Crisis Intervention

The Reflective-Transition Phase

The survivor develops a larger personal perspective on the traumatic events and becomes positive and constructive with a forward, rather than backward, looking perspective. The individual comes to grips with the trauma and confronts the problems.

Euthanasia

someone else administers it

Depression - Battered women

-May appear as laziness -May really be trying to regroup their psychic energy. -Workers task becomes one of trying to help them move past their inactivity but not by pressuring them or taking them on a guilt trip.

Assessing for suicidal/homicidal potential

-Most suicidal and homicidal clients emit definite clues and believe they are calling out for help or signaling warnings. -Realization that suicide and homicide are always possible.

Eco-Systems Crisis

-Occurs when some natural or human-caused disaster overtakes a person or a group. -Adversely affects every member of the environment. -Biological crisis.

Death of a spouse

-One of the most emotionally stressful and disruptive events in life. -Increases mortality rate for the surviving spouse. -Worker should be aware of the part that bereavement and grief play in physical health issues.

ABCs of assessing in crisis intervention

-Severity of the crisis is assessed from the client's subjective viewpoint and from the worker's objective viewpoint. -Affective state -Behavioral functioning -Cognitive state

Terror - Battered women

-Stress related syndrome similar to agoraphobia arises after woman has been in the shelter for a while. -May have extreme/unexplainable attacks of error that are touched by seemingly innocuous incidents. -Incidents greatly restrict their activities and new freedom. -Fear of their mates, their predicament, separation and an undefinable future can cause the onset of this. -Worker should not allow it to continue.

Traumatic death bereavement

-The potential for complicated grief increases exponentially -The degree of trauma is increased by: 1. The suddenness and lack of anticipation 2. Violence, mutilation and destruction 3. Preventability or randomness 4. Multiple deaths 5. The mourners own confrontation with death or witnessing of violence or mutilation -The degree of distress has more to do with situational factors such as degree of violence, extent of maiming of the body and physical proximity to and witnessing of the death. -PTSD-like

Task # 7 - Follow up

-Time frame of minutes, hours, days. -Keeping track of clients' success in maintaining pre-crisis equilibrium. -Short-term is also important as a reinforcing event that tells clients you are still with them. -Especially important when clients have little social support.

Behavioral functioning

-Worker focuses much attention on doing, acting out, taking active steps, behaving or any number of other psychomotor activities. -Best way to get client to become mobile is to facilitate positive actions that the client can take at once. -Engage in some concrete or immediate activity. -Problem in immobility is loss of control. -Once client becomes involved in doing something concrete, an element of control is restored, a degree of mobility is provided and the climate for forward movement is established.

Dynamics of sexual abuse in families

1. Do not show feelings, especially anger. 2. Be in control at all times, do not ask for help. 3. Deny what is happening and do not believe your own senses/perceptions. 4. No one is trustworthy 5. Keep the secret because no one will believe you anyway. 6. Be ashamed of yourself, you are to blame for everything.

A plan should be able to...

1. Identify additional persons, groups and other referral resources that can be contacted for immediate support 2. Provide coping mechanisms - something concrete and positive for the client to do now.

Principles of bearing confidentiality

1. Legal principles 2. Ethical principles 3. Moral principles

Cohen and Mannarino - 5 tasks gradual exposure to loss

1. Resilience-building stress management skills 2. Affective expression skills development 3. Cognitive coping skills 4. Trauma specific interventions 5. Grief-focused interviews

Characteristics of people who commit suicide

1. Situational characteristics 2. Motivational characteristics 3. Affective characteristics 4. Cognitive characteristics 5. Relational characteristics 6. Serial characteristics

Psychobiological assessment

1. Traumatic events cause dramatic changes in the discharge of neurotransmitters. 2. Abnormal changes in neurotransmitters are involved in mental disorders that range from schizophrenia to depression. -Legal and illegal drugs have a major effect on mental health.

Underreporting

50 - 90% of all rapes or attempted rapes go unreported. Date rapes and stranger rapes are not reported out of shame, humiliation, cultural taboos and fear of secondary victimization at the hands of medical and legal authorities. This disparity suggests that only 1 in 9 rapes is actually reported.

Psychoanalytic Theory

Based on the view that the disequilibrium that accompanies a person's crisis can be understood through gaining access to the individual's unconscious thoughts and past emotional experiences.

Existential Crises

Can emerge when we are experiencing inner conflict about important human issues such as the meaning and purpose in life, responsibility, commitment and independence.

Emic Model

Components that make up individuals, not just what their individual parts are, but how they come together.

Ensuring safety

Depends on helping abused women take actions steps rather than remaining immobilized.

Cultural reinforcement

Finds the roots of violence in institutions ranging from the culture at large down to the family unit.

Basic Crisis Intervention Theory

Focuses on helping people in crisis recognize and correct temporary affective, behavioral and cognitive distortions brought on by traumatic events.

Callers agenda - paranoid

Guarded, secretive and pathologically jealous. Difficult to shake their persecutory beliefs. See themselves as victims and expect deceit and trickery from everyone. Counseling focus is to stress their safety needs.

Religiosity

Helps people cope and provides hope.

Perception

How the client views the threat. 1. Threat to life goals - work, maturation, love, intimacy, social interest. 2. Threat to affectional ties. 3. Threat to security. How individuals interpret events has a great deal to do with how amenable the crisis will be to resolution.

Legal principles of confidentality

Human service workers have varying degrees of privileged communication. Also, volunteers do not have such protection unless specifically provided by law.

Survivors of childhood sexual abuse

If survivors are left untreated, they may experience recurring episodes of revictimization and exhibit debilitating symptoms (transcrisis points) for many years.

The Emergency or Outcry Phase

Individual experiences heightened fight/flight reactions to the life threatening situation. Termination of the event itself is followed by relief and confusion. Questions about why the event happened and what its consequences are dominate the individual's thoughts.

Normal Developmental Maturation Crisis

Typical flow of human growth and evolution whereby a dramatic change or shift occurs which produces abnormal responses (birth of child, retirement, aging process, mid-life crisis, college graduation). Can be a positive thng.

Brief Therapy Theory

Typically attempts to remediate ongoing emotional problems.

Dying with dignity/rational suicide

Typified by a person's rationally choosing death in the face of a painful, decimating and incurable illness or some other major calamity that has no forseeable positive outcome for a reasonable person.

Metastasizing Crisis

When a small, isolated incident is not contained and begins to spread. Not easy to excise or remedy at this point.

Callers agenda - obsessive compulsive

Preoccupied and fixate on tasks. Expend and waste time and energy on these endeavors. Do not hear counselors because of their futile attempts to obtain self-control over their obsessions. Counseling focus is to establish the ability to trust others and the use of thought stopping and behavior modification to diminish obsessive thinking and compulsive behavior.

Dynamics of rape

Psychosocial, cultural and personal attitudes of both males and females.

Cognitive restructuring

Reframing the client's negative and distorted beliefs about him or herself is critical in allowing the client to separate the fact and fiction of an abusive childhood.

Egoistic suicide

Related to one's lack of integration or identification with a group.

Altruistic suicide

Related to perceived or real social solidarity such as the traditional Japanese hara-kiri or to put it in a current context the suicide attacks by members of the Middle Eastern extremist groups.

Silent

Remaining _____ but attending closely to the client can convey deep, empathetic understanding.

Stalking

Repeated harassment, following, and/or threats that are committed with the intent of causing the victim emotional distress, fear of bodily harm and/or actual bodily harm. -Strangers demonstrate a variety of pathologies, are angry and want power over their victims and are extremely dangerous sexual predators and murderers.

The Integration Phase

Survivor successfully integrates the trauma with all other past experiences and restores a sense of continuity to life. The trauma is successfully placed fully in the past.

Situational characteristics

The common stimulus in suicide is unendurable psychological pain. The common stressor in suicide is frustrated psychological needs.

Chaos Theory

"Emergent complex messiness" - evolves into a self organizing mode whenever a critical mass of people come to perceive that they have no way to identify patterns or preplan options to solve the dilemma at hand.

Basic strategies of crisis intervention

- Creating awareness -Allowing catharsis -Providing support -Promoting expansion -Emphasizing focus -Providing guidance -Promoting mobilization -Implementing order -Providing protection May be used singly or in combination

Support Groups

- Emotional attachment and social involvement are basic and important ingredients in armor plating the individual against PTSD. For most of those that suffer from PTSD, social isolation and emotional estrangement are the norm. -Group work is helpful because of the shared experience, mutual support, sense of community, reduction of stigma and the restoration of self-pride it fosters. -The primary task of any group therapy is to help people regain a sense of safety and mastery because of a shared sense of having gone through the same trauma.

Mobile crisis teams

- Geriatric or physically disabled clients may need home visits to provide services. -When a client is out of control and unwilling or unable to go to a client, crisis workers go wherever the client is. -The community mental health act of 1963 mandates that those clinics receiving federal funds must provide 24-hours emergency service.

Type II Trauma PTSD

- Longstanding and comes from repeated traumatic ordeals. - Result in the psyche's developing defensive and coping strategies to ward off the repeated assaults on its integrity. - Massive denial, psychic numbing, repression, dissociation, self-anesthesia, self-hypnosis, identification with the aggressor and aggression turned against the self and prominent. -Emotions are an absence of feeling and a sense of rage and/or unremitting sadness.

Family Treatment PTSD

- One of the worker's major tasks is assessing the family's willingness to engage in treatment. - Treatment objectives are to develop and implement an intervention program to deal with both the stress disorder of the individual and assorted family dysfunctions that were in place prior to the event or that developed after the event. - Learning about the disorder, dealing with the boundary distortions of intimacy and separation caused by it, alleviating psychosomatic results of rage and grief, urging recapitulation of the trauma, facilitating resolution of the trauma-inducing family conflicts, clarifying insights and correcting distortions by placing blame and credit more objectively, offering new and more positive and accurate perspectives on the trauma, establishing and maintaining new coping and adapting skills as family dynamics change.

Type I Trauma PTSD

- One sudden, distinct, traumatic experience - Characterized by fully detailed, etched-in memories, omens such as retrospective rumination, cognitive reappraisals, reasons, misperceptions, and mistiming of the event.

Interpersonal Theory and Suicide

-"People commit suicide because they can and because they want to kill themselves" -Theory proposes that while many people consider committing suicide and large numbers develop the capability, few actually do so because all three ingredients must be present at once to create the critical mass necessary for the act to occur. 1. People acquire suicidal capability by decreasing their innate fear of death by habituating themselves to the fear and pain of self-injury. 2. They perceive burdensomeness to others to the extent that they are so flawed or defective they are beyond repair. 3. Failed belongingness, means that the person has no attachments or value to any other member of society.

Client's reservoir of emotional strength

-A client who lacks emotional strength needs more direct responses from the crisis worker than the client who retains a good deal of emotional strength. -The lower the reservoir of emotional strength, the less the client can get a hold of the future.

ADDRESSING

-Age -acquired and Developmental Disabilities -Religion -Ethnicity -Social Class -Sexual Orientation -Indigenous heritage -National origin -Gender

Toddler Bereavement

-Ages 18 months to 3 years do not understand how death differs from going away. -Because they live in an egocentric world, they may assume that they caused the death to occur. -May exhibit high levels of anxiety such as agitated/restless behavior, excessive crying, thumb sucking, biting and tantrums. -May also have some physicals memories.

Pre-school Bereavement

-Ages 3 to 5 may experience profound reactions to loss and may display feelings of sadness, anger, crying spells, feelings of remorse and guilt, somatization and separation anxiety. -Likely severe separation anxiety from caretakers, including excessive clinging and crying on separation, needling to be held and not wanting to sleep alone.

Stockholm Syndrome

-Akin to being held hostage, the woman is completely isolated and subjugated by her abuser and her survival is entirely dependent on his whims, desires or purposes. -Because she is shown occasional kindness and is completely isolated from other support systems, she develops a strong emotional bond with the abuser.

Death of a child

-Always a major loss -Survivors don't get over this quickly -Traumatic for a parent at any age

The Dual Process Model

-Approach-Avoidance Model that has two components: loss orientation and restoration orientation. -Recognizes that grief is not static, but a series of waves with crests and troughs that ebb and flow at their own pace but gradually move into more quiet, placid and calm affective, behavioral and cognitive waters that nourish growth.

Task # 6 - Obtaining commitment

-Asking the client to verbally summarize the plan, a handshake, a signed agreement, etc. -Objective is to enable the client to commit to taking one or more definite, positive, intentional action steps designed to move that person toward restoring pre-crisis equilibrium.

Grief experience inventory

-Assesses the longitudinal course of grief. -Self-descriptive items that are answered true/false compromise the inventory. -Nine clinical scales cover despair, anger/hostility, guilt, social isolation, loss of control, rumination, depersonalization, somatization, and death anxiety. -Six research scales include sleep disturbance, appetite, loss of vigor, physical symptoms, optimism-depair and dependency. -Three validity scales cover denial, atypical response and social desirability.

ACT Model

-Assessment of the presenting problem including emergency psychiatric and other medical needs and trauma assessment. -Connecting clients to support systems -Traumatic reactions and posttraumatic stress disorders.

Primary school age Bereavement

-At age 6 or 7 children understand the universality and irreversibility of death. -Death is more specific, precise and factual. -These children operate in the concrete stage of development. They may report matter of factly the gory details of a death and be seen as cold and uncaring. -May also become agitated at hearing details of a death and may avoid such conversation. -May be able to run a balance sheet and see that while their sisters death is a sad thing, their parents will now be able to spend more time and money on them. -Play is used extensively to attempt to work through the trauma.

Avoidance Style Coping

-Avoidance and denial are not always bad. Sometimes they help a client digest what has just occurred. -It can help them stay glued. -We don't want someone stuck in denial. -In the beginning it's okay because it's helping that person adjust to the "sharp blow" that has occurred. Eventually, however, we will need to quicky move them along.

Systems Theory

-Based not so much on what happens within an individual in crisis as on the interrelationship and interdependence among people and between people and events. -Represents a turning away from focusing on only what is going on with the client.

Myths about battering

-Battered women overstate the case -Battered women provoke the beating -Battered women are masochists -Battering is a private, family matter -Alcohol abuse is the prime reason for wife abuse -Battering occurs only in problem families -Only low-income and working-class families experience violence -The battering cannot be that bad or she would not stay -A husband has patriarchal rights -The beaten spouse exaggerates the problem to exact revenge -Women are too sensitive, especially when they are pregnant -Battering is rare -Battering is confined to mentally disturbed or sick people -Violence and love cannot coexist -Elder abuse between a couple is neither prevalent nor dangerous.

Psychoeducation

-Benefit client by helping them understand what is going on with them psychologically. -Definition is to provide information to victims and survivors about what is happening and probably going to happen to them psychologically in the aftermath of a traumatic event.

Child abuse as a predictor of PTSD

-Child abuse has been shown to predict the development of PTSD later in life. -A younger age of onset of sexual abuse and coercion to maintain secrecy predicted a higher number of total diagnoses. -Children had more diagnoses when physical abuse had come from males rather than females. -Adding sexual assault during the rape of children was predictive of chronic PTSD. -Developmental processes associated with affect regulation and interpersonal relationships skills may be severely disrupted and pave the way for future assaults.

Existential-Constructivist Framework

-Comes from Yalom's work on human pathology -Four corner posts of existence: 1. death (unavoidable) 2. existential isolation (we enter existence alone and leave existence alone) 3. meaninglessness (our attempt to make sense of a universe that is beyond knowing) 4. freedom (the absence of external structure, which means that each person is responsible for making choices, taking actions and enjoying or suffering the consequences of those decisions). -Constructivism views death, existential isolation and meaninglessness as the principal ingredients that provide the motivation for meaning-making activities central to human life. -As individual construct their view of self, others and their relationships, they also construct a worldview where they encounter environmental challenges to which they have to respond. -They have three options in response to these challenges: 1. Retain original constructions 2. Alter them to build new constructions 3. Decide that neither response is viable and consider suicide as a final construct.

Parasuicde

-Commissioned acts, although not directly lethal, can habituate a person to the pain necessary to kill themselves by inflicting hesitation wounds. -Clients may also engage in self-injurious behavior such as cutting or burning their bodies to reconnect to reality from a dissociative state. -Or they may indirectly set themselves up to harm themselves by abusing alcohol, driving too fast, combining the two, daredevil behaviors, etc.

Task # 3 - Providing support

-Communicating to the client that the worker is a person who cares about the client. -Psychological support, logisitical support, social support, information support. -Default task is safety

Learned helplessness/battered woman syndrome

-Conditioned to believe that they cannot predict their own safety and that nothing they or anyone else does will alter their terrible circumstances. -Over time, through continuous conditioning, this syndrome emerges and causes the woman to lose hope and feel incapable of dealing with the situation. -Childhood factors: witnessing or experiencing battering, sexual abuse, molestation, health problems/chronic illness, stereotypical sex roles and rigid tradition. Teaches children that external autocratic forces dictate outcomes. -Adulthood factors that are instigated by the batterer: violence, sexual abuse, jealousy, overpossessiveness, intrusiveness, isolation, threat of harm, observed violence (people, animals or things) and alcohol/drug abuse. -Women choose behavioral responses that have the highest predictability of causing them the least harm in the known situation.

Losing a client to suicide

-Crisis intervention does not always work. -Guilt, rumination, recrimination, perseveration and constant second guessing. -Psychological autopsy or debriefing and supervision should be mandatory for the worker. -Worker may experience vicarious traumatization.

Triage assessment

-Critical in crisis intervention -Dictates what the interventionist will do in the next seconds and minutes as the crisis unfolds. -Should be fast, efficient way of obtaining a real-time estimate of what is occurring with a client.

Psychological support

-Deep, empathetic responding using reflection of feelings and owning statements about the client's present condition. -Serves as a bonding agent that says emphatically "I am here with you right now".

Safety

-Default task that is always operational. -Assessing and ensuring this is always part of the process. -Important for not only the client but for those who may interact with him or her. -Nothing is more paramount. -Pertains to psychological aspects as well.

Task # 2 - Problem exploration: defining the crisis

-Define and understand the problem from the client's point of view. -Core listening skills: empathy, genuineness and acceptance or positive regard. -Attempting to identify the precipitating event across the affective, behavioral and cognitive components of the crisis. -Serves two purposes - 1) the worker sees the crisis from the client's perspective 2) defining the crisis gives the worker info on the immediate conditions, parties and issues that led to eruption of the problem into a crisis.

Psychological factors of men in a battering relationship

-Demonstrate excessive dependency and possessiveness toward their women, although they deny it. -Unable to express any emotion except anger and generally have poor communication skills where emotional issues are concerned. -Unrealistic expectations of their spouses and idealize marriage or the relationship far beyond what realistically may be expected. -Lack of self control and paradoxically set up rigid family boundaries for everyone else. -Alcohol or drug abusers -Have been abused as children or saw their mothers abused. -Deny and minimize problems, particularly battering that they generate in families. -Emotionally cycle from hostility, aggressiveness and cruelty when they do not get their way, to charm, manipulation and seductiveness when they do. -Be characterized as jealous, denying, impulsive, self-depreceating, depressive, demanding, aggressive and violent. -Feel a lack of comparative power to the woman in economic status, decision making and communication skills.

Hogan Grief Reaction Checklist

-Designed to discriminate grief reactions from depression or anxiety. -61 items target categories of despair, panic, blame/anger, disorganization, detachment and personal growth. -It can discriminate variability in the grieving process as a function of cause of death and time elapsed since death.

Attachment/traumatic bonding theory

-Disruptions of attachments in realy life lead to anxiety, anger, grief, sorrow and difficulty forming relationships as an adult. -Men whose parents were unreliable, abusive, needy or otherwise unequal to the task of child rearing may be very sensitive to fears of abandonment and enmeshment. -Partner may have her own fears of abandonment. -Each partner creates ways to control the other to void being abandoned, including violence. -Traumatic bonding may explain why some women stay with or return to their abusive partners.

Schneider's Growth Model

-Eight stage process model of loss -Holistic, growth-promoting model designed to nurture as much personal growth as possible within a context of stress, loss and grief. 1. Initial awareness of loss, which is generally a significant stressor. 2. Attempts to limit awareness of the loss 3. Attempts at limiting awareness by letting go 4. Awareness of the extent of the loss, recognizable as mourning - most painful, lonely phase. 5. Gaining perspective on the loss, accepting what is done is done. 6. Resolving the loss 7. Reformulating loss in a context of growth 8. Transforming loss into new levels of attainment.

Thought Stopping

-Enables the individual to change debilitating, intrusive thoughts to self-enhancing ones. -Crisis worker sets the scene and builds the images until the fear-evoking stimuli are at maximum arousal and then shouts "STOP" and replaces them with positive, self-enhancing thoughts.

Interpersonal Theory

-Enhancing personal self-esteem such as openness, trust, sharing, safety, unconditional positive regard, accurate empathy, and genuineness. -The essence is that people cannot sustain a personal state of crisis for very long if they believe in themselves and in others and have confidence that they can become self-activated and overcome the crisis. -The goal is returning the power of self evaluation to the person.

Task # 4 - Examining alternatives

-Exploring a wide array of appropriate choices to the client -Situational supports - people known to the client who might care about what happens to the client. -Coping mechanisms - actions, behaviors or environmental resources the client might use to help get through the present crisis. -Positive and constructive thinking patterns - ways of reframing that might substantially alter the client's view of the problem and lessen the client's level or stress and anxiety. -Appropriate choices that are realistic for their situation.

Extinguishing trauma

-Facilitating the reduction or loss of a conditioned response as a result of the absence or withdrawal of reinforcement. -When working through the traumatic events, the client will experience a dramatic increase in affective and autonomic arousal. The social worker must be very careful to provide palatable doses of the traumatic material that do not exceed the client's coping abilities and prompt a crisis within the therapy session. Careful processing with the client before and after each session of extinguishing and reframing traumatic memories is important in preventing such crises. -

Journaling

-For PTSD clients, speaking about what has happened to them is difficult. -This is an excellent method of opening up affect and allowing non-verbal catharsis to occur. By putting down their thoughts in their own words and then hearing them, individuals place their terrible memories at a safe enough psychological distance that they and the worker can analyze them.

Bowlby's Attachment Theory

-Generated from his studies of separation and reunion of young children with their parents. -Linear phase model that focuses on the nature of the griever's relationship to the deceased. -The need to emotionally turn loose or detach from the person or object is the end goal of the grief process. -Grief may not always follow a prescribed set of stages as proposed.

Stressors in a battering situation

-Geographic isolation -Social isolation -Economic stress -Medical problems -Inadequate parenting skills -Pregnancy -Family dysfunction -Alcohol and drug abuse -Educational or vocational disparity -Age -Disenfranchisement -Rejection -Threat to masculinity

Informational support

-Giving adequate information to help the client make informed decisions. -Where, who, and what resources the client can access to get out of the predicament they are in.

Pet loss bereavement

-Human/animal bond is recognized as an integral part of pet owners lives and it is important for us to recognize and validate the grief that pet owners experience when their beloved companion animals die. -Profound grief, depression, guilt. -High and low grief groups. -High grief groups were distressed by dreams of their pets, fond memories, kept their pets belongings, erected shrines and memorials and felt more social constraints, feelings of alienation and lack of support for their grief. -Low grief groups were comforted by dreams of their pets, gave their pets belongings away and were comforted by fond memories of their pets. -May be a naturally occurring opportunity for a family to introduce children to the concept and experience of death and dying.

Logistical support

-Instrumental (pamphlets, arranging transportation, a drink of water) -Giving concrete assistance to help weather the crisis.

Psychological factors of women in a battering relationship:

-Lack of self-esteem as a result of being told over and over that they are stupid, incompetent or otherwise inadequate. -Lack of control and little confidence in their ability to take any meaningful steps to improve their marriage. -Experienced a history of abuse that leads them to accept their role as victim, or saw their mothers abused and accepted it as their lot. -So ashamed that they hide their physical and emotional wounds and become socially and emotionally isolated. -Lack personal, physical, educational and financial resources that would allow them to get out of the battering situation. -Extremely dependent and willing to suffer grievous insult and injury to have their needs met. -Idealized view of what a relationship should be and somehow feel they can fix or change the man. -Not have good communication skills, in regard to asserting their rights and feelings. -Stereotyped sex roles and thus feel guilty if they do not adhere to a rigid patriarchal system. -Be unable to differentiate between sex and love and believe that love is manifested through intense sexual relationships.

Parent survivors of suicide

-Likely to suffer severe psychological repercussions as they attempt to come to terms with their loss. -Immediate response tends to be hostility towards others, denial of the suicide and rationalization of death as accidental. -Guilt and depression soon follow and the likelihood of severe and continuing dysfunction with the surviving family members grow. -Keeping them from becoming more isolated with their negative feelings is critical.

Loss due to caregiving

-Major issue for spouses and parents -Relief from long term care of the terminally ill seems to allow caregivers to cope with their loss better.

Emergency/Outcry

-Major problem is to get the individual stabilized--reducing anxiety and physical responses associated with the trauma. -Relaxation training and meditation teaches the client how to relax body muscle groups systematically and to focus calmly on mental images that produce psychic relief of boy tensions and stress.

Dynamics of partner violence

-Male supremacy -Expects women to be passive and submissive -"Traditional" male and female roles -Question of power is the fuse that ignites -Complex interplay of social, cultural and psychological factors.

Grief - Battered women

-Many battered women go through this. -May be viewed as "pathological" and often puzzles those trying to help her. -Coming to terms with the loss of a significant relationship, shared parental responsibilities and a clearly defined role as a wide. -For what is she mourning? In most cases, she has defined herself in terms of her relationship with the batterer and if that relationship ends, she feels she has lost everything, including her sense of self.

The Adaptive Model

-Martin and Doka identify grieving as three basic styles that operate along a continuum with intuitive grieving on one end, instrumental grieving on the other and an infinite number of variations between the two. -Heavy emphasis on spiritual components because of the model's strong theoretical basis in Jungian psychology and the fact that many people place a great deal of emphasis on the spiritual aspects of adaptive grieving.

Bereavement in childhood

-May show overt signs of bereavement, but sometimes their grief may be covert, leading caregivers to assume that they are not affected by the loss. Strengthening school support systems is important .

Motivation for the batterer

-Men who are younger, less educated, have lower incomes, were abused as children, and are minorities drop out of treatment at higher rates. -Older, have no arrest record, better educated, employed, have more children and witnessed abuse but were not abused themselves as children do better in treatment. -Structure groups tend to be more effective.

Texas revised inventory of grief

-Most widely used inventory to measure grief -Two scales: current grief and past disruption, allows the workers to determine the kind of process in grief resolution has been made. -Inventory asks respondents to rate themselves on a Likert scale (1= completely false, 5= completely true) in response to 8 questions about pasts behavior at the time the person died and 13 questions about how the person presently feels about the person's death. -Few validity studies

Intervention and treatment in childhood bereavement

-Must be approached not in terms of adult perspectives but in terms of each child's understanding and developmental stage. -Care must be taken to provide reassurance and support during family bereavement. -Need to hear over and over again the simple, truthful, reassuring words of adults who are relatively secure and who show genuine concern for the child's feelings. -Children who are informed about the loss truthfully and permitted to participate in active mourning will make healthier adjustments. -Should be permitted to proceed with mourning at a level and pace appropriate to their development.

Bereavement in adolescence

-Needing to be included in the family's grief while also needing periods of privacy. -May feel a deep sense of pain, fear, anger, guilt, hopelessness, confusion, loneliness and grief they may not know how to express or feel comfortable in expressing these emotions. -Interventions that include parents individually or in treatment groups can be effective in supporting both adolescents and surviving parents in moving forward. -Parents should understand and acknowledge the importance of the loss and avoid discounting the loss and turning it into disenfranchised grief. -School is a major source of support.

Suicide in older adults

-One of the most neglected areas in the field of suicidology. -The most lethal and often well planned. -Male/Caucasians at highest risk -75% had been to their family doctor within the previous 30 days. -May engage in chronic or passive suicide when they decide to quit taking their medication because of side effects, cost, or the notion that stopping taking it will hasten death. -Primary technique is to remotivate them to live.

Vicarious traumatization

-Phenomenon of countertransference -Transformation that occurs when an individual begins to change in a manner that mimics a client's trauma related sumptoms. -Constructivist model in which the individual's experience and worldview are changed as a direct result of secondary exposure to trauma through crisis intervention. -Occur as a result of an accumulation of experiences across therapies and clients are felt far beyond the transference-countertransference issues of a specific client-therapist relationship. -Potential to permanently change the psychological constructs of workers who engage in intense and long-term trauma and are an inevitable occupational hazard of trauma work.

Compassion fatigue

-Phenomenon of countertransference -Used interchangeably with secondary traumatic stress disorder. -Similar and parallel to PTSD, except that exposure is to the person relating the event and not the event itself. -Potential to permanently change the psychological constructs of workers who engage in intense and long-term trauma and are an inevitable occupational hazard of trauma work. -Occur as a result of an accumulation of experiences across therapies and clients are felt far beyond the transference-countertransference issues of a specific client-therapist relationship.

Task # 5 - Planning in order to reestablish control

-Planning to reestablish control to mobilize the client. -Making plans in collaboration with the client so that the clients feel a sense of ownership of the plan and that they do not feel robbed of their control/autonomy/independence. -Plans help restore sense of control. -Planning is about getting through the short term and getting some semblance of equilibrium and stability restored (most plans are measured in minutes, hours, days). -Psychoeducation

Child survivors of suicide

-Potential for severe pathological problems is extremely high. -Other outcomes include psychosomatic disorders, learning disabilities, obesity, running away, tics, delinquency, sleepwalking, fire setting, encopresis, social adjustment problems, depression, ptsd symptoms. -May exhibit shame, denial, concealment and experience ostracism by their peers. -If intervention does not occur, they may feel bound to suffer the same fate. - Can cause complicated traumatic grief.

Task #1 - Predispositioning/engaging/initiating contact

-Predisposing individuals to be receptive to our intervention when in many instances, they may not be enthused about our presence or be so out-of-control that they are only vaguely aware of us. -Has a lot to do with the attitudinal set and predisposition of how the crisis worker enters the situation. -The ability to convey empathy and be authentic to who and what you are doing without pretense. -Establishing a psychological connection - introduce yourself in a non-threatening and helpful way. -One of the most important elements in making first contact is getting the client's name and introducing yourself.

Expanded Crisis Theory

-Psychoanalytic Theory -Systems Theory -Eco-Systems Theory -Adaptational Theory -Interpersonal Theory -Chaos Theory -Developmental Theory

Psychache

-Refers to the hurt, anguish, soreness and aching pain of the psyche or mind. -Term coined by Edwin Shneidman -His cubic model combines psychache, perturbation and press... when all three are combined, they create the critical mass necessary to activate a suicide.

Grounding

-Refocuses clients' attention onto the immediate therapeutic environment or when over the phone or internet, on the physical surroundings they are presently inhabiting as opposed to flashbacks, intrusive thoughts and dissociative states that are beginning to overwhelm them. -Critical component in which clients are taught to put their feet on the ground, get physically and psychologically anchored and stop the fragmentary thought processes and heightened affect that lead to depersonalization, flashbacks and overpowering emotions.

RESPECTFUL

-Religious/spiritual -Economic class -Sexual Identity -Psychological development -Ethnic/racial identity -Chronological age -Trauma and threats to well being -Family -Unique physical issues -Language and location of residence.

Emile Durkheim's Social Integration

-Social integration and social regulation are major determinants of suicidal behavior. -Four types of suicide: egoistic, anomic, altruistic and fatalistic.

Hopelessness Theory

-Some individuals believe that highly desired outcomes will not occur or that highly aversive outcomes will occur and that there is nothing they can do to change the situation. The only escape is death. -Beck's cognitive triad of negative thoughts about self, the world and the future are at the heart of hopelessness.

Freudian Inward Aggression

-Suicide is triggered by an intrapsychic conflict that emerges when a person experiences great psychological stress. -Sometimes stress emerges either as regression to a more primitive state or an inhibition of one's hostility toward other people or toward society so that one's aggressive feelings are turned inward toward the self. -Freud called this the melancholic state, we now call it depression. -In some cases, melancholy becomes so severe that self-destruction or self-punishment is chosen over urges to lash out at others.

Inventory of Complicated Grief

-Targets symptoms of grief that are distinct from bereavement-related depression and anxiety and predicts long-term functional impairments.

Developmental Theory

-Tasks that are not met and accomplished during particular life stages tend to pile up and cause problems. -When an external, environmental or situational crisis feeds into a preexisting developmental crisis, intrapersonal and interpersonal problems may reach the breaking point.

The dual process model

-The griever sometimes confronts and sometimes avoids the stressors of both a loss of orientation and a restoration of orientation. -Job of the worker is to encourage this oscillation. 1. Identify and explore loss and restoration stressors and the specific avoidance and confrontation responses the client uses. 2. Keep in mind that an initial period when the client is fixed in a loss of orientation is normal. Identify evidence (or lack thereof) of oscillation as time moves forward. 3. Normalize and validate the dual process model by explaining how it works and why it applies to the client's particular situation. 4. Address problematic avoidance such as excessive alcohol/drug use, extreme denial, suppression of emotion or acting out. 5. Do not push clients toward the restoration, let the oscillation work. 6. Psychoeducation with family and other support systems as to how this model works.

Realities for abused women

-The woman has a fear of reprisal or aggravating the attacks even more. -Situation may be intolerable but the women and her children have food, clothing and shelter. -Woman would suffer shame, humiliation and ridicule if her secret got out. -Her self-concept is so strongly dependent on the relationship and perceived social approval that leaving would be very destructive to her. -Early effection and prior love in the relationship persist and by staying, the woman hopes to salvage them. -If financially well off, the woman is unable to forgo a reduction in her financial freedom. -Cyclic nature of abuse may cause the victim to forget the battering and remember only the good times. -Early role models of an abusive relationship may lead her to believe that relationships exist is no other way. -Woman may hold religious values that strongly militate against separation, divorce or anything less than filial subjugation to the man's wishes. -Woman may be undereducated have small children to raise and no job skills. -She may be kept socially, physically, geographically and socially isolated that she has no resources of any kind to help her get out. -She may be so badly injured that she is physically unable to leave. -She may believe the mans promise to reform -She may be concerned for children who are still at home. -Love or sorrow at the mate's professed inability to exist without her may impel her to stay. -Because of previous negatives experiences with the authorities, she may believe she has no options. -Due to language barriers or immigration status, she may be unable to communicate her abuse or she may be afraid to seek help.

Numbing/Denial

-This phase is concerned with bringing to conscious awareness the traumatic event and the hidden facts and emotions about it that the individual denies. - In a gentle but forceful way, the worker guides the individual in the here and now of the therapeutic moment, to re-experience in the fullest possible detail what occurred in the traumatic experience so that submerged feelings are uncovered an ultimately expunged.

People with borderline personality disorder

-Ultimate test of the therapist's ability to handle manipulative behavior and can create severe crises for themselves and the therapist if not dealt with in specific ways. -Somewhere between neurosis and psychosis -Possible childhood abuse and neglect, "complex PTSD" -Hallmark of the person who is in transcrisis -Severe attachment problems -Harbor a deep sense of betrayal -Testing of the relationship and paranoia -Manipulative

Defining rape

-Unwanted act of oral, vaginal or anal penetration committed through the use of force, threat of force or when incapacitated; sexual assault refers to a broader range of criminal offenses such as sexual battery and sexual coercion up to and including rape.

Positive aspects of an effective multicultural counselor

-Uses methods and strategies and defines goals consistent with the life experiences and cultures values of the client. -Worker should demonstrate empathy, caring and positive regard while searching for a role that is compatible with the client's worldview and offers to act as advocate without injecting his or her own values or condition into the situation. 1. Examine and understand the world from the client's viewpoint 2. Search for alternative roles that may be more appealing and adaptive to clients from other backgrounds 3. Help clients from other cultures make contact with and elicit help from indigenous support systems.

Chronic state

-Usually requires a greater length of time in counseling. -Needs help in examining available coping mechanisms, finding support people, rediscovering strategies that worked during previous crises, generating new coping strategies and gaining affirmation and encouragement from the worker and others as sources of strength by which to move beyond the present crisis.

Acute state

-Usually requires direct intervention to facilitate getting over the specific event or situation that precipitated the crisis. -Having reached a state of precrisis equilibrium, the client can usually draw on normal coping mechanisms and support people and manage independently.

Exchange theory

-Variant of a learning theory approach -Proposes that batterers hit people because they can. -As long as the costs for being violent do not outweigh the rewards, violence will invariably be used as a method of control. -When police, criminal charges, imprisonment, loss of status and income are not used as punishment, batterers will continue to batter. -Gender inequality allows batterers to become violent without fear of retribution. -Certain subcultures in which aggressive and violent behaviors are proof of being a "real man". -Exacting costs from a partner to pay or her or his supposed sins and transgressions is itself satisfying to the batterer.

Job loss bereavement

-We are defined by our careers -Alcoholism, drug use, battering, child abuse, divorce, suicide and murder may occur at the hands of this. -Depression, anger, blame, projection, loss of self-esteem, loss of personal identity, lower self-concept, loss of social support systems, stigmatization, loss of control, disintegration of ego integrity and overall negative mental health may occur. -The view of the newly unemployed person is shattered, their view of a just world is challenged, and views of themselves as valuable and worthy are invalidated.

Complicated/prolonged grief bereavement

-When a person is unable to mourn a loss and move on in a context of renewal and growth -Persistent and does not tend to go away. -Some don't have symptoms until 6 months after the loss. -Others have acute symptoms that occur immediately and continue for a year or more. -Tend to experience co-occuring disorders such as PTSD, major depressive disorder and generalized anxiety. -Higher incidence of suicide -The person denies, represses or avoids aspect of the loss, its pain and the full realization of its implications for the mourner. -The individual holds onto and avoids relinquishing the lost loved one.

Intermediate/middle school age bereavment

-Will understand the permanence of death but may exhibit a good deal of anger and rage at the unfairness of it. -May experience a foreboding and doom about a foreshortened future and see their existence as now pretty meaningless. -May alternately feel euphoria and excitement at having survived, then guilty feelings for having survived when others didnt. -Such mood swings may occur often and dramatically as they attempt to cope with emotional dysregulation.

HIV/AIDS Bereavement

-Worker must be prepared to consider a variety of the client's secondary losses such as stigmitization, personal rejection, prejudice, religious rejection, job loss, economic deprivation, guilt, shame and loss of self-esteem. -Victims may feel emotional and physical abandonment, romantic betrayal, and face medical treatment issues that spread a sense of loss and grief across multiple dimensions of their lives. -Short and long term prognosis may be grim -Lack of privacy and confidentiality, loss of dignity with increasing physical dependency, sexual unacceptability, lose physical and financial independence. -Typically strikes people who have fewer resources to combat it.

Types of Resolution Coping Methods

1. Active Cognitive Coping 2. Active Behavioral Coping 3. Avoidance Style Coping

7 Characteristics of Coping Behavior

1. Actively exploring realty issues and searching for information. 2. Freely expressing both positive and negative feelings and tolerating frustration. 3. Actively invoking help from others. 4. Breaking problems into manageable bits and working through them one by one. 5. Being aware of fatigue and pacing coping efforts while maintaining control. 6. Modeling feelings, where possible, being flexible and willing to change. 7. Trusting in oneself and others and having a basic optimism about the outcome.

Client functioning in crisis case-handling mode

1. Affectively, the client is impaired to the extent that there is little understanding of his or her emotional state. 2. Cognitively, the client shows inability to think linearly and logically and formulate strategies to alleviate the crisis. Irrationality is the norm. 3. Behaviorally, the client is out of control and may pose a danger to self or others.

Chicago's Rush Presbyterian St Luke's Medical Center protocol to be followed in the medical setting once a battered woman has been identified

1. Assign a primary nurse. 2. Notify appropriate support services within the hospital. 3. Give complete physical exams along with a neurological exam and x-rays. 4. Document statements about who caused the injuries. 5. Make a body map of old and new injuries. 6. Depending on the jurisdiction, make a call to the police, identify the assailant and have him arrested if possible. 7. Take photographs of the victim's injuries. 8. Inform the patient of her right to access her medical files and how to do it. 9. Discuss with the woman a posthospital plan that will include shelter or other referral, safety plans if she is not leaving the abusive situation and community support services.

Grounding steps

1. Attempt to focus the client's attention on the therapist - "I am right here, we are together in this room and we are doing exposure therapy. You are not back in the bedroom 20 years ago" 2. Ask the client to describe the internal experience he or she is presently having - "Describe whats going on right now". 3. Orient the client to the immediate environment that he or she is in- the room with the worker, where it is, how it looks, whats in it and how safe it is and that it is not in the bedroom 20 years in the past. 4. If the client is still indicating stress, start deep breathing and relaxation techniques (teaching these techniques to the client is reccommended). 5. Repeat step 2 and assess the clients ability to return to therapy.

Communicating empathy

1. Attending 2. Verbally communicating empathetic understanding 3. Reflecting feelings 4. Nonverbally communicating empathetic understanding 5. Silence as a way of communicating empathetic understanding

Communicating genuineness

1. Being role free 2. Being spontaneous 3. Being nondefensive 4. Being consistent 5. Being a sharer of self

Myths about males and sexual assault

1. Boys and men cant be willing victims 2. Homosexuals are usually perpetrators of sexual abuse of boys. 3. Boys are less traumatized than girls. 4. Boys abused by males will later become homosexuals. 5. Vampire/zombie syndrome - once you get bitten, you become one. 6. If a boy or girl experiences sexual arousal or orgasm from abuse this means he enjoys it. 7. If the perpetrator is female, the boy just got lucky.

Changing behavior through skill building and reconnecting

1. Changing behavior to more self-determining choices is the major end goal of therapy. 2. Reeducation is necessary for survivor skill building. 3. Important to urge survivors to join therapy or support groups so that new behaviors can be tested out and discussed with peers. 4. As survivors reconstruct their lives and start to become interested in developing meaningful relationships, there are 5 basic fears that they will have to deal with: abandonment, exposure, merger, attack, and their own destructive behavior.

Client functioning in long-term therapy mode

1. Client shows sufficient affect; manifests some basis for experiencing and understanding his or her emotional state. 2. Client shows some ability to cognitively understand the connection between behavior and consequences - between what is rational and irrational 3. There is some modicum of behavioral control

Approach to Psychological First Aid

1. Contact and engagement - goal: respond to contacts initiated by survivors or to initiate contacts in a non-intrusive, compassionate and helpful manner. 2. Safety and comfort - goal: to enhance immediate and ongoing safety and provide physical and emotional comfort. 3. Stabilization (if needed) - goal: to calm and orient emotionally overwhelmed or disoriented survivors. 4. Information gathering, current needs and concerns - goal: to identify immediate needs and concerns, gather additional information and tailor psychological first aid interventions. 5. Practical assistance - goal: to offer practical help to survivors in addressing immediate needs and concerns. 6. Connections to social supports - goal: to help establish brief or ongoing contacts with primary support persons and other supports (family, friends, community). 7. Information on coping - goal: provide information on stress reactions and coping to reduce distress and promote adaptive functioning. 8. Link to collaborative services - goal: link to services needs presently or in the future.

Treatment goals for children and the victimized parent

1. Creating an alliance with the parent to help the child heal 2. Providing psychoeducation to both parent and child about the trauma and therapy 3. Restoring the parent's self esteem and confidence. 4. Establish a safe therapeutic environment for the child to express thoughts and feelings 5. Relieving the child's symptoms, including difficulty with living transitions, sleeping, nightmares and other trauma symptoms. 6. Reestablishing the child's previous level of cognitive functioning and strong attachment with the caregiver. 7. Reassurance that what has happened is not the child's fault and the child is not guilty of anything. 8. Helping the child to express thoughts and feelings and regain cognitive and emotional regulation. 9. Providing stress reduction strategies to aid in stopping emotional dysregulation.

ACT Model Linear Stages

1. Crisis assessment 2. Establishing rapport 3. Identifying major problems 4. Dealing with feelings 5. Generating and exploring alternatives 6. Developing plans 7. Providing follow up

What is covered in CIT (crisis intervention team program) training

1. Cultural awareness of the mentally ill 2. Substance abuse and co-occurring disorders 3. Developmental disabilities 4. Treatment strategies and mental health resources 5. Patient rights, civil commitment and legal aspects. 6. Suicide intervention 7. Using mobile crisis team and community resources 8. Psychotropic medications and their side effects 9. Verbal defusing and de-escalating techniques 10. Borderline and other personality disorders 11. Family and consumer perspectives 12. Fishbowl discussion on-site with mentally ill patients on patient perceptions of the police.

Types of Loss

1. Death of a spouse 2. Loss due to caregiving 3. Death of a child 4. Bereavement in childhood 5. Bereavement in adolescence 6. Bereavement in elderly people 7. HIV 8. Job loss 9. Separation 10. Death of a pet 11. Complicated/prolonged grief, bereavement, and mourning reaction. 12. Traumatic death 13. Traumatic grief

Cognitive-Behavioral Problem Solving

1. Define a problem as clearly as possible. 2. Review ways that you have already tried to correct the problem, paying attention to what worked and what didn't. Build on their strengths and develop new strengths so that the client can effectively problem solve. 3. Think through the plan of action and possible alternatives. 4. Commit to following through on the plan of action. 5. Review results. 6. Evaluate progress and follow up.

Effects of sexual abuse on adult survivors

1. Depression, anxiety, shame, humiliation. 2. Borderline personality disorder, dissociative disorder and PTSD. 3. Social stigmatization, alienation, inhibitions, introversion and interpersonal hypersensitivity. 4. More contacts with medical doctors for somatic complaints including chronic pain problems such as fibromyalgia and irritable bowel syndrome and long term physical health deficits. 5. Negative self image, poor interpersonal relationships and poor parenting skills and suicide.

Principles of long-term therapy mode

1. Diagnosis - complete diagnostic evaluation 2. Treatment - focus on basic underlying causes: on the whole person 3. Plan - personalized comprehensive prescription directed toward fulfilling long-term needs 4. Methods - knowledge of techniques to systematically effect a wide array of short-term, intermediate-term and long-term therapeutic gains. 5. Evaluation of results - behavioral validation of therapeutic outcomes in terms of the client's total functioning.

Principles of crisis-case handling mode

1. Diagnosis - rapid triage crisis assessment 2. Treatment - focus on the immediate traumatized component of the person 3. Plan - individual problem-specific prescription focused on immediate needs to alleviate the crisis symptoms 4. Methods - knowledge of time-limited brief therapy techniques used for immediate control and containment of the crisis trauma 5. Evaluation of results - behavioral validation by client's return to pre-crisis level of equilibrium.

Myths about suicide

1. Discussing suicide will cause the client to move toward doing it. 2. Clients who threaten suicide don't do it. 3. Suicide is an irrational act. 4. People who commit suicide are insane. 5. Suicide runs in families, it is an inherited tendency. 6. Once suicidal, always suicidal. 7. When a person has attempted suicide and pulls out of it, the danger is over. 8. A suicidal person who begins to show generosity and share personal possessions is showing signs of renewal and recovery. 9. Suicide is always an impulsive act. 10. Suicide strikes only the rich. 11. Suicide happens without warning. 12. Suicide is a painless way to die. 13. Few professional people kill themselves. 14. Christmas season is lethal. 15. Women don't use guns to kill themselves because of disfigurement. 16. More suicides occur during a full moon. 17. Suicidal people rarely seek medical attention. 18. Most elderly people who commit suicide are terminally ill. 19. Suicide is limited to the young. 20. Suicidal thoughts are relatively rare.

People with borderline personality disorder therapeutic relationship

1. Do everything in their power to turn the therapeutic relationship upside down. 2. Frequent crises (suicide threats, drug abuse, sexually acting out, financial irresponsibility, problems with the law). 3. Extreme or frequent misinterpretations of the therapist's statements, intentions or feelings with strong transference issues which can illicit even stronger countertransference issues in the therapist. 4. Strong, negative, acting-out reactions to changes in appointment time, room changes, vacations, fees, or termination in therapy. 5. Low tolerance for direct eye contact, physical contact or close proximity in therapy. 6. Strong ambivalence on issues. 7. Fear of and resistance to change with inability or resistance to carry out therapeutic assignments. 8. Frequent calls to, spying on and demands for special attention and treatment from the therapist. 9. Inordinate hypersensitivity to significant others including the therapist.

Don'ts of suicide management

1. Don't lecture, blame, give advice, judge or preach. 2. Don't crticize choices or behaviors. 3. Don't debate the pros and cons of suicide. 4. Don't be misled by the client telling you the crisis has passed. 5. Don't deny the client's suicidal ideas. 6. Don't try to challenge for shock effects. 7. Don't leave the client unobserved, isolated and disconnected. 8. Don't analyze or diagnose behavior confront the client with interpretations during the acute phase. 9.Don't be passive. 10. Don't overract 11. Don't keep the client's suicidal risk a secret. 12. Don't get sidetracked on extraneous or external issues or persons. 13. Don't glamorize, martyrize, glorify, heroize or deify suicidal behavior in others, past or present. 14. Don't become defensive or avoid strong feelings. 15. Don't hide behind pseudoprofessionalism and clinical objectivity as a way of distancing yourself from painful and scary material. 16. Don't fail to identify the precipitating event. 17. Don't terminate the intervention without obtaining some level of positive commitment (you may get sued if you don't). 18. Don't forget to follow up (you may get sued if you don't). 19. Don't forget to document and report (you may get sued if you don't). 20. Don't be so embarrassed or vain that you don't consult (you may get sued if you don't). 21. Don't fail to make yourself available and accessible (you may get sued if you don't) 22. Take your time, don't be hurried. 23. Watch for countertransference. 24. Don't be blackmailed into caving into client demands.

Assessing the client's current emotional functioning

1. Duration of the crisis (acute/situational, chronic/long-term) 2. The degree of emotional stamina or coping at the client's disposal at the moment (determing how much coping strength is left in the client's reservoir) 3. The ecosystem within which the client resides 4. The developmental stage of the client

Phases of Recovery PTSD

1. Emergency or outcry phase 2. Emotional numbing and denial phase 3. Intrusive-repetitive phase 4. Reflective-transition phase 5. Integration phase

Phases of childhood sexual abuse

1. Engagement 2. Sexual interaction 3. Secrecy 4. Disclosure 5. Suppression 6. Survival

Objectives of crisis-case handling mode

1. Ensure client safety 2. Predisposition 3. Define problem 4. Provide support 5. Examine alternatives 6. Develop a plan 7. Obtain commitment 8. Follow-up

Treatment goals for the batterer

1. Ensure the safety of the victimized partner 2. Alter the batterer's attitudes towards violence 3. Increase the batterer's sense of personal responsibility and teach him about equity issues 4. Help the batterer learn nonviolent alternatives to past behaviors. Usually treated with a combo of anger management, stress reduction, communication skills and sex role resocialization.

Social/cultural factors of rape

1. Gender inequality - economic, political and legal status of women in comparison to men 2. Pornography - reduces women to sex objects, promotes male dominance and encourages or condones sexual violence against women 3. Social disorganization - erodes social control and constraints and undermines freedom of individual behavior and self determination 4. Legitimization of violence - the support the culture gives to violence as portrayed in the mass media, laws permitting corporal punishment in schools, violent sports, military exploits and video games.

Massachusetts Coalition of Battered Women's Service Groups recommendations

1. Help women think and act on their situation by providing legitimate reinforcement for their efforts. 2. Help women figure out what they want by providing a sounding board for examining ideas and alternatives. 3. Help women identify feelings that prevent them from making decisions. 4. Be honest - the worker cannot tell a person what to do but can clearly state from her own life how the situation would affect her. 5. Help women to do things for themselves, but do not let them become dependent on the worker. 6. Know and offer resources from which battered women can get specific kinds of assistance: spell out who, what, where, when, why and how. 7. Help women gain a sense of self-confidence and ability to take care of themselves. 8. Be challenging. Support women, but do not be afraid to push them toward a decision making point. 9. Be open to choices. Each woman has control over her life, the crisis worker must not attempt to assume control for clients. 10. Hear and understand what women have to say, particularly if it does not run parallel to the worker's own beliefs, attitudes and outlooks. 11. Build on the commonalities that women, particularly battered women, share, but recognize the worth of the individual differences of each person. 12. Assess lethality (suicide) "I'm fed up".

Personal and psychological factors of rape - The male offender:

1. Hostile, aggressive, angry, condescending, domineering and believes he is strong, courageous and manly although he often feels weak, anxious, inadequate, threatened and dependent and believes women are inherently dangerous. 2. Lacks interpersonal skills to make his point in society, particularly with women. 3. Need to exercise power to prove to himself and to the victim that he is powerful and in control. 4. Sadistic patterns, extreme violence and mutilates or murders the victim in order to attain a feeling of triumph over the victim. 5. Sees women as sex objects and his urges are uncontrollable and all consuming. 6. Holds stereotypical views of male/female roles. 7. Chronic feelings of anger, hostility and fear towards women and seeks to control them by his sexual conquests.

Active Cognitive Coping

1. Identify crisis 2. Help them get back to the resolution, the "upswing", so that they can function in the world. 3. Help them develop a plan. 4. When people are in this state, they are more receptive to help.

Crase's finding how older generations deal with loss

1. Ignoring death issues - 1st group 2. Thinks about death and dying excessively - 2nd group 3. Healthier balance - 3rd group

Treatment outcomes for children (domestic violence)

1. Increased knowledge of emotional and physical effects of family violence 2. Understanding that violence in the family is not okay and its not their fault. 3. A reduction in stress-related or ptsd symptoms" increased ability to self-regulate emotions. 4. Decreased negative self-talk 5. Improved ability to identify feelings and the ability to communicate those to peers and adults. 6. Increased sense of social support. 7. Stronger connection with the nonabusive parent. 8. Resilience to cope with future crises.

Assessment in long-term therapy mode

1. Intake data - client is stable enough to provide in-depth background regarding the problem. Comprehensive may be performed. 2. Safety - usually not primary focus 3. Time - more time 4. Reality testing - worker assumes client is in touch with reality 5. Referrals - have implications for long-term development 6. Consultation - available as needed 7. Drug use - has information to determine the level and type of prescription medication or illicit drug or alcohol use. 8. Disposition - starts and finished with the same therapist over a course of months. Come and go voluntarily.

Assessment in crisis-case handling mode

1. Intake data - may not be able to fill out intake form because of instability or time 2. Safety - first concern 3. Time - no time for administering formal instruments 4. Reality testing - by using simple questioning procedures 5. Referrals - implications of immediacy 6. Consultation - May be available but most often the worker is on their own 7. Drug use - relies on verbal and visual responses 8. Disposition - starts and stops with the same worker over a course of hours or days.

Myths about rape

1. It's just rough sex. 2. Women cry rape to gain revenge. 3. Motivated by lust. 4. Rapists are weird, psychotic loners. 5. Victims provoked the rape or wanted to be raped. 6. Only bad women are raped. 7. Real rapes only happen in bad parts of town at night in abandoned buildings or lonely fields by strangers or have knives or guns and who engage in brutally beating the victims when they resist heroically, even unto death 8. If the woman doesn't resist, she must have wanted it.

Conceptual Approaches to Bereavement

1. Kubler-Ross's Stages 2. Bowlby's Attachment Theory 3. Schneider's Growth Model 4. The Dual Process Model 5. The Adaptive Model

Telephone crisis strategies

1. Making psychological contact 2. Defining the problem 3. Ensuring safety and providing support 4. Looking at alternatives and making plans 5. Obtaining commitment 6. Errors and fallacies

Applies Crisis Theory

1. Normal developmental maturation crises 2. Situational crises 3. Existential crises 4. Eco-systems crises

Active Behavioral Coping

1. Now that the client has a plan, they are going to follow it through. 2. If it's not a great plan or not working, go back to individual and start thinking through a better plan and working through the procedure.

Suicide risk factors

1. Older than 70 or younger than 20 2. Male 3. Caucasian 4. Hx alcoholism and other substance abuse 5. Schizophrenia, bipolar, borderline, anorexic, depressed. 6. Single 7. Lost a job etc, etc, etc.

Risks of PTSD Treatment

1. Partial recovery 2. Therapy/hospitalization may impact employment. 3. May get worse before gets better. 4. Interpersonal relationships may be impacted by personality changes. 5. Psychic pain may become intolerable. 6. Individual may fear that giving vent to those emotions will lead to uncontrolled anger and result in physical harm to others. Difficult to give up the idea of revenge. 7. Individual will safeguard against change and may have difficulty doing what others suggest. 8. Individual is in danger of losing patience with the world and falling bck in PTSD vortex. 9. Acceptance of one's own set of infirmities, bad memories may return, relationships might not be perfect, others might get the job for no good reason, etc.

Bereavement in the elderly

1. Present more somatic problems than psychological problems. 2. No indication that the intensity of grief varies significantly with age of the person. 3. May be more prolonged than among younger people. 4. Tend to be lonelier and to have far longer periods of loneliness than younger people.

Objectives of long-term therapy mode

1. Prevent problems 2. Correct etiological factors 3. Provide systematic support 4. Facilitate growth 5. Re-educate 6. Express and clarify emotional attitudes 7. Resolve conflict and inconsistencies 8. Accept reality 9. Reorganize attitudes 10. Maximize intellectual resources

Webb Play Therapy for Grief

1. Provides cathartic relief from tensions and anxiety 2. Provides ways for child to symbolically review in play what happened, build armor plate against the feared feelings of the traumatic event in concrete form through manipulating the play media. 3. Permits role rehearsal to strengthen the child's feeling of competence in handling the future. 4. Can provide a restorative function and transformative experiences that moves the child from despair, hopelessness and lack of self confidence to reconciliation, hope and self confidence.

Psychological First Aid

1. Seeks to address the immediate crisis situation and provide immediate relief possible to a wide range of individuals. 2. Establishing safety of the client, reducing stress-related symptoms, providing rest and physical recuperation and linking clients to critical resources and social support systems. 3. Prevailing approach is an intervention that is non-intrusive and does not promote discussion of the traumatic event. 4. Designed to provide non-intrusive physical and psychological support.

Ground rules for counseling difficult clients

1. Start and quit on time. If couples are involved, both parties must be present 2. No physical violence or threats of violence 3. Everyone speaks for themselves 4. Everyone has a chance to be fully heard 5. We deal with the here and now, try not to get bogged down in the past 6. Nobody gets up and leaves because the topic is uncomfortable, everyone stays for the entire session. 7. Everyone gets an opportunity to define the current problems, solutions and make at least one commitment to do something positive. 8. Limits to graphic descriptions, abusive language and swearing/cursing need to be clear as to what will and will not be tolerated. 9. Everyone belongs because he or she is a human being and because he or she is here. 10. The worker will not take sides. 11. No retribution, no retaliation or grudges over what is said in the session. Whatever is said in the session stays in the session. 12. Time spent together is for working on the concerns of the person or people in the group-- not for playing games, making personal points, diversion, ulterior purposes, or carrying tales or gossip outside the session. 13. When we know things are a certain way, we will not pretend they are another way. We will confront and deal with each other as honestly and objectively as we possibly can. 14. We will not ignore the nonverbal or body messages that are emitted, we will deal with them openly if they occur. 15. If words or messages need to be expressed to clear the air, we will say them either directly or with role playing--we will not put them off until later. 16. We will not expect each other to be perfect. 17. No "wet" clients-- we don't work when clients are drunk or using drugs. 18. If ground rules are broken, the consequences will be discussed by the persons involved immediately with the crisis worker. People who comply with the rules will not be denied services because one person disobeys the rules.

Grief Assessment Tools

1. The Texas revised inventory of grief (trig) 2. Grief experience inventory (gei) 3. Hogan grief reaction checklist (hgrc) 4. Inventory of complicated grief (icg)

Benefits of group treatment

1. The individual's sense of shame, stigmatization, and negative self image are reduced by meeting other survivors who appear normal. 2. Commonality of experience raises members' consciousness about incest, so the experience becomes more normalized and may be seen from an interpersonal and sociocultural perpsective rather than an "only me" perspective. 3. The group serves as a new surrogate family where new behaviors and methods of communicating , interacting and problem solving can be practiced in a safe, accepting and nurturing environment. 4. The group allows for safe exploration and ventilation of feelings and beliefs that have been denied and submerged from awareness. 5. Childhood messages and rules that were generated within the abusive environment can be challenged and dissected to determine how they still influence the survivor's maladaptive patterns.

PTSD

1. The person must have been exposed to trauma in which he or she was confronted with an event that involved actual or threatened death or serious injury or a threat to self or others' physical well being. 2. The person persistently re-experiences the traumatic event. 3. The person persistently avoids stimuli. 4. The person has persistent symptoms of increased nervous system arousal that were not present before the trauma. 5. The disturbances cause clinically significant distress or impairment in social, occupational or other critical areas of living.

Tarasoff

1. There must be a special relationship, such as therapist to client. 2. There must be a reasonable prediction of conduct that constitutes a danger. 3. There must be a foreseeable victim.

Personal and psychological factors of rape - rapist's reasons for assault:

1. Use rape to punish or exact revenge because a specific woman has done them wrong. See all women as responsible for one woman's supposed transgressions. 2. Added bonus - it's here for the taking, so why not? 3. Attaining the unattainable - a woman they would otherwise never have a chance with. 4. Impersonal experience and preferred over any demonstrated caring or mutual affection. No obligations. 5. Gang rapists - see rape as recreation, adventure and proving they are macho. Male bonding.

People with borderline personality disorder presenting problem

1. Variety of presenting problems that may shift from day to day, week to week 2. Unusual combinations of symptoms ranging across a wide array of neurotic to sub-psychotic behaviors 3. Self-destructive and self-punitive behaviors ranging from self-mutilation to suicide attempts 4. Impulsive and poorly planned behavior that shifts through infantile, narcissistic or antisocial behavior 5. Intense emotional reactions out of all proportion to the situation 6. Confusion regarding goals, priorities, feelings, sexual orientation and so on 7. A constant feeling of emptiness with chronic free-floating anxiety 8. Unstable low self-esteem and high and unstable negative affect 9. Poor academic, work and social adjustment 10. Extreme approach and avoidance behavior to social relationships 11. Chronic suicidal and/or homicidal ideation 12. Paranoid ideation 13. Depersonalization and hallucinations 14. Drug and alcohol abuse 15. Sexual promiscuity and sexual victimization

Assessment in Suicide

1. Verbal clues - direct and indirect statements 2. Behavioral clues - purchasing a headstone, slashing one's wrists as a practice run. 3. Situational clues - concerns over death of a spouse, divorce, bankruptcy, or other drastic changes in one's life situation. 4. Syndromatic clues - constellations of suicidal symptoms as severe depression, loneliness, hopelessness, dependence and dissatisfaction with life.

Homicide/suicide of the elderly

3 Types 1. Aggressive - history of marital problems and violence. A pending separation for health, financial, domestic discord or other reasons will not be tolerated. Death for both is the only answer. 2. Dependent-protective caregiver - Couple have been married for a long time and are dependent on each other. The man is depressed and fears losing control when the health of one or both changes or if he merely believes it is changing. Increasing isolation and increasing helplessness in the male caregiver are the primary stimuli. 3. Symbiotic - Couple is highly interdependent. Both are usually very sick. Male has a dominant personality and female is submissive.

Freud's definition of psychic trauma

A process initiated by an event that confronts an individual with an acute, overwhelming threat. When the event occurs the inner agency of the mind loses it's ability to control the disorganizing effects of the experience and disequilibrium occurs.

Definition of Crisis

A state of disequilibrium - emotional distress that occurs after a stressor or a precipitating event. The person is unable to function in one or more areas of his or her life because of customary coping methods that have failed. Usually lasts 6-8 weeks. Impact may last a lifetime.

Affective state

Abnormal or impaired affect is often the first sign that the client is in a state of disequilibrium. Client may become overemotional or out of control, withdrawn, detached. -Often the worker can assist the client to regain control and mobility by helping the client express feelings in appropriate and realistic ways.

Non-verbal communication

Accurately picking up and reflecting more than verbal messages. Involves accurately sensing and reflecting all the unspoken cues, messages and behaviors the client emits. Worker should carefully observe body posture, body movement, gestures, grimaces, vocal pitch, movement of eyes, movement of arms and legs and other body indicators. Worker should be keenly aware of whether nonverbal messages are consistent with the client's verbal messages.

Problem Solving

Achieve a goal that's not easily attained.

Adolph Stern

American psychotherapist that described a group of clients who did not respond well to treatment and in fact generally got worse. He labeled them as somewhere between neurosis and psychosis (borderline personality disorder).

Confidentiality in case handling

An explicit promise to reveal nothing about an individual except under conditions agreed to by the source or the subject. Under scrutiny when the case involves the potential for violent behavior.

Anomic suicide

Arises from a perceived or real breakdown in the norms of society such as the financial and economic run of the great depression.

Validation

As a client starts through the process of therapy, numerous transcrisis points will occur as long-buried trauma is brought back to wareness. In an active, directive, continuous and reinforcing manner, the human services worker: 1. Validates that the abuse did happen, despite denial of this fact by significant others; the client is not to blame, it is safe to talk about it and the worker does not loathe the client for having been a participant. 2. Acts as an advocate who is openly, warmly interested in what happened to the survivor as a child and makes owning statements to that effect but still maintains neutrality and neither advocates for nor dismisses legal action The worker also understands there is a high potential for transference/countertransference and is clear and consistent in maintaining boundaries. 3. Reinforces the resourcefulness of the victim to become a survivor. 4. Provides a mentor/reparenting role model to help with childhood developmental tasks that were missed.

Callers agenda - passive aggressive

Cannot risk rejection by displaying anger in an overt manner. Rather, they engage in covert attempts to manipulate others and believe that control is more important than self-improvement. Counseling focus is to promote more open, assertive behavior.

Callers agenda - borderline

Chameleon-like and at any given time may resemble any mental disorder. Always at the borderline of being functional and dysfunctional.

Callers agenda - self defeating

Choose people and situations that lead to disappointment, failure and mistreatment by others. Reject attempts to help them and make sure that such attempts will not succeed. Counseling focus is to stress talents and the behavioral consequences of sabotaging them.

Grief resolution

Client comes to grips with the reality that there is no retrieving the past or changing it and that attempts to do so are fruitless. Only the future holds promise for he/she and he/she can control only that.

Adaptational Theory

Depicts a person's crisis as being sustained through maladaptive behaviors, negative thoughts and destructive defense mechanisms. Based on the premise that the person's crisis will recede when these maladaptive coping behaviors are changed to adaptive behaviors.

Play Therapy

Directive - collaborative and interactive between the child and the worker Non-directive - child-centered and worker passive. Non-directive may cause destructive behaviors or anxiety. Take the global, nebulous, uncontrollable chaos of the event and make it into a concrete, real object that the child can gain a sense of control over. May allow the therapist to enter the trauma on the child's cognitive terms, reduce the threat of the trauma, establish trust and determine the child's current means of coping and current ways of defending against the trauma.

Ethical principles of confidentiality

Do not have the weight of the law. General guiding codes of conduct for a particular profession. Violation may result in censure or loss of license mandated by the professions board, but it does not necessarily expose the professional to legal problems.

Complex PTSD

Dramatic personality changes that may occur with long-term intensive trauma. 1. Somatization - physical problems, associated pain and functional limitations. 2. Dissociation - division of the personality into one component that attempts to function in the everyday world and another that regresses and is fixed in the trauma. 3. Affective dysregulation - alterations in impulse control, attention and consciousness, self perception, perception of perpetrators, relationships to significant others and systems of meaning.

Callers agenda - bipolar (manic depressive)

Extreme mood swings. Manic phase to depressive phase. Counseling focus is to slow down and pace the client. Confrontation of grandiose plans only alienates them. In depressive stage, suicide prevention is a primary priority.

Callers agenda - Schizotypal

Feelings of inadequacy and insecurity. Strange ideas, behaviors and appearances. Counseling focus is to give them reality checks and to promote self-awareness and more socially acceptable behavior in a slow-paced supportive manner.

Hybrid Model of Crisis Intervention

Generally linear in progression but can also be seen in terms of tasks that need to be accomplished. Adaptable. Task # 1 - Predispositioning/engaging/initiating contact Task # 2 - Problem exploration: defining the crisis Task # 3 - Providing support Task # 4 - Examining alternatives Task # 5 - Planning in order to reestablish control Task # 6 - Obtaining commitment Task # 7 - Follow-up

Callers agenda - narcissistic

Grandiose, self-centered and believe they have unique problems that others cannot comprehend. Tend to see themselves as victimized by others and always need to be right. Counseling focus is to get them to see how their behavior is seen and felt by others, while not enaging them in a no-win debate or argument.

Promoting expansion

Helps clients step back, reframe the problem and gain new perspectives. Helps clients resolve stuck cognitive reactions. Effective with clients who are not able to recognive environmental cues that may help them to perceive alternative meanings of events and possible solutions to them.

Suicide warning signs

IS PATH WARM I for ideation S for substance abuse P for purposelessness A for anxiety and agitation T for feeling trapped H for hopelessness W for withdrawal A for anger R for recklessness M for mood fluctuations

Allowing catharsis

Letting clients talk, cry, swear, berate, rave, mourn or do anything that allows them to ventilate feelings and thoughts. Worker provides a safe and accepting environment that says that it is okay to say and feel these things.

Callers agenda - avoidant

Loners who have little ability to establish or maintain social relationships. Fear of rejection paralyzes their attempts to risk involvement in social relationship. Counseling focus is to encourage successive approximations to meaningful relationships through social skills and assertion training.

Ecosystems Theory

Looks at crises in relation to the environmental context within which it occurs. Systems in which all elements are interrelated and in which change at any level of those interrelated parts will lead to alteration of the total system.

Use of referral sources

Many clients need to be referred early to sources of help regarding financial matters, legal assistance, long-term individual therapy, family therapy, substance abuse, severe depression or other personal matters.

Cognitive state

May provide answers to important questions: -How realistic and consistent is the client's thinking about the crisis? -To what extent, if any, does the client appear to be rationalizing, exaggerating or believing past truths or rumors to exacerbate the crisis? -How long has the client been engaged in crisis thinking? -How open does the client appear to be towards changing?

Spirituality

Meaning and purpose in life, a sense of belonging-ness, a sense of universality, a sense of transcencedence, a sense of rising above human suffering.

Survivor's Guilt

Mental condition that occurs when a person believes they have done something wrong by surviving a traumatic event when others did not.

Callers agenda - histrionic

Move from crisis to crisis. Shallow depth of character and are extremely ego involved. Crave excitement and become bored with routine and mundane tasks and events. May behave in self-destructive ways and can be demanding and manipulative. Counseling focus is to stress their ability to survive using resources that have been helpful to them in the past.

Fatalistic Suicide

Occurs when a person sees no way out of an intolerable or oppressive situation, such as being confined in a concentration camp.

The cycle of violence

Phase 1-Tranquility prevails Phase 2-Tensions starts to build Phase 3-A violent episode occurs Phase 4-The relationship takes on crisis proportions A. The abuser becomes remorseful and asks forgiveness. Sooner or later the victim forgives the abuser and calm is restored. B. The abuser is not remorseful and feels his control over the situation has been established. The victim gives in and relinquishes control and calm is restored. C. The victim takes new actions. Within this option are two possibilities: the abuser negotiates the situation and given that the negotiation is agreeable to the victim, calm is restored or the abuser rejects the new action and a crisis state continues (victim most likely to seek help at an abuse center).

Callers agenda - schizoid

Restricted emotional expression and experience. Few social relationships and feel anxious, shy and self-conscious in social settings. Guarded, tactless and often alienate others. Counseling focus is to build a good sense of self-esteem through acceptance, optimism and support.

Positive reinforcement

Should be used in regard to a behavior as opposed to a personal characteristic. Often used in crisis intervention to gain compliance. Can be a double-edged sword as it may breed dependency.

The Intrusive-Repetitive Phase

Survivor has nightmares, volatile mood swings, intrusive images and amplified startle responses. Other pathological and anti-social defense mechanisms may be put into place in a futile attempt to rebury the trauma. At this point, the delayed stress becomes to overwhelming that the individual is propelled to seek help or becomes so mired in the pathology of the situation that outside intervention is mandated.

Cognitive characteristics

The common cognitive state in suicide is ambivalence between doing it and wanting to be rescued. The common perception is of constriction such that one's options become very narrowed and the world is seen through tunnel vision so that no alternative thoughts can emerge.

Serial characteristics

The common consistency in suicide is with lifelong coping patterns when deep perturbation, distress, threat and psychological pain are present.

Affective characteristics

The common emotions n suicide are hopelessness and helplessness.

Relational characteristics

The common interpersonal act in suicide is communication of intention (letting another person know that one's decision makes sense). The common action in suicide is egression (the right to exit or go out as one wishes or the right to autonomously find a way out of one's pain).

Motivational characteristics

The common purpose of suicide is to seek solution. The common goal of suicide is cessation of consciousness.

PTSD - Fourth criteria

The person has persistent symptoms of increased nervous system arousal that were not present before the trauma, as indicated by at least two of the following problems: 1. Difficulty falling or staying asleep 2. Irritability or outbursts of anger 3. Difficulty concentrating on tasks 4. Constantly being on watch for real or imagined threats that have no basis in reality (hypervigilance). 5. Exaggerated startle reactions to minimal or non-threatening stimuli.

PTSD - First criteria

The person must have been exposed to trauma in which he or she was confronted with an event that involved actual or threatened death or serious injury or a threat to self or others' physical well being. Examples: military combat, physical or sexual assault, kidnapping, being held hostage, severe vehicle accidents, earthquakes, concentration camp detention, life-threatening illness.

PTSD - Third criteria

The person persistently avoids such stimuli in at least three of the following ways: 1. Attempts to avoid thoughts, dialogues, or feelings associated with the trauma. 2. Tries to avoid activities, people, or situations that arouse recollections of the trauma. 3. Has an inability to recall important aspects of the trauma. 4. Has markedly diminished interest in significant activities. 5. Feels detached and removed emotionally and socially from others. 6. Has a restricted range of affect by numbing feelings. 7. Has a sense of a foreshortened future, such as no career, marriage, children, or normal life span.

PTSD - Second criteria

The person persistently re-experiences the traumatic event in at least one of the following ways: 1. Recurrent and intrusive recollections of the event. 2. Recurrent nightmares of the event. 3. Flashback episodes, including those that occur on awakening or when intoxicated, that may include all types of sensory hallucinations or illusions that cause the individual to dissociate from the present reality and act or feel as if the event were recurring. 4. Intense psychological distress on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event. 5. Physiologic reactivity on exposure to events that symbolize or resemble some aspect of the trauma such as a person who was in a tornado starting to shake violently at every approaching storm.

The Emotional Numbing and Denial Phase

The survivor protects psychic well-being by burying the experience in subconscious memory. By avoiding the experience, the individual temporarily reduces anxiety and stress symptoms. Many individuals remain forever at this stage unless they receive professional intervention.

Promoting mobilization

The worker attempts to activate and marshal clients' internal resources and to find and use external support systems to help generate coping skills and problem-solving abilities.

Creating awareness

The worker attempts to bring to conscious warded off, denied, shunted and repressed feelings, thoughts and behaviors that freeze clients' ability to act in response to the crisis.

Emphasizing focus

The worker attempts to partition, compartmentalize, and downsize clents' all encompassing, catastrophic interpretations and perceptions of the crisis event to more specific, realistic, manageable components and options. This strategy has utility across all tasks of the crisis intervention model.

Providing support

The worker attempts to validate the clients' responses as as reasonable as can be expected given the situation. Often, clients believe they must be going crazy, but they need to understand that they are not crazy and that most people would act in about the same way given the kind, type and duration of the crisis.

Implementing order

The worker methodically helps clients classify and categorize problems so as to prioritize and sequentially attack the crisis in a logical and linear manner.

Providing guidance

The worker provides information, referral, and direction in regard to clients' obtaining assistance from specific external resources and support systems.

Providing protection

The worker safeguards the client from engaging in harmful, destructive, detrimental and unsafe feelings, behaviors and thoughts that may be psychologically or physically injurious or lethal to themselves or others.

Obtaining commitment

The worker should ask the client to summarize verbally the steps to be taken. This verbal summary helps the worker understand the client's perception of both the plan and the commitment and gives the worker an opportunity to clear up any distortions. Also provides the worker an opportunity to establish a follow-up checkpoint with the client.

Facilitative listening

To function in this way, workers must give full attention to the client by: 1. Focusing their total mental power on the client's world. 2. Attending to the client's verbal and nonverbal messages (what the client does not say is sometimes more important than what is actually spoken). 3. Picking up on the client's current readiness to enter into emotional and/or physical contact with others, especially with the worker. 4. Emitting attending behavior by both verbal and nonverbal actions, thereby strengthening the relationship and predisposing the client to trust the crisis intervention process. 1. The worker should make initial owning statements that express exactly what he or she is going to do. 2. Respond in ways that let the client know that the crisis worker is accurately hearing bot the facts and the emotional state from which the client's message comes. 3. Facilitative responding - provides impetus for clients to gain a clearer understanding of their feelings, inner motives and choices. Enables clients to feel hopeful and to sense an inclination to begin to move forward toward resolution and away from the central core of the crisis. 4. Helping the clients to understand the full impact of the crisis situation.

Callers agenda - dependent

Trouble making decisions and see to have others to do. Feelings of worthlessness, insecurity, fear of abandonment. Prone to become involved and stay in self-destructive relationships. Counseling focus is to reinforce strengths and act as a support for their concerns without becoming critical of them or accepting responsibility for their lives.

Closed-ended questions

Used early on in crisis intervention to obtain specific information that will help the crisis worker make a fast assessment of what is occurring. Some guidelines for formulating: 1. Request specific information 2. Obtain a commitment 3. Increasing focus 4. Avoid negative interrogatives (don't, doesn't, isn't, aren't and wouldn't)

Open-ended questions

Usually start with "what" or "how" to ask for more clarification or details. Encourages clients to respond with full statements and at deeper levels of meaning. Some guidelines for formulating: 1. Request description 2. Focus on plans 3. Expansion 4. Assessment 5. Stay away from "why" questions

Situational Crises

Usually uncommon and extraordinary events that can be frustrating or very controlling (job lay off, terrorist attack, sudden illness, automobile accident, rape). It is random, sudden, shocking, intense and catastrophic.

Kubler-Ross's Stages

Views loss as a series of 5 stages that people go through as they come to grips with their own imminent death: 1. Denial 2. Anger 3. Bargaining 4. Depression 5. Acceptance Little empirical evidence to substantiate its use and it causes problems when people stubbornly refuse to move through its stages as proposed.

Moral principles of confidentiality

When one shares problems of a deeply personal nature, common decency dictates that the recipient should keep the confidence of the individual who shares such information.

Intent to harm and the duty to warn

When the client provides information about doing harm to himself or herself or another person, rules of confidentiality take on an entirely different perspective.

Disposition

Worker discusses treatment recommendations and possible services with the client. Clients decision to accept or reject services. If accepted, case will be referred to a therapist who will be in charge of case. A full clinical team meeting is held to confirm or alter the initial diagnosis and treatment recommendations. At that time, a primary therapist is designated and assumes responsibility for the case.

Assisted suicide

someone else provides the means (lethal agent), but the person who is dying administers it.