BHS 230: CRISIS INTERVENTION

Caplan's Seven Characteristics of Effective Coping Behavior

1. Actively exploring reality 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 at a time. 5. Being aware of fatigue and pacing coping efforts while maintaining control in as many areas of functioning as possible. 6. Mastering feelings where possible; being flexible and willing to change. 7. Trusting in oneself and others and having a basic optimism about the outcome.

Behavioral Problem-Solving Model

1. Define the problem. 2. Review ways that you have already tried to correct the problem. 3. Decide what you want when the problem is solved. 4. Brainstorm alternatives. 5. Select alternatives and commit to following through with them. 6. Follow up.

Trauma informed care model

1. Realizing the prevalence of trauma 2. Recognizing how trauma affects individuals 3. Responding by putting this knowledge into practice.

Paraphrasing

A basic attending skill, or clarifying technique, in which counselors restate in their own words what was just said by the client.

Plan

A blueprint for action that clients have devised for killing themselves.

Bipolar Disorder

A condition in which states of manic behavior (i.e., out of control, hyper, grandiose behavior) fluctuate with states of extreme depression. It is sometimes known as manic depression.

Schizophrenia

A disorder usually requiring the attention of a psychiatrist and characterized by the following symptoms: hallucinations, delusions, loose associations, blunt affect, and poor appearance.

Fear of Missing Out (FOMO)

A feeling of anxiety that an exciting or interesting event may currently be happening elsewhere.

No-suicide contract

A formal written or verbal contract between the client and the crisis worker in which the client makes a commitment to speak to the counselor before harming himself or herself. It is considered an effective intervention for low- and middle-risk clients.

Development of cultural sensitivity

A four-stage process during which counselors learn to consider cultural factors when they are conducting counseling sessions. The stages are (1) lack of awareness of cultural issues; (2) heightened awareness of culture; (3) realization of the burden of considering culture; and (4) beginnings of cultural sensitivity.

Black Lives Matter

A movement begun in 2012 in which social justice for all is the focus in reaction to perceived unjust shootings of young Black people.

Social resources

A person's friends, family, and coworkers. The more resources one has, the better will one weather a crisis.

Suicide Assessment

A process in which the crisis worker asks a series of directive questions to ascertain the seriousness of a client's suicidal intent and ideation. It includes identifying various risk factors, a means for suicide, a plan for suicide, and reasons for wanting to harm oneself.

Dual Relationships

A relationship that a counselor engages in with the client outside the professional one- for example, a social, sexual, or business relationship.

Nurturance

A sense of emotional support and love.

Countertransference

A situation in a counseling relationship that arises from unresolved feelings experienced by a counselor in a session with a client. These feelings come out of the counselor's personal life and cause him or her to act out these feelings with a client, behavior that may cause emotional harm to the client.

Summarization

A skill useful in tying ideas together, wrapping up a session, or moving from the B phase of the ABC model to the C phase; the skill is also useful when the counselor does not know where to go next. It is a statement that pulls together the various facts and feelings discussed in the session.

Rapport

A special type of bonding that a counselor seeks with a client. The more rapport there is between the client and the counselor, the greater the client's sense of trust and security.

Enmeshed

A state in which an individual lacks a sense of separateness from others with whom he or she has an emotionally intense relationship.

Psychotic Decompensation

A state in which the client is out of touch with reality and shows symptoms such as delusions and hallucinations. This often happens when a schizophrenic patient stops taking medication or at the beginning of a person's first schizophrenic episode. The state can also be associated with bipolar disorder and paranoid disorders. This person usually requires involuntary hospitalization.

Depression

A state of being in which the client is sad, low in energy, and suicidal; he or she feels worthless, helpless, and hopeless; the person lacks desire, is socially withdrawn, and is slowed in processes such as thinking and concentrating. This person should be referred to a physician for an evaluation.

Crisis

A state of disequilibrium that occurs after a stressor (precipitating event). The person is then unable to function in one or more areas of his or her life because customary coping mechanisms have failed.

Autonomy

A state of independence and self-sufficiency needed to function as an adult in society. Adolescents often struggle to achieve this with their parents.

Mental status exam

A structured way of observing and interviewing clients to assess for possible psychotic states.

Gravely Disabled

A term used to describe individuals who are unable to care for their own personal needs such as food, shelter, and clothing due to a mental disorder.

Close-ended questions

A type of question that can be answered with a "yes" or "no" or some other one-word answer. Its best use is for obtaining facts such as age, number of children, or number of years married. Forced-choice questions, or "do you," "have you," questions, are generally not effective. These types of questions can bring the interview to a dead end or sound like an interrogation.

Norman L. Farberow

An American pioneer in the field of suicidology. Created the first suicide prevention center and hotline in Los Angeles.

Precipitating Event

An actual event in a person's life that triggers a crisis state that can be either situational or developmental.

Psychoanalytic Theory

An approach considered the opposite of crisis intervention but with certain ideas useful for the crisis worker. The notion that we have only a certain amount of psychic energy to deal with life stressors leads us to keep our clients proceeding at a slow pace so they do not deplete this energy. Also, ego strength is a useful concept.

Confidentiality

An ethical standard providing the client with the right for all disclosures in counseling to be kept private.

Behavioral Problem-Solving Model

Approach focusing on goal setting, problem solving, and brainstorming alternatives.

Cognitive Approaches

Approaches focusing on a person's perceptions and thinking processes and how these lead to crisis states.

Attending Behavior

Behavior that has to do with following the client's lead, actively listening, and demonstrating presence.

Caplan's seven characteristics of Effective Coping Behavior

Behaviors proposed by Gerald Caplan (1964) as essential for getting through a crisis state. They can be learned through formal crisis intervention, through experience, or while growing up. In any case, the crisis worker needs to acknowledge these characteristics and to transmit them to clients when possible.

Delusions

Beliefs and thoughts often observed in individuals who are suffering from psychotic episodes due to schizophrenia, dementia, a manic episode, or substance intoxication. These beliefs have no basis in reality.

High-risk suicidal clients

Clients who have a plan, the means, and the intent to complete suicide; they cannot be talked out of harming themselves. Hospitalization is often indicated for such clients.

Middle-risk suicidal clients

Clients who have been thinking about suicide and feel depressed. These clients probably still have some hope, but they might also have a suicide plan. A no-suicide contract works as well for such persons as does a suicide watch. Crisis intervention should be intense and frequent.

Low-risk suicidal clients

Clients who have pondered but never attempted suicide. These clients have adequate support systems and can usually be treated as outpatients. Therapy and educational interventions are encouraged.

Danger to others

Condition in which a client is deemed to be a threat to others. At this time, the counselor must breach confidentiality and report his or her concerns to the police or the intended victim, or both. This is called the duty to warn.

Gravely Disabled

Condition in which a client is psychotic or suffering from a severe organic brain disorder. People with such disorders are often incapable of meeting basic needs such as obtaining food or shelter and managing finances. Grave disability is often a reason for involuntary hospitalization of a person.

Organic brain disorder

Condition resulting from neurological disturbance, genetic abnormality, or tumor.

African Americans

Counselors should keep in mind the history of slavery and ongoing racism and how this group while highly acculturated to mainstream values, often turns to the church for solace and leadership and may distrust mainstream institutions, Black Lives Matter is a recent movement that should also be explored when possible or necessary.

Grief Work

Crisis intervention largely based on working with survivors and family members of victims of the Coconut Grove fire. It was with this population that Caplan and Lindemann learned how to conduct short-term interventions.

Involuntary hospitalization

Detaining clients against their will in a psychiatric facility for evaluation and observation when they have been deemed a danger to themselves or others, or are gravely disabled because of a mental disorder.

Personal resources

Determinants of how well a person will deal with a crisis. They include intelligence, ego strength, and physical health.

Wellesley Project

Developed by Caplan and Lindemann, the first organized attempt at introducing crisis intervention into a community.

Danger and Opportunity

Dichotomy associated with a crisis. A crisis can be an opportunity when the person grows by developing new coping skills and altering perceptions. It can be a danger when the person does not seek help and instead copes with the crisis state by using defense mechanisms, resulting in a lowered functioning level and possibly psychosis or even death.

Carl Rogers

Founder of person-centered therapy and well-known contributor to the humanistic approaches to counseling.

HMOs

Health Maintenance Organizations; The current trend in health insurance. The organizations focus on maintaining health rather than curing illness. The orientation of mental health care under this style of management is definitely crisis intervention.

Non-suicidal self-injury / self-mutilative behavior

Intentionally causing tissue damage to oneself without desiring to kill oneself.

Gerald Caplan

Known as the father of modern crisis intervention. Worked with Eric Lindemann on the Wellesley Project after the Cocoanut Grove fire.

Community Mental Health Act of 1963

Legislation enacted during the Kennedy administration directing all states to provide mental health treatment for people in crisis.

Brief Therapy

May be confused with crisis intervention, but focuses on changing longer-standing behavior patterns rather than on only the current precipitating event.

Curvillinear model of anxiety

Model showing that anxiety has the potential to be either a positive or a negative influence for someone in crisis. Too much anxiety may overwhelm the person and lead to lowered functioning. However, moderate anxiety may offer an opportunity for growth and transition from one stage of life to another or may motivate the person to grow from the experience of trauma. People who have no anxiety tend not to be motivated to make any changes at all.

Humanistic approach

Model using a person-centered approach in developing rapport with clients; counselor uses basic attending skills to focus on the inherent growth potential in the client.

Support Systems

Networks of helping individuals and agencies. A crisis worker uses the client's natural support systems, such as family and friends, and also helps the client build new support systems.

Cocoanut Grove Fire

Nightclub fire in 1942 in which over 400 people died, leaving many survivors in crisis; considered one of the major events leading to the development of crisis intervention as a form of mental health treatment.

Developmental Crises

Normal transitional stages that often trigger crisis states, which all people pass through while growing through the life span.

Suicide watch

Observation by family or friends of those who are at middle risk of hurting themselves. Someone stays by the client's side 24 hours a day to ensure that the person does no harm to himself or herself. Suicide watches are also conducted in psychiatric facilities with high-risk clients.

ABC Model of Crisis Intervention

One way to structure crisis intervention that includes (A) developing and maintaining contact, (B) identifying the problem, and (C) coping.

Paraprofessionals

Originally community volunteers. Because of the tremendous number of clients needing help at the same time after the Coconut Grove fire, it was necessary to employ community volunteers who were not professionally trained, to conduct crisis intervention sessions. These paraprofessionals became part of many agencies in later decades.

Emotional Distress

Painful and uncomfortable feelings experienced by a person in crisis.

Disengagement

Parental behavior in which parents do not relate to their child in a nurturing manner; the child feels little support or sense of belonging.

Informed consent

Permission for treatment given by a client to a therapist after the client has been thoroughly informed about all aspects of the treatment. Anyone entering a counseling relationship has the right to understand the nature of therapy, give his or her consent for it, understand that it is voluntary, and be told the limits of confidentiality.

Elder Abuse

Physical abuse, fiduciary abuse, neglect, or abandonment of someone 65 years old or older. In many states, anyone working with clients over 65 years of age must report suspected cases of elder abuse to the state's adult protective services agency. This reporting is often mandatory and grounds for breaching confidentiality.

Medical or legal referrals

Referrals made by the crisis worker if the client needs the services of other professionals, as when a person has been arrested, wants a restraining order, or has a severe mental or other illness.

Child Abuse Reporting

Reporting required of anyone working with children as a counselor, doctor, teacher, or in any other capacity since passage of the 1974 Child Abuse Prevention and Treatment Act by Congress. These people must report any suspicions of child abuse to the child protective services agency in their state. The requirement is mandatory and in many states overrides the client's right to confidentiality.

Exceptions to privilege and confidentiality

Situations in which communications between therapist and client can be legally and ethically shared with others. In the case of confidentiality, these include elder abuse and child abuse, grave disability of the client, and danger posed by the client to self or others. In the case of privilege, these include voluntary waivers given by the client for information to be shared in a limited forum as well as some involuntary disclosures, as in certain court cases.

Resources

Sources of help in the community. A crisis worker must be knowledgeable about community resources to be able to connect a client in crisis when the appropriate support group or other service.

Material resources

Tangible things such as money, transportation, clothes, and food. They constitute one determinant of how well a person is able to deal with a crisis.

Means

The actual physical implement, pills, or action that a suicidal person uses to kill himself or herself.

Coping Methods

The behaviors, thinking, and emotional processes that a person uses to handle stress and continue to function.

Reflection

The best way to show emotional empathy for a client; the counselor points out the client's emotions by stating them as either seen or heard.

Suicidal ideation

The cognition component of suicide, the thinking involved.

Ego Strength

The degree to which people can see reality clearly and meet their needs realistically. People with strong egos usually cope with stress better than people with weaker egos.

Nonmaleficence

The ethical guideline that focuses on doing no harm to clients based on the Hippocratic oath.

Privileged communication

The legal counterpart of confidentiality. Clients may waive the right to privilege if they wish the counselor to share certain information in court or other limited venues.

Evolutional Crises

The normal stages a family experiences as it evolves through the life span of its members. The crises result from having to adjust to the formation of the following subsystems: marital, parental, sibling and grandparents.

Cognitive Key

The perception a person has of the precipitating events that led to emotional distress. The crisis worker must identify the perception if he or she is to help the client change it and thereby increase functioning.

Open-ended questions

The questions usually begin with "what" and "how" and allow clients to expand on material they have brought up on their own.

Preventive Psychiatry

The term Caplan originally used to describe his work with the survivors of the Coconut Grove fire and others going through crises.

Bibliotherapy

The use of books as an alternative coping strategy.

Reel therapy

The use of movies to aid clients in understanding and resolving their own issues.

Functioning Level

The way a person behaves socially, occupationally, academically, and emotionally. The functioning level is impaired when a person is in a crisis. The goal of crisis intervention is to increase functioning to pre-crisis levels or higher.

Existential Theory

Theory from which crisis intervention took the ideas of choice and anxiety. The crisis worker believes that anxiety can be a motivator for change and encourages the client to master anxiety realistically by making choices and accepting responsibility for the choices.

obsessive-compulsive disorder

This clinical syndrome is thought to be primarily due to chemical imbalance. Individuals suffering from this disorder engage in unwanted behaviors, often rituals that he or she cannot control. Along with behavioral rituals, the person often has thoughts that are felt to be out of control as well. Some examples are compulsive hand washing, checking lights, and thinking constantly about running over children.

Homeostasis

This is the steady, stable state of a family which is maintained when family members adhere to the acceptable rules and roles created verbally or nonverbally by the family.

The Lanterman-Petris Short Act

This legislation was created to set up conditions for the involuntary hospitalization of the mentally ill and define patient rights in California.

Etic

This refers to behaviors and traditions of all or most humans regardless of race, ethnicity, or culture.

Emic

This refers to behaviors and traditions particular to a certain cultural group.

Psychiatric emergency treatment (PET)

To assess whether someone should be involuntarily hospitalized due to a mental disorder.

Situational Crises

Unexpected traumas having a sudden onset that impair one's functioning level.

Grassroots Programs

Upward movement from local groups that led to the creation in the 1960s and 1970s of many agencies to meet the needs of various populations not being helped by traditional governmental agencies.

Emergency Psychiatry

When services are provided in an emergency setting such as a hospital to people with serious suicide attempts, life threatening substance abuse conditions, vegetative depression, psychosis, violence, or other rapid changes in behavior.

Eric Lindemann

Worked with Gerald Caplan on the Wellesley Project and helped create crisis intervention as it is known today; recognized for his contributions to grief work.

Ataque de Nervios

a self-labeled syndrome found in Latinos in which they experience a mixture of anxiety, panic, depression, and anger.

Cultural Humility

a willingness to suspend what you know, or what you think you know about a person based on generalizations about their culture.

Trauma-Informed Care

an approach to engaging people with histories of trauma that recognizes the presence of trauma symptoms and acknowledges the role that trauma has played in their lives.

Hallucinations

false sensory perceptions. Auditory hallucinations are associated with schizophrenia; visual and tactile ones with substance abuse withdrawl; and gustatory and olfactory ones with organic brain disorders. Any hallucination is indicative of severe illness; when hallucinations are present, a doctor should be consulted.

Asian Americans

issues such as family lineage, obligation and shame are emic considerations for this subgroup.