Chapter 1 - Basic concepts of crisis intervention

Case study 1.1 (continued) Nguyen

1. Apply the task model of crisis assessment and intervention to the case of
the Nguyens and develop a treatment plan for intervention.

Essential crisis assessment tasks:

Address safety, stability and risk.

The first step is to consider that the crisis experienced by the Nguyen family does
not go beyond the limits of the crisis itself, that is to say, that an objective
evaluation should be made to ensure that the stressors that make up the family
crisis do not trigger a series of behaviors that put the integrity and lives of the
members at risk, as well as a continuous evaluation of the state of the Nguyen
family should be considered in each intervention. Therefore, it is proposed to carry
out a continuous evaluation of the Nguyen family, always maintaining an ethical-
professional relationship without falling into assistentialism.

Follow a holistic bio-psycho-social-spiritual approach.

A comprehensive assessment of all the areas considered in the Nguyen crisis must
be carried out in order to determine the cause or the connection with the crisis
event. Therefore, within our plan, we propose a medical evaluation, hand in hand
with the public health system, and also an evaluation where aspects of affect,
behavior and cognitions are considered, always seen from the development and
the immediate environment of the Nguyen, for which standardized evaluations can
be used, but as long as the link is established with this within the process of
accompaniment.

Clarify the problems.

The relationship within the intervention should be based on transparency, therefore

the dialogue and communication should be clear and objective, the Nguyen family
should be aware of the situation and should be aware together with the therapist or
interventionist of the problems they are experiencing. Biweekly sessions are
planned in which patients are given the full opportunity to express the situation they
are experiencing at the moment. For this, active listening must always be present
since this is the main way to look for connections and facilitate new ways of coping
with the situation that is being experienced at that moment.

Explore coping skills, resources and supports.

The Nguyen family has coping skills, however, it is necessary to address questions
about their situation as migrants. As it is known, natural disaster is one of the
situations that the Nguyen family must face, as it creates a change in the structure
of the family system, however, it also creates a state where a Nguyen family
encounters economic and health complications. The possible resources of the
Nguyen family is to request assistance as people in a situation of migration, as well
as as intervention strategies it is necessary to carry out models of resilience, and
active listening. On the other hand within the skills that the Nguyen have we can
find: initiative, ingenuity and a strong ethical conviction. Tareas esenciales de
intervención en crisis.

Normalize and educate.

We will work with the Nguyen family to normalize their response to the unleashed
crisis, that is to say that from the exploration of the elements that make up the
crisis, we will show them that the maladjustment in the family dynamics is a
response that comes from the crisis itself. Therefore, an exercise of revision of past
events is proposed to show how these facts have modified the dynamics. The
intention is to remove from the Nguyen's mind any feeling of fear, abandonment,
hopelessness or loss of control, what is sought is the normalization of the reality
that the Nguyen live and thus release much of the power that the crisis can have
on them.

Explore options.

Among the options that the Nguyen have we find that they have several resources
that are derived from their context which are internal and external, but above all the
Nguyen have an option that in turn is a resource that will allow them to address
and improve their situation, and is that they belong to a very large community of
people in a situation of migration from which they receive a great social support, on
the other hand can be made of public support that is given to them from the
medical community and basic needs.

Develop a plan and obtain commitment.

The interventions will be carried out from the guidelines already established, that is
to say with ethics and under a model of intervention where the patient has the full
opportunity to make the most appropriate decisions from the review of past events.

The established goals are: to reduce feelings of anxiety and worry within a month,
with weekly or biweekly visits.

Prepare documentation, follow up and provide referrals.

No referral is required. The Nguyen's are not in extreme danger of any kind, as
they have adequate resources to carry out each intervention with proper
accountability.

2. What sources of resilience and support can the Nguyens harness to cope
with their circumstances?

The Nguyen's are likely to experience a developmental crisis in the future, since
events are likely to arise in which all family members are expected to live from the
disruption of the family system. While in the aspect of the situational crises which
are events that are incesperated such as the natural situation that was lived and
even situational crises according to their condition as people in situation of
migration. And finally it will be evident that the family will live existential crises,
where they will be in a situation of doubt about their own life.

3. What additional developmental or situational crises are likely to occur in this

family in the years ahead? How can you help prepare or inoculate them to
better adjust to those circumstances?

The Nguyen's have tangible resources, but also intangible resources, however,
within the resilience section they have the support of a large social community, in
addition to the birth of their daughter despite having a medical condition, the
element of struggle to improve the daughter's condition is a factor of relevance to
them..

Chapter 1 – Basic concepts of crisis intervention – Fundamentals of working

with clients in crisis.

Activity 1.2

Examples of directive, non directive, and collaborative aproches in crisis situations

follow. Discuss How each could be an appropiate stamente in especific
circumstances.

Example 1

 Please put the gun down. (directive)

 What would help you feel more comfortable about putting the gun down?
(nondirective)
 I want to help, but knowing you have that gun in your hand scares me. Can
you put the gun down for me so I can help you more? (collaborative

Jackson & Erford (2017) states that directive approaches that lead to the counselor
can guide the person in crisis in a specific direction, in this case we see that the
counselor seeks to give the direction that he is not in danger or himself, not the
patient, in this way the intervention is more directed at the time to give a direction
to show the patient that a guide must be followed in order to perform the
intervention. Subsequent to this fact we see that a non-directive approach is
carried out, and for this Jackson & Erford (2017) states that this allows the person
in criris to propose the directives, so that the advice I can facilitate the process. In
this case we see that by using a non-directive approach it is achieved that the
patient is empowered and finally by using the collaborative approach the patient
discovers that the counselor is part of the situation, which leads us to recognize
what Jackson & Erford (2017) states this leads to stability and normality.
Example 2

 It sounds like you are thinking about killing yourself during most of the day
and every day and have decided nothing else can take away your pain. You
tell me that you will not follow through with whatever we plan and that you
will kill yourself. I am concerned for your safety and want you to be here,
alive. I really think some time to focus on just you is the best option. I want
to help you stay alive, and the only option I see to do that is for you to be
admitted to the hospital (directive)
 You have generated some ideas on how you can stay safe and they seem
like Good options. (nondirective)
 I am happy to hear that you do not want to follow through on killing yourself.
I also hear you saying that the pain at times is unbearable. You have been
able to generate many options for staying alive. Can we continue to work
together to see what resources are the best options and make a list so that
when you start to have thoughts of wanting to kill yourself you can act on the
best options first? (collaborative)

In this case we see the same scheme: Directive, non-directive and collaborative.
Well, in this case it is quite right to start with a directive approach since, the person
is at risk, we are talking about a suicidal situation. So the counselor should seek to
guide, that is to give a direction so that the patient does not commit the act,
therefore Jackson & Erford (2017) states that this approach is going to allow the
patient to find guidance. Whereas, in the non-directive aspect, this section I do not
see it as necessary, since it does not make an intervention that fits the situation,
however, Jackson & Erford (2017) states that, if the client is able to make rational
decisions, it can enable the client to move forward. It is clear that the patient does
not have the capacity for rational thought at the time. The last argument
demonstrates that intervention from a more collaborative approach than
intervention effectively enabled the patient to find stability and normalcy.

Example 3

 I'm going to call the police. (directive)

  Do you think calling the police will help? (nondirective)
 If I bring you the phone, would you call the police? (collaborative)

The first intervention from the managerial approach you give us to know seeks to
establish a guide, to trace a path by means of which you are going to get
something that will be functional or not. For indeed that response seeks to position
us in a place, from which the other arguments will follow its path, as stated by
Jackson & Erford (2017) in that these provide some kind of direction. The second
intervention is quite successful as it is in the form of a question, which immediately
leads to reflection and even more so is given from the non-directive model, since
as Jackson & Erford (2017) considers this approach allows us to move forward in
reducing tension, as clearly seen in the example. While in the last intervention,
which is carried out collaboratively we see that a reflective response is evidenced,
so that intervention is given in an appropriate way.

Reference:

Jackson, L., & Erford, B. (2017). Crisis Assessment, Intervention, and Prevention

(3.a ed.). Pearson.