Midterm Study Guide Flashcards
“Crisis” is derived from which Greek word?
Krisis
What does the Greek word “krisis” mean?
Decision or turning point
What symbols does the Chinese word for “crisis” come from?
Combination of the symbols for “danger” and “opportunity”
What happens when a crisis continues without assistance or with lack of resources?
Builds on itself leading to lower and lower functioning
How many ACEs for someone to be likely to be crisis-prone?
4, 5, or more
What expectation can we not have when considering the ACE study?
Expectation that the person will respond to the world the same way that we would
What are examples of material resources?
Money, food, shelter, transportation, clothing
Who is known for the hierarchy of needs?
Maslow
What will happen if one’s needs are not met?
Will continue in crisis
What are examples of personal resources?
Physical well-being, ego strength, structure
What are examples of social resources?
Family, friends, church, work, school
What are the steps to conceptualizing a crisis?
1) A precipitating event occurs
2) A person has a perception of the event as threatening or damaging
3) This perception leads to emotional distress
4) The emotional distress leads to impairment in functioning due to failure of an individual’s usual coping methods that previously have prevented a crisis from occurring
What step of conceptualizing a crisis is the most crucial part to identify?
The perception of the event
Why is the perception of the event the most crucial part to identify?
It is the part that is most readily altered by the counselor
What is demand?
The environment’s requirement for a response by the system
What does research show is the most important factor when it comes to demand?
Perceived Environmental Demand (PED)
What is coping?
The system’s response to the environmental demand
What does research show is the most important factor when it comes to coping?
Perceived Coping Resources (PCR)
What is stress?
Perceived Environmental Demands (PED) = Perceived Coping Resources (PCR)
What is crisis?
Perceived Environmental Demands (PED) significantly exceeds Perceived Coping Resources (PCR) and normal coping resources deteriorate
What is trauma?
Perceived Environmental Demands (PED) so significantly exceeds Perceived Coping Resources (PCR) that coping resources deteriorate and basic schemas are destroyed
What is dissociation?
Our brain trying to keep us sane; the world doesn’t make sense, and one will do whatever one can to make the world make sense
What happens over time as the Perceived Environmental Demands (PED) increases?
Moves from coping to stress point to crisis point to trauma point
What are the problems included in the triage model?
Green problem, yellow problem, red problem
What is the green problem?
Problems that cannot be helped
What are examples of the green problem?
Pregnancy, affair, DUI, terminal illness
What is the yellow problem?
Problems that can wait
What are examples of the yellow problem?
Afraid to tell parents, need to call a lawyer
What is the red problem?
Must be addressed to reduce crisis
What are examples of the red problem?
Suicidality, homicidality, substance use, STI, depression/anxiety, safety
What are the steps of the ABC model of crisis intervention?
A - achieve rapport
B - boiling down the problem to basics/identifying the problem
C - coping - exploring client’s own attempts at coping and introducing alternative coping behaviors
What are characteristics of a crisis?
An event or multiple events which are perceived as…
- Happening suddenly or unexpectedly
- Arbitrary and somewhat unstructured
- Requiring more than available coping resources
- Potentially dangerous to some element of a person’s life-space
- Posing the threat of exacerbation of a person’s maladaptive coping responses
What is the option that a crisis offers an individual?
Growth, adaptation, and strengthening of coping response
What are the goals of crisis management?
- Attempt to return client to pre-crisis functioning
- Emotional first aid to stop the emotional bleeding
- Increase perceived coping resources and options
- Realistic assessment of demands of crisis events
- Increase in viability and desirability of available options
- Problem management (not resolution) of immediate short-term demands and plans for eventually addressing long-term issues at a later date
- Final problem resolution is delayed for a reasonable period
- Facilitation of future client services with traditional forms of counseling
- Present evidence of the pragmatic effectiveness of crisis intervention to client
What are characteristics of crisis management when compared to traditional counseling?
- Every minute may count
- The immediate “stakes” of an effective intervention to an immediate problem are paramount
- Stop the downward spiral
- Counselor’s expectation for problem resolution
- Immediate, accurate assessment
- Stress level in session is immediately high
What are characteristics of traditional counseling when compared to crisis management?
- No particular time crunch
- Effectiveness is not as immediate
- Waiting for client to “hit bottom”
- Client resolves problem with counselor’s assistance
- Assessment may be delayed
- Stress levels tend to be more moderate
What happened in the 1940s in the history of crisis counseling?
Establishment of Wellesley Project after Boston’s Coconut Grove Fire
What happened in the 1960s in the history of crisis counseling?
Crisis intervention trend gives rise to suicide prevention movement
What is the Community Mental Health Act of 1963?
- Came directly from President Kennedy
- Rise of effective psychotropic medication leads to closure of psychiatric institutions and support through community mental health centers; did not work out that way
- Patients were sent to jail
What happened in the 1970s in the history of crisis counseling?
Trend towards de-medicalization of community mental health care
What happened in the 1980s in the history of crisis counseling?
Rise of managed care
What is the role of non-professionals, volunteers, and paraprofessionals?
Vital in providing services to client populations (ethical with appropriate supervision by trained professionals)
What kind of state do clients in crisis come to counselor in?
A vulnerable state of disequilibrium and instability
What are some ethical issues to consider in crisis counseling?
- 1013 - involuntary transportation
- Diagnosis/misdiagnosis
- Multicultural competence
- Fraud
- Competence/supervision/consultation
- Self-awareness
- Dual relationships
- Confidentiality
- Informed consent
What are the exceptions to privilege and confidentiality?
- Danger to self or others
- Abuse or neglect of older adults
- Abuse or neglect of children
- Abuse or neglect of people with disabilities
What is multicultural competence?
Counselors must not impose personal values on clients, but instead be aware of how their values may be part of the problems that exist
How does rehabilitation counseling relate to crisis?
Particularly prone to seeing clients in crisis; normal part of adapting to rehabilitation needs
How does school counseling relate to crisis?
Unique features because of the school’s social structure and the sense of community (culture) within the school
What is the professional school counselor’s primary role in crisis?
Provide direct counseling service during and after an incident
What should one know prior to seeing their first crisis client?
The specific steps and procedures within their school or agency for crisis intervention
What should one use in order to not feel the need to make major decisions alone?
Supervision and consultation
How should a counselor judge the severity of the crisis?
By the client’s reactions, not some isolated event which “triggered” the crisis
What is a “centered” counselor?
Blocks the exacerbation of contagious emotions, such as anger, helplessness, hopelessness, depression, and anxiety
What is the prime goal of crisis intervention?
Clarity
When are many poor decisions made?
Before clarifying the problem, its options, and its potential consequences
How is a good crisis counselor creative?
In outlook and problem solving style
Why are most clients’ creative coping and problem solving limited?
- Cognitive rigidity
- Dichotomous thinking
- Poor perceived and/or actual problem solving skills
- A number of cognitive distortions
What is escape syndrome?
When anxious individuals are highly motivated to do anything to terminate an anxious situation rather than resolving it
What is bite-the-bullet syndrome?
When some clients want total resolution of their crisis now, when that is just not possible
How does a crisis counselor assist in the outcome of a crisis?
May not always end in a successful outcome; assists in creating the possibility of a resolution; actual outcome is affected by myriad of factors far beyond the counselor’s control
What type of crisis counselors do not last long?
Control-oriented and achievement-needing crisis counselors
What does an effective crisis counselor create during crisis?
An “eye” in the midst of the hurricane so that a temporary respite occurs
Why is a clear, concise contract (verbal and/or written) important?
For safety and problem solving between client and counselor
What is at the root of all suffering?
The search for meaning
What are some characteristics of the “crisis prone client”?
- General chronic psychosocial instability
- Poor expression of social interests
- Low perceived sources of social support
- Low impulse control and/or little long-term problem solving style
- Financial pressures
- Substance abuse issues
- Various forms of associated mental difficulties
- Prolonged medical concerns
What are some characteristics of the “crisis client”?
- Strong sense of urgency in the client’s life
- Overt and covert signs of lower coping
- Press of perceived demands
- Indicators of impending stress breakdown
- High levels of dysfunctional problem solving
What are some life events that precipitate a crisis?
- Accident in home/car/work
- Legal entanglement
- Job and/or career disruption
- Sudden/unexpected major financial burden
- Threat of disruption of significant intimate family relationships
- Physical illness and/or mental difficulties
- Natural disaster/war/famine
- Alteration of family structure
- Sanctions or penalty for non-successful performance
What are the 8 fears that are nearly always a concern to individuals dealing with medical crisis?
- Fear of loss of control
- Fear of loss of self-image
- Fear of dependency
- Fear of stigma
- Fear of abandonment
- Fear of expressing anger
- Fear of isolation
- Fear of death
What should a novice crisis counselor do instead of rushing to fix the crisis?
Use their basic skills; calm the client and complete a thorough assessment
What do veteran counselors do when facing a crisis?
Communicate empathy and hope first, then move to intervene
What should a counselor do because it will not exacerbate the problem?
Ask the client directly about the issue
What are the two things that be gin to slow a crisis down?
- The recognition of viable options
- The availability of social and instrumental resources
What are the stages of a client crisis?
- Impact
- Coping
- Withdrawal
- Adjustment
What happens in the impact stage of a client crisis?
Initial reactions to what is an unavoidable and apparently insurmountable problem
What are common reactions to the impact stage of a client crisis?
- Learned helplessness
- Anxiety, frustration, anger
- Agitated depression
What is learned helplessness?
Belief that efforts will have no effect in producing desired outcomes or preventing undesirable events
What does learned helplessness lead to?
Deficits in motivation, cognition, and emotion
What happens in the coping stage of a client crisis?
Individual exerts mental and behavior effort to address demands that seem to exceed resources
What does failure to grasp solution create in the coping stage of a client crisis?
Feelings of urgency to decrease pressure and increase motivation
What does increased motivation lead to in the coping stage of a client crisis?
- Trying new problems-solving strategies
- Openness to influence of others
- More likely to seek help
- If help is not available, may “cry for help” via suicide attempts
What is emotion-focused coping?
Attempts to reduce distressing feelings; leads to increased emotional distress and unrelated to successful problem resolution
What are some examples of emotion-focused coping?
- Problem and emotion distorted, denied, or repressed
- Restricted viewpoints and unbending attitudes
- Avoidance through drug and alcohol use
- Psychological problems become physical problems
What is problem-focused coping?
Attempts to alter stressful circumstances; leads to decreased psychological distress and satisfying outcomes
What are some examples of problem-focused coping?
- Problem and emotions recognized, explored, and understood
- Conditions that cannot be changed are accepted
- Breaking down problems into manageable segments
- Hope
What is hope?
The belief that things will get better and that one’s efforts can make a difference
What is withdrawal?
Occurs if none of the adaptive and maladaptive coping attempts have alleviated the distress
What does adjustment lead to?
Lifestyle that is more, less, or equally effective compared to pre-crisis
How long does it take most crises to resolve?
2 months
What are some factors that influence outcome?
- Hazardous circumstances
- Person’s emotional response
- Personality characteristics
- Social support
What are the stages of crisis intervention?
- Immediacy
- Control
- Assessment
- Disposition
- Referral
What should counselors inquire about in addition to exploring stressors and clients’ perceptions of them?
Clients’ emotional distress and functioning levels and how the precipitating events are affecting them
What are some ethical checks that a counselor should be aware of?
- Suicide check
- Homicidal or abuse issues
- Organic or other concerns
- Substance abuse issues
What is grief?
Noun for a deep sorrow
What is bereavement?
The process of grieving for the persons we love who die
What does grief induce?
Crisis when we are faced with it and our coping resources are too low to bear the sorrow
Why might this grief-induced crisis occur?
- Client development unprepared
- Pre-grief coping resources already too stressed
- Client is suffering illness or associated biological impairment
- Grief occurs soon after previous grief prone episode
- Client unaccustomed to the intensity of loss-related emotions
How do people grieve?
In their own unique way
What are the most effective coping skills available that should not be removed from the client?
Shock and dissociation
Who was one of the first to normalize the reactions of “disorganization” to a loss?
Bowlby
What is the first emotion that a counselor should express for the loss?
Empathy
What should adults look for in the way that children grieve?
Changes in child’s physical behavior, emotional feelings, thinking, and in relationships
What should adults be aware of in the way that children grieve?
- Young children may begin to blame themselves for loss
- Young children may not be able to verbalize the deep pain
- Young children may not be able to conceptualize the loss
What does death exacerbate?
All of one’s attachment issues
How do 3- to 5-year-olds understand loss?
- Do not understand the permanence of death
- Ask repeatedly when the deceased person is coming back
- Are frightened by adults’ grieving
- Demand a replacement for the deceased
What does complicated grief include for 3- to 5-year-olds?
Anxiety and regressive behaviors longer than six months after the death
How do 6- to 8-year-olds understand loss?
- Understand that death is universal and permanent
- Assume blame and guilt for the death
- Mourn through stories, pictures, and remembrances
What does complicated grief include for 6- to 8-year-olds?
School refusal, physical symptoms, suicidal thoughts, and regressive emotions and behavior
How do 9- to 11-year-olds understand loss?
- Demand detailed information about the death
- Avoid sadness and other strong emotions
- Increasingly express anger
- Feel a sense of the deceased’s presence
What does complicated grief include for 9- to 11-year-olds?
Shunning friends and increased moodiness and misbehavior 3-6 months after the death
How do 12- to 14-year-olds understand loss?
- Act callous, indifferent, and egocentric
- Strongly sense the deceased person’s presence
- Describe ongoing conversations with the deceased and take comfort in the deceased’s clothing and possessions
What does complicated grief include for 12- to 14-year-olds?
Refusing to attend school, persistent depression, drug or alcohol use, associating with delinquents, and precocious sexual behavior
How do 15- to 17-year-olds understand loss?
- Express thoughtfulness and empathy
- Resist excessive demands at home
- Feel overwhelmed by survivors’ emotional dependence and grief
- Grieve in adult-like ways with sadness and painful memories, but grief is of shorter duration
- Worry about their own vulnerability and death
- Have private conversations with the deceased
What does complicated grief include for 15- to 17-year-olds?
Mood swings, withdrawal from friends and group activities, poor school performance, and high-risk behaviors such as alcohol and drug use (also, sexual behavior)
What are the stages of grief for the very young?
- Numbness or protest
- Yearning and searching
- Disorganization and despair
- Reorganize if comfort present
What are the stages of grief for older children and adults?
- Denial
- Anger
- Bargaining
- Depression
- Acceptance
What is denial?
A refusal to admit and face the loss
What is anger?
Emotional reaction to being forced to encounter the loss
What is bargaining?
The attempt to try to escape the loss via negotiation
What is depression?
Emotional surrendering to the loss
What is acceptance?
Coming to terms with the loss
How long can the stages of grief be expected to last for meaningful loss?
A year or more
We should be clinically worried about clients who are in extreme grief for how long after a loss?
2 years
What is a memory box?
A helpful way of coping after a loved one passes away; can put items inside of the box that remind you of good memories you had with that person
What are nature’s greatest healers?
Movement and time
What are the steps to effective helping?
- Listen and support
- Identify the type of loss
- Determine if loss is single or cumulative and how does the loss add to pre-existing and post loss stressors
- Decide on intervention
What type of loss produces the most problems?
Sudden death or prolonged illness
What should a counselor ensure to do wherever possible?
Normalize, normalize, normalize
What is childhood traumatic grief (CTG)?
- Loss was accompanied by horror or terror
- Loss often sudden and violent
- Initiation of avoidance symptoms
- Onset of a variety of intrusive and numbing symptoms
- Child or adult becomes stuck
What was the record in 2015 for teen pregnancy?
Record low for U.S. teens
How do teen pregnancy rates in the U.S. compare to other western industrialized nations?
Significantly higher in the U.S.
What is the trend of birth rates per 1,000 females aged 15-19 years between 2007 and 2015?
Steady decrease among all races and ethnicities
What are the two main functions of a family noted by Minuchin?
- To provide support and nurturance
- To create individuals who can function in society independently of their family of origin
What may happen when a family system does not allow both autonomy and nurturance?
Teens may engage in self-destructive behaviors in an attempt to meet these needs
What are teen mothers more and less likely to do?
- Less likely to get or stay married
- Less likely to complete high school or college
- More likely to require public assistance and live in poverty
When is teen pregnancy more likely (noted by Samson et al.)?
- Child of a teen parent
- Low self-esteem
- Dating at an early age
- Dating men or boys who are five or six years older
Who owns the legal rights of minors in the state of Georgia?
Parents
What are physicians in Georgia required to do?
Offer women seeking abortion information about issues about procedure and information about public and private services available to assist throughout pregnancy, upon child birth, and while the child is dependent
What pills can be used to terminate pregnancy medically within the first 10 weeks of pregnancy?
Mifepristone and Misoprostol
What is the counselor’s role in addressing teen pregnancy?
- Neither to encourage nor discourage any specific procedure or response to unplanned pregnancy
- Offer information and/or referrals as necessary
- Provide a shame-free, safe space for clients to discuss fears and confusion
- Provide psychoeducation and explore options
- Seek consultation and supervision as necessary
What percentage of students have ever been tested for HIV?
10%
What percentage of “young people” have had sexual intercourse at least once?
41%
What age group do most reported chlamydia and gonorrhea infections occur among?
15- to 24-year-olds
What STI tends to be drug resistant and only has one option remaining for treatment in the U.S.?
Gonorrhea
What percentage of gonorrhea infections are resist to at least one drug?
30%
Do women or men face the most serious consequences of STIs?
Women
How many women in the U.S. become infertile each year because of an undiagnosed STI?
20,000
Which group has particularly high HIV infection rates?
MSM (men who identify as heterosexual, but have sex with men)
What percentage of all youth do not know they are infected with HIV?
60%
What groups of men are 40 times more likely to have HIV than other groups of men?
Gay and bisexual men
What is the red problem when facing an STI?
Reaction to the STI
What is the only 100% effective way to prevent HIV and most other STIs and pregnancy?
Abstinence (vaginal, anal, oral)
What significantly reduces (though not 100%) STI transmission and pregnancy?
Correct and consistent use of male latex condoms
What radically increases the chance of HIV/STI in sexually active teens/young adults?
Alcohol and drug use
What vaccine prevents 9 strains of HPV?
Gardasil
What types of cancer does HPV more commonly develop into?
Anal or oral cancer
What type of herpes can later turn into shingles?
Chicken pox
What age are both boys and girls when they first see pornography?
Boys are around 13 and girls are around 14
What percentage of male and female college students saw online porn before they were 18?
93% of male college students and 62% of female college students
What website has more traffic than Pinterest, Tumblr, or PayPal with 80 million visitors a day?
Pornhub
In terms of sexuality, what leads to stress/crisis response in teens?
Emerging sexuality and stress over sexual identity/performance
What does presentation of rough images on Snapchat, Facebook, and other social media lead to?
Confusion about how to communicate with a partner about sex and expectations
What is bullying?
Aggressive behavior that is intended to cause stress or harm, involves an imbalance of power, and occurs regularly over time
What are some consequences of bullying?
Suicide, low self-esteem, mental health issues
Who does the U.S. Department of Health and Human Services identify as being at the forefront of bullying intervention?
School counselors and teachers
What are the primary reasons for teens running away from home?
Conflicts with parents or parents actually told them to leave
What percentage of cases included teens who reported having been sexually or physically abused?
80%
What group makes up 20-40% of the 1.6 million homeless youth in America?
LGBTQ
What percentage of LGBTQ homeless youth are exploited through child prostitution?
58.7%
Approximately how many females and males in the U.S. are affected by an eating disorder?
7 million females and 1 million males
What disorder has the highest mortality rate of any mental disorder?
Anorexia nervosa
What are some signs to watch out for when considering eating disorders?
- Highly emotionally reserved and cognitively inhibited
- Prefer routine, orderly, predictable environments; adapt poorly to change
- Show heightened conformity and deference to others
- Avoid risk and react to appetitive or affectively stressful events with strong feelings of distress
- Focus on perfectionism, negative self-evaluation, and fears of adulthood
What is usually the crisis in the case of an eating disorder?
Discovery of the eating disorder or a medical crisis brought on by the disorder
What are eating disorders an attempt to do?
Regain control fo self and the environment
What is the response to disaster for children 1 to 6 years old?
- Startle response
- Somatic response
- Sudden immobility/freeze response
- Heightened arousal
- Loss of age appropriate verbal skills and motor function
- Clinging to caregiver/separation anxiety
- Repeated play of the disaster/trauma event
What is the response to disaster for children 7 to 11 years old?
- Behaving like a younger child/regression
- Anger/aggression
- Worrying about safety
- Sleep problems
- Somatic symptoms
- Preoccupation with safety/danger
- Anxiety
What is the response to disaster for adolescents?
- Increased withdrawal
- Self-destructive behavior
- Becoming more accident prone
- Shortened sense of the future
- Suicidal ideation
- Sleep problems
What are interventions when facing children’s and adolescents’ response to disaster?
- Do not punish regressive behavior
- Create structure and structured activities
- Provide age appropriate information about the disaster in a calm and factual manner
- Allow children to mourn in their own way and in their own time
- Encourage child to help with a family disaster plan
What is the key to de-escalation?
Do not become escalated yourself
What are de-escalation techniques aimed at?
Reducing violent and/or disruptive behavior
What are de-escalation techniques intended to do?
Reduce/eliminate the risk of violence during the escalation phase, through the use of verbal and non-verbal communication skills
What are characteristics of effective de-escalators?
- The ability to empathize
- Appear non-threatening and have a permissive, non-authoritarian manner
- Open
- Supportive
- Coherent
- Non-judgmental
- Confident, without appearing arrogant
Why is the ability to empathize vital?
It makes the clients feel understood and validates their experiences
What are effective de-escalators able to create even when anxiety is being experienced internally?
An appearance of calm
What is a sense of calm conveyed by counselors believed to do?
Help clients manage feelings of anger and aggression and communicate to clients that despite their anger, they are trusted not to be violent
What does calmness convey to the client?
That the counselor is in control of the situation
What are some strategies for controlling anxiety?
- Focusing attention on assessment of the client, rather than own feelings
- Acknowledging feelings of fear, rather than attempting to deny them
- Avoid personal feelings toward the client
What are some verbal and non-verbal skills to utilize during de-escalation?
- Using a calm, gentle, and soft tone of voice
- Tactful language and the sensitive use of humor
- Body language should express concern for the patient
- BE aware of body language in terms of posture, intention movements, eye contact, proximity, touch, and facial cues
- Active listening
Why should efforts to establish a bond with the client displaying aggression be made?
To foster a sense of mutual regard
What should the focus of engaging with a client be on?
Promoting the autonomy of the client, through minimizing restriction as far as possible
What are decisions regarding whether or not to intervene based on?
- Knowledge of the client
- Meaning of behavior
- Whether the clients’ behavior deviates from their “normal” presentation
- Dangerousness of behavior
- Impact on others
- Impact on the setting
- Staff resources
What assessments must be made to ensure safe conditions for de-escalation?
An assessment as to what level of staff support is necessary to safely de-escalate the client and an assessment of the area, in terms of potential weapons and exits for staff to leave the area safely
What are some strategies for de-escalation?
- Be empathic
- Try to understand the issue
- Respect personal space
- Use non-threatening body language
- Avoid direct confrontation
- Set limits
What is culture?
Any group of people who identify or associate with one another on the basis of some common purpose, need, or similarity of background
What are the three steps of psychological first aid?
- Direct
- Protect
- Connect
What percentage of the U.S. population aged 12 or older needed treatment for an illicit drug or alcohol problem in 2007, and what percentage of those people actually received treatment at a speciality facility?
9.4% needed treatment, and only 10.4% of those who need treatment received treatment
How many U.S. teens and young adults admit that they are binge drinkers?
More than 1 in 4
What is binge drinking?
Having four or more drinks for women, and five or more drinks for men over about 2 hours
What is the only way to determine if drug or alcohol use is an issue?
An excellent assessment as a component of your triage
What is a common component of drug and alcohol problems as well as the main barrier to helping the client feel better?
Denial
What should a counselor always check for during assessment for drug and/or alcohol abuse?
- Always check all the risk factors
- Always check all possible sources
- Always check for interactions
What are the questions for the CAGE addictions test?
- Have you ever felt you should CUT down on your drinking?
- Have you ever been ANNOYED when people commented on your drinking?
- Have you ever felt GUILTY or bad about your drinking?
- Have you ever had an EYE OPENER first thing in the morning to steady your nerves or get rid of a hangover?
What are two aspects that affect drug usage and the values around such?
Culture and SES
What is related to increased substance usage?
Stress
What is an expected component of recovery?
Relapse
What may or may not be related to substance dependence?
Functionality
What increases suicide risk and poor impulse control?
Substance usage
What are aspects of treatment for drug or alcohol abuse?
- Address denial
- Present options to client and emphasize the strengths to build upon
- Support decision making
- Follow-up
