Crisis Trauma and PTSD Exam 2

Dr. Maloney

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, lowered functioning

Danger

No help: lower level of functioning via defense ,mechanisms, or not functioning

i.e suicide, homicide, psychosis

Opportunity

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

Factors influencing a person’s response to crisis

Material, personal and social resources

Typical reactions to crisis

shock, disbelief, distress, and panic

The cognitive key

The perception a person has of the precipitating events that lead to emotional distress

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

A person cannot tolerate extreme tension and psychological disequilibrium for more than a few weeks

Instead of stabilizing at a lowered level of functioning, an individual who receives help is likely to stabilize at a higher, more adaptive level of functioning, learning coping skills that might prepare him or her for future stresses

Does stress always result in crisis

no

Major goal of crisis intervention

to increase client’s functioning

Stress

Reframing

the process of redefining events and experiences from a different point of view, best thing to do in a low risk suicidal client situation

Validation Statment

these help the speaker feel that their points of view and subjective experiencing is valid and that the listener empathizes with their plight. Listeners let the speaker know that their feelings are normal and difficult

Coping Strategies

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

Support groups, 12 step groups, marital/family therapy, lawyer, doctor, assertion training, stress management, shelters, or other agencies, securing commitment and following up

Crisis

Precipitating event

Perception of the event as threatening or damaging

Perception leads to subjective distress

Impairment of functioning due to failure of usual coping skills

Confidentiality

All disclosures by clients are private and professionals may not share information with anyone except supervisors

the legal counterpart is called Privileged Communication, and the client owns it in the court

Exceptions to breaking confidentiality

Danger to self

Danger to others

Child abuse

Elder and disabled adult abuse

Client signs waver and gives permission to breech confidentiality

Patriot Act

Client sues counselor in court actions

Ethical mandates

suspected abuse and neglect of child or elderly

The Mental Status Exam

Formal assessment tool to determine severity of disorder

Appearance, attitude, Behavior, Speech, Mood and affect, Thought process, Thought content, Perception, Cognition and orientation, Insight, Judgment

Why clients must come up with their own coping mechanisms

they are more likely to follow through if they come up with it

Ego defense mechanisms

repression, denial, dissociation

Assessing suicide risk

Low, middle, high-determines type of intervention

Low

ideation, may have a plan, have no means

Middle

Ideation and plan, have means but something can stop them

High

Ideation, plans, have means, and nothing can stop them. Sometimes angry.

ABC method

ATTENDING: Developing & maintaining rapport, Questioning, Paraphrasing, Reflection of feelings, Summarization

BELIEFS: Identify the nature of the crisis--Climbing the cognitive tree, Emotional distress and impairments in functioning, Ethical issues, Therapeutic interaction statements

COPING: Present alternative coping

Rapport

Develop and maintain contact, Basic attending skills, Follow person

Attending skills

Eye contact, body language, soothing calm voice, overall empathy

Reflections

KISS: best are short, and focus just on the emotion expressed either verbally or nonverbally

Summarization

\-Ties together al that has been said.Helps to move the interview along and into other areas. Useful when the counselor is not sure where to lead the speaker. Includes emotions, facts, cognitions disclosed throughout the entire session

Restatment

Saying back to the client in the listener’s own words what s/he heard the speaker just say

Climbing the cognative tree

\-Find the meaning the speaker gives to the precipitating event that is leading to the subjective emotional distress. Explore the entire cognitive schema until the cognitive key is formed. Counselor can alter cognitions...to empower control

Beliefs

Listeners need to id the nature of crisis

focus on predicting events, cognitions of events, emotional distress, how client has been functioning socially, academically, occupationally and behaviorally

Coping

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

What you must do at the end of the crisis intervention interview

Commit and follow-up

Countertransference

counselor/crisis responder’s past unresolved issues interfere with objective and appropriate care of a client.

Self awareness

Responders own emotions, values and opinions, behaviors

Dual relationship

Responders should have only one relationship with a client: the therapeutic one

No sexual, social, employment, or financial relationship allowed.

Because power differential between client and professional exists.

Importance of client developing support system

natural help available

dependence of mental health workers is reduced

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

Preoccupied with death

Recent death of a friend or relative

Feelings of hopelessness, helplessness, and worthlessness

Increased drug and alcohol use

Psychotic behavior

Agitated depression

Living alone/being isolated

Verbal hints

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 commands hallucinations

the feeling of being controlled by an outside force

the belief that other people wish to harm them

perceptions of rejection or humiliation at the hand of others

being under the influence of substances

past history of antisocial personality disorder

frontal lobe dysfunction or head injury

age group who has the highest rate of NSSI

adolescents

Examples of open ended questions

Tell me, what do you think about that? What is it you like about the idea? Why would you suggest that? How do you plan to achieve that? What do you think will happen now? How would you change things? What do you want to happen? What's causing the problem? What's the best-case scenario?