Crisis Intervention- Exam 1

FROM QUIZ 1

There are two types of crises…

Situational and Developmental

Contributing models that were helpful in crisis intervention included what theory?

Cognitive-Behavioral theory

Will a crisis prone individual always seek help to resolve the crisis?

No; a crisis prone individual will not always seek help to resolve the crisis?

Is coping is a part of the development of a crisis?

Yes; coping is a part of the development of a crisis

Is a crisis always a danger to the client?

No, a crisis is not always a danger to the client

In the 1960's, the suicide prevention movement began.

T

Would risk of self-harm be a possible danger for a person who is in crisis?

Yes, risk of self-harm would be a possible danger for a person who is in crisis

Developmental crisis

predictable change;

normal transitional phases;

predictable patterns of behavior and change occurring throughout the lifespan

Situational crisis

unexpected change;

sudden onset, unexpected, emergency;

change that results when a person faces an event or situation that causes a disruption in one's life

Remember:

C - CRISIS: A specific precipitating event/stressor has disrupted the person's usual coping or equilibrium. Immediate stabilization/crisis intervention may be appropriate.

P - PROBLEM: A current difficulty or stressor exists, but the person appears able to cope and function. Problem-solving or support may be appropriate, but the situation has not reached crisis.

O - ONGOING/CHRONIC ISSUE: A longer-standing condition, pattern, or concern that is generally better addressed through ongoing services, treatment, case management, or longer-term intervention.

? - NEED MORE INFORMATION: The event or circumstance alone does not tell us whether the person is experiencing a crisis. Additional assessment is needed

Practice from Quiz 1

Mary just retired from her teaching job of 30 years. As she prepared for her retirement, she expected it to be rewarding as she could spend more time with her family. However, she lost her sense of purpose and became depressed and stopped leaving the house or spending time with family. Mary would be experiencing a situational crisis.

True or False

False

Following a relapse, a client's spouse announces they are leaving and taking the children. The client becomes highly distressed and says, "I've lost everything. There's no point anymore."

Please select the category which best describes this scenario:

a. C - CRISIS

b. P - PROBLEM

c. O - ONGOING/CHRONIC ISSUE

d. ? - NEED MORE INFORMATION

a. C - CRISIS

Mark is 30 years old and was just diagnosed with terminal brain cancer. Mark feels afraid he might die and feels completely paralyzed on how to manage his fears.

Which of the following could Mark experience?

a. Situational crisis

b. Developmental crisis

c. Mark would not experience a crisis.

a. Situational crisis

A family has struggled financially for several years. They frequently fall behind on utilities and rely on food pantries near the end of each month. They would like assistance developing longer-term financial and resource supports.

Please select the category which best describes this scenario:

C - CRISIS

P - PROBLEM

O - ONGOING/CHRONIC ISSUE

? - NEED MORE INFORMATION

O - ONGOING/CHRONIC ISSUE

FROM QUIZ 2

Family systems theory indicates that change such as a change in employment or additions to the family can cause anxiety.

T

Legal behavior does not equal ethical behavior.

T

In the ABC Model, the crisis interventionist is not responsible for determining what the client's primary problem is and explaining it to the client.

T

A crisis worker should use knowledge about cultural groups as a starting point for understanding a client while remaining willing to question generalizations and learn how the individual client understands their experience.

T

Dating a client would be considered a dual relationship.

T

Beginning a question with "what" or "how" would be an example of using attending skills.

T

A crisis worker should recognize the limits of their training and make an appropriate referral when a client's needs fall outside their professional competence.

T

The cultural background of your client would have impact on the approach you would take with them.

T

To speak to a family member of a client, you would be required to obtain a release of information.

T

As a Crisis Worker, you are responsible to protect the privacy of your client.

T

Practice from Quiz 2

A client describes relying heavily on extended family and members of their faith community when making important decisions. The worker's own approach usually emphasizes individual independence. Which response BEST demonstrates cultural humility?

a. Ask the client who they would like involved and how family or faith supports are typically used when facing difficult situations.

b. Assume that family members should participate because this is customary in the client's culture.

c. Encourage the client to make the decision independently so others do not influence the crisis intervention.

d. Avoid discussing culture so the worker does not risk stereotyping the client.

a. Ask the client who they would like involved and how family or faith supports are typically used when facing difficult situations.

During the beginning of a crisis interview, a student asks several questions in rapid succession because they want to gather enough information to understand the crisis. What is the primary concern with this approach?

a. Open-ended questions should not be used during a crisis.

b. The interaction may begin to feel like an interrogation rather than a supportive conversation.

c. Gathering information is more important than rapport during the first interview.

d. Crisis workers should avoid asking questions until the client requests help

b. The interaction may begin to feel like an interrogation rather than a supportive conversation.

A client recently lost their job and says, "I'm upset, but I have some savings, my family is helping me, and I've already started applying for other jobs." Based on the definition of crisis discussed in class, what is the BEST initial conclusion?

a. The worker should immediately begin crisis stabilization.

b. Job loss automatically constitutes a crisis.

c. The client is experiencing a developmental crisis.

d. The event is stressful, but more assessment is needed to determine whether it has overwhelmed the client's usual coping and functioning.

d. The event is stressful, but more assessment is needed to determine whether it has overwhelmed the client's usual coping and functioning.

Which response BEST demonstrates empathy rather than sympathy?

a. "I feel so sorry for you. That's terrible."

b. "Everything is going to be okay."

c. "I know exactly how you feel."

d. "It sounds like you're overwhelmed and unsure what to do next."

d. "It sounds like you're overwhelmed and unsure what to do next."

A client begins a crisis interview by saying, "Nobody understands what I'm dealing with. Everyone keeps telling me what I should do." Which response would BEST support achieving rapport?

a. "You should try not to focus on what other people think."

b. "What have you tried so far to solve the problem?"

c. "Why haven't their suggestions been helpful?"

d. "It sounds like you've had a lot of people giving you advice when what you really need first is to feel heard."

d. "It sounds like you've had a lot of people giving you advice when what you really need first is to feel heard."

FROM LECTURES/MODULES: LECTURE 1

What is the ABC Progression? (Kanel's)

Achieving rapport, Boiling down the problem, Coping

"Achieving Rapport" General Examples

Create safety and connection

Active listening

Empathy & Validation

Cultural humility

"Achieving Rapport" Body Language & Nonverbal Communication

1. Posture- Open

2. Orientation- facing the client

3. Eye contact- attentive

4. Facial Expression- congruent with what the client is sharing

5. Tone & Pace- calm, warm, unhurried

6. Physical Distance- respect personal space and client comfort

7. Silence- allowing space for thinking and emotion

8. Distractions- minimize electronics, etc.

Core Skills for Achieving Rapport

1. Attending & active listening

2. Open-ended questions

3. Reflection of feeling and meaning

4. Clarification

5. Empathy

6. Validation

7. Therapeutic silence

8. Summarizing

9. Cultural humility

10. Emotional safety

Core Skill Examples

1. Attending & active listening

2. Open-ended questions

3. Reflection of feeling and meaning

4. Clarification

5. Empathy

6. Validation

7. Therapeutic silence

8. Summarizing

9. Cultural humility

10. Emotional safety

1. Attending & active listening: The worker puts away their phone, turns toward the client, uses a calm tone, and does not interrupt

2. Open-ended questions: "Where would you like to start?" "What has been the hardest part of this for you?"

3. Reflection of feeling and meaning: "You sound exhausted from trying to hold everything together."

4. Clarification: "When you say you 'can't do this anymore,' help me understand what you mean."

5. Empathy: "It sounds like you've been carrying this by yourself for a long time."

6. Validation: "Given everything that happened today, it makes sense that you're feeling overwhelmed."

7. Therapeutic silence: The client becomes tearful. The worker remains present and waits rather than immediately asking another question.

8. Summarizing: "So several things have happened this week, but getting the eviction notice yesterday is when everything started to feel unmanageable. Am I understanding that correctly?"

9. Cultural humility: "Please correct me if I'm misunderstanding. I want to understand this from your perspective."

10. Emotional safety: "We can slow this down. You don't have to figure everything out right now."

Rapport Builders

• "Help me understand what this has been like for you."

• "I don't want to make assumptions. What feels important for me to understand?"

• "It sounds like there may be more to that decision. Help me understand."

• "Please correct me if I'm misunderstanding."

Rapport Barriers

• "I know exactly how you feel."

• "Most people from close families would probably feel the same way."

• "Why didn't you just tell your family what was happening?"

• "That's not something you need to be embarrassed about."

Factors that get in the way or rapport:

• Asking too many questions

• Filling every silence

• Giving advice too soon

• Reassuring before understanding

• Minimizing or comparing

• Focusing on facts while missing emotion

• Thinking about your next response instead of listening

Rapport response example

Client: "I got the eviction notice yesterday. I haven't told my kids. I have no idea what I'm going to do."

Crisis worker: "You're trying to hold things together for your kids, but it sounds like underneath that you're pretty scared yourself."

This single response demonstrates active listening, reflection of feeling and meaning, and empathy.

Empathy, Reflection, & Validation

Empathy: "It sounds like you've been carrying an enormous amount by yourself."

Reflection: "You're feeling completely overwhelmed right now."

Validation: "Given everything that happened this week, it makes sense that you're feeling overwhelmed."

"Boiling Down the Problem" Examples

Clarify & prioritize concerns

Access strengths, resources, & safety

"What happened?”

"What is making this a crisis now?"

"Coping" Examples

Promote stabilization

Identify coping strategies

Strengthen supports & resources

Develop realistic next steps

When the stressor exceeds available coping/resources > temporary disruption or loss of equilibrium > ?

CRISIS

Is a serious problem automatically a crisis?

No;

A serious problem is not automatically a crisis

What does Crisis mean?

1. Precipitating Event/Stressor

a. What happened? What changed? Why now? How has coping been affected?

2. Person's Perception

a. What does the event mean to the person?

3. Coping & Resources

a. Are usual coping, supports, and resources sufficient

Crisis can be classified as an opportunity or danger

T;

We tend to see a crisis in a negative light, however, we can learn from the experience and then when the next crisis occurs, we are better equipped to handle it.

Crisis as Opportunity

• With help: growth, insight, better coping skills, higher level of functioning, and better prepared for future stresses

• "New normal"

Crisis as Danger

• No help: lower level of functioning via defense mechanisms or nonfunctioning

• Ex. suicide, homicide, psychosis, frequently hospitalized, etc.

Crisis-Prone Person

• No help when in crisis

◦ May not seek help or has a poor support system

• Uses ego strength to defend rather than manage reality

• Unprepared to manage future stresses and enters crisis states frequently and easily

• Personality disorders are created, chronic depression and lowered functioning

• It is not uncommon to see people not reach out for help until it is too late. At that time, it is harder to regain their previous level of functioning.

Other Crisis Determinants

1. Material resources, could be financial, employed

2. Personal resources, coping skills

3. Ego strength

4. Social resources, positive relationships

• This is an important point. People with fewer resources tend to experience more crises vs someone with adequate resources. I would say this is especially true of those with few social resources.

Precipitating Events

The incidents or circumstances that set off a crisis. (They may be catastrophic incidents or small things that are the last in a series of upsetting circumstances that leave the person feeling overwhelmed and unable to cope.)

Curvilinear Model of Anxiety

Low anxiety: Low motivation, inertia

•Moderate anxiety: Highest level of performance, optimal motivation

•High anxiety: Overwhelming paralysis

•Cannot change emotions directly except with medication

Who coined the term "grief work"

Erich Lindemann

First time crisis work was recognized

The Wellesley Project after the Coconut Grove Fire (1942)

Caplan's Seven Characteristics of Effective Coping Behavior

1. Explore reality, search for information

2. Freely express feelings, tolerate frustration

3. Seek help from others

4. Work through problems bit by bit, one at a time

5. Pace coping, be aware of fatigue, function where possible

6. Be flexible and willing to change

7. Trust in oneself and others, optimism

Community Mental Health Act of 1963

The goal of 1 community mental health center per 100,000 individuals (2,000 centers nationwide) by 1980

(Psychiatric emergency treatment (PET) services dealing with psychotic, suicidal, and homicidal crises)

Suicide Prevention Movement

Early 1960s:

-Crisis intervention led to suicide prevention hotlines, the use of nonprofessional volunteers

-Critical life crises attracted nontraditionalists, grassroots, nonprofits

-Legislation was created to help deinstitutionalize the mentally ill

-Joint commission on mental illness and health created

Crisis Intervention progress in the 1970s

• Journals such as Crisis Intervention and Journal of Life-Threatening Behavior

• Growing anti-medical attitude

• Increase in psychologists and masters level workers paid at lower rates

• Provided crisis and case management

• Increase in university programs focused on counseling

• Professionalization of mental health lead to insurance companies paying for treatment

Rise of Managed Care: 1980s

• Complaints by insurance companies led to a return to short-term crisis intervention

• HMOs, PPOs

• By the 1990s, 40 million people had no coverage

Contributions from Other Theoretical Models: Humanistic

Trusting clients, optimism and hope, basic attending skills and rapport-building

Contributions from Other Theoretical Models: Cognitive-Behavioral Theory

Problem-solving models, changing perceptions to change emotions

Contributions from Other Theoretical Models: Brief Therapy

• Not crisis intervention specific

• Based on psychoanalytic principles

• Focus on changing patterns, not on increasing functioning

Contributions from Other Theoretical Models: Critical Incident Debriefing

• Used to help during community disasters, victims of unexpected trauma

• Often referred to as trauma response

• Frequently used with increase in school/workplace shootings and other violent acts.

Contributions from Other Theoretical Models: Trauma Informed Care

• Recognize the widespread impact of trauma and its role in crisis responses

• Prioritize safety (physical & emotional) in all interactions

• Support choice, collaboration, and empowerment

• Shift from "What's wrong with you?" → "What happened to you?"

FROM LECTURES/MODULES: LECTURE 2

What are Ethics?

• Customs, morals

• Guide behaviors that are deemed good for society and the individual

• Standards set forth by professions

Defining Law

• Standards, principles, processes, and rules adopted, administered, and enforced by governmental authority that regulates behavior

• Sometimes overlap with ethics

• Legal behavior does not equal ethical behavior

◦ Ex. it is not illegal to borrow money from a client, however it is unethical

Controversies

• Current mental health laws and regulations may be biased against the poor and minorities, particularly African Americans

• Preventive detention may raise constitutional questions

• Use of paraprofessionals—used more widely throughout Mental Health facilities resulting in less controversial

Ethical Issues

• Self-awareness

• Personal biases, know your own triggers

• Dual relationships

• Having outside relationships with clients

• Confidentiality

• Competence

• Client's rights

• Virtual or e-therapy

• Multicultural competence

Self-Awareness

• Self-monitoring to prevent countertransference problems

• Use of supervision to discuss potential issues.

• Prevents inappropriate interventions due to a trigger on an emotional issue within the counselor

• Protects client and counselor

Dual Relationships

• Sexual

• Social

• Having a client to your house for dinner

• Employment

• Hiring a client to mow your lawn, etc.

• Support a business your client owns.

• Financial

• Loaning or borrowing money.

• None is acceptable!

• Even though we think these are common sense, it happens.

Breaching Confidentiality

• Duty to protect your client.

• May mean involuntary detaining client

• Danger to self: Must report

• Danger to others: Must report

• Child abuse: Must report

• Elder abuse: Must report

• Disabled abuse: Must report

• Tarasoff case

• As professionals, we are required to report to authorities any real or suspected abuse to both children (under 18) or elderly (including adults with disabilities). If you notice unexplained injuries on either, you are required by law to report. For children, it would be reported to CPS (Child Protective Services) and for elderly and those with disabilities to APS (Adult Protective Services)

Competence

• Evidence-based practice

• Keeping up with current trends

• Supervision

• Training

• Acting within the scope of your degree.

• A bachelor level cannot do therapy! Remember this.

• Referrals, multidisciplinary team

• Knowing limits

• When providing services, follow the following guidelines:

• Intervene within the limits of your background, don't provide therapy without the proper credentials

Other Issues

• Client's rights:

• Right to consent, benefits and risks, fees, qualifications of counselor, and termination rights

• Virtual or e-therapy:

• Can help people that might not otherwise be served

• Concerns about security and lack of legal recourse

Multicultural Competence

• Preparation and practices that integrate multicultural and culture-specific awareness, knowledge, and skills into counseling interactions

• Know the population you work with.

• Don't be afraid to ask questions from the client

FROM LECTURES/MODULES: LECTURE 3

CHAPTER 5 - Developmental and Cultural Crises

Life Cycle Crises

• Infancy: Nurturance and trust

• Toddlerhood: Autonomy and control

• Preschool: Assertion and social identity

• Middle school: Mastering of skills and social rejection

• Adolescence: Identity and differentiation

• Young adulthood: Intimacy and emotional transition away from parents

• Fear of Missing Out (FOMO)

• Middle adulthood: Productivity and empty nest

• Maturity: Integrity vs. despair

Family Systems Theory

• Change causes anxiety

• Change in employment, additions to family, empty nest, etc.

• Prefer homeostasis

• Focus on brief interventions

Structural Family Therapy

• Boundaries, hierarchies

• Enmeshment

• Disengagement

• Goal to bring new homeostasis without pathological behaviors

Evolutional Crises

The normal stages a family experiences as it evolves through the life span of its members. The crises result from having to adjust to the formation of the following subsystems: marital, parental, sibling, and grandparent.

Developing Cultural Humility

• Ethnicity, religious affiliation, gender, and race should be acknowledged and considered

• Maintain willingness to suspend what you know, what you think you know based on generalizations (and biases).

Etic Issues

Behaviors and traditions exist in all or most humans regardless of race, ethnicity, or culture

Emic Issues

Behaviors and traditions particular to a certain cultural group.

Latinos

largest minority group in the US

• Personalismo: Relating to others vs. task oriented

• Marianism: Female is pure and self-sacrificing

• Machismo: Pride in being virile and protective of family

• Catholicism: Religion of choice though movement toward fundamental Christian religions on rise

• Familismo: Value of family above all

• Enmeshed family structure: Very little independence, much emotional support

• Emotionalism: Exaggerated expression, dramatic

• Different rates of acculturation

• Ataque de nervios

African-American Families

• Acculturated to mainstream values

• Religion: Important history as slaves found solace in God

• Racism: Present in today's world, distrust of racist society perceived by some as paranoia

Asian-American Families

• Family structure: Males are respected, oldest son is privileged, mother as nurturer, father dictates all family decisions

• Shame and obligation: Lack of differentiation between family as a whole and its members

• Obligated to respect elders

• Problem-solving approaches are best