Section 12: Crisis Intervention

UCLA

Give me some examples

Form groups of 4-6. Agree on 3 examples of crises faced by

your staff What made these crises challenging to

deal with?

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Things to Consider When Facing a Crisis

Things to Consider…

Are you safe?Are other clients safe?Is the client in crisis safe?Can I handle this?What other resources do I need?How do I feel better after it’s over?

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Are Are you safe? safe?

Protecting your safety is protecting the safety of the client

• If they hurt you

• They will no longer feel safe,

• They will no longer be able to receive treatment from your agency

• Putting your safety first is in the best interest of the client.

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Keeping yourself safe…

The Office SetupBe conscious of where you are in the office

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CounselorClient

Counselor

Client

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The Office Setup Be conscious of where you are in the office Be aware of ways of asking for help

Keeping yourself safe…

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Keeping yourself safe…

Be careful not to reflect negative emotional states

Watch your body language Stay calm and keep you voice tone low and

soft Be careful not to stand over or lean into

patient

Personal Style

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Keeping yourself safe…

Get outTake a breakLeave the officeLeave the building

Get helpCall a supervisorCall a colleagueCall the police

If none of that works…

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Things to Consider…

Are you safe?Are other clients safe?Is the client in crisis safe?Can I handle this?What other resources do I need?How do I feel better after it’s over?

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Are Are other clients other clients safe?safe?

Where is the crisis happening?

• If other clients are observing, they may not feel safe

• We do not want to contribute to the chaos of their lives

• They want to have confidence in their environment.

• A crisis with one client may lead to a crisis with another

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Keeping other clients safe…

Calm the participant (and you)Protect confidentialityProtect other clients from direct harmProtect other clients from “helping”

Remove the situation to a quiet, safe place. This will help to:

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Things to Consider…

Are you safe?Are other clients safe?Is the client in crisis safe?Can I handle this?What other resources do I need?How do I feel better after it’s over?

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Is the Is the client in crisis client in crisis safe?safe?

Is the Client a danger to:

• Self?

• Others?If danger = being aggressive, follow recommendations above

If danger = killing self or others, follow recommendations above AND make sure they get assessed.

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What is a Suicide/Homicide Assessment?

If you think that someone wants to kill him/herself or someone else, they must be evaluated. If risk is significant, they may need to be

hospitalized If risk is minimal, a plan needs to be developed

in case feelings get worse.

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Risk factors

Common psychiatric risk factor leading to suicide Depression* Major Depression Bipolar Depression Alcohol and Drug abuse and dependence Schizophrenia

Other psychiatric risk factors with potential to result in suicide

Post Traumatic Stress Disorder (PTSD) Eating disorders

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Risk factors for Suicide

Symptom Risk Factors During Depressive Episode Desperation HopelessnessAnxiety/psychic anxiety/panic attacksSudden change in moodAggressive or impulsive personalityHas made preparations for a potentially serious

suicide attempt or has rehearsed a plan during a previous episode

Recent hospitalization for depressionPsychotic symptoms

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Risk factors

Major physical illness-especially recent Chronic physical pain History of trauma, abuse, or being bullied Family history of death by suicide Drinking/Drug use Being a smoker

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Symptoms and Danger SignsWarning Signs of SuicideDanger Talking about suicide. Statements about hopelessness, helplessness,

or worthlessness. Preoccupation with death. Suddenly happier, calmer. Loss of interest in things one cares about. Visiting or calling people one cares about. Making arrangements; setting one's affairs in

order. Giving things away, such as prized possessions.

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Symptoms and Danger SignsWarning Signs of Suicide

Warning Signs Observable signs of serious depression

Unrelenting low mood Hopelessness Anxiety Withdrawal Sleep problems

Increased alcohol and/or other drug use Recent impulsiveness and taking unnecessary risks Threatening suicide or expressing strong wish to die Making a plan (giving away possessions, obtaining

other means of killing oneself) Unexpected rage or anger

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Assessment of Suicide

HistoryInfluencesLethalityPsychological OrganizationEvaluation of Risk PotentialRecommendations

Crisis Intervention: CASE STUDIES

The following two case study exercises present crisis scenarios. Please break out into groups of 2-4 and carefully read each scenario, then write down your response as counselor. You will then share your responses to the class.

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Exercise 1Case Study 1: Farida

Farida is a 25-year old Ritalin and Valium addict with 3 months of sobriety, whom you have been seeing once a week. When she walks into your clinic today, she appears forlorn and acts withdrawn. She refuses to answer your open-ended and closed-ended questions. Finally, she mutters, “My husband is seeing another woman and he told me he is leaving me. Without him, my life isn’t worth living anymore. I just want to go to sleep and not wake up.”  What do you do?

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Exercise 2Case Study 2: Mariam

Mariam is a 32-year old heroin addict who comes to your clinic for a scheduled appointment. She has not used drugs for 1 month. Today she seems uncharacteristically happy and in a calm, almost content state. You know she has tried to commit suicide 3 times in her past.  When you ask her if she has had any thoughts of suicide lately, she responds, “Oh, I don’t know…maybe once or twice. No big deal.” Describe your next steps.

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