Principles of Crisis Intervention | CEUs for LCSWs, LPCs and LMFTs
this episode was pre-recorded
as part of a live continuing education webinar on-demand CEUs are
still available for this presentation through all CEUs register at allceus.com/counselortoolbox ten principles of crisis intervention we’re
going to start by defining crisis of course identifying the six basic threats and how
they relate to the crisis we’ll discuss some of the characteristics of crisis and examine culturally
influences in behavior explore the safer model and identified ten principles of crisis intervention
so what is a crisis happens when people are facing an untenable obstacle to goals and people
life cycles are significantly disrupted now that doesn’t necessarily mean just having those two
things don’t necessarily mean somebody’s going to have a crisis what you have to have that third
ingredient the person has no appropriate response to deal with the situation so their coping skills
are completely overwhelmed for whatever reason and this depends on the person I mean some people get
completely overwhelmed when like my grandmother bless her heart used to get completely overwhelmed
when something would would break at the house and it would just throw her for a loop and she’d have
panic attacks and it was unpleasant for her and it was stressful for somebody else
something goes bad at the house they just call up a repairman and bought a bang it’s done so we
don’t want to assume that everybody’s crisis or crises are the same Oh lovely so one of the things
we need to consider when we’re looking at a crisis when we’re getting ready to intervene with
someone what is it that we need to know about them to effectively what’s the word I’m
looking for effectively intervene with them so an extrovert is going to want to be around other
people so if they experienced something that may lead them to feel isolated that may precipitate
more of a crisis likewise if they’re in BIRT and they’re in a situation where they feel like
everybody’s looking at them which could escalate this situation so we want to be aware of
what situations are going to exacerbate the crisis and what things can we do to help mitigate
anything that’s going on and reduces the stress in the immediate moment the next thing we want to
think about how they conceptualize the problem and you can get a lot of this obviously
you’re not going to give them a Myers-Briggs or something while they’re in crisis but you can get
a lot of this by listening to what they’re saying if they’re talking about fairness and justice and
looking at things more logically point A to point B sort of thing they’re probably more sensing and
and they probably are more detail-oriented so you know that’s one of the things you want to focus
on is hear the details but try to get them to pick their head up so to speak and look at the bigger
the picture we’re focused on this one aspect right now which may suck don’t get me wrong but let’s
look at the bigger picture about what’s going on and eventually, you’ll get there if you’re working
with somebody who’s intuitive, they may be seeing the bigger picture but missing the details so this
one event happened and this is how it’s going to affect my life and yeh yeh yeh missing the
details that there are things they might be able to do there are details and parts of this that
they do have control over they’re just seeing it as a global thing that they are out of control
thinking and feeling is where they get meaning from so again by listening to the words they use
are they more logic-oriented what’s the logical resolution what’s the fairest resolution if they
are more feeling-oriented and collectivistic then you might want to focus on having them
identify things that are going to help everybody feel better and the impact of what they’re doing
you know potentially on their significant others so thinking about and the timing of these is
going to be very critical you’re not going to walk up to somebody and go what
are you doing how do you think your kids are going to react if you do this that’s not
appropriate but you might start talking about you know they start talking about their family
and their kids and how they’ve let them down and everything and you can say okay you know tells me
a little bit more about your kids so let’s start talking about that that broadens the situation you
know gets them to look at things more than just this one little thing broadens the situation and
also helps them start focusing on their impact on others and then judging and perceiving you know
some people like structure and like to know how things are gonna play out things some people
are a little bit more spontaneous and that’s okay when you’re creating an action plan for them
what are you going to do in an hour what are you gonna do in three hours or tomorrow some people
will want more structure other people will want a list of things you know let’s try to get this
done tomorrow and these five things done this week so ask them what feels comfortable to them
and obviously, that’s in the later versions are later parts of crisis intervention when you’re
talking about implementing the plan so their temperament does have a lot to do with it when
you’re looking at interventions that are helping you know the extrovert is going to need to be
around other people, extroverts typically draw their energy from others and they talk and think
at the same time, they’re thinking everything out wow they’re talking so if an extrovert doesn’t
have somebody to bounce ideas off of they may feel very stuck whereas an introvert needs some
downtime they need some quiet time where they can think and get their thoughts together that
they’re more than happy to share but we want to look at these sorts of things when figuring
out how to mobilize resources for the person so crisis represents the presence of opportunity
and danger you know it’s an opportunity for change because as they say change causes crisis
and crisis causes change when we change you know New Year’s is New Year’s right now and a lot
of people make new year’s resolutions and they’re trying to change something and it’s going to get
a little comfortable now crisis doesn’t have to be something where somebody’s a suicidal crisis
means life is going to get uncomfortable there is an element of discomfort or crisis or shaking
things up a little bit change cause you know when you alter the equilibrium of something when
you alter the patterns of something it’s going to require some time to adjust to and then the crisis
causes change when things are kind of up in the air or in that flux sort of State people want
to get back to a state of equilibrium so they can either go back to the way it used to be and
just you know that was more comfortable or they can say I don’t want to go back there that was
uncomfortable I want to continue this change but let’s figure out how I can do it and make
it works for me one thing we need to recognize though is while there is this present presence
of opportunity so whatever’s happened you know how can we make lemonade out of it whatever you
however, you want to look at it but if somebody is feeling overwhelmed then as the anxiety increases
they may do more things that are more impulsive and violent so we want to make sure that we don’t
start throwing opportunities at them and make getting they feel overwhelmed they want things
to go back to the way they were or they want things to go back to a certain way so we don’t
want to push too much we need to recognize though that this is an opportunity for a growth crisis
is complicated it generally does not have one simple cause it’s kind of like an onion you know
there there are things or maybe Jenga if you want to think about a Jenga block each block is built
and balancing on one another and there’s you know a certain dynamic holding everything together
when a crisis happens you know generally it’s not somebody woke up in the morning and everything
is perfect and then you know something happens and things are not perfect anymore and they’re in
the crisis generally there have been things leading up to it isolation loss of friends changes in jobs may be
sometimes it’s having you know getting married or having a new baby in the house now I will say
that they find that being married is a protective factor against suicide but the change that happens
when you go from being especially if you didn’t live together beforehand or whatever and you
suddenly got married and are living together there’s gonna be an adjustment period same thing
when you bring in a new baby you know that new baby may be great but think about the crisis that
happens the first time that baby’s running a fever of 104 it’s not just that the fevers front the
baby has a fever it’s that the parents may feel oh my gosh I don’t know what to do I feel so inept
it’s that parent may not have been sleeping for two or three months because the baby’s not sleeping
through the night yet so there’s a lot of things that build up on each other and you know parents
may not have had any respite from jr.
I know God loved him my oldest had gastric reflux
when he was an infant and he did not sleep he would sleep for 15-20 minutes at a time and then
he would wake up and the poor little thing was in such pain he would just scream and I felt so
helpless so there were a lot of things going into it you know when he got sick and you
know the first time and I was just like oh my gosh how much more can I take so we want to look at
all the causes you know what caused the person to lose their job you know generally maybe they
started coming to work late because they separated from their spouse and now they had to get the
kids to school by themselves and you know you see other things are going on here so let’s
see what led up to this crisis beliefs may be operating when an emotion or reaction seems out of
proportion so we want to look for those cognitive distortions and you know everybody’s against me
nobody understands and gently challenge those challenge those thoughts as they as come
up and as appropriate but we want to validate how people are feeling if they feel
like everybody’s against them right now I’m not going to tell them now there’s got to be
somebody for you you know I’m gonna validate that Wow you know you must feel like you’re pretty
isolated if everybody’s against you and its exhausting and precipitating events may impact
many different areas of life so things that happen like I said bringing home a new baby that’s
a precipitating event that can end up causing a crisis if jr.
Gets sick because it impacts
physical people aren’t getting enough sleep which may impact their nutritional probably not eating as well as
it could be because you know they’re taking care of the baby may impact social it I don’t know about you
when my children were infants there were periods when they were young getting
a shower was you know a luxury, especially getting a shower by myself without having a baby
a carrier right outside so there were a lot of different ways that have a new baby in
the house while it was one of the greatest joys in the world changed things so looking at how
things changed and how things change with this person that you’re you’re working with that end
up resulting in or leading up to this place where the person feels completely hopeless and hopeless
generally, there are no panaceas or quick fixes for crises they are complicated so you can’t just
wave a magic wand and make it fixed or you can’t say oh well you just need to do this you know
go down here and talk to this person it’ll be good that’s likely not going to happen if somebody
loses their job for example a lot of times there’s poor work performance that led up to it there’s
a lot of other things that may have happened or if the person got laid off you know maybe there’s
a downturn in the economic stuff or the economic climate in that community so it may be harder
to get a job so we don’t want to say you know you lost your job that’s tough go down here I’m
sure you’ll get one next week that may not be true we want to help them figure out things they
can do to ensure that they don’t make the problem worse though so you’re here right now where do
you want to go what are your options now let’s look at those options if you do this you know and
I’m thinking the television hostage situations or whatever that make a situation worse
with somebody who you know has lost their job you know if they don’t start applying for new jobs if
they feel defeated and they don’t want to go out and do that again I get that I get that
however, gaps in employment can make it harder to get another job a bad attitude about having to
apply an interview again can make the problem worse so you want to look at what you need to
do what are some things that step that you can take and what do you need to make sure you do so
the problem doesn’t get worse and when there is a crisis there’s a necessity of choice you have
to do something now you can sit there and be in crisis but eventually, something’s got to give so
you’re required to do something either go back to the way things were if possible or change if a
the relationship ends sometimes going back into that relationship isn’t an option so what do you do
you have to take an action to move out of that crisis or you’re gonna stay in that crisis state
choosing to act is still a choice so if somebody breaks up from a long-term relationship or it gets
divorced or whatever it is and you know going back is not an option but they’re not ready to date
yet they don’t want to go out and see anybody else they want that old thing back they can
choose to sit there and be unhappy and think about what they lost and you know do all that sort
of stuff or they can choose to start working on those issues and dealing with the grief so
we want to look at what choices you have for types of crises and like I said not every crisis
for one person is going to be a crisis for another person developmentally for example identity
the formation is a crisis when people are in high school trying to figure out where they belong
what they want to be you know you know with a lot of people now who end up having three four
careers there’s a repeating pattern of identity formula formulation and formation what do I
want to be after this so that may precipitate some sort of a crisis the empty nest you know if
you’re a parent and all of a sudden you don’t have any kids at home anymore it’s like Oh golly now
how do I redefine myself if I’m not responsible for this what am I doing if I’m not doing this
every day taking kids to martial arts and this and that what am I what do I do and then midlife you
know we’re all familiar with that stereotypical midlife crisis that not everybody goes through
but developmentally even if you look at Erickson stages it’s pretty natural to look back over your
life about this point and go oh either I’ve done a lot or I thought I would have been further than
this by now so people may try to recapture some of the things that they missed out on or accomplish
some of the things on their bucket list they haven’t gotten to yet other crises chronic
illness or pain such as HIV or fibromyalgia if somebody is diagnosed with some sort of paralysis
that will precipitate a crisis in their life is going to change I had my hand in a cast for six weeks
and you know that’s not that big of a deal but it was amazing to me it was my right hand of
course and it’s amazing to me how much stuff I do with my right hand and how much my life had
to be altered a little bit when my hand was in that cast and I couldn’t get it wet so washing
my hair even became kind of an ordeal yes you can get around it and there are adaptations you can
Making but something as simple as that can cause a lot of changes so think about if you are in an
accident and you wake up and you’re paralyzed from the waist down or you have a stroke and one side
If your body is paralyzed that is a huge thing it’ll take a toll or it’ll have an impact on your
self-esteem your self-concept your self-efficacy your potentially other aspects of your physical
the health you know there are a lot of ways that these kinds of diagnoses may impact a person so we want
to look at you know what are all the ways that your pain from that accident you had last year is
affecting your life and what are your options the same is true if the spouse has a chronic illness
and then you throw in their caregiver exhaustion and the need for respite so the spouse has a
chronic illness will affect your socialization patterns it will likely affect some of your
physical stuff you know you may worry so you have more stress-related illnesses you may not sleep
as well as whatever it is so we want to look at all those things and the situational crises that are
things that just happen death you know somebody dies it can be expected it can be unexpected
but that’s a situational crisis that may throw somebody for a loop and it doesn’t have to be just
a human some people you know and you know I’m I’ll say I’m an example when our animals pass and even
our chickens but that don’t hurt me as much as when you know one of our dogs or cats passes away
but death is one of those things that precipitates a little crisis when relationships end when you
lose a job for people who are homeless you know they had a home and then all of a sudden they’re
living out of their car and it’s not by choice or you know think of the shining and cabin fever you
know not being able to get out not being able to do the things that you used to do sometimes can
precipitate a mental health crisis so we want to look at exacerbating and mitigating factors and
vulnerabilities when we’re trying to get a pulse on what’s going on with this person are their
pre-existing mood issues was the person already depressed or anxious if so about what mentally
and cognitively if they’re in this situation what is that critical inner voice telling them
there’s that critical inner voice saying I knew you were gonna screw this up or is it quiet most
likely when somebody’s in crisis that critical inner voice is just screaming at the top of its
lungs so we want to hear what those thoughts are and we want to talk with the person about
whether they believe negative perceptions when they’re looking and if everything they see
looks like doom and gloom encourage them to kind of look at the silver lining of certain things
and look at some of the positive things that are going on but if they already have a negative
way of viewing the world then you can kind of get in their headspace and see how they’re seeing
this current situation and once you start to understand how they’re seeing it and what they’re
hearing in their head it starts to make a lot of sense why they’re reacting the way they are and
we also want to listen for cognitive distortions those unhelpful thoughts and if somebody says
everybody’s always doing this you know file that away and then when appropriate you know you may
ask for if everybody always leaves me or nobody can be counted on okay you know file that away
then later when you’re talking about mobilizing resources you might say you know I’m wondering
who is it in your past that you have relied on or who do you think you could rely on now to be there
for you and if they don’t have anybody that that’s okay you know we can start brainstorming where we
might find those people’s pain and illness can also exacerbate a crisis if somebody’s already in pain
and then all of a sudden they lose their job you know I’ve seen people that have worked as cashiers
or whatever who have significant back pain and have to sit they can’t stand for
very long or maybe it’s their knees I don’t know but if they’ve already got pain and illness
going on they may have high medical bills and then if they lose their job on top of that everything
could exacerbate and I know I tend to react a little more strongly to things when I don’t feel well
sleep deprivation same thing as low blood sugar or dehydration we don’t think clearly when we’re
dehydrated and when blood sugar is low people tend to be in that fight-or-flight a little bit more
so they can be a little bit more snippy or react a little less logically now this is you’re not
going to give somebody an apple and a drink of water and their crisis is going to go away but
this is one of those things that can mitigate if you’ve been talking to this person for two
hours you know their blood sugar is probably getting low and they’re probably starting to get
dehydrated so offer them something to eat offer them something to drink help them feel how much
you care to help them also mitigate some of their physical vulnerabilities if they have new meds or
there’s been a med change especially psychotropic meds or pain meds that might also precipitate
a crisis or make it worse and this can be blood pressure meds this can be pain meds psychotropics
you know and we want to look not only at whether is it doing what it’s supposed to be doing to the degree
we need it to do it but we also want to look at what are the side effects of this medication
for some medications you know the first couple of days of a med change of increasing dosages or
decreasing dosages or starting a new medication can be ugly you know they it can have a
a fair amount of side effects so talking with them about what things may or may not go away and how
they can advocate for themselves with their doctor social exacerbating factors lack of a healthy
supportive social environment so we want to try to figure out if they’ve got people they can rely on
on and if not we want to start looking for what where might you be able to connect spiritually
exacerbating factors and mitigating factors their sense of interconnectedness and connection
to something bigger than themselves if they think that there’s a higher power of some sort or
spirits or karma you know let’s talk about that what gives them hope faith meaning and courage
what helps them want to go on what are their values and do you know any of these questions
we can start talking to them about you know maybe they’re a really honest person
and they feel like people should be honest okay so that’s one of your values but maybe this
particular incident maybe they were in business with somebody and the person embezzled a hundred
thousand dollars well that’s dishonest and that’s a lack of trust and all those things so whatever
happened may fly in the face of their values so this incident has kind of shaken up the way they
View the world and safety and how other people are and all that kind of stuff so yeah it’s going
to cause a significant crisis but we also want to look at whether are there things spiritually that can help
give this person comfort and in their religion in their spiritual beliefs are there things that can
help them see the proverbial light at the end of the tunnel that can help them feel like the world
is not spinning out of control what can we look at what values do they have that they can embody
to get through this challenge environmentally you know look around and when we’re talking about
crisis intervention a lot of times we’re talking about the immediate situation looking around
what visual auditory triggers or auditory triggers might be there if people are cheering them
on if there are you know cheering them on are saying ugly things or whatever the case may be
if there are things that they’re seeing that are making them stressed out may not have anything
to do with the particular crisis but if they’re seeing things around them or hearing things that
are stressing them out that’s going to keep them on edge we want them to be as comfortable and
relaxed as possible because the more they’re that way the less that fight-or-flight reaction
has to keep going if there’s an audience try to get rid of the audience even for extroverts you’re
right there so the person can bounce ideas off you people don’t need an audience because a lot of
times they will hold on to those but they had for fear of losing face they may act out more if
there’s an audience so try to remove that audience and try to make it as calm and environment as
possible remember the fear and anchor rip anger represents responses to some kind of a threat so
when we’re listening to what’s going on what led up to this and how it’s impacting them listened
to fears of the unknown, I don’t know how I’m gonna feed my kids, okay well let’s talk about that fears
or the threat of loss of control or power I don’t know if I’ll ever be able to get another job or
you know this just came from out of the blue and I wasn’t able to defend myself okay rejection so
we want to listen to them saying you know people will hate me or you know I can’t look at my family
in the face now isolation nobody’s there for me failure you know what that’s gonna sound
like threats of death and when I’m talking about that the threats I’m talking about
did they feel like their life was in danger or do they feel like there is imminent danger to
we’re going to consider suicide on homicidal ideation as part of this assessment
but when we’re doing crisis intervention we want to figure out what things triggered this person
to be in crisis models of crisis intervention have the following goals equilibrium
and stabilization we want to remove reinforcers for any aggressive behavior and identify reasons
for the person to calm down and please don’t tell people to calm down most of the time and
occasionally that’ll work probably but most of the time if you tell somebody to calm down what’s
gonna happen I know what happens if I’m upset and somebody tells me to calm down I’m like don’t you
tell me how to feel so calm down there’s probably not the right thing but we can identify you know I
want to help you I need you to slow down a little bit so I can understand everything
that’s going on that’s saying calm down without saying calm down cognitively we want to help
them gain control by starting to change their thinking like I said start looking up instead
of being stuck down in the details seeing the big picture or if they’re over-generalizing to that
the big picture helps them see the details and help them see what parts they do have control over psycho
socially we want to assess internal and external factors that could be making this worse from
physical to mental health to cognitive and help them choose and identify or identify and choose
workable alternatives now when we’re doing this you’re balancing temperament and crisis
and trying to figure out what’s going on let’s just add another layer of cultural competence there
is no one normal range of behaviors if somebody is upset you know they get fired and they are really
enraged about it and they’re in crisis they feel out of control they may get angry and act out they
may just break down crying they may get very quiet and stoic or they may do something completely
different but those are kind of the three points along the continuum we don’t unless we know
that person well you probably can’t predict how they’re gonna react to something so being
aware of that when you’re working with somebody from a different culture or maybe from the same
culture be aware that not everybody is from an individualistic society a lot of the things if
you remember back to the past few webinars a lot of other cultures are collectivistic so what
is in the best interest of the person is less important than what’s in the best interest of
the whole family so we don’t want to talk about but what is it that you need what is it that’s
in your best interest we want to talk about you know your family is very important to you how
can you do what’s in the best interest of the family and the best interest of yourself you
now try to find that dialectic language is not always interpreted in the same way so don’t
use colloquialisms and even things like the word depression don’t necessarily translate the
same and love doesn’t necessarily translate the same between cultures so make sure that you’re not
having a communication impasse we must accommodate the client’s needs so being cognizant of what
their needs are if they need an interpreter if they need you to know the time for prayer whatever
it is remembered that history certainly does impact current events so if they are an oppressed
minority for example they may be reacting from some of that learning from some of that experience
they may be reacting from something that happened you know 50 years ago that is currently still
impacting their culture so we want to be aware of those things and we want to be aware of our
personal assumptions about that person’s culture when we’re working in crisis intervention so the
safer ER model stabilizes makes sense acknowledges what’s going on facilitates understanding encourages
adaptive coping restores functioning and refer is needed because we can’t do everything so so
ensuring state safety is the part is stabilized physically remove the client from the situation
if possible get them to a place where that’s kind of neutral inform them you want to help but it’s
hard for you to focus while they are maybe being I don’t want to say being aggressive while they
are pacing around so much so maybe proposing a solution that doesn’t take away his power is one of
the things when I have highly agitated clients we go walk outside so they’re still able to move
they’re not having to sit but it’s in a situation where I’m safer and I don’t feel like I’m in a
bad position psychologically removes bystanders because an audience may add fuel and reframe the
the situation with the client not being bad the client struggling the client feeling out of control
they’re not bad maybe they made an unfortunate decision or an unfortunate choice but they’re
a good person stabilizes through assessing the ABCs what is their affective state and this
is different than this is not the cognitive ABCs what is their affective state what level of
behavioral functioning do we have are they erratic and impulsive or are they pretty controlled where
are they at with cognitive functioning reality testing are they able to think through things are
they in their emotional mind full-bore and what is the severity of the crisis is this something
where somebody is suicidal or homicidal or is this something where somebody is uncomfortable
acknowledged you want to define the problem and seek help from the client in understanding what’s
going on listen to the person’s orientation to figure out whether you want to pair it or
or identify their feelings or start with silly so one of the things that we’re looking at here
is if somebody is a feeler an F on the MBTI they need to have their feelings acknowledged and
validated if somebody is a thinker and they’re talking about solutions from the get-go you
know sometimes it may be helpful to start with solutions it usually never hurts to acknowledge
and validate feelings first but then are they visual auditory or kinesthetic let’s talk
about what are you seeing what are you hearing what you feel and what can you do to empathize to
see the problem is the client does ask open-ended questions and pay attention to their verbal and
nonverbal messages you know that’s pretty much counseling 101 but here we’re really
working on that therapeutic alliance acknowledge the situation and or the client’s feelings not
that they’re incorrect because their client’s feelings are the client’s feelings and they are
as they are radical acceptance you may not agree but you don’t have the same life experience and
perception necessarily that that person does so we want to acknowledge where they’re at and then
we can help them move out from their feelings when you’re facilitating understanding
you know you may stop and say I’m confused here or I’m feeling frustrated it feels like
we’ve been going over the same thing for an hour and I’m wondering what I’m missing so
I’m owning the fact that I’m feeling frustrated because likely the client is feeling frustrated to
be aware of transference and countertransference reactions you know what you represent to
that person that they may be transferring on to you do you represent this is the system do you
represent someone helpful do you represent a mother figure or whatever it is and at the same
time what is that person triggering in you so be aware if you have any feelings of irritation or or
whatever what is that person triggering in you or do you need to rescue kin understanding
preferably not by saying I understand but by using good paraphrasing and please don’t assure the
the person that everything’s going to be alright you can assure them that you’re going to do
everything you can to help them but you don’t know how things are going to turn out provides
positive reinforcement for positive behaviors if they start calming down and stuff like that
you may consider you know at offering them food or a drink or something avoid value judgments and set
limits don’t tolerate controlling or aggressive behavior encourage adaptive coping what thoughts
reactions and behaviors help you get closer to a rich and meaningful life that basic question
from a CT so we want to ask the person what this rich and meaningful life looks like to you
all right you’re here and that’s there so what responses do we have to this situation that can
help you resolve how you feel or improve the next moment and still work towards your goals for a
rich and meaningful life reduces tunnel vision or increases focus on meaningful things
to the person so you might say something like this is an awful situation right now but you keep
mentioning your kids tell me a little bit more about them then they might start thinking about
all the things they have to lose if they make a rash decision examine with them the alternatives
what response options do you have what supports can help you what coping mechanisms do you have
how can you alter your thinking to not see this as destroying you or however they’re
seeing it and restoring functioning by promoting mobilization preferably nearly immediately you
know you want them to walk out of that crisis intervention session with a plan they want you
want them to be mobilized so they feel like they can start implementing order and getting control
back over their life because crisis represents a loss sense of loss of control and obtain
commitment with a search assertion statement from them by saying you know I need you to call
me tomorrow after you make your appointment with your psychiatrist or I need you to do this and
the person will say ideally yes write all this down don’t expect them to remember diddly squat
right now write it down so they can look at it tomorrow morning when they get up if they have a
social support person that’s going to drive them home or that’s there if the crisis occurred in
their house make sure with permission obviously but that person is looped into what the plan is
so they can help the person who’s in crisis follow through when we’re in crisis our memory is not
well referring to medical and psychiatric services is needed you know if chronic pain is part of the
the problem that’s contributing to what’s going on is maybe you know maybe they lost their job because
they couldn’t work as many hours because they were having too much pain so they’re calling
in too much now they lost their job and they are wondering how they’re going to pay the bills
okay so the crisis is they lost their job but what led up to its part it is uncontrolled pain
so we may need to refer them for medical stuff and obviously if they’ve got others if they haven’t
had a physical in a while there may be other medical things going on that need to be addressed
to help them be happy and healthy and psychiatric referrals as appropriate referrals for medication
if they’re on medication make sure they’re able to access it if they can’t help them learn
about patient assistance programs formularies at different stores and Oh golly what’s the other
one some of the discount pharmacy programs and most of them are online they can find refer them
to support groups survivors of suicide depression anxiety divorce substance abuse there is support
groups for everything contact your local Namie for mental health groups you can also contact
your local United Way information and referral generally have a pretty exhaustive list of
support groups refer for vocational counseling if they need a new job or a different job Reverb
for legal assistance, if they’ve got issues with domestic violence child welfare issues to force
bankruptcy those sorts of things a lot of times attorneys as part of their ethics or part of
their continuing education can do a certain number of pro bono hours every year in areas where
there’s a university that has a law school a lot of times there’s a free legal clinic at the law
school again information and referral should know about this provide specialized counseling or
refer to specialized counseling if they need treatment for trauma or what substance abuse or
whatever and maybe they’re just they’re struggling right now to even get up and put one
foot in front of the other and they would benefit from having some sort of assistance with child
care or even just an hour to have respite a week from taking care of the children they’re just
at their wit’s end, we can look for ways to help find that a lot of times churches have help
boards that people volunteer to help out church members United Way information and referral and
sometimes depending on your community there may be vouchers that they can get for temporary
respite care child day care vouchers so change causes crisis whenever you change it can
be it gets uncomfortable when you’re having to learn new behaviors so we want to recognize that
something changed in this person’s life and we want to help them figure out how they can get back
to a state of equilibrium but to do that we need to know what equilibrium looks like for
the crisis by its very definition is a state of extreme anxiety you know well I shouldn’t say by
its very definition you can have minor crises and but when we’re talking about crisis intervention
the crisis was generally dealt with as a state of extreme anxiety the person feels helpless and
hopeless and out of control and they don’t know what to do next and they feel like they’re kind
of spinning it’s important when the client is in the state to hear them understand what’s going
on with them, it may not be this particular thing it may be the fallout from this particular
the thing I remember is I was watching one show oh I can’t remember the name of it right now but
hostage negotiation situation this guy had had his house foreclosed on and he was at the bank and
he was holding people hostage and whatever but the interesting thing was it wasn’t the house going
into foreclosure that tore him up and put him here, it was the fact that his wife committed suicide
after the house went into foreclosure that got him to this point so we want to hear what’s going
on and hear all of the nuances helpless that the client reestablish equilibrium and what can they do to
help them feel like they’re not spinning anymore what is the first thing that could help them
and sometimes clients will know and sometimes they won’t whatever it’s the first thing that comes
out of their mouth is probably what they’re hoping for and if that can be something that can
be achieved right now then great if not you may say well that’s probably a long-term goal what’s
you know maybe they want to get their house back if they had their house foreclosed on okay getting
a house is probably a that’s long-term goal I can’t help you get another house tomorrow you’re
looking for somewhere for you and your kids to be safe and have a roof over your head until you
can get another house that we can start working on tomorrow so help them start breaking it down
into manageable steps where they don’t feel like they’re just kind of fighting against a mountain
identify environmental and social supports and social supports are obvious you know what things
what people in your environment can help you and it may be friends it may be family but it also
maybe resources such as social services food stamps Red Cross you know what other supports are
out there that help you manage this if a person’s house burned down the Red Cross is great
about helping them get a roof over their head and enough new clothes so the kids can start getting
back to school and start reestablishing normalcy because that’s what people are often looking for
is to get back to that routine help them develop a plan and then help them take action and help
them take action don’t say here’s your plan go off and do that and you know have a great life
no give them the plan and then say all right so what’s the first thing you’re gonna do tomorrow
all right please call me tomorrow after you do that first thing and tell me how it went which
will encourage them if they feel accountable so to speak to you if they’ve got a report in on it
it will encourage them to take action if they’re not willing to do it you may find that they’re
apprehensive about calling and doing whatever it is they may feel not okay about calling certain
facilities are asking certain questions so we can help them through that process if they don’t feel
like they can go down to apply for food stamps by themself or maybe they don’t know how they don’t
have a car anymore because their car got totaled and they have to take the bus to get to work
but they don’t they’ve never ridden a bus before they have no idea how to even get a bus schedule
well we can help walk them through that or find somebody who can walk them through that it’s not
always something that we as clinicians can do but a lot of times we’re going to do it anyway and
then the safer our model stabilize acknowledging the issue facilitates understanding so you know
you acknowledge what’s going on that they’re in crisis yeh yeh and then you start developing
an understanding of what led up to it and what the possible options are then encouraging adaptively
coping to help start restoring functioning and shouldn’t be or should be
and refer because most of the times this crisis is complicated it’s not just one thing there’s
no panacea when you were for when you come to some conclusion and you’re encouraging them to
take action there will be places that you need to refer to it maybe another clinician or it may
be somewhere like the Red Cross or a church that can help them out to get their needs met during the crisis
represents the presence of opportunity and danger and necessitates choice it’s complicated and
there are no panaceas or quick fixes these are the 10 points I told you about persons in crisis
are initially at high risk for maladaptive coping or immobilization they may act impulsively
and do things that make poor choices or they may not do anything at all they may just freeze
because most of the time we talk about the fight-or-flight response but its a fight
flight or freeze emotional mental physical social environmental and spiritual factors can exacerbate
the crisis or it can mitigate it so if the person has emotions we want to look at things that
make them happy what can help them get restored to happiness mentally what factors do they have
Do you know what can we help them focus on how can we help them change their thinking to
mitigate the crisis physically how can we help them mitigate this crisis there how can we
help them get more sleep know that they’re going to be able to feed their kids or whatever the case
is socially what factors are out there what people can they rely on who do they trust environmentally
how can we mitigate the crisis what can we do to help you feel calmer in this environment right
now approximately in this crisis incident but also when you walk out of this office or this
scenario when you go home tonight how can we help your environment mitigate that crisis be more
calming more supportive be more restorative and spiritual factors you know I’m Catholic so I can
speak more to those and Christian factors than I can to other religions but all religions have some
sort of sense of connectedness and control by a higher power people who are not religious are
also very spiritual though so encouraging them to look at what spiritual factors can help them
overcome this to help them find peace crisis intervention involves regaining equilibrium
gaining control of thoughts which is kind of getting into their wise mind and identifying
and choosing will workable alternatives remember there’s no one normal quote unquote range of
behaviors people are going to react however they do and what you may expect from someone
even if you’ve known them since you were three years old may not be how they react so we just
want to take it as it comes crisis impacts the person emotionally cognitively physically socially
environmentally and spiritually so not only do all of these factors exactly surveyed or mitigate the crisis
but a crisis also impacts all of these factors so we want to look at how is the crisis impacting
these areas and how can we mitigate or minimize the negative impact the crisis crisis is going to
have on these areas resource mobilization should be immediate in order to provide persons in crisis
with the tools, they need to return to some sort of order and normalcy facilitating an understanding of
the event by processing the situation or trauma helps the person gain a better understanding of
what has occurred and allows him or her to express their feelings about the experience so we want to
talk about and get have them tell us what happened and have them explain it to us and we can ask
questions to probe and help them see a little bit more of the bigger picture who else was there when
this happened or what else contributed to this so they can start looking and broadening their view
and problem-solving within the context of their situation and feelings is necessary for developing
self-efficacy and self-reliance so we don’t want to write down the plan and give it to them and go
here we want to work together and mutually problem-solve to develop a plan that they can
start to implement and then encourage and assist them to take action now there is some thinking
traps that I’m going to go over if you want to stick around that is the end of the quoted official
part of the CEU class are there any questions up till now I apologize for the little hiccup at
At the beginning of this morning, I’m not sure why my computer freaked out on me but I think it was
just reacting to being cold – alrighty everybody I appreciate you being here like I said if you
want to stick around for the next few slides on the thinking traps more power to you love to have
otherwise have a great day and I’ll see you tomorrow so talking about thinking traps these are
some of the things we may be hearing from clients when we’re in that facilitating understanding
the period they may say I’m the sole cause of every problem I encounter so we lost her I lost
my house because I did this and I did this when the person lives in a house with a spouse
and children and yada yada so you know what part of this was that person’s responsibility
and what parts were out of their control encouraged they encouraging them to determine
the appropriate level of personal responsibility examines all the contributing factors and limit
self-criticism okay the problems happened you can sit here and lash yourself with it wet noodle or
we can figure out what to do to improve the next moment thinking error is focusing on always
believing that problems are always unchangeable and I have little or no control over them so sit
down and conduct a problem analysis you know what happened what led up to it what’s maintaining
this identifies what you can and cannot change and then develop a plan of action for addressing
those things that you can change and then for the ones you can’t you need to learn how to
except for reality figure out how you can sort of embrace the bad and make meaning out of it you
know dialectical behavioral therapy is good at helping people accomplish these things
then them as opposed to me me me in this thinking error the person has a very external
locus of control and they believe that outside circumstances cause every problem so encouraging
people again to look what are all the causes of the problems and what factors contributed to it
what are the facts for and against your belief that you had no part in this and this was done
to you examine how you may have contributed and then develop a plan you know likely there are
outside circumstances at work but what part did you have nobody understands so encourage the
client to identify the support from others or referral sources to help them focus on what’s important to
them and then you know it is very basic to develop that therapeutic alliance so if nothing else
you understand at least a little bit you know and you know you won’t probably when they’re
saying this you probably don’t fully understand but you can say I I’m not you I don’t really
understand everything that’s gone into this but I want to so help try to help me understand
what’s going on and how I can help her five is jumping to conclusions despite having little or
no evidence to support it this is one of those typical cognitive distortions that encourage people to
understand complex events you know this X happen or you did X and then Y happened okay well that’s
that’s fine but what else contributed to it a lot of times it’s not a single cause-and-effect
review events objectively and realistically appraise situations and encourage clients to
acknowledge personal limits in preventing problems and thinking errors six what-ifs and shoulds
well we can what if and should until we’re blue in the face you know there’s always
what if some shoulds but you can you waste a lot of energy doing that so we want to
encourage clients to accept it is what it is and remember that change takes time be
aware of memories grudges and resentments encourage them to write it out or talk it out
what whichever learning style they prefer to identify if they have what if I would have done
well let’s play that play out that scenario from beginning to end let’s just get it out of
your mind figure out what they would–if might have been and encourage them to focus on what
they can control what ifs and shoulds you know what if this happens is generally a worry what if
you know I get fired and I lose my job or I get fired and I lose my house and then we’re homeless
or I should have or I should be doing something so a lot of that represents worry or anger or other
dysfunctional things where the person doesn’t feel okay with the way things are or they’re worried
about things they can’t control so,, we want to look at those things and go alright what’s the
present what is the actual reality of right now we can’t change the past you can make amends for
you can there are a lot of things you can do you can learn from them but you can’t change it and the
future you can’t predict and the weatherman can’t even predict the weather tomorrow very well
so what ifs just wind you up so what is the present and what is the likelihood that these
what-ifs are going to come to fruition alrighty thank you for sticking in with me and
I will see you guys tomorrow if you enjoy this podcast please like and subscribe either in your
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Snipes
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