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    Crisis Intervention

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
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    34 views25 pages

    Chapter 3 Crsis and Trauma

    Uploaded by

    Zainab Farrukh
    Crisis Intervention

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
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    Sue, D. W. (1977). Community mental health services to minority groups: Some optimism, some pessimist, American Psychologist, 32(6), 616-624 Suc, D.W, (1992, Winter). The challenge of multiculturalism: “The road less traveled, American Counselor, 1, 5-14 Sue, D.W. (1999, August). Multicultural competencies in the profession of psychology. Symposium address delivered at the 107th Annual Convention of the American Psycho- logical Association, Boston, Sue, D. W. (1999b, August). Surviving monoculturaisn and racism A personal journey. Division 45. Presidential Address delivered at the 107th Annual Convention of the American Psychological Association, Boston, Sue, D. W, Arredondo, P., & MeDaris, R. J. (1992), Muli cultural counseling competencies and standards; A call tothe profession. Journal of Counseling and Development, 70,477-486, Sue, D. W,, 8 Sue, D. (2002), Counseling the culturally diverse: ‘Theory and practice (4th ed.) Hoboken, NJ: Wiley Sullivan, C,, & Cottone, R, R, (2010). Emergent characteris: tics of effective cross-cultural reseacch: A review of the literature. Journal of Counseling & Development, 883), 357-362. Summerfield, D. (1998). 4 critique of seven assumptions be- hind psychological trauma programmes in war affected areas, Socal Science and Medicine, $8, 1449-1462. “Taylor, R, Chatters, L. M, 8 Levin, JS. 2008) Religion in the lives of African Americans: Social, psychological, and heath perspectives. Thousand Oaks, CA: Sage, ‘Taylor, SE. (2007). Social support. Ia H.$. Friedman &R.C. Silver (Eds), Foundations of health psychology (pp. 45— 171), New York: Oxford University Press ‘Thompson, C, E., & Neville, H. A. (1999). Racism, mental heath, and mental health practice. Coustseling Payckolo- gist, 27, 155-223, ‘Trimble, J. B. (2007), Prolegomena for the connotation of ‘consiruct use in the measurement of ethnic and racial ently. Journal of Cownseling Psychology, 54, 247-258, US. Department of Health and Human Services, (2003). De oleping cultural competence in disaster mental health pro grams: Guiding principles ant recommendations. DHHS Pub. No. SMA 3828, Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Ser vices Administration. van den Eynde, J, & Veno, A. (1999). Coping with disastrous ‘events: An empowerment modal for community healing In R Gist &B. Lubin (Eds), Response to disaster: Psycho- social, community and ecological approaches (pp. 167— 192) Philadelphia: Brunnen/Mazel, CHAPTER TWO Culturally Efective Helping 49 Weinrach, S. G. 2003, January). Letter: Mucb ado about ‘multiculturalism, part 4, Counseling Today, 45,31 Weinrach, S. G., & Thomas. KR, (1998). Diversity-sensitive counseling today: A postmodern clash of values, Journal of Counseling and Development, 76115122. ‘Weisaeth, L, (2000). Briefing and debriefing: Group psycho logical interventions in acute stressor situations. In B. Raphael & J. P. Wilson (Eds), Psychological debriefing ‘Theory, practice, and evidence (pp. 43-57). New York Cambridge University Press ‘Whaley, A. L., & Davis, X. E. (2007). Cultural competence and evidence-based practice in. mental health services. American Psychologist, 62(6), 363-574 Williams, B, (2003). The worldview dimensions of tn- dividualism and collectivism: Implications for counseling. Journal of Counseling and Development, 8163), 370-372, Winter, B, & Battle, L (2007, Mazch). Rolling sesslons: Squad car therapy, Paper presented at Thirty-first Annual Con- vening of Crisis Intervention Personnel and CONTACT USA Conference, Chicago. Worthington, R, L., & Dillion, FR. @01)), Deconstructing ‘multicultural counseling competencies research: Com- ment on Oven, Leach, Wampold, and Rodolfa, Journal of Counseling Psychology, $840), 10-15. Worthington, R.L.. Sot-MCNett, A. M,,& Moreno, M, V, (2007). Mutticulteral counseling competencies research ‘A 20-year content analysis. Journal of Counseling Psychol 24), 54, 39-36, Wortman, C. B. & Lehman, D. R. (1985). Reactions to vie~ tims of life rises: Support attempts tha fall. In 1.G, Sara son & B. R, Sarason (Eds), Socal support: Theory research and application (pp. 483-488). Dordrecht, The Nether Jands: Martinus Nijhodtf ‘Wubbolding, R.E, (2003, fenuary) Letters: Much ada about ‘mutticulturalisn, part 3. Cosseling Today, 45, 30-31. Zalaquett, C., Carrion, [, & Exum, H, (2010). Providing di- aster services to culturally diverse survivors. In Webber & J.B. Mascasi (Eds), Terrorism, trauma ond tragedies: A counselors guide to preparing and responding (rd ed, pp. 19-24). Alexandria, VA: American Counseling Asso lation Foundation Zalaquett, C. P, Fuertb, K. M., Stein, C, Wey, A. Ey Selvey, ‘M. B. (2008). Reftaming the DSM-IV-R from a muiticul- tural/social justice perspective. Journal of Counseling & Development, 863), 364-371 Zimbethofl, A. K, & Brown, L. S, (2006). “Only the goyim ‘beat their wives, right” Paychology of Wonten Quarterly, 20, 422-424, CHAPTER 3 The Intervention and Assessment Models Introduction ‘The purpose ofthis chapter isto present an applied cri- ‘sis intervention model that describes in detail the major tasks involved in dealing witha crisis. The Triage As sessment System i introduced as a rapid but systematic technique for the crisis workee to use to adjudicate the severity ofa client's presenting crisis situation and gain some sense of direction in helping the client cope with the dilemma. Finally, this chapter shares some ideas on using referrals and gives some suggestions regarding counseling difficult clients. This chapter and Chapter 4. The Tools ofthe Trade, area prerequisite far succeeding chapters, and we urge you to consider this foundation material carefully ‘The model of crisis intervention you are about to encounter emphasizes an immediacy mode of actively, assertively, intentionally, and continuously assessing lis- tening, and acting to systematically help the clint regain as much peecrsis equiibeium, mobility, and autonomy as possible. Two ofthose terms, equilibrium and mobility, and their antonyms, disequilibrium and immobility, are commonly used by crisis workers to identify client states of being and coping. Because we will be using these terms often, we would like to frst provide their diction- ary definitions and then give a common analogy, so their seaning becomes thoroughly understood, Equilibrium. A state of mental or emotional stabil- ity, balance, or poise in the organism. Disequilibrium, Lack or destruction of emotional stability, balance, or poise in the organism. Mobility. A state of physical being in which the person can autonomously change or cope in re- sponse to different moods, feelings, emotions, 50 needs, conditions, influences; being flexible or adaptable to the physical and social world Immobility, A state of physical being in which the person is not immediately capable of autono- ously changing or coping in response to differ ent moods, feelings, emotions, needs, conditions, influences; inability to adapt to the immediate physical and social world. A healthy person is in a state of approximate psy- chological and behavioral equilibrium, like a motorist driving, with some starts and stops, down the road of life—for both the short and the long haul. The person ‘ay hit some potholes but does not break any axles. Aside from needing to give the car an occasional tune- up, the person remains more or less equal to the task ‘of making the drive, In contrast, the person in cris whether it be acute or chronic, is experiencing seviot difficulty in steering and successfully navigating life's highway. The individual is at least temporarily out of control, unable to command personal resources or those of others in order to stayon safe psychological pavement. A healthy person is capable of negotiating hill ‘curves, ice, fog, stray animals, wrecks, and most other ‘obstacles that impede progress. No matter what road: blocks may appear, such a person adapts to changing conditions, applying brakes, putting on fog lights, and estimating passing time. This person may have fender benders from time to time butavoids head-on collisions. ‘The person in a dysfunctional state of equilibriam and mobility has failed to pass inspection. Careening down hills and around dangerous curves, knowing the brakes have failed, the person is frozen with panic and despair and has little hope of handling the perilous situation. ‘The result is that the person has become a victim of the situation, has forgotten all about emergency brakes, downshifting, or even easing the car into guardrails. He or she flies headlong into catastrophe and watches transfixed as it happens, The analogy of equilibrium and mobility applies to most crisis situations. Thus, it becomes every crisis worker's job to figuratively get the client back into the driver's scat ofthe psychological ve- hicle, As we shall see, sometimes this means the client ‘must temporarily leave the driving to us, sometimes it ‘means sitting alongside the client and pointing out the rules of the road, and sometimes it means just pretty ‘much going along for the ride! All of that being said, the crisis worker will mect a number of individuals who were not poster children for psychological equilibrium before the crisis. Many people who were displaced by Hurricane Katrina, for example, were physically and psychologically fragile before the hurricane. We will have more to say about such people, who are more typically in a state of transcrisis, in Chapter 5, Crisis Case Handling A Hybrid Model of Crisis Intervention Perhaps the biggest change in the seventh edition of this book is our notion of how a model for crisis inter- vention operates, There are numerous models for crisis intervention (Aguilera, 1998; Kanel, 1999; Kleespies, 2009; Lester, 2002; Roberts, 2005; Slaikeu, 1990). All of these models depict crisis intervention in some lin car, stepwise fashion. Indeed, through 20-plus years of publishing this book we did much the same, with the admonition that changing conditions might well mean that the interventionist would have to recycle and move back to earlier steps. In our eatlier model we depicted crisis intervention as starting with problem explora tion, examining safety concerns, looking for support, ‘examining alternatives to present behaving, planning how to restore equilibrium, and finally gaining a com- mitment to take action, We no longer believe that a stage or purely step model captures the way crisis inter- vention works, and here's why. ‘The problem that we have struggled with as we try to teach students like you about crisis intervention is that at times crisis is anything but linear. lot of the times, ‘tisis intervention absolutely epitomizes chaos theory— with starts, stops, do-overs, and U-turns. At times doing crisis work is @ lat like being a smoke jumper, CHAPTER THREE The Intervention and Assessment Models 51 controlling a psychological brush fire on ths side of the mountain only to be faced with @ new one on the other side of the valley. Fighting those psychological fires ac- cording to a neat, progressive, linear plan is easly said but not so easily done. Therefore, we have combined our former linear model with a systems model we helped de- velop (Myer, James, & Moulton, 2011), resulting in what could more appropriately be called a hybrid model for individual crisis intervention that is generally linear in its progression but can also be seen in terms of tasks that, need to be accomplished. While certainly some of these tasks would usually be done in the beginning, middle, ‘or end of a crisis, changing conditions may mean yout have to accomplish some task you would normally do Inter, first, Or indeed, a task you thought was already accomplished comes apart and has to be done over not ‘once, but raultiple times. {A further problem with a strict linear model is that each step should be discrete, following from step one to step two and 90 on, with particular techniques to employ in each of those steps. In crisis intervention, issues sud Iimayaitarcot patonwioa- |Sootornueng |ayeereemenes [sceeret | Selah om rotstcaton, | See Seesoset am |ehaowt end | Rater att | wth ety minor onksion contusion sstoconsitusa. | distortions. (Chent’s perception Client's perception | severe distortion of realty, incuding | Identity and describe bey the crs situation Of crisis event may | paranoia, hat Get insomere, | olcrsis event may | sie sussiaialy |uchallone and | poate fom realty | afer natzaably | fomreamrar | Serene, of stuation, from reaty ot | fom real creer , sation. CRISIS EVENT Se ete eee AFFECTIVE DOMAIN ‘dentty and describe brielly the aft thats presont. (iimore han one aifoet is experienced, rate with #1 being primary, #2 secondary, #3 tertiary) ANGERIMOSTILITY eee FIGURE 2.2 (continued) 64 PARTONE Basie ‘rainings Crisis Intervention Theory and Application CRISIS EVENT (continued) ANXIETY FEAR, ‘SADNESSIMELANCHOLY. FRUSTRATION, BEHAVIORAL DOMAIN Identity and deserite briety which behaviors curently being used. (ifmera than ene behavir ie utized, rate wih #1 boing primary, #2 secondary, #3 tetany.) APPROACH: AVOIDANCE: IMpAOILIT¥: ‘COGNITIVE DOMAIN Idonity it ransgression, test, or loss has occured in he folowing areas and describe bile (free than ono cognitive response occurs, rate with #1 Doing primary, #2 cecencary, # tariary) PHYSICAL (lood, water, safety, shoe, et.) Transgression _Threat__ Losa_ FSYCHOLOGIGAL (sel-concept, sense of emotional welktueing, ego Integy selFidenity, ee): Transgression ‘SOCIAL RELATIONSHIPS {positive inleraction anc euppont, ‘amily end, coworkers, chuteh, clube, ete. ‘Threst___ Loss, Transgression__Threst__ Loss FIGURE 3.2 (continued) CHAPTER THREE ‘the Intervention and Assessment Models 65 CRISIS EVENT (continued) MORAL/SPIRITUAL (persona rtegiy, values, bait system, epi econeilation) Peete eee Hee Transgression _ Tweat___ Lose. TRIAGE ASSESSMENT (x = Ital Ascossment / = Torna! Assessmen) Feelings: Behaviors: Anger___Fear__Sadness__ ‘Approech___Avcidanee__immobla_ — ——__ 123456789 0 124456789 9 Thinking: ‘Wansgression___ Twweat____Loss. 123456789 0 Ina Total Scere: @X)__— Terminal Total Score {0)__ [Describe the observations that led you to check the characteristics above FIGURE 3.2 (continued) The Affective Severity Scale. No crisis situa tion that we know of has positive emotions attached to it. Crow (1977) metaphorically names the ustal emotional qualities found im a crisis as yellow (anxi- ety), red (anger), and black (depression). To those we would add orange (our students chose this color) for frustration, which invariably occurs as clients attempt to meet needs, These needs range all across Maslow's needs hierarchy, from inability to get food, water, and shelter (Hurricane Katrina) to interpersonal issues (cttempts to regain boyfriendgirlfriend) to intraper- sonal issues (get rid of the schizophrenic voices) to spiritual concerns (God can't let this happen). Frus- tration of needs is often the precursor of other nega tive emotions, thoughts, and behaviors that plunge the client further into crisis. Even more problematic, some very famous psychologists have investigated the relationship between frustration and aggression and found that aggression is always a consequence of frustration (Dollard et al., 1938, p. 1). That outcome particularly does not bode well when the client is in Undergirding these typical emotions may lie a can: stellation of other negative emotions such as shame, be trayal, humiliation, inadequacy, and horror (Collins & Collins, 2005, pp. 25-26) Clients may manifest these emotions both verbally and nonverbally, and the astute crisis worker needs to be highly aware of incongruen-

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