PSYC 317 Crisis Intervention Ch. 3-4

high-risk suicidal clients say things such as ..

"I'm going to kill myself and you cannot stop me"; usually depressed and angry, have tried suicide before, lack support from loved ones; They may admit to having a viable plan and means for killing themselves

Questions to ask in order to elicit the client's frame of reference regarding the crisis situation

"how do you put it together in your head", "what do you think about this", "what does it mean to you", "what are you telling yourself about", "what assumptions are you making about"

Validation statements are NOT false hopes. Do not use words such as ..

"it'll be okay", "don't worry", "forget about it" ....Instead use statements such as "I know that right now you feel that everything is falling apart, but many people have gone through the same situation and have survived. You have every reason to believe you can survive too." or "it is understandable that you might feel that way" or "your pain is understandable considering how difficult your situation is" or "many people going through this would also feel and think this way"

What are the 4 phases in the structure of Adlerian counseling?

1) Establishing the relationship 2) Exploring individual psychological dynamics 3) Encouraging self-understanding and insight 4) Reorientation and re-education

What are the phases of the ABC model for crisis intervention?

A) Developing and maintaining rapport B) Identifying the problem and providing therapeutic interaction C) Coping

Know the difference between emotions and thoughts/beliefs

An emotion is "I feel sad, mad, scared, happy" and a thought/ or belief is "I feel like I don't want to live, that my boss doesn't understand me, my world is coming apart, I am finally on the right track"

a form of soft close-ended questions that counselors use when they are not quite sure of what the client just said

Clarifying/ Clarification questions; "are you saying" "did you mean"

Who is one of the founding fathers of modern suicidology whose pioneering contributions to suicide research, treatment, and prevention spans that last 50 yrs in the US

Dr. Norman L Farberow

Assessment of NSSI

Have you intentionally hurt yourself in any way? When you hurt yourself, were you trying to commit suicide? How old were you when you first hurt yourself? How often do you hurt yourself? Have you had to seek medical treatment for hurting yourself? How do you feel after you hurt yourself? Do you ever have the urge to hurt yourself? Do you want to stop hurting yourself? Have you ever been able to stop right before you hurt yourself? Do you use drugs or alcohol before hurting yourself? Is there a certain time of day, situation, person, or place that makes you feel like hurting yourself? Do you know of anyone in your family or any friends who have hurt themselves?

How must you identify that nature of the crisis?

Identify ... precipitating event, cognitions, emotional distress, impairments in functioning: behaviorally, socially, academically, occupationally

a formal assessment tool that aids in determining if someone is psychotic and therefore gravely disabled, a danger to self or others

Mental status exam

An intervention for NSSI

S.A.F.E. - helps teens learn to face problems and communicate feelings to others. The program uses supportive, cognitive-behavioral and psychodynamic therapy. It uses 4 tools: the no harm contract, impulse control log, a list of five safe alternatives to self injury, writing assignments to build awareness and organize thoughts and feelings and focus energy in a constructive way

_________ is to help another individual pull his or her thoughts together. A secondary purpose it to check on whether you as a helper have distorted the client's frame of reference. This may be helpful in the beginning of an interview if you have seen the client previously; it may help to bring together threads of data over several interviews or simply clarify what has gone on in the present interview

Summarization

What is rapport in crisis intervention?

a state of understanding and comfort between the client and counselor

Assessments in the MSE --mental status exam

appearance, attitude, behavior, speech, mood and affect, thought process, thought content, perception, cognition, insight, judgement

Questions that Steiner(1990) suggests when crisis workers are assessing suicide:

ask if the person has though of killing himself, ask family members if they are concerned that the person will commit suicide, Check the person's plan for suicide, Check ther person's mental status, Check the history of suicide in a person's life; find out about the individual's support system by asking questions, find out how much control ther person has by asking questions, Ask the person for a commitment talk

no-suicide contract

clients agree that for two to three days they will give up the right to kill themselves while they see the crisis worker

questions in the SIS-MAP may relate to

demographics, ideation, management of suicide ideation, current state of suicidality, planning for subsequent attempt, comorbidities, family history, biological, clinical ratings, psychosocial environmental problems

It is important to know whether your client has mental health conditions such as..

depression, bipolar disorder, ocd, schizophrenia, alzheimers, ADHD, or any other organic brain disorders; substance abuse issues

What are some therapeutic interaction statements?

educational, empowerment, validation, reframes

What does coping strategy assessment involve?

explore ..what the client wants to do now to cope, how client has tried to cope in the past, other things the client can do to cope

signs of a suicidal person...

giving things away; putting things in order; writing a will; withdrawing from usual activities; being preoccupied with death; the recent death of a friend or relative; feeling hopeless, helpless, or worthless; increasing drug and alcohol use; displaying psychotic behavior, giving verbal hints such as "I'm of no use to anyone anymore"; showing agitated depression; living alone and being isolated

What are some aspects of attending behavior?

good eye contact, attentive body language, expressive vocal style, verbal following, active listening

what are risk factors for violence against others?

history of violence, thoughts of commiting harm, poor impulse control and inability to delay gratification, impairment or loss of reality testing, delusions, command hallucinations, feeling of being controlled by an outside force, belief that other people wish to harm him, perception of rejection or humiliation, being under the influence of substances, antisocial personality disorder, frontal lobe injury

with high-risk suicidal clients what is sometimes necessary?

involuntary hospitalization

clients who have never tried suicide, have adequate support systems and make comments such as "I thought about it but I am not sure", "it scares me to have feelings like this", "I need someone to talk to"

low-risk suicidal clients

What are the types of questions in therapy?

open-ended, close-ended

when counselors restate in their own words what they thought they hear clients say

paraphrasing

viewing relatable films to help clients better explain their own symptoms

reel therapy

empathy; letting clients know you understand their feelings is important in therapy. What is a statement that reflects the affective part or emotional tone of the client's message, whether verbal or nonverbal, and is a powerful tool in creating an empathetic environment?

reflection simple reflection: "you sound angry", "I sense a lot of anxiety", "I see tears in your eyes" complicated reflection: "Yes I can se how mad your wife makes you when she nags at you", " So you are afraid that you won't get into graduate school", "I notice you are crying when you speak of your father and it seems like you don't want to talk about it"

a cognitive restructuring tactic that aims at changing the crisis from danger to opportunity

reframing statements

damaging one's own body tissue without suicidal intent

self-mutilative behavior and more recently known as nonsuicidal self-injury

What are some ethical checks you should make as counselor?

suicide, homicide, organic issues, psychosis, substance abuse, child abuse, elder abuse,

Alternative strategies for coping?

support groups, twelve step groups, marital or family therapy, lawyer, doctor, bibliotherapy, reel therapy, assertion training, stress management, shelters or other agencies, secure commitment and follow up

clients who function at work but are not feeling well and are difficult to evaluate; they feel there is no way out of their situation; may have even threatened to kill himself

the most common; middle-risk suicidal clients

Summarization may include..

the precipitating event, cognition, and emotion