck et al., 2016).
In this module, a crisis conversation means a goal-directed, time-limited conversation held in an acute situation of strain that combines three tasks: it is meant to establish a reliable relationship, relieve the person affected emotionally and help them, out of the feeling of being overwhelmed, to see a manageable part of their situation again. This working definition is a didactic summary; it draws on the principles of crisis intervention as presented in the standard literature (Sonneck et al., 2016) but is not a definition taken over word for word.
Contact, relief, focus – three movements
The title of this module names three movements that run through every crisis conversation. Contact means the offer of a relationship: the person should sense that someone is there who listens, does not judge and can bear the situation. Relief means the space in which feelings and thoughts may be spoken – often the first moment when the inner pressure noticeably eases. Focus finally means clarifying together what is most urgent now and agreeing on first, manageable steps. These movements are not a rigid scheme to be worked through one after another. They interlock: if you notice that a person is flooded by feelings again while talking about concrete steps, you return to relief; if you sense that contact is breaking off, you first work on the relationship again.
PART 2 – Professional foundations: relationship, phases of crisis and structure
Relationship as the precondition for every intervention
The BELLA mnemonic introduced in Module 2 does not begin with the relationship by chance: Sonneck et al. (2016) structure crisis intervention into the steps of building the relationship, assessing the situation, relieving symptoms, involving people and finding an approach to coping with the problem. For conversation this means: before a situation can be meaningfully assessed, let alone an approach to a solution developed, a minimum of trust is needed. People in crisis often experience loss of control, shame or the feeling that they must not be a burden to anyone. A counterpart who stays calm, shows genuine interest and takes the distress seriously without dramatising it cannot dissolve this state, but can offer a first stable point to which the person can hold on.
In a crisis, a relationship forms more quickly than in longer counselling processes, but it is also more fragile. Even small signals – a glance at the clock, premature advice, an offhand ‘It’ll be fine’ – can be taken as rejection. Conversely, a single sentence that aptly picks up the person’s experience can clearly strengthen contact. Relationship work in a crisis is therefore less a matter of particular wording than of attention to what the person needs right now.
The phase of the crisis determines the tone of the conversation
For traumatic crises, Cullberg (1978) described a course in phases: a shock phase, in which those affected often appear astonishingly unremarkable outwardly while experiencing chaos inwardly, is followed by a reaction phase, in which the reality of the event reaches awareness with changing, often intense feelings; a processing phase and a phase of reorientation follow later. The phases merge fluidly into one another and do not run the same way for everyone (Cullberg, 1978). For conversation, this model is useful above all as an aid to orientation: it helps to place a person’s current state and to adapt one’s own approach accordingly.
In the shock phase the ability to take things in is limited. Long explanations, complex questions or too much information hardly reach the person. Orientation, safety and simplicity help here: short sentences, clear information about what is happening now, concrete support with immediate needs. In the reaction phase by contrast, the emphasis is on allowing feelings. Grief, anger, guilt or despair may show themselves without the professional having to calm or reinterpret them straight away. The following comparison cards summarise the differences.
- Person seems outwardly composed or ‘numb’, chaos inside
- Give orientation: who am I, where are we, what is happening now?
- short, clear sentences; repeat information if needed
- clarify immediate safety and basic needs
- do not force far-reaching decisions
- Feelings break open and change quickly
- Allow, name and bear feelings
- Respect the person’s pace, allow pauses
- Do not talk away feelings of guilt and self-reproach too quickly
- gently lead on to first concrete concerns
In crises of change, whose concept goes back to Caplan and is described in detail in the standard literature (Sonneck et al., 2016), the build-up is often more gradual. Here, conversation often calls less for orientation amid chaos than for the shared insight that earlier attempts to cope no longer hold – and for the careful search for the point at which change can begin.
Structure as support
People in acute crises often experience their situation as unmanageable and confusing. A professional who comes across as calm and structured offers a counterweight: they signal that it is possible to look at the situation step by step. Structure shows itself in conversation at several levels – in the outer framework (an undisturbed room, clarified time, phone switched off, as far as possible), in the build-up of the conversation and in your own language. Making clear at the start how much time is available and what is possible in that time creates reliability. Structure does not mean control: it is an offer the person can use for orientation, and it stays flexible enough to respond to unexpected turns. The mind map summarises the building blocks of the crisis conversation.
PART 3 – Practice I: making contact and enabling relief
The first minutes
The first minutes of a crisis conversation shape whether a person can open up. It helps to introduce yourself briefly and clearly, to name your role and to ask openly about the person’s concern: ‘I’m Ms K. from the social service. I’ve heard you’re having a very hard time right now. I have time for you now – would you like to tell me what happened?’ An opening like this combines transparency with an offer of a relationship. It leaves the person the choice of where to begin and at the same time signals that the professional is ready to engage with what has happened.
Just as important as the words is the non-verbal level: a sitting position that is attentive but not crowding, a calm pace of speech, a lowered voice if the person is loud or agitated. Your own calm is often passed on to the other person – not as a technique, but because it conveys safety. If you are inwardly restless yourself, you may take a moment to breathe out consciously before the conversation begins. On the phone, where eye contact and body language are missing, voice, pauses and short responses such as ‘I’m still here’ take over this function.
Active listening, naming feelings and bearing them
Active listening means visibly following the other person: through short summaries, through questions that check understanding and by picking up emotional messages. In a crisis, naming feelings is particularly effective, because those affected often perceive their own state only vaguely. A sentence like ‘It sounds as if you are very afraid right now of how things will go on’ helps to order the inner confusion and shows that the professional has understood not only the content but also the experience. A tentative, questioning form matters here: the person should have the chance to correct.
Bearing feelings is often harder than naming them. Crying, silence, anger or despair trigger in many professionals the impulse to comfort quickly, to distract or to offer a solution. This impulse is human, but it can convey the message that the person’s feelings are too much. Bearing them means letting pauses stand, staying present and acknowledging feelings as an understandable reaction to a distressing situation. Sonneck et al. (2016) count relieving distressing symptoms among the core steps of crisis intervention; in conversation this relief often happens precisely because feelings are given a place instead of being suppressed.
Relief through speaking out
Many people already experience it as a relief simply to be able to tell what has happened in a coherent way. This telling orders what was experienced, makes it communicable and breaks through the isolation that often accompanies crises. Professionals support this process by not interrupting, inviting the person to continue with open questions and not pressing for details that the person (as yet) does not wish to share. Relief is, however, not an end in itself: if the telling goes round in ever new loops and the person visibly becomes exhausted or even more agitated, it makes sense to structure gently and move on to the question of what is most pressing now. The following table compares typical responses.
A father on the phone to the family counselling service. Mr D. phones the family counselling centre in the afternoon. He speaks haltingly and after a few sentences begins to cry. His partner separated from him the previous day and has moved with the two children to her parents. He says he does not know how to go on, he has hardly slept for two nights and ‘can’t think about anything else’. The counsellor, Ms Y., first lets him cry and says calmly: ‘I’m here, there’s no need to hurry.’ After a while she summarises what she has understood and names that he is evidently very exhausted and very afraid of losing contact with his children. Mr D. confirms this. Together they clarify what is weighing on him most today: the uncertainty about when he can see the children. Ms Y. offers an in-person appointment the next morning, asks who could support him this evening and tells him how to reach the counselling centre and gives him the number of the telephone counselling service (TelefonSeelsorge) for the night.
Putting it in context: The counsellor follows the three movements: she makes contact by allowing the crying, makes relief possible by summarising and naming feelings, and finds with Mr D. a focus that allows a small, concrete step. She refrains from legal advice on contact arrangements, which he would hardly take in in this state. If signs of suicidal thoughts emerge in the conversation, they should be raised directly and calmly – this is explored further in Module 4.
PART 4 – Practice II: finding focus, making agreements, closing the conversation
Clarifying the trigger and the most urgent concern
Crises often bundle several strains: a separation brings financial worries, housing questions and conflicts about the children; losing a home affects health, work and social relationships. Anyone who tries to discuss everything at once reinforces the feeling of being overwhelmed. Focusing on the current trigger is therefore a core principle of crisis intervention (Sonneck et al., 2016). In conversation it helps to clarify together what set off the crisis, what has happened since and what is weighing on the person most right now. Questions such as ‘What has happened since yesterday?’ or ‘What of all this is hardest for you at the moment?’ invite the person to pick a manageable part out of the whole picture.
Focusing does not mean declaring other topics unimportant. It can be a relief to ‘park’ them explicitly: ‘The question of maintenance is important, we’ll take it up at the next appointment. Today it’s about how you can get through the next few days well.’ In this way the person is not turned away but experiences that their concerns are seen and put in order. At the same time, the professional keeps in view whether the stated trigger hides signs of acute danger, which must take priority.
Small, concrete next steps
The experience of being able to do something yourself again is particularly valuable in a crisis. Agreements in a crisis conversation therefore aim at small, concrete and realistically achievable steps: phoning a trusted person this evening, coming to the agreed appointment tomorrow morning, spending a night at your sister’s, looking out a particular document. Big solutions – such as a new flat or sorting out custody – usually overwhelm in this phase. Sonneck et al. (2016) describe finding an approach to coping with the problem as the last step of their BELLA mnemonic; in conversation this means searching together with the person for ways of coping that they can carry themselves, instead of giving them ready-made solutions. It helps to sum up the agreed step once more at the end in the person’s own words.
Involving people close to the person – with consent
Social support is one of the most important resources in crises; it is no coincidence that involving other people is part of the BELLA mnemonic (Sonneck et al., 2016). In conversation you can ask who is around, who has helped in similar situations before and whom the person would like at their side now. Whether and how people close to them are involved is in principle decided by the person affected. Professionals can offer to phone together or think with the person about what they would like to say to the other person. They pass on information from the conversation only with the person’s consent.
What people confide in a crisis conversation is subject, for social workers and social pedagogues, to professional confidentiality protected by criminal law under Section 203 of the German Criminal Code (StGB). Involving relatives, friends or other services therefore generally requires the consent of the person affected; it is always the first route. Only as an exception – where there is a present danger that cannot be averted in any other way, for example to life or limb – can disclosure without consent be justified under Section 34 StGB (justifying necessity). This requires careful weighing in the individual case, consultation with the manager according to the organisation’s procedures and traceable documentation; Section 34 StGB is not a blanket permission. Module 6 covers the details. Social work professionals do not give legal advice in individual cases. Legal position: September 2026.
Closing the conversation and leading on to safety planning
The end of a crisis conversation deserves particular care, because afterwards the person is on their own again. A good close sums up what was discussed, names the agreed steps, clarifies when and how the next contact will take place and makes clear whom the person can turn to if they feel worse before then. This is where safety planning starts: Stanley and Brown (2012) describe the safety plan as a written, prioritised list drawn up together with the person affected and in their own words – from personal warning signs through their own coping strategies and supportive people to professional points of contact. It is expressly not a no-suicide contract (Stanley & Brown, 2012). First elements of such a plan often become visible in the crisis conversation itself; Module 5 shows how it is developed in detail. The following step sequence summarises the course of a crisis conversation.
Part of closing the conversation is that the person knows accessible points of contact – ideally in writing. The telephone counselling service (TelefonSeelsorge) can be reached on 0800 1110111, 0800 1110222 and 116 123 free of charge, anonymously and day and night, and also offers chat and email (TelefonSeelsorge Deutschland, n.d.). In acute danger to life, the emergency number 112 applies for the fire service and ambulance service; in acute threat, the police on 110; 116 117 is the on-call medical service and not an emergency number (Land Niedersachsen, 2025). There is so far no nationwide uniform phone number for crisis services; regional services differ from state to state. Clarify in advance which services are responsible in your region and under your organisation’s crisis guideline.
Conversations under difficult conditions
Not every crisis conversation takes place in a quiet counselling room. Language barriers make understanding harder on both sides. Simple, short sentences, checking understanding and – where possible – professional interpreting help here. Using children or relatives as interpreters is particularly problematic in crises, because they are distressed themselves and confidentiality suffers. In cases of intoxication through alcohol or other substances, the ability to converse is limited; exploring things in depth is then usually not sensible. Immediate safety takes priority, as does, where appropriate, a medical check and agreeing a follow-up contact. In acute danger to life or health, the ambulance service is to be called on 112.
Aggression in crises is often an expression of powerlessness, fear or hurt. Taking it seriously without taking it personally is a demanding task. A calm tone, naming the anger, avoiding power struggles and sufficient physical distance have a de-escalating effect. Self-protection always takes priority: professionals make sure they have a clear way to the door, inform colleagues, do not hold conversations alone where the risk is known to be raised and may end a conversation if they feel threatened. In acute threat the police are called on 110. The organisation should have clear agreements and emergency procedures for this – protecting staff is not an individual but an organisational task.
Upset in the emergency shelter. Mrs M., a resident of an emergency shelter for the homeless, comes into the office shouting angrily. Her bag with her ID, bank card and documents from the job centre has been stolen. She accuses other residents and the staff, slaps the flat of her hand on the table and shouts that now ‘nothing matters anyway’. The social worker, Mr T., remains standing, keeps his distance, makes sure the door stays open and signals to a colleague with a look to stay within earshot. In a calm voice he says: ‘Your papers are gone – that’s a real blow, I understand that you’re angry.’ Mrs M. becomes somewhat quieter. Mr T. offers her a chair and a glass of water and asks what is most urgent now. Together they note: report the theft to the police, have the bank card blocked and apply for replacement documents the next day with support. At the end Mr T. picks up the phrase ‘nothing matters anyway’ once more and gently asks what she meant by it.
Putting it in context: Mr T. combines self-protection (distance, open door, colleague nearby) with an offer of a relationship. Naming the anger has a de-escalating effect, and the focus on three concrete steps gives Mrs M. back a little ability to act. That he does not overlook the remark ‘nothing matters anyway’ is professionally important: it can be an expression of frustration, but also a sign of hopelessness that should be raised openly.
Read the following extract from a conversation in the hospital social service. The patient, Mrs R., has just learned that she cannot return to her previous flat after discharge. Reword the professional’s three remarks so that they better support contact, relief and focus, and briefly explain your changes.
Mrs R.: ‘I just don’t know what to do any more. Everything is falling apart.’
Professional (1): ‘Now don’t paint it so black, we’ll sort it out.’
Mrs R.: ‘It’s easy for you to say. I don’t have anyone.’
Professional (2): ‘Why didn’t you see about another flat earlier?’
Mrs R. (crying): ‘…’
Professional (3): ‘Well, you now need to make an application to the social welfare office, then go to the housing association, and you should also ask for legal custodianship (rechtliche Betreuung) to be considered.’
Show solution notes
On (1): The reassurance overlooks her experience. Better: ‘That is a great deal all at once. It feels as if the ground is slipping away under your feet.’ This names the feeling and strengthens contact.
On (2): The why-question sounds accusing and increases shame. Better: ‘You feel completely alone with this. I’m here for you now, and together we’ll look at who else can support you.’ This picks up the statement ‘no one’ and opens the view to possible people close to her.
On (3): Tears are not followed by a list of tasks. First leave a pause and stay present, for example: ‘Take your time.’ Then focus: ‘What worries you most at the moment?’ and agree on a single small step, e.g. a follow-up appointment tomorrow at which the housing question is tackled together. Also watch whether remarks such as ‘Everything is falling apart’ point to hopelessness that should be raised openly (Module 4).
PART 5 – Critical perspective: limits, tensions and consequences
Clarity of role: conversation is not therapy
Crisis conversations in social work are effective forms of support, but they have clear limits. They are neither psychotherapy nor diagnosis. Social work professionals make no diagnoses and use no therapeutic procedures; their task is to stabilise, to orient and – where necessary – to refer on to further help. This clarity of role protects both sides: the person affected receives the help they need, and the professional does not overload themselves with demands that their mandate does not include. The conversational stances presented in this module are, moreover, not techniques with a guaranteed effect. Whether a sentence is helpful depends on the person, the situation and the relationship. The literature describes principles and experiential knowledge (Sonneck et al., 2016); it provides no script that works equally in every crisis.
Tensions in the crisis conversation
Several tensions cannot be resolved, only handled consciously. The first concerns structure and openness: too much structure can constrain the person and give the feeling of being dealt with; too little structure leaves them alone in the chaos. The second concerns pace: the crisis demands quick action, but the person needs time to sort out their feelings. The third, and perhaps most important, tension lies between autonomy and protection. In principle, the person affected decides what they tell, whom they involve and which steps they take. If, however, signs of acute danger appear, the professional may be called upon to take responsibility more clearly – always in the team, according to the organisation’s procedures and within the legal framework covered in Module 6.
The phase model also calls for a critical approach. Cullberg (1978) describes fluid transitions, not fixed stages. Anyone who assigns people to a phase too quickly risks overlooking their individual experience – for example when an outwardly calm person is taken to be ‘stable’ although they are in the shock phase. The model is an aid to perception, not a yardstick for how someone ought to react.
Open questions and consequences for practice
In many organisations it remains open how crisis conversations are secured organisationally: Is there a crisis guideline? Is it clarified who can be reached in the background if a conversation escalates or onward referral becomes necessary? Are rooms available in which an undisturbed and at the same time safe conversation is possible? The National Suicide Prevention Strategy points to the importance of early recognition, onward referral and the networking of support services (BMG, 2024) – requirements that can only be met if individual professionals are not left alone. For practice, it follows that conversational skill develops through practice, reflection and peer consultation. Noticing your own limits, seeking support after distressing conversations and reviewing experiences in the team is not a sign of weakness but part of professional practice. How aftercare, documentation and self-care can succeed is shown in Module 8.
- A crisis conversation combines three movements: making contact, enabling relief and finding a focus that allows small next steps.
- Relationship is the precondition for every further intervention; calm, transparency and genuine interest matter more than particular wording.
- The phase of the crisis determines the tone of the conversation: in the shock phase orientation and safety, in the reaction phase room for feelings.
- People close to the person are in principle involved only with consent; professional confidentiality under Section 203 StGB applies, and exceptions are narrowly limited.
- A careful close to the conversation with agreements and accessible points of contact leads on to joint safety planning.
- Self-protection, team agreements and clarity of role are part of professional crisis work – conversation does not replace therapy.
Voluntary self-reflection – not evaluated, only for your own understanding:
- Which of your spontaneous reactions to other people’s strong feelings (comforting, distracting, giving advice) do you recognise in yourself – and how could you handle this in a crisis conversation?
- How would you recognise that a person is more in the shock phase or more in the reaction phase, and what would you do differently in conversation in each case?
- What does the framework for a crisis conversation look like in your organisation: room, time, availability of colleagues, emergency procedures?
- Which points of contact in your region would you give a person at the end of a conversation, and where do you find reliable information on them?
- How do you handle the tension between a person’s autonomy and the wish to protect them?
Bundesministerium für Gesundheit. (2024). Nationale Suizidpräventionsstrategie [National Suicide Prevention Strategy]. https://www.bundesgesundheitsministerium.de/fileadmin/Dateien/5_Publikationen/Praevention/abschlussbericht/240430_Nationale_Suizidpraeventionsstrategie.pdf
Cullberg, J. (1978). Krisen und Krisentherapie [Crises and crisis therapy]. Psychiatrische Praxis, 5, 25–34.
Land Niedersachsen. (2025). Die wichtigsten Notfallkontakte in Niedersachsen [The most important emergency contacts in Lower Saxony]. Portal Niedersachsen. https://www.niedersachsen.de/notfallmonitor/kontakte/die-wichtigsten-notfallkontakte-in-niedersachsen-236449.html
Sonneck, G., Kapusta, N., Tomandl, G., & Voracek, M. (Eds.). (2016). Krisenintervention und Suizidverhütung [Crisis intervention and suicide prevention] (3rd updated ed.). facultas.
Stanley, B., & Brown, G. K. (2012). Safety planning intervention: A brief intervention to mitigate suicide risk. Cognitive and Behavioral Practice, 19(2), 256–264. https://doi.org/10.1016/j.cbpra.2011.01.001
Strafgesetzbuch (StGB) [German Criminal Code] in the version published on 13 November 1998 (BGBl. I p. 3322), § 34 Rechtfertigender Notstand [Justifying necessity], as currently in force. Available at https://www.gesetze-im-internet.de/stgb/__34.html
Strafgesetzbuch (StGB) [German Criminal Code] in the version published on 13 November 1998 (BGBl. I p. 3322), § 203 Verletzung von Privatgeheimnissen [Violation of private secrets], as currently in force. Available at https://www.gesetze-im-internet.de/stgb/__203.html
TelefonSeelsorge Deutschland. (n.d.). TelefonSeelsorge – Sorgen kann man teilen [TelefonSeelsorge – Worries can be shared]. https://www.telefonseelsorge.de/
Figures and tables: own illustration. Citation style: APA 7 (German-language adaptation).
Self-reflection – 5 questions
Voluntary · not evaluated – your answers are not saved and are not evaluated by anyone. Click an answer; the explanation helps you assess your own understanding.
Question 1. Which response is most likely to support relief for a person who is crying in a crisis conversation?
Question 2. In the shock phase of a traumatic crisis according to Cullberg (1978), what is particularly helpful in conversation?
Question 3. What does focusing mean in a crisis conversation?
Question 4. How is the safety plan according to Stanley and Brown (2012) to be understood?
Question 5. A client does not want her sister to learn about the crisis conversation. What applies in principle?