Studied by 9 people
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?
Note
Flashcard