Study Guide Test #2 Flashcards
Identify the need for strong ethical practices in Crisis Intervention
By definition, clients in crisis are in a vulnerable state
It would be easy to take advantage of someone – even if inadvertently.
Especially if they see you as a hero or rescuer.
Ethical guidelines protect you both
Nature and Importance of ethical issues like paraprofessionals:
Some think crisis intervention should be provided only by licensed professionals.
However, crisis intervention began with, and continues to be done by non-professionals / paraprofessionals.
They can be effective if properly trained and supervised.
And they are cost-effective.
Nature and Importance of ethical issues like self-awareness and countertransference:
You need to be aware of your own values, emotions, opinions, assumptions, motivations, and hangups.
(Be familiar with the turmoil surrounding death.)
Work through your own crises
They can be of great benefit to you if you do.
They will be of great hindrance if you don’t.
They can interfere with your ability to remain calm, objective, and client-focused.
Don’t assume too much
Nature and Importance of ethical issues like Dual Relationships:
Defined as having more than one kind of relationship with the client. Social, financial, sexual, etc. Avoid them if at all possible. Account for them when not. It is awkward at best. There is a dangerous power differential.
Nature and Importance of ethical issues like Confidentiality:
As a rule, clients are to be protected against any unauthorized disclosures of information made in the therapeutic relationship.
Deliberately or accidentally.
This right can be waived by the client
Continuity of care, supervision, coordinating with insurance, etc.
This right must be overruled in some cases
Danger to self/others, child abuse, etc.
Nature and Importance of ethical issues like Informed Consent:
Definition – permission for treatment by a client after he/she has been thoroughly informed about all aspects of treatment.
Anyone entering treatment has the right to know…
The nature of treatment
That it is voluntary
And what the limits of confidentiality are.
No rules for how much information to give.
Three elements
Clients must be able to make rational decisions
If not, a guardian must give informed consent
Clinicians must give information in a clear way and check clients’ understanding of risks, benefits, and alternatives
Clients must consent freely.
Exceptions to these requirements when clients are dangerous or gravely disabled
Medications, not ECT or surgery.
Nature and Importance of ethical issues like Supervision:
Don’t handle crises alone if you don’t have to.
Consult with supervisors and colleagues.
Let your clients know you will be doing so.
Professionals and paraprofessionals should receive continuous education.
Be familiar with the DSM.
Describe the elements of a good condolence letter.
Acknowledge the loss Express your sympathy Note a special quality of the deceased Recount a memory of the deceased Note a special quality of the bereaved Offer assistance Close with a thoughtful word, phrase, quotation, or Scripture passage
Describe the needs people have in grief that make the Psalms of Lament particularly valuable.
People need a way to make the unspeakable stuff speakable.
“The deeper the sorrow, the less tongue it has.”
People need to know they aren’t alone
People need to know it is OK
To complain / lament to God
To feel like they do, including anger at God
To ask God hard questions
People need to know there is hope.
List the 5 elements of a personal psalm of lament.
Invocation of God
Complaint / description of pain
Recalling of past salvation experiences
Petition / cry for help
Praise
Believing the prayer has been heard
For deliverance (thanking Him in advance)
Describe each step of the ABC model (be familiar with Kanel Ch 4)
-Core of this model is a cognitive process
Stage A: Developing & Maintaining Rapport
Use good attending behaviors
Use good listening skills (questioning, paraphrasing, reflecting, & summarizing)
Stage B: Identifying the Problem
Explore cognitions and emotional distress
Identify precrisis level of functioning
Identify ethical issues
Stage C: Coping
Identify current coping attempts
Present alternatives (emphasis on past successes)
Describe each step of the LAPC model:
Listen: What is the victim saying? Not saying?
Assess: What is the victim thinking and feeling? How is he/she acting?
Plan: What can the victim do right now? Is it reasonable?
Commit: Has the victim agreed? What resources are needed?
Describe the three core elements of empathy, genuineness, and unconditional positive regard
As you go, practice good attending, listening, and questioning skills.
List the primary attending skills.
Making & keeping eye contact Squaring & Leaning your body Nodding your head Keeping open posture Don’t force them too much. Match or pace your clients.
Distinguish between restating, paraphrasing, reflecting, and summarizing.
Clarifying – gather more information on previous statements
Restating & Paraphrasing
Reflecting – rephrasing the emotional content
Summarizing – in 1 or 2 meaningful statements
Identify the competing needs between counselors and clients
Counselor's needs: To be active To model helpfulness To help with the problem To express universality of the problem To use short-term interventions
Clients needs: To be autonomous To grieve first To retain ownership of the problem To express individuality of the experience To continue work long-term
List and describe the signs of effective and ineffective coping.
look up
Describe the reasons why some people do not complete the grieving process.
Misunderstanding of grief process Pain is too much to bear Fatigue in face of hard work Busyness in face of time needed Isolated from others Resistance from others
Describe what it means to “develop a context for acceptance”
Making sense out of the events and seeing how they fit into the greater scheme of life.
Finding meaning and purpose.
Not only surviving or recovering, but growing.
Listen for statements with depth.
May be demonstrated in actions instead of words
May be demonstrated in a commitment to helping others
“When individuals cope ineffectively… the trauma event tends to define who they are. When they cope effectively… the growth defines who they are.”
Describe some of the challenges involved in doing crisis assessment
look up but below is some
A client in crisis may not be interested in assessment
Overassessment is as dangerous as underassessment
Identify the goal, process, and materials of crisis assessment
Goal: Gather information about the crisis Help client mobilize resources Process: Ongoing, throughout counseling process Materials: Very few materials needed. No lengthy inventories or questionnaires
List the four areas of safety you should assess:
Lethality – threat to self, threat to others, return of perpetrator
Environmental – floods, building collapses, hurricanes, mudslides, etc.
Physical – immediate physical needs (food, shelter, financial maintenance, transportation, etc)
Emotional – caring relationship while vulnerable
Distinguish between the 5 levels of suicidal behavior.
Ideations Threats Gestures Plans Attempts
List the four main assessment questions for suicide
Ask if the person has thought of killing himself
How often?
How badly does he want to die (scale 1-3)?
Check for a person’s plan for suicide
Is it detailed? General?
Does the person have the materials?
Does the person have the intent?
Distinguish between each of Slaikeu’s areas of assessment (based on definition and/or example)
Behavioral – work, exercise, diet, sleep, use of drugs, aggression, etc.
Affective – feelings about the crisis or surrounding issues
Somatic – the basic senses, general physical functioning (headaches, tics, stomach problems, etc)
Interpersonal – quality and quantity of social relationships
Cognitive – memories, religious beliefs, intrusive thoughts, hallucinations, nightmares, etc.
List and describe each of the three areas of the Triage Assessment Form, including each of the sub-divisions.
Affective Domain:
Anger/hostility
Anxiety/fear
Sadness/melancholy
Cognitive Domain:
Perceptions of…
Transgression – perception of violation by others
Threat – perception of personal harm to the client
Loss – perception that something is not recoverable
These perceptions are identified in four areas:
Physical
Psychological
Social relationships
Moral/spiritual
Behavioral Domain:
Approach – attempts to address the crisis
Avoidance – ignoring or escaping the crisis
Immobility – nonproductive, disorganized, or self-defeating attempts to cope with the crisis
Describe the key areas of preparation for the minister
Understanding crisis and trauma
Knowing what support is available
Gifted members, church programs, denominational resources, community resources, etc.
Knowing when/where to refer
Describe the importance of confidentiality and distinguish how it is handled in formal counseling and crisis counseling settings.
Confidentiality is a cornerstone of all counseling relationships.
It creates an atmosphere of safety and trust.
But there are limitations:
Person is a danger to him/herself or others
Abuse of a child, older adult, or disabled person
When required by law/court
Formal vs. crisis counseling
Don’t make promises that can’t be kept
Describe when a minister should seriously consider referring a client to someone else.
When the minister’s time is too limited
When the minister is not gifted in counseling
When counseling is complicated
When there is no change
When there are significant self-harm issues
Identify the important questions to consider when making a referral to someone else.
Who sponsors the counselor?
What is the counselor’s spiritual orientation?
Is the counselor licensed?
What is the counselor’s training / education?
How long has counselor been in the community?
What is the counselor’s reputation?
What is the counselor’s claim about effectiveness?
Identify the major differences between general counseling and crisis counseling.
Intensity
G = more relaxed, for both client & counselor
C = intense emotions, need for alertness on symptoms / safety, need for rapid decision making
Location
G = familiar surroundings of an office
C = often on-site, unfamiliar, sometimes dangerous
The social work function
G = more focused on individual and internal
C = often includes social work
Accessing community resources and advocacy
Length and timing of sessions
G = multiple, scheduled, weekly, 50-minute sessions
C = wide variety
Single, spontaneous, irregular, brief sessions
Connect, talk, assess, tangible help, workable plan
Function rapidly and efficiently, remaining calm
Identify the common mistakes counselors make when doing crisis counseling.
Assuming everyone needs crisis counseling
Attempting to take away the pain
Attempting to rush through the recovery process
Mistaking temporary relief for recovery
Failing to work from a multidimensional view
Trying to make the client fit a certain model
Exempting themselves
Describe appropriate ways to help clients tell their stories
look up
Describe ways to help a client honor the memory of a deceased loved one.
look up
Describe the gender differences in those who attempt and complete suicide.
Men commit suicide 3-4 times more often than women
Women attempt suicide 3-4 times more often than men
Identify some common myths regarding suicide
Discussing suicide will make it more likely a client will commit suicide.
People who are serious about suicide to threaten suicide, the just do it.
Suicide is a completely irrational act.
Only crazy people commit suicide.
Once someone thinks about suicide, the thought never goes away.
Suicide is always an impulsive act.
List the clues and risk factors for suicide
History of suicidal gestures or attempts Chronic medical condition / pain Drug / alcohol use Psychiatric disorder Agitated depression Physical or psychological trauma Isolation from others Feeling hopeless or helpless Putting things in order
List the five areas to address in suicide assessment
Ask if the person has thought of killing himself
How often?
How badly does he want to die (scale 1-3)?
Check for a person’s plan for suicide
Is it detailed? General?
Does the person have the materials?
Does the person have the intent?
Check for their level of control.
“Is there anything or anyone that could stop you?”
“What has been stopping you?”
Describe how to intervene at each level of risk
Low-risk “I thought about it, but I’m not sure. It scares me to have feelings like these and I need someone to talk to.” Supportive crisis intervention Outpatient treatment Verbal no-harm contract
Moderate-risk
Most common a crisis counselor will see
May be able to function at work/home but feel as if there is no way out of the situation
May have made some threats
Regular (daily?) contact
Increased family contact and/or “suicide watch”
Remove the means of suicide
Written no-harm contract
Focus on future (reasons to live / meaning in life)
High Risk “I’m going to kill myself. You can’t stop me.” If pressed, will admit to having a viable plan and means for suicide Voluntary hospitalization Empowers clients, reduces conflict Involuntary hospitalization 911 Court petition
Describe the advantages and disadvantages of ministers counseling those who are suicidal.
Should ministers counsel suicidal persons?
NO
Legal liability
Lack of effective training
Lack of time / energy to be effective
YES
Suicide is not just a psychiatric problem, it is also a spiritual one.
Ministers may be more available and trustworthy in the eyes of some.
Identify the best predictor of violent behavior
past history of violence
Identify the psychological disorders and the substances often associated with violence
Intermittent Explosive Disorder
Paranoid Schizophrenia
Antisocial Personality Disorder
Alcohol
Stimulants
Hallucinogens
Steroids
Describe how to intervene with violent persons at each level
Level 1 – Anxiety Level Behavioral changes are noted (agitation or restlessness) Use a supportive, empathetic approach Do not be judgmental or dismissive Validate their frustration, etc.
Level 2 – Defensive Level
Person loses rationality, may also lose control
Person may be verbally abusive
Do not enter a shouting match
Don’t give ultimatums or threaten
Set limits in firm, calm, professional voice
Give choices & knowledge of consequences
Level 3 – Acting Out Level
Person has lost control over behavior
Continue verbal intervention, and add physical restraint as a last resort
Get training in non-injury restraint techniques
Describe practical tips for intervening with violent persons
Do not stare the person down. Move slowly, telegraph movements Be aware of throwable objects Do not get cornered Keep assistance nearby Let one person do the talking
Describe the Tarasoff case and the implications for treating violent persons
A School counselor had a student that was threatening to kill his girlfriend. He went to the campus police and warned them but the guy eventually killed his girlfriend
What does it mean?
You have a duty to break confidentiality when others are in danger of harm
You should notify authorities
You should notify the potential victim
You should consider possibility of hospitalization
“The law does not require that counselors always be correct in making assessments… but the law does require that counselors make those assessments… and fulfill their professional obligations.”
