crisis management Flashcards by Eric Stullmam

effects of divorce on pre school

fear of abandonment
trouble separating from parents
difficulty sleeping through the night
developmental regression
increased crankiness
self-blame, sadness and withdrawal

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effects of divorce on latency (5-10)

preoccupation with feelings of loss, rejection, guilt and loyalty conflicts
fear of being replaced
bx that reflects fears and fantasies of absent parent’s return (crying, crankiness, diff. concentrating
intense longing among boys for fathers

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effects of divorce on pre teens

anger and blame at parents for withdrawing stability
formation of alliance with one parent to hurt the other
parentification, somatization, delinquent bx
drop in school performance
overstimulation from dating and sexual bx of parents

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effects of divorce on adolescents

fear that they will repeat their parents’ failures
worry about the future
feeling of rejection from both parents
acute anxiety, more time away from home,
feeling of anger and abandonment leads to early sexual bx, or increased responsibility
alcohol abuse, lower gap, depression

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rape trauma syndrome stages

acute - immediately after rape - shock, panic attacks, somatic complaints, sexual dysfunction, sleep/appetite disturbances, guilt, self blame
rescue and recovery - depression, denial, anxiety, months to years, try to be normal
reorganization - feeling resurface, attempt to work through the feelings

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types of dependent and elder abuse

PAINFA

physical, abandonment, isolation, neglect, financial, abduction

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physical abuse behavioral signs

wary of adults, clingy, angry, dull or flat affect, frightened of parent, may defend abusive parent, running away, problems at school, aggressive/destructive, substance abuse

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sexual abuse physical conditions

sudden change in appetite, clingy, fearful: school phobia, anxiety, depression, withdrawal into fantasy, regressive bx, fear or mistrust of adults, poor peer relations, sexuality, promiscuity, antisocial bx, self destructive, self mutilation, eating disorders, school problems, secretive, protective of abuser

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Physical neglect, behavior

stealing for food, hoarding, sleeplessness and inattentiveness at school, poor attendance, learned helplessness, regressive bx, clingy, whiny, indiscriminate attachment, depressed, lonely, isolated, suicidal, delinquency including theft

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sexual abuse behavior/affect of child

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sexual abuse physical conditions

fatigue from sleep disturbances, difficulty walking or sitting, eating disorders, enuresis/encopresis, painful urination/defecation, somatic disorders, pregnancy

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Crisis intervention with rape victims

Goals

Restore control; achieve pre crisis level of functioning; reduce isolation ->support groups
coping strategies for long term effectiveness

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Crisis intervention with rape victims

Interventions during acute phase

directive, educational approach
practical problems - police, med eval. and care
info on expected emotional reactions
help with deciding to disclose to family/friends
help dealing with shame, anger, fear, blame

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Crisis intervention with rape victims

interventions during reorganization phase

-Dealing with obsessive memories/flashbacks
-Working through feelings
-Integration of crisis
EMDR; Stress innoculation Training

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Treatment of families with abused children

Assessment

Observation,interview, see members alone, drawings, house-tree-person, kinetic family drawing

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Treatment of families with abused children

Therapist’s role

monitor feelings/countertransference; see abusers as suffering, take child advocacy position
Actions: gain trust, develop rapport, be non-confronational; be assertive/establish rules re: future abuse; reparent; educate re: cycle of violence; escape plan; reinforce small positive changeso

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Treatment of families with abused children

techniques/ interventions

remove IP label
absolve child of guilt/ responsibility
asess family (family mapping, genogram, fam life chron)
educate re: normal child development
empathy training - recall childhoods
teach parenting skills
anger managment skills
Referrals

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Treatment of incestuous families

Dysfunctional family model

Cause: power imbalance, childhood abuse
Goal: prevent further trauma by seeking reconciliation
tx format: ind->conjoint->family
same sex therapist, the opposite
Process: uncover childhood trauma, accept abuser as a person of value who can change

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narrative middle stage interventions

Addictions model

Cause: sexual deviance; sexual arousal pattern; characterological dx
Goal: change offender’s attraction to kids, control bx, strengthen parent, heal child, keep offenders out of family
tx format: separate offender from NOP and child
Process: offender - disclosure, accept responsibility, curb bx
NOP - strengthen ego, self-sufficiency
child: counteract self-blame
adult survivor: “getting clear”

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narrative middle stage interventions

role of therapist

model healthy confrontation; countertransference
believe child’s story, build rapport, make referrals
remove perp not child; provide for safety; make referrals; advocate for the child; clarify rules and roles/restore boundaries

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families with….

more apt to have abuse

sickly, disability, only children, families with 4 or more; child is unplanned/unwanted; children 0 to 3; hyperactive; premature or difficult birth

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Rates of abuse

adolescent girls- higher rate of sexual/physical

adolescent boys - higher rate of neglect

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Suicidal children

may indicate child abuse, neglect

go jump past her cute care

guns, jumping, pills, hanging, cutting, carbon monoxide

Tasks of crisis resolution

physical survival; expression of feelings; cognitive mastery; behavioral/interpersonal adjustments

in crisis protocol

ensuring safety; shifting counseling priorities; adhering to protocol; maintaining flexibility

in crisis awareness

professional territoriality; intellectual-emotional fusion; tunnel vision (less conscious of options)

characteristics of person in crisis

emotional shock; impaired judgment; powerlessness; intense need for immediate action

suicide | most common precipitating factor

loss; death; divorce; changes in social role; loss of prestige due to criminal involvement; loss of health; depression symptoms; radical shifts in bx and mood, habits; troubled by past abuse

suicide risk in ethnic groups

high in hispanic, native american youth, low in elderly | high in asian elderly; low in youth

suicidal adolescents | characteristics

interpersonal conflicts; school attendance/academics; criminal bx; psychiatric disorder; rage; drug/etoh; exposure to other suicides; family conflict; recent severe stressor

adolescents in treatment

include family, treat despite resistance; drug/etoh assessment of whole family; consider abuse; focus on communication patterns in family and important events

the chronically suicidal person

older isolated, withdrawn male; etch abuse; depressed; hx of attempts and tx; hx of job relationship problems; keeps a diary

psychological profile of violent individual

persistent retaliatory rage rage structured into a belief system rage or vengeance in context of disappointment, loss, relationship failure

correlates of violent bx | biological factors

low intelligence; hormonal imbalance; organic brain disorders; neurological problems; traumatic injury

correlates of violent bx | psychosocial factors

violent environment and peer group urban dwellers employment and/or residential insecurity

correlates of violent bx | age

males, between 15 and 30 | elderly clients

correlates of violent bx

hx of violence

correlates of violent bx | psychological variables

antisocial; borderline types; paranoia; manic; explosive; schizophrenia; depression/suicidality; dissociated states

correlates of violent bx | specific situational problems or provocations

recent losses; availability of weapons, victim; impulsivity; stated desire to kill someone

correlates of violent bx | family history

hx of violence; physical, emotional or sexual abuse, parental neglect, refection or loss within the family, antisocial bx as a child

longer term interventions with violent individuals

review client's hx examine cognitive distortions teach anger mangt techniques

assessment of family violence

assess for alcohol/drug abuse, neurological impairment; children with unusual temperamental or physical characteristics; pregnant women

treatment violent families | general techniques

contracts | time-outs

crisis intervention with violent families

``` identify stressors, cues contingency plan maintain safety for all members identify issues and root cause referrals long term therapy ```

Child abuse characteristics of parent personality, attitudes and bx

substance abuse; poor impulse control; low self esteem; emotional immaturity; frequent depression; authoritarian; high demands on child; little concern for child; punishment is character building; low capacity for enjoyment in life; inability to as for help

child abuse characteristics of parent misperceptions about children

lack of knowledge about normal growth, development, bx inadequate child rearing knowledge child seen as extension of parent reliance on child for emotional needs sees child as all bad, burdensome takes child's bx personally projection of adult motives onto child's actions

child abuse characteristics of parent social isolation

``` little community contact paucity of interpersonal resources loneliness marital or employment problems lack of outlet for tension/anger ```

emotional abuse | behavior/affect of child

``` displays extreme behaviors physical, emotional, and/or in intell. retardation inappropriate social bx/conduct disorder self-deprecating and self-critical depressed, anxious attempts to please adults substance us suicidal ideation or attempts seeks acceptance from inappropriate sources: gangs, other rejected peers ```

effects of dv on children | boys

conduct disorders -> anti-social personality disorder

effects of dv on girls

somatic sx's - headaches, degestive tract disorders, asthma

effects of dv on children in general

withdrawal, fears and phobias, excessive crying, passivity, dependence, aggressiveness, impulsivity,tantrums, depres sion, neurotic bx's, sleeping difficulties, school-related problems, self-mutilation

battered women

high incidence of incest in family of origin, somatic complaints pg. 49

batterers

less educated/lower see than partner in military, poor communication skills high incidence of law troubles and of abusing children, controlling, jealous, "out of touch" with feelings, witnessed as a child

risk of violence increases..

pregnancy and birth of a child | more common in lower SES groups