Crisis/ Supervision Flashcards
Gilliland and James provides an outline of steps in working with with a client in a crisis:
1) Define the problem
2) ensure client safety
3) provide support
4) examine alternatives
5) make plans
6) obtain a commitment from the client
Six steps in crisis intervention:
The first three steps are listening activities:
1) Define the problem- the client tells his or her story.
2) Ensure safety- Minimize the physical, emotional, and psychological danger to self and others.
3) provide support- acknowledge and validate emotional responses to the crisis
The last three are actions activities:
4) examine alternatives: solving skills are utilized to help the client see that many alternatives are available.
5) make plans: advice may be appropriate as the clent formulates a plan of actions
6) make a commitment: a contract provides the client with a sense of direction and a sense of hope.
Suicidal Clients
Suicidal theory may best be understood by studying four theoretical models. These models are:
1) Overlap Model- Greater the overlap in the damins the greater the risk of suicide.
2) Three elements model- predisposing factors, family history, social environment, personality, life situation, and availability of means.
3) Suicide Trajectory Model- Interactive influences of risk factors.
4) Cubic Model-that people have reached a point of hopelessness and suicide is the only exit.
Durkheim identifies three types of suicide:
1) Egoistic: which occurs when a person commits suicide as a result of not feeling like they belong to society; they struggle to find a reason to live. People who commit egoistic suicide have weak or very little social bonds to their society.
2) Anomic: are linked to disillusionment and disappointment. Its a condition where social and also moral norms are confused, unclear, or simply not present.
3) altruistic: is committed for the benefits of others.
Myths considered to be false: (suicide)
- Those who talk to suicide are not going to commit suicide and desire attention.
- Impulsive acts of suicide are rare.
- if a person survives suicide, the person will not make a second attempt.
- attemptng suicide is genetic
- a person is mentally ill if atttempting suicide.
- talking about suicide gives the person the idea.
Risk factiors associated with suicide:
1) past history or attempts
2) family history of suicide
3) involved in drugs or alcohol
4) history of psychotic disorder
5) history of severe trauma
6) isolation from others
7) radical shift in behavior or mood
8) expression of hopelessness or helplessness
9) chronic medical issues
10) suicidal ideations or a plan and means
11) living alone or divorced
12) relationship instability
13) poor support system
14) childhood trauma
15) physical illness and/or financial stress
Psychological first aid
to offer support, reassurance, comforting, and calm communication and a physical presence. The emotional well being through psychological first includes basic human responses of comforting and consoling.
Psychological first aid strategies
- protecting the person from further threats or distress as is possible.
- Furnishing immediate care for physical necessities, including shelters.
- Providing goal orientation and support for specific
reality based tasks. - facilitating reunion with loved ones from whom the individual has been separated
- Sharing the experience
- linking the person to systems of support and sources of help that will be ongoing
- facilitating the beginning of some sense of mastery
- identifying needs for further counseling or interventions.
Two types of supervision
Clinicial and Administrative Supervision
Clinical Supervision
- Clinical supervision focuses on the work of the supervisee with his or her clients.
- Areas to be examined in clinical supervision include (Remley & Herlihy, 2001;
Bernard & Ladany, 2001; Borders and Leddick, 1987):
Client welfare
The counseling relationship
Assessment
Diagnosis
Intervention
Prognosis
Referral procedures
Administrative Supervision
- The focus of administrative supervision is on how the supervisee is performing his
or her job as a member of the organization. - Areas of focus in administrative supervision include (Remley & Herlihy, 2001;
Bradley & Ladany, 2001; Borders and Leddick, 1987):
Case records
Referrals
Performance evaluations
Anything else that impacts organizational functioning - Sometimes a supervisor will provide both administrative and clinical supervision to
the same supervisee.
Supervisory Relationships
Supervision vs education
A. Supervision is distinct from education in that education typically includes an explicit
curriculum with goals that are uniformly imposed on every learner.
B. Supervision must be tailored to the needs of the individual supervisee and to the supervisee’s
clients (Bernard and Goodyear, 1998).
Supervisory Relationships
Supervision vs Counseling
Supervision is distinct from counseling in at least two ways (although the supervisee may
examine his/her thoughts and feelings toward his/her client(s) as it directly relates to providing
competent professional service):
A. Clients have a choice of whether or not to attend counseling and who their counselor will be.
Supervisees do not have a choice about supervision and very often do not have a choice
of supervisors.
B. Unlike clients, supervisees are actively evaluated on their performance against criteria
imposed on them from others.
Supervisory Relationships
Supervision vs Consultation
A. Supervision
In comparison with consultation, supervision is a longer-term relationship.
Supervision is not a choice for those trainees inexperienced in the field.
B. Consultation
Consultation, on the other hand, is usually not imposed on someone, and the
consultant, unlike the supervisor, does not assume an evaluative role.
Furthermore, the consultant may not be of the same professional discipline whereas in
supervision the supervisor serves as a role model for the profession of which the supervisor and supervisee are members.
Supervisory Relationships
Supervision Contracts
A. To facilitate a working alliance between the supervisee and the supervisor, supervision
agreements or contracts are suggested.
B. According to Osborn and Davis (1996), supervision contracts should include the following:
1. Purpose, Goals, and Objectives
2. Context of Services (where, when, what modalities will be used, etc.)
3. Methods of Evaluation
4. Duties and Responsibilities of Supervisor and Supervisee (e.g., the behaviors expected
form both supervisor and supervisee)
5. Procedural Consideration (emergency procedures, record-keeping, etc.)
6. Supervisor’s Scope of Practice (the supervisor’s experience and credentials should be
made explicit)