Crisis, Trauma, PTSD Final

Stress

A natural, through trying part of life. A reaction to difficult events usually involving feelings of anxiety. Stressful events do not become crises if a person can cope with them and functioning is not impaired.

Crisis

A state of disequilibrium that occurs after a stressor (precipitating event). The person is then unable to function in one or more areas of his or her life because customary coping mechanisms have failed.

Confidentiality

An ethical standard providing the client with the right for all disclosures in counseling to be kept private.

Ethical Mandates

Moral principles that govern a person’s behavior or the conduct of an activity. A combination of character and customs that: guide behaviors that are deemed good for society and each individual

Standards set forth by professions

Coping Strategies

Have individual explore their own attempts at coping and think of what they would like to do now.

Encourage development of new coping. If they think it’s their own plan, they are more likely to follow.

Journaling, reading, view films or participate in assertive training or stress management courses

Referrals to support groups, 12 step groups, long term, family, or marital therapy, shelters, and other agencies

Duty to warn

“privileged communication ends where public peril begins”

This includes peril to clients if they endanger themselves because of a mental disorder

Countertransference

Unconsciously determined attitudinal set by the therapist which interferes with his work

Self-awareness

Being conscious of one’s own emotions, values, opinions, and behaviors

Dual Relationships

Occur when a counselor has more than one kind of relationship with a client

Cultural Sensitivity

Consider cultural factors when conducting counseling sessions

A willingness to suspend what you know, or what you think you know about a person based on generalizations about their culture.

Assessing Suicide Risk

Determine risk level the more signs, symptoms and clues that a client presents, the higher the risk factor of actually attempting or completing a suicidal attempt

Compassion Fatigue

A state of exhaustion experienced by medical and psychological professionals, as well as caregivers, which leaves the individual feeling stressed, numb or indifferent

Learned Helplessness

The hopelessness and passive resignation an animal or human learns when unable to avoid repeated aversive events

The Crisis-Prone Person

No help when in crisis

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

The Mental Status Exam

A formal assessment tool that aids in determining if someone is psychotic and therefore gravely disabled, a danger to self, or to others.

Structured way of describing a person’s current state of mind under the domains of appearance, attitude, behavior, speech, mood and affect, thought process, thought content, perception, cognition, insight, and judgment.

Ego Defense Mechanism

The degree to which people can see reality clearly and meet their needs realistically.

People with strong egos usually cope with stress better than people with weaker egos.

Typical reactions to crisis

Shock, anxiety, intellectualization

Closed Ended Questions

Questions that can be answered in short or single word responses.

Open Ended Questions

Questions for which the patient must provide detail to give an answer.

What causes trauma

Any force that is unable to be adapted by the body

Secondary Trauma/Secondary Traumatic Stress

Condition that can develop when either working with someone suffering from PTSD or being involved in a close relationship with someone with PTSD.

How can a person benefit from a crisis- danger and opportunity

Dichotomy associated with a crisis.

A crisis can be an opportunity when the person grows by developing new coping skills and altering perceptions.

It can be a danger when the person does not seek help and instead copes with the crisis state by using defense mechanisms, resulting in a lowered functioning level and possibly psychosis or even death.

Factors influencing a person’s response to crisis

Social and personal (internal) resources

Dr. Bruce Perry’s Neurosequential Model and Brain Regulation

Brain development occurs in a sequential manner - from the brainstem up to the cortex.

Brain regulation, in this model focuses on helping individuals achieve a calm, regulated state by addressing the lower parts of the brain first- through sensory and rhythm-based activities- before engaging in cognitive or talk-based interventions.

The impact of how quickly a person receives intervention and long-term outcomes

Early intervention helps regulate the brain’s stress response systems before they become overactive or “stuck”, reducing the risk of chronic issues like PTSD, anxiety, or emotional dysregulation.

In contrast, delayed intervention can allow maladaptive coping mechanisms to form, making recovery more difficult and long-term outcomes less favorable. Prompt, developmentally appropriate support improves healing and resilience.

Does stress always result in crisis?

No, stress can be healthy.

Major goal of crisis intervention

Increase functioning to precrisis levels or higher

Helping professionals’ response to low-risk suicide

Tell the patient that coming to get help is evidence that they do not want to kill themselves

Tell them that contemplated death is a common human experience

Make an informal, verbal non-suicide contract

Encourage them to make appointment with crisis counselor or therapist.

Prevention of Secondary Trauma/Secondary Traumatic Stress

Establish and maintain healthy emotional boundaries.

Engage in self-care routines to promote mental and emotional well-being

Seek supervision and support from colleagues or mentors.

Rotate responsibilities and tasks to limit exposure to trauma.

Practice mindfulness and stress reduction techniques.

You have to get the person to help themselves, you cannot provide that help for them yourself

ABC Method

One way to structure crisis intervention that includes:

1. Developing and maintaining contact

2. Identifying the problem

3. Coping

Overall role of a helping professional

Improve individual’s quality of life

Mental, physical, spiritual, and social

Importance of client developing support system

“The idea of encouraging clients to help themselves [through natural support systems] parallels the adage of teaching a man to fish versus just giving him fish. Self-sufficiency is more economical in the long run.”

AA groups

Co-dependents Anonymous

Cocaine Anonymous

Shelters and other agencies

Bibliotherapy

Journaling

Characteristics of an individual who is at risk of harming themselves

Giving things away

putting things in order

writing a will

withdrawing from usual activities

being preoccupied with death

the recent death of a friend or relative

feeling hopeless, helpless, or worthless

increasing drug and alcohol use

displaying psychotic behavior

giving verbal hints

showing agitated depression

living alone and being isolated

Characteristics of an individual who is at risk of harming others

history of violence

thoughts of committing harm

poor impulse control and inability to delay gratification

impairment or loss of reality testing

delusions or command hallucinations

feelings of being controlled by an outside force

belief that other people wish to harm him or her

perception of rejection or humiliation at the hand of others

being under the influences of substances

past history of antisocial

personality disorder

frontal lobe dysfunction or head injury

Worden’s Talks of Mourning

1. Accept the reality of the loss

2. Process the pain of the grief

3. Adjust to a world without the deceased

4. To find an enduring connection with the deceased while embarking on a new life

Kubler-Ross Stages of Grief

Denial, anger, bargaining, depression, acceptance

Typical reactions of those who experience crisis

Relief

Sadness and anger

Guilt for surviving and for the losses of others

Fear that the event will reoccur

Inability to make decisions and plan everyday life

Feeling disconnected and having difficulty in explaining their emotions to others

Physical symptoms, such as pain, loss of appetite, and trouble sleeping

Intense anger and despair

Shock and disbelief

Nonverbal expressions like clinginess, tantrums, crying and trembling

What to suggest for those suffering from loss

Acknowledge the loss

Take your feelings seriously

Make necessary accommodations

Be patient

Find your own way to memorialize the loss

Don’t forget

Aspects of list affected by trauma

Pretty much everything

1. emotional well-being

2. relationships

3. physical health

4. cognitive functioning

5. behavior

6. development

7. self-image

Traits of those most at risk for suicide

1. depressed, angry have tried suicide before, lack support from loved ones

2. have a plan for suicide

Traumatized person’s feelings of guilt

Survivor’s guilt

self-blame

moral injury

Overall impact of trauma on the brain and body

1. Brain Changes: Trauma disrupts key areas like the amygdala (fear), hippocampus (memory), and prefrontal cortex (reasoning), leading to heightened fear, poor emotional regulation, and memory problems.

2. Physical Effects: The body may stay in a state of hyperarousal (anxiety, tension) or hypoarousal (numbness, fatigue), causing chronic pain, sleep issues, or digestive problems.

3. Long-term Consequences: If untreated, trauma can impact overall health, behavior, relationships, and daily functioning - especially with repeated or early-life trauma.

Four manifestations of normal grief

1. feelings

2. physical sensations

3. cognitions

4. behaviors