Managing Crisis Situations Flashcards
You have seen a client for the ten sessions authorized by her HMO, and have given her three referrals for long-term therapy. Before she has a chance to make an appointment with a new therapist, a crisis arises and she calls you for help. The most appropriate way to manage this crisis is to:
Select one:
A.
tell the client you can’t talk to her because you are not her therapist anymore.
B.
schedule an appointment to see the client and continue seeing her until the crisis has abated.
C.
refer the client to a 24-hour suicide help line.
D.
call each therapist on the referral list to see who can schedule a first appointment most quickly.
Answer B is correct: The client’s welfare is of paramount importance, and this is clearly the only answer that addresses her best interests. It is likely you will not be reimbursed by the HMO, but this should not be a consideration.
Answer A is incorrect: This answer is easy to eliminate because simply telling the client you can’t talk to her is clearly not in her best interests.
Answer C is incorrect: This answer can be eliminated because there is nothing in the question indicating that the crisis is about suicide.
Answer D is incorrect: This does not adequately respond to the client’s current crisis state. Also, you would be breaching the client’s confidentiality by taking this action.
The correct answer is: schedule an appointment to see the client and continue seeing her until the crisis has abated.
Which of the following is the most appropriate message that a therapist should give a client during the beginning of crisis intervention?
Select one:
A.
“Let us look at your irrational thoughts and beliefs about this crisis.”
B.
“Trust me and follow my guidance and you will get through this.”
C.
“I will do everything in my power to help you if you will let me.”
D.
“You will have to learn how to handle these things.”
Answer B is correct: A person in crisis needs reassurance and guidance and must come to believe that he or she has the ability to overcome this temporary situation. This message is consistent with the overall process used in crisis intervention. While a client is in crisis, the therapist should give the client hope, participate actively, and be very directive in recommending activities that will help the client resolve the crisis.
Answer A is incorrect: Using cognitive strategies to help the client understand the crisis, eliminate mistaken or irrational beliefs that contributed to the crisis, or view the precipitating event in a different way can be a part of crisis intervention, but this answer does not describe an important message you would want to give a client at the onset of crisis intervention.
Answer C is incorrect: While the therapist should be directive and give the client hope, this message conveys that the client is helpless. Instead, the therapist should work to protect the client’s self-esteem while also encouraging his or her self-reliance. This requires striking a balance between providing support and direction and encouraging the client to be independent.
Answer D is incorrect: This could be interpreted as correct since one goal of crisis intervention is often to help a client develop more adaptive coping strategies that he or she can use now and in the future. However, the way this message is stated sounds like a criticism, which would not empower the client or protect his or her self-esteem.
The correct answer is: “Trust me and follow my guidance and you will get through this.”
Your new therapy client has been abused by her husband but denies that this is a problem for her. She asks you to help her relax so that she can sleep better at night. Regarding addressing this client’s denial, experts suggest that you should initially do which of the following?
Select one:
A.
If the client is not in immediate danger, focus on building a trusting relationship with her.
B.
If the client is not in immediate danger, collect a detailed history so that the client will see the patterns in her relationship.
C.
Encourage the client to face the reality of her situation.
D.
Confront the client about the reality of her situation.
Answer A is correct: According to experts, when a battered woman is in denial about the existence or extent of domestic abuse but is not in immediate danger, the therapist should focus initially on building a trusting relationship with her. The woman should be allowed to overcome the denial at her own pace, and the therapist should avoid attempting to break through the denial by confronting the woman about her situation.
The correct answer is: If the client is not in immediate danger, focus on building a trusting relationship with her.
You are treating a single mother of four young children. She was abused by her boyfriend over the weekend and has massive bruises on her forearms and face. If you rely on an object relations approach to therapy, what will you do first?
Select one:
A.
evaluate her coping skills
B.
create a safe holding environment
C.
allow her to free associate
D.
refer her to a medical doctor
Answer D is correct: The fact that you rely on object relations theory is a distractor, and the question is asking what you (regardless of your theoretical orientation) should do when a client has been physically abused. Given the client’s obvious injuries, the first thing you should do is refer her for a medical exam.
Answer A is incorrect: Information about the woman’s coping skills might be useful but not as an initial intervention.
Answer B is incorrect: This is a good intervention for the middle stage of object-relations therapy, but this question is asking what you would do in a crisis situation.
Answer C is incorrect: This is a psychodynamic intervention and does not address the client’s immediate needs.
The correct answer is: refer her to a medical doctor
You have determined that your new client’s symptoms meet the criteria for a diagnosis of major depressive disorder. The presence of which of the following MOST suggests that he is at high risk for suicide?
Select one:
A.
He has a family history of suicidal behavior.
B.
He has a history of one or more suicide attempts.
C.
He reports that he takes no pleasure in previously enjoyed activities.
D.
He has recently experienced the death of a family member.
Answer B is correct: The research has generally confirmed that a history of one or more suicide attempts is the strongest predictor of completed suicide.
Answer A is incorrect: People with family histories of suicide are at increased risk, but one or more previous suicide attempts is a stronger predictor.
Answer C is incorrect: This is a symptom of depression but is not considered a good predictor of suicide since many depressed individuals are not suicidal.
Answer D is incorrect: A recent loss or death is associated with an increased risk for suicide, but one or more previous suicide attempts is a stronger predictor.
The correct answer is: He has a history of one or more suicide attempts.
You are seeing a family that consists of Mom, Dad, two teen-age daughters, and an 11-year-old boy. Both parents are very authoritarian. The father, in particular, is very autocratic and has a fixed set of rules governing all aspects of his children’s lives. For instance, he does not allow them to entertain friends at home or go to the mall or park. You have not observed any expression of affection between the members of the family. The mother seems the most frozen and displays no sadness when relating the death of an older son last year from chronic asthma. Given the observable isolation, inflexibility, and inability to connect with feelings, you would FIRST want to rule out the possibility of:
Select one:
A.
spouse abuse.
B.
child abuse.
C.
father-daughter incest.
D.
enmeshment.
Answer B is correct: This should be your first consideration and encompasses answer C, since incest is a form of child abuse. Abusive families are typically closed and characterized by rigidity, inflexibility, authoritarianism, and isolation
Answer A is incorrect: This is an important consideration, but your reporting obligation makes answer B a better first consideration.
Answer C is incorrect: This is possible but answer B is a better answer because it includes this and allows for the possibility of other types of abuse as well. Also, the question says both parents are authoritarian. With father-daughter incest, it’s more typical for the father to be authoritarian and the mother to be passive, absent, or unable to assume a protective role.
Answer D is incorrect: Ruling out child abuse is clearly more important than identifying the family’s structure.
The correct answer is: child abuse.
Your new client is a recently retired postal worker, aged 67, who was referred by his pastor. The client approached the pastor several times in the last few weeks, and the pastor referred him to you because he felt the client’s problems are beyond his scope. The client says he thinks he’s depressed. You would be most concerned about the client’s risk for suicide if he reports that:
Select one:
A.
he was recently divorced, his father committed suicide a year ago, and he is not eating or sleeping well.
B.
he was recently divorced, he recently changed his will, and he feels quite hopeless about his future.
C.
he feels lethargic and has not been eating or sleeping well, and he resists your suggestion to see a physician.
D.
he’s had a worsening problem with alcohol since his retirement, he has trouble concentrating, and he isn’t very interested in his usual activities and hobbies.
Answer B is correct: Each answer includes indicators of depression and/or factors associated with suicide risk. However, this answer includes a sense of hopelessness, which has been identified as one of the best predictors of suicide and an activity (changing his will) that suggests the man is preparing for his own death. These two factors combined with the recent divorce indicate a high risk for suicide.
Answer A is incorrect: This answer describes two recent losses – the divorce and the father’s suicide – but it does not suggest that the client is feeling a sense of hopelessness or helplessness. While there is an increased suicide risk for an individual who has had another family member commit suicide, suicidal signs and symptoms in the individual himself (rather than in a family member) would be more significant.
Answer C is incorrect: Although this answer suggests that the client may be very depressed (he is lethargic and has not been eating or sleeping well), depression does not always lead to suicide. In addition, these symptoms could be due to a medical problem.
Answer D is incorrect: While alcohol use, a recent life change (retirement), and loss of concentration and interest are associated with depression, they are less indicative of a high suicide risk than the factors included in answer B.
The correct answer is: he was recently divorced, he recently changed his will, and he feels quite hopeless about his future.
You are working at a crisis center and your new client was raped a few hours ago when she was jogging in a local park. Your first intervention should be to:
Select one:
A.
refer the woman to a support group.
B.
mobilize the woman’s support system and coping ability.
C.
help the woman make a self-care plan for the next 24 to 48 hours.
D.
encourage the woman to relate the details of her experience.
Answer C is correct: Since this is crisis counseling, identifying immediate goals and ways to achieve them are most important. Making a self-care plan will involve identifying and addressing the woman’s immediate needs and will include obtaining appropriate medical care, mobilizing her support system (answer B), and providing information on community resources. Relating the details of her experience (answer D) may be re-traumatizing at this stage, and a support group (answer A) will be more appropriate later.
The correct answer is: help the woman make a self-care plan for the next 24 to 48 hours.
A client has been in therapy with you since the break-up of his marriage two months ago. He arrives for his current session looking disheveled and, after a few minutes, he tells you that he hasn’t been able to eat or sleep. As he speaks, his voice begins to quiver and he appears to be in significant distress. Your FIRST step should be to:
Select one:
A.
refer the client for a medical evaluation.
B.
ask the client how long he has felt this way.
C.
evaluate the client’s risk for suicide.
D.
ask the client if any event precipitated his current symptoms.
Answer C is correct: Suicidal ideation can accompany a major depressive episode and, based on the client’s symptoms (e.g., he can’t eat or sleep, is disheveled, has recently experienced a significant loss), you can conclude that he is depressed. Consequently, your first priority should be to assess the client’s risk for suicide by asking him if he has thought about suicide, has a plan, etc.
Answer A is incorrect: A medical evaluation is appropriate but not as a first step. Your primary concern should be that this client may pose an immediate danger to himself.
Answer B is incorrect: The duration of the client’s symptoms is not the first question you would ask. Instead, it is more important to explore factors that are associated with suicide risk.
Answer D is incorrect: Asking the client about precipitating events is not one of the first questions you would ask this client. In addition, you already know that he has recently experienced a significant stressor – i.e., the breakup of his marriage.
The correct answer is: evaluate the client’s risk for suicide.
One of your jobs is to assess families that have been referred for protective services due to allegations or suspicions of child abuse. Based on your experience and knowledge of the research, you know that which of the following is LEAST likely to be a contributing factor in parental abuse of a child?
Select one:
A.
Abusive parents were themselves abused or neglected as children.
B.
Abusive parents often expect the child to provide them with emotional support and companionship.
C.
Abusive parents often view the child as a sibling with whom they had a rivalrous relationship in childhood.
D.
Abusive parents have a history of childhood deprivation.
Answer C is correct: The research has not found this to be characteristic of abusive parents.
Answer A is incorrect: Studies have found that parents who mistreat their children were often themselves abused and/or neglected as children.
Answer B is incorrect: The research has also found that abusive parents tend to expect the child to provide them with emotional support and companionship.
Answer D is incorrect: The research has confirmed that abusive parents often have a history of childhood deprivation – e.g., separation, divorce, or death of a parent; alcohol-or drug-addicted parent; abuse, neglect, or abandonment.
The correct answer is: Abusive parents often view the child as a sibling with whom they had a rivalrous relationship in childhood.
Lenore Walker’s “cycle of violence” model of spouse abuse predicts that, immediately following an incident of abuse, there is a period of:
Select one:
A.
withdrawal and reconsideration.
B.
tension-building.
C.
loving contrition.
Correct
D.
retribution.Lenore Walker’s “cycle of violence” model of spouse abuse predicts that, immediately following an incident of abuse, there is a period of:
Select one:
A.
withdrawal and reconsideration.
B.
tension-building.
C.
loving contrition.
D.
retribution.
Answer C is correct: Lenore Walker’s (2009) cycle of violence model includes three stages which, in order, are tension building, acute battering incident, and loving contrition. According to Walker, abusive relationships tend to remain stable when the costs of the abuse and the benefits of the loving contrition behaviors exhibited by the abuser after an abusive incident are about equal.
The correct answer is: loving contrition.
While conducting your initial assessment of a family, you become concerned that the father and daughter may have an inappropriate sexual relationship. Signals that may indicate father-daughter incest in a family include all of the following EXCEPT:
Select one:
A.
parentification of the teenaged daughter.
B.
a rigid family atmosphere.
C.
antagonism between the father and daughter.
D.
overprotectiveness of the daughter by the mother.
Answer D is correct: Overprotectiveness by the mother is unlikely. More often, the mother is passive, absent, or unable to assume a protective role. She may also unconsciously sanction the incest by directly or indirectly fostering the daughter’s assumption of a sexual role. The other answers all describe family characteristics than have been linked to father-daughter incest.
The correct answer is: overprotectiveness of the daughter by the mother.
A person experiences a traumatic event. Which of the following factors is LEAST likely to play a role in determining whether this event will activate a crisis?
Select one:
A.
the person’s problem-solving ability
B.
the person’s cultural values regarding the event
C.
the person’s current levels of social, material, and other support
D.
the actual nature of the traumatic event
Answer D is correct: Crisis may stem from personal or material losses, transition states, and social and cultural factors, but events alone do not usually activate crisis. Instead, a crisis occurs when a person’s interpretation of the event and available coping methods and social resources produce tension so severe that the person cannot find relief. Key determining factors include the person’s cultural values regarding the event, the person’s previous problem-solving ability, and the person’s current levels of social, material, and other support.
The correct answer is: the actual nature of the traumatic event
You work for a social service agency that specializes in treating delinquent youths. Alexander is a 15-year-old runaway referred to you by his school guidance counselor. He has a history of delinquent behavior, including truancy, shoplifting, and excessive use of alcohol. Prior to his most recent attempt at leaving home, he was expelled from the high school he was attending. Alexander appears to be hostile and resentful about his forced meeting with the “head shrinker.” During the initial interview, he reveals that he hates his father (who drinks excessively and beats his mother) for ruining his life. You ask Alexander why he ran away and he responds “they probably have not noticed anyway.” Alexander refuses to discuss his relationship with his mother. As a therapist familiar with treating runaways, you would suspect which of the following?
Select one:
A.
Alexander has been physically abused.
B.
Alexander will turn out to be just like his father.
C.
Alexander’s mother probably also drinks excessively.
D.
Alexander’s father beats the other children in the family.
Answer A is correct: More than one of the answers could be true. However, the question states “as a therapist familiar with treating runaways,” which implies that the correct answer is the one that describes something that is usually true about runaways. Runaways are usually running from something and, often, it is physical or sexual abuse.
Answer B is incorrect: Alexander is beginning to parallel his father’s drinking behavior (although he is not displaying violent behavior), but it is not generally true that runaways turn out like their fathers (or mothers).
Answer C is incorrect: Although Alexander’s mother may also have a drinking problem, it is not generally true that both parents of a runaway have a drinking problem.
Answer D is incorrect: This is a possibility, but there is no mention in the question of other children in Alexander’s family.
The correct answer is: Alexander has been physically abused.
A mother brings in her six-year-old daughter. She tells you that the girl has no friends at school and that her teacher says she seems to have trouble paying attention. The girl is clingy and looks scared. What should you do first?
Select one:
A.
consider a diagnosis of Separation Anxiety Disorder
B.
assess for child abuse
C.
contact the child’s teacher
D.
refer the child for psychological testing
Answer B is correct: The girl’s clingy and fearful behavior and lack of peer relationships are indicators of possible child abuse. Safety issues should always be addressed first in therapy, and your top priority in this situation is to determine if you need to report abuse.
Answer A is incorrect: Although the girl’s behavior could be the result of Separation Anxiety Disorder, it also could indicate that she has been abused and this would need to be addressed first.
Answer C is incorrect: Although the mother mentions that the child is having difficulty in school, this is not the most important first concern. However, once you’ve dealt with the possibility of child abuse, it would be useful to obtain information directly from the girl’s teacher.
Answer D is incorrect: This does not address the child’s safety, which should be your immediate concern.
The correct answer is: assess for child abuse
