Midterm Exam Flashcards
Crisis Intervention- Initial Phone Call
1) Basic information gathering
2) Briefly assess mental health emergencies
* Suicide, violence, severely impaired
judgement
3) Do not decrease anxiety too much
* who, what, where, when, how process
happens
4) Set up first appointment for no more than 24
hours away (don’t let more than 1 night pass)
* In person is much better way to assess
* Crisis = 6 weeks
* Crisis Intervention = within 24 hours
* Emergency = See them IMMEDIATELY
Process Issues in First Session
1) Take charge
2) Build communication and rapport
3) Normalization
4) Empathy and active listening, clarifying,
paraphrasing, support, etc.
5) Avoid “why” questions
6) Process feelings but beware of excessive
ventilation
* May dilute motivation and cause later
embarrassment
* Warn Client
7) Note “Client Request” (handout)
Client Request
- Control/ Support
- Reality contact
- Constancy/ Check-in
- Confession
- Ventilation/ Good Listener
- Advice
- Clarification/ Perspective
- Psychotherapy
- Medical Treatment
- Legal/ Administrative Help
- Social Help
- Triage
- Nothing
* Good way for the person to heel heard* Many ppl don't even know what they want but will feel satisfied. * Increase satisfaction will promote higher rates of the outcome
Content of First Session/ Assessment of Crisis: Client tells his/ her story
1) Client tells his/ her story- A chronology of recent events, leading up to and including the crisis state.
- Was there a hazardous situation prior to the precipitating event?
- What was the precipitating event(s)?
- Why was the precipitating event "the final straw"?
- Why now?
- Don't pressure the client to tell the entire story at first if it is too upsetting
* take it over time in small doses
Content of First Session/ Assessment of Crisis: Establish that this is a crisis
2) Establish that this is a crisis
* Borderline personality / substance abuse ppl
- Degree of functional impairment
- nature and intensity of feelings
- obtain picture of previous equilibrium or
baseline including:
* occupational functioning
* quality of relationships
* Degree of impulsivity
- Don't do crisis intervention if this is not a
crisis
* Intense emotionality
* Chronic instability
* or a chaotic lifestyle do not constitute
a crisis
- Crisis intervention is appropriate for TYPE 1
trauma ONLY
Content of First Session/ Assessment of Crisis: Explore previous similar experiences
3) Explore previous similar experiences:
- Did anything like this ever happen to you
before?
- Have you ever felt like this before?
Content of First Session/ Assessment of Crisis: Assess coping, support, and meaning
4) Assess Coping, Support, and Meaning
- Coping:
* assess coping mechanisms used
* assess the extent to which the client
can talk about the event and manage
the feelings elicited
* assess adaptive vs. maladaptive coping
strategies
- Support:
* assess extent of support system and
client's willingness to use it
* Especially note support from S.O.
during "homecoming"
- "Homecoming" = the initial
response immediately after crisis
- Meaning:
* assess the meaning of the event for
this person at t his time
* the precipitating event often
corresponds to an area of importance
in the client's life
* the meaning often represents a real
or symbolic loss in this area
Content of First Session/ Assessment of Crisis: Assess mental health emergencies
5) Assess mental health emergencies:
- potential suicide
- potential violence
- states of severely impaired judgement
* Important to say the phrase “Hurt yourself
and Suicide when assessing
* Methods: cutting, shooting, hanging, co2
* If ppl have vague thoughts that's normal
* If ppl have a plan, then need to investigate
further (Huge red flag for concerns)
Content of First Session/ Assessment of Crisis: If traumatic stress assesses trauma symptoms
6) If traumatic stress assesses trauma
symptoms:
- Intrusive thoughts
- Distressing images
- thoughts
- memories
- re-experiencing (flashbacks)
- distress at reminders (even clients who did
not witness the event create images) =
re-living the event
- Purposeful avoidance of reminders of the
event
* People, places
- Dissociation: the structured separation of
mental processes that are normally
integrated (4 categoreis):
1) Dissociation of emotion
* lack of emotional response
* emotional numbness
2) Dissociation of consciousness
* Feeling “spaced out”
* Depersonalization
* Derealization
* feelings of unreality
* Altered sense of time
* Lack of pain if injured
3) Dissociation of memory
* Partial or complete amnesia
* but note that head injuries are
a more common cause of
amnesia that dissociation
4) Dissociation of identity
*Dissociative fugue, DID
- Note extent of peritraumatic dissociation
- defense mechanism vs marker of distress
- Heightened general physiological arousal and anxiety:
* Difficulty sleeping
* difficulty relaxing
* irritability
* Hypervigilance
* heightened startle response
Content of First Session/ Assessment of Crisis: Diagnostic Impression
7) Diagnostic Impression
- Acute Stress Disorder (ASD)
- Adjustment Disorder
Content of First Session/ Assessment of Crisis: Mandatory Reporting
8) Mandatory Reporting:
- Child Abuse/ Neglect
- Elder Abuse/ Neglect
- Exploitation
- Duty to warn regarding potential violence
* No law on this
* Can be sued by victim, though is not a
law or mandated to report.
Content of First Session/ Assessment of Crisis: In Cases of Traumatic Stress that Involve Death
9) In Cases of Traumatic Stress that Involves Death:
- Traumatic stress reactions must be
treated first
- Grief reactions second
* can co-occur together
Content of First Session/ Assessment of Crisis: Hope and Expectations
10) Hope and Expectations:
- You are attempting to convey by your
entire approach your attitude that the
client is:
*capable
* Decent person who has been
temporarily overwhelmed by extreme
stresses
* who will use your help to cope with
these stresses and get back on track
Content of First Session/ Assessment of Crisis: Define the problem as something that can be changed
11) Define the problem as something that can be changed
- “your reaction to losing your job”
- NOT “losing your job”
Content of First Session/ Assessment of Crisis: Avoid blaming self or others
12) Avoid blaming self or others
