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Crisis Assignment - Critique
Crisis Assignment - Critique
Crisis Assignment - Critique
Scenario:
You have attended several counselllng sessions since your husband
gave you an ultimatum: either you get counselling to learn to control
your temper or the marriage is over. You are feeling quite pleased with
your progress in counselling, when suddenly your husband announces
that he is moving out to go and live with a woman he has been seeing
for several months. You can’t understand how this could have
happened, your world has fallen apart. You are angry, hurt and
confused.
Introduction
The roleplay which is the subject of this critique loosely follows the fourstage Crisis
Intervention Model provided to students. The critique begins with a
description of the structure of the session, followed by an overall
evaluation of the structure, and of the effectiveness of the session’s key
elements. It then assesses some of the particular counselling skills
demonstrated in the encounter, before offering a brief conclusion. An
Appendix contains transcripts of several excerpts from the interview.
Structure of Session
Most of the steps in the Crisis Intervention Model are present in some form in this
session, although not necessarily in the order given in the model. Several
issues arose more than once at different points during the session. This
resulted in a relatively loose structure, which can be summarised as
follows:1
Stage 1:
1. Greeting.
1
The numbering of these steps does not follow the numbering in the Crisis Intervention Model
distributed with the assessment guidelines. Also, some of the ‘steps’ are more like key incidents in the
session rather than aspects of the structure. Lettered numbers in square brackets after most steps refer to
the Appendix.
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2. Client breaks news of husband’s departure.
3. Reassurance of client; normalisation of her reaction [C1].
Stage 2:
4. Reflection of feelings [C2]; encouragement of client to tell her story further [C4, C9]; affirmation
of client [C10].
5. Client experiences/expresses emotional response to situation [P2–P9 and elsewhere].
6. Affirmation of client—her strengths and resources [C10–C13 and elsewhere].
7. Assessment of suicide risk [C14].
8. Assessment of client’s situation, perceptions and further symptoms [C15].
9. Assessment of social resources [C20].
10. Investigation of conflicting comments in relation to suicide [C21].
Stage 3:
11. Development of shortterm plan (relaxation technique; tapestry; art journal) [C22].
12. Assessment of need for referral and additional counselling sessions (referred to naturopathic doctor;
increased schedule of counselling appointments; affirmation of my availability by phone out of
hours).
Stage 4:
13. Reassurance that client will recover a strong basic level of functioning; that I will be there to help;
that it is okay to get angry.
14. Closure: enquiry about client’s frame of mind before leaving session; other urgent issues to be dealt
with.
comments from the observer and the person roleplaying Patricia, I was
able to create an atmosphere that was very calming and empathic, and the
client experienced acceptance, genuineness and validation in the
counselling relationship. I used periods of silence, combined with
attentive, empathic nonverbal communication, to create a safe place in
which Patricia could express her feelings without fearing she would be
judged. I encouraged her to tell her story, while also seeking to clarify
and assess her suicide risk, symptoms, coping mechanisms and social
supports. I allowed her to question and challenge herself, and I was
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comfortable with the fact that I did not try to offer her answers for all her
concerns and fears—while reassuring her that I wanted to work with her
as she came to terms with this dramatic change in her life circumstances. I
reflected the client’s feelings, and offered reassurance and affirmation. I
actively worked with the client on developing a shortterm action plan
which incorporated both my own and her suggestions.
While my manner with the client may have appeared quite empathic from the start of
the session, it took me a few minutes to become fully engaged in the
client’s story. For example, I feel I could have responded much more
congruently to the news of her husband’s departure, and could have used
more verbal interventions in helping to reduce the distress she was
experiencing at the outset of the session. This rather uninvolved start, as
well as the fact that my main verbal responses to her announcement were
rather lowkey (‘Really!’ … ‘What a blow!’) was largely the result of the
artificiality of the roleplay (i.e., I already knew what she was going to
disclose), and some initial nervousness about working on a roleplay that
was not grounded in reality. In a real situation, where I had been working
with this client over a number of weeks, I know that my early responses
would have been much more genuine, and would have expressed my
concern in a much more empathic way.
On a similar theme, through much of the session I felt that I could have been more
active in reassuring and affirming the client. This was made difficult by
the fact that the client was so verbally and emotionally expressive, and I
wanted to respect this by giving her every opportunity to get her own
thoughts and feelings out. However, I could have taken the opportunity to
give her some very simple affirmations, perhaps along the following
lines:
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I can see how painful and difficult this is for you, Patricia, and I’m full of admiration for the
courage and strength you’re demonstrating in the way you’re coping with such a devastating
event. I’m sure we can work together to help you get through this, and I’d really like the
opportunity to do this in the next few weeks.
I made two attempts to encourage the client to tell more of her story (C4, C9), and yet
the main focus of her responses was on her feelings rather than on the
details of what had happened to her. On balance, because I was imagining
that we had a history of interactions which already familiarised with me
some aspects of Patricia’s story, I feel that it was not important for me to
return to this a third time. I could see no merit in deflecting the client
from her apparently urgent need just to work through some of her feelings
aloud rather than having those thoughts ‘going bananas’ inside her head. I
would expect more details of what happened to emerge in later sessions,
as we moved into grief work over her lost relationship.
One area I feel I could have explored more persistently was the social supports that
were available to the client. When I attempted to do this by asking
whether there was anyone who could come and stay with her (step 9—
C20), the client said she did not want this. However, perhaps with some
gentle probing I might have discovered that this response was based on
her desire not to be a trouble to anyone rather than on what she really
needed. Her difficulty accepting the offer of my home phone number
earlier in the session should have given me a clue that she just might not
want to be ‘a problem’. It would therefore have been valuable for me to
persevere in helping her identify someone who could come and stay with
her for a while, or at least someone who could call and see her daily. I
would also have offered to contact this person if Patricia felt she could
not do so herself.
In considering resources and coping strategies that could be harnessed in a shortterm
plan for the client (step 11—C22), my strategy was to make some
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suggestions to the client based on my (imagined) history of working with
her. I judged that, given her highly fragile and volatile emotional state,
she might not be particularly responsive to being invited to suggest ways
in which she had coped with difficult situations in the past, or techniques
she felt might help her now. As it happened, Patricia volunteered an idea
which I was able to turn into a further suggestion (the idea of a ‘journal’
involving her black and white drawings). Therefore, with hindsight I now
feel that it would have been worthwhile to offer her the opportunity to
identify useful strategies for herself before making my suggestions—
perhaps as follows:
Patricia, I’d like us to look at some ways to help you get through this in the short term, and I
have some suggestions I can make if you’d like. But I’m also keen to know whether you can
think of anything that’s worked for you in the past when you’ve run into tough times, and
which might help you now—coping strategies, hobbies, that sort of thing.
The client’s response might well have been to throw it straight back to me; but at least
asking her would have given her the chance to shift the focus away from a
reliance on me towards greater selfreliance—if she felt strong enough to
do so at this stage of her crisis.
open questions (C15), closed questions (C4), paraphrases (C14, C18,
C21), reflections of feelings (C1, C2), minimal encouragers (C3, C5, C8),
affirmations (C6, C9, C10, C11), probes (C4, C7, C9, C15) and gentle
challenges (C14, C17, C21). This critique only allows space for a very
cursory examination of three examples of these skills.
At step 4 of the structure, I encouraged Patricia to tell more of her story, as follows:
C4: Patricia, I … I would really like us to kind of work through this today, at least make a start on
it. It’s … it’s obviously very difficult for you, and you probably don’t want to talk about it, but
… but what I’d like to suggest that we do today is to just start by perhaps getting you to fill in
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the story a bit about how it happened—you know, when you found out, some of the details—
that may be a bit upsetting for you, but would you be happy to … to go through that stuff?
[closed question; probe]
P4: Oh, I don’t know whether I’d be happy to Jim, but I trust you, and um … you know, I’ve
learned a lot from you in the last few weeks. I, um … you know, like I said I’m kind of split
off; there’s this part of me that … that wants to get to the core of it, and then there’s this other
part of me that wants to just give up.
I feel that this was not a very effective intervention, for three main reasons. First, it was
unnecessarily wordy and tentative. A client in Patricia’s state of mind
may have had difficulty in absorbing exactly what I was asking in this
rather prolix, overcautious manner. Second, I put words into the client’s
mouth (‘…you probably don’t want to talk about it’), and this was not
necessarily what the client was thinking. After all, she had been very
willing to talk about the emotional impact of her husband’s departure, so
there were no grounds assuming that she would not want to discuss the
factual details of what had happened. Finally, I ended by asking her
whether she would be happy to ‘go through that stuff’, which, as the
client’s response indicates, jarred with her current state of mind.
(Comments that arose in the debriefing confirm this impression.) In
summary, then, this intervention was not a very strong example of an
empathic probe for someone in crisis. Perhaps I could have intervened
along the following lines instead:
C4a: Patricia, I can hear how much this has upset you [reflection of feelings], and I think it’s great
that you’re able to express that upset with me here [affirmation]. It would really help me to
understand what you’re going through if you could tell me some more details about what
you’ve been through—would you feel up to that? [closed question; probe]
This intervention uses nearly half the number of words of the original, is much more
clear and direct about why I would like the client to tell me more of the
story, and yet it does so in a very empathic way. It also acknowledges the
fact that the client might not feel like talking about this at the moment, by
ending with a question that gives her permission to say ‘no’.
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A key turning point in the session seemed to come towards the end of step 4 of the
session, with the following intervention (C10):
P9: … How dare he do this? I… I just … what is it with men, you know? [pause] Is it all men,
Jim? I mean, I don’t know: do all men do this? They do in the movies; now it’s happening to
me. I just … what is …what is it with men? [pause] Maybe if … maybe if I’d been able to have
children or … I don’t know what I’ve done wrong. I just … um …
C10: Patricia, you haven’t done anything wrong. [pause] You’ve done everything that was asked of
you. [affirmation]
P10: [starting to cry] It wasn’t good enough Jim; it wasn’t good enough. I’m not good enough. You
know? I’m not good enough. I did everything that was asked of me. I’ve been the perfect wife,
the perfect hostess. All right, I’ve let myself go a little bit, but I’m not, you know, I’m the age
that I am. The only … the only thing he ever said was, you know, he always said ‘You’re
wonderful if you just didn’t have that temper; if you just didn’t have that temper’. And so, I’m
almost perfect. That’s how he painted me: almost perfect, except for my temper. So what does
that—I’ve come, I’ve done something about my temper, and he’s gone.
Until this time the client had not really been in touch with the hurt she was feeling. It
was only at this point that she began to cry, and her comments in the
debriefing make it clear that it was here that she really felt she had been
given permission to experience her sadness with me. At the time I had
some reservations about making this affirmation because I felt the client
might have experienced it as a refusal to accept her selfdescription (‘I
don’t know what I’ve done wrong’). However, it had quite the opposite
effect, allowing her to continue expressing her selfblaming feelings in an
apparently healing way. The only other option I may have tried instead
here is simply to have reflected the client’s feelings, perhaps as follows:
C10a: You’re really feeling rejected, and you think it must be because of something you’ve done
wrong. [reflection of feelings]
This may not have facilitated this client’s emotional expression as powerfully as my
original intervention. However, I believe it could nevertheless be a
valuable intervention to use with some clients, depending on the stage of
the counselling process and their individual needs.
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I feel that my assessment of the client’s suicide risk was both effective and empathic.
My initial approach to this topic was at step 7 of the session:
C14: So … I suppose something you said a little bit earlier makes me ask, um … you sort of
suggested that, you know, this is the end, you know; what more is there to look forward to, that
sort of thing. [paraphrase] How bad is that thought? How serious is that? [challenge]
P15: Um… I don’t want to tell you because I’m afraid you’ll, um, you’ll do something to me then. I
mean, you’re a therapist and … I’ve actually thought of, um, taking my own life a couple of
times. It’s really bad at about three or four in the morning, and the rest of the time I’m okay
and, you know, I’ve got my job, that … I’m going to take some leave from my job because I
just keep bursting into tears and I’m not functioning very well at work and, um, I’m just really
too ashamed to tell anybody. I, I really feel like a failure, and having him go is just sort of like
the last straw. I’m … I don’t know whether I would kill myself, but I, um, you know it’s really
hard at four o’clock in the morning to be alone in the house ...
I felt I needed to explore this further, and the opportunity to do so arose in response to
the following comment from the client:
P20: Most of my pain is in the wee hours and, and I’d ring lifeline I think, um [pause]. I’m not the
suicidal type. I just feel so low right now, so terribly low. I was so lonely … I wish I had a cat
or a dog or something, anything, just anything, anything in that house.
At step 10 I therefore sought to clarify the apparent contradiction between these two
comments, by challenging the client as follows:
C21: There’s something I need to come back to, because you’ve given me a couple of different
messages about something Patricia and … at one stage you were saying that sometimes, a
couple of times, you really felt like killing yourself. And then a little while later you said that
you’re not the suicidal type, and I’m trying to get an idea of what to make of that. [paraphrase
—challenge]
P22: Yeah. That’s a contradiction, isn’t it? [pause] Oh, gosh … Yeah, all right. At four o’clock in
the morning I want to die. I, I don’t know if I really want to die, Jim. I, want to go to sleep for
days; I just want to go to sleep for a really really long time, and wake up and have it all gone
and fixed. So it’s not really that I, I want to die; I just, I want it to go away …
The client’s response here (P22) was not fully reassuring. However, she did not
currently have the means to kill herself (she made it very clear that she
would only be prepared to use pills if she ever did make an attempt on her
own life), and she had no apparent plan. (Perhaps I could have ruled this
out more fully by making a direct enquiry about a plan, but at the time I
did not feel this was necessary.) By the end of the session I had therefore
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formed the opinion that the immediate threat of suicide was low. I
nevertheless reaffirmed my offer to be called at any hour if things got
really bad for the client, and in my referral to the doctor I would have
indicated that caution might be necessary in prescribing any strong
sleeping medication.
Conclusion
This critique has examined the structure of a roleplay session involving a woman
experiencing crisis after the unexpected departure of her husband. I have
also explored some of the counselling skills I demonstrated in the
roleplay, with a focus on skills that may be more relevant to crisis
intervention. I have identified a number of strengths in these areas, and
have also indicated several ways in which both structure and skills could
have been improved.
There are many aspects of the roleplay that I have been unable to discuss, in order to
keep my critique to a reasonable length. Some of these are touched on in
the debriefing session on tape, while others only emerged for me in
observing and reflecting on the session. Overall, however, I feel that the
session was quite effective in meeting the main goals of the Crisis
Intervention Model I was working with, and that as a result of this
exercise I am now much more confident about working with clients who
are grappling with genuine crises.
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Appendix
Transcript of Excerpts from
Session
(C=Counsellor; P=Patricia)
C1: I can see you’re really distressed, and that’s … seems to me that that’s a perfectly natural
reaction. [reflection of feelings; normalisation]
P1: III don’t believe it. I’m .. I just don’t believe it. There’s a part of me that knows he’s gone,
and there’s another part of me that just … it can’t be. It can’t be. I haven’t done anything; I
haven’t … I haven’t done anything. [pause]
C2: So you’re feeling pretty terrible at the moment. [reflection of feelings]
P2: I, um … I don’t know. I have moments where I’m sort of like I am now where I just … it’s not
real; it … And then there’s other moments when I’m really really angry, I’m so angry I could
kill him; I really could. I could just … you know, I don’t care that he’s a really big guy, I …
oh, I just want to kill him. And then I have other times where I just, um … I mean, he’s my…
he’s my world.
C3: Yeah. [minimal encourager]
P3: We’ve been married for 18 years, and um … that’s my world; he’s my world. I … What have I
got now? I mean, he’s all I’ve got.
C4: Patricia, I … I would really like us to kind of work through this today, at least make a start on
it. It’s … it’s obviously very difficult for you, and you probably don’t want to talk about it, but
… but what I’d like to suggest that we do today is to just start by perhaps getting you to fill in
the story a bit about how it happened—you know, when you found out, some of the details—
that may be a bit upsetting for you, but would you be happy to … to go through that stuff?
[closed question; probe]
P4: Oh, I don’t know whether I’d be happy to Jim, but I trust you, and um … you know, I’ve
learned a lot from you in the last few weeks. I, um … you know, like I said I’m kind of split
off; there’s this part of me that … that wants to get to the core of it, and then there’s this other
part of me that wants to just give up.
C5: Mmm. [minimal encourager]
P5: Just give up and just go … go to sleep … Uh, yeah … Yeah, II’ll have a go, yeah.
C6: Whatever feelings come up, that … that’s perfectly okay. [affirmation] We’ll just maybe set
aside our work on the anger and the temper because I think at the moment it might be better for
you to get in touch with that … that stuff. And then we can look at … look at reworking that
stuff later after you’ve got this out of your system. [session planning]
P6: Yeah, I feel sad right now, which is unusual for me. I … it’s … I’ve only really been feeling
sad since I’ve been seeing you. It’s … you know, you opened me up to that side; I’ve always
been a … you know, a person who just gets out there and, like, it’s all new. It’s a … it’s a …
it’s an awful feeling; I really don’t like it at all. I feel quite powerless, and weak. You know, I
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just … in a funny way when I used to lose my temper II felt strong; I felt like I was in control;
II have no control; I’ve lost my … I’ve lost everything.
C7: Feeling really vulnerable, perhaps? [probe]
P7: I … I just feel like I’ve lost everything, and um, I just don’t know what to do. I … I just can’t
see any point in doing anything, ‘cos I did what I was asked to do, and um, the way I feel right
now is there’s nothing else I can do.
C8: Yeah. [minimal encourager]
P8: I’ve reached the end of the road now … the end of the road … [pause]
C9: Well, maybe through talking it through today we might start to see a little pathway somewhere.
[affirmation] But … but, um, I’d still really like to hear a bit more about what actually
happened, and how you found out, if you could face up to that. [probe]
P9: Didn’t I tell you? He’s … he’s gone with another woman. He … he told me on the weekend,
he’s left me, for another woman. She’s younger. That’s what he’s done. That’s what he’s done
to me. I just … I’m not unattractive, I’m … what has she got that I haven’t got? What … what
is … what does he need? What does … You know, she’s younger, she’s prettier. Wha … what
does that tell me? That tells me I’m older and uglier, that’s what it tells me. Well how dare he
do this? How dare he do this? I… I just … what is it with men, you know? [pause] Is it all
men, Jim? I mean, I don’t know: do all men do this? They do in the movies; now it’s
happening to me. I just … what is …what is it with men? [pause] Maybe if … maybe if I’d
been able to have children or … I don’t know what I’ve done wrong. I just … um …
C10: Patricia, you haven’t done anything wrong. [pause] You’ve done everything that was asked of
you. [affirmation]
P10: [starting to cry] It wasn’t good enough Jim; it wasn’t good enough. I’m not good enough. You
know? I’m not good enough. I did everything that was asked of me. I’ve been the perfect wife,
the perfect hostess. All right, I’ve let myself go a little bit, but I’m not, you know, I’m the age
that I am. The only … the only thing he ever said was, you know, he always said ‘You’re
wonderful if you just didn’t have that temper; if you just didn’t have that temper’. And so, I’m
almost perfect. That’s how he painted me: almost perfect, except for my temper. So what does
that—I’ve come, I’ve done something about my temper, and he’s gone.
…
P11: … Nothing I ever did was good enough. That’s why I’ve been so perfect: perfect housewife,
perfect cook, perfect … looking perfect, always perfect—except for my temper! Is that really
such a terrible thing? Can’t I just have a little flaw? [pause]
C11: And you and I both know that you can manage that when you want to too. [affirmation]
P12: I know, and you taught me that, and I was just feeling really bad that I yelled in front of you,
and …
C12: No, let it out.
P13: And I’m wondering if you think I’m a failure too. [pause]
C13: I don’t think you’re a failure at all, Patricia. I’ve been amazed at the rate at which you’ve
moved in the last few weeks, and I think you’ve made terrific progress at, at really working
hard on yourself, and I’m, as I say, very impressed. And I think you’ve got a hell of a lot to
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hang onto—a lot of really strong assets that, that I see every time we meet, and, um, maybe we
need to kind of ground you a bit in, in just some of the things that, that you’ve really got going
for you. I mean, you’re really intelligent, you’re very articulate; when your temper’s under
control you’re very good at planning and seeing things … seeing how things need to be
organised. Uh, and they’re just, that’s just the start of some of the strengths I think that you’ve
got there to build on. And one of the things that I think is really important for us while you’re
going through this really dreadful crisis is just to kind of keep grounding you back in those
strengths and those, those coping mechanisms that you’ve got that could be really helpful.
[affirmation of client’s resources and coping skills]
P14: Mmm…
C14: So … I suppose something you said a little bit earlier makes me ask, um … you sort of
suggested that, you know, this is the end, you know; what more is there to look forward to, that
sort of thing. [paraphrase] How bad is that thought? How serious is that? [challenge]
P15: Um… I don’t want to tell you because I’m afraid you’ll, um, you’ll do something to me then. I
mean, you’re a therapist and … I’ve actually thought of, um, taking my own life a couple of
times. It’s really bad at about three or four in the morning, and the rest of the time I’m, okay
and, you know, I’ve got my job, that … I’m going to take some leave from my job because I
just keep bursting into tears and I’m not functioning very well at work and, um, I’m just really
too ashamed to tell anybody. I, I really feel like a failure, and having him go is just sort of like
the last straw. I’m … I don’t know whether I would kill myself, but I, um, you know it’s really
hard at four o’clock in the morning to be alone in the house ...
…
C15: What are some of the other ways in which things have changed for you, physically or
emotionally, since, since he left? [open question—probe]
P16: Well, I suppose one good thing out of it is I haven’t, uh, it’s sort of good and bad, I, I’m not
eating, I’m, I’m not sleeping; I’m not sleeping at all; I’m just wide awake, chainsmoking out
on the balcony and I’m starting, you can hear I’m starting to really, you know, get hoarse from
the fags …
…
P17: … You think I’m in denial, don’t you Jim?
C17: Do you think you’re in denial? [challenge]
P18: Oh, I heard my own voice … I heard my own voice tell myself he’ll be back, and I, um, I, I
knew it was bullshit when I heard myself say it. [pause]
C18: But it sometimes gives you hope to think that. [paraphrase]
P19: Yeah, it does, actually. It takes the pain away for a while …
…
P20: Most of my pain is in the wee hours and, and I’d ring lifeline I think, um [pause]. I’m not the
suicidal type. I just feel so low right now, so terribly low. I was so lonely … I wish I had a cat
or a dog or something, anything, just anything, anything in that house.
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C20: Is there anyone who could come and stay with you?
P21: No, we moved up from Sydney. I, I don’t, I don’t really want people to know anyway; it’s too
soon, it’s been four days …
…
C21: There’s something I need to come back to, because you’ve given me a couple of different
messages about something Patricia and … at one stage you were saying that sometimes, a
couple of times, you really felt like killing yourself. And then a little while later you said that
you’re not the suicidal type, and I’m trying to get an idea of what to make of that. [paraphrase
—challenge]
P22: Yeah. That’s a contradiction, isn’t it? [pause] Oh, gosh … Yeah, all right. At four o’clock in
the morning I want to die. I, I don’t know if I really want to die, Jim. I, want to go to sleep for
days; I just want to go to sleep for a really really long time, and wake up and have it all gone
and fixed. So it’s not really that I, I want to die; I just, I want it to go away …
…
C22: We’ve got a few minutes left before we finish today Patricia, and I think we should try and,
kind of, bring all of this into some kind of plan for, for how you’re going to go from here.
[initiating plan]
P23: Yeah, I need a plan, Jim, for the next two days. I need something to hang onto, particularly for
the middle of the night …
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