FAMILIES IN CRISIS

1. FAMILIES IN CRISIS Chapter 3 & 4 Basic Crisis Assessment & Intervention Skills

2. TRIAGE ASSESSMENT SYSEM • Assesses severity of clients presenting crisis situation • Assistance for gaining sense of direction for helping client cope with the dilemma • Integrated problem-solving process

3. SEVEN STEP ASSESSMENT PROCESS • Examining alternatives • Making plans • Obtaining commitment to action • Follow-up • Predispositioning/engaging/initiating contact • Problem exploration • Providing support

4. LISTENING (PSYCHOLOGICAL FIRST AID) • Caring support • Empathic responding • Concrete information and assistance • Reuniting social support systems • Survival needs (Maslow) • Nonintrusive (Not time for ‘cure’ or ‘fix’)

5. SAFETY • Minimizing psychological and physical danger • Client • Self • Others

6. STEP 1: PREDISPOSITIONING/ENGAGING/INITIATING CONTACT • From the clients perspective • Active Listening/Attending Skills (observing, understanding, and responding) • Respect • Without judgment • Caring • Empathy • Genuineness • Acceptance or positive regard • Use open ended questions • Attending to verbal and non-verbal messages

7. STEP 2: EXPLORING THE PROBLEM • Defining the crisis • From the clients point of view

8. STEP 3: PROVIDING SUPPORT • Caring emotional support • Non possessive • Informational support • In order to make good decisions • Instrumental support • Basic needs

9. ACTING (STRATEGIES) • Nondirective • Collaborative • Or Directive (if needed)

10. STEP 4: EXAMINING ALTERNATIVES • Exploring choices and options • Immediate Situational Supports (people) • Coping mechanism (actions or resources) • Positive and constructive thinking patterns (reframing to alter the clients view) • Look for a few that are appropriate and realistic to discuss with client (not too many)

11. STEP 5: MAKING PLANS (ACTION STEPS) • To restore clients emotional equilibrium • Easy for client to own and understand • Short term (minutes, hours, days) • Identifying additional resources and coping tools • Systematic problem solving • Concrete and positive • Things client can ‘do now’ • Collaborative with since of control and autonomy

12. STEP 6: OBTAINNG COMMITMENT • Brief and simple • Ask client to verbalize the plan • Written and signed (if severe) • Handshake • Free, voluntary and believed to be doable • Honest, direct and appropriate commitment • Before termination

13. CLIENT FUNCTIONING • Generally, no time for formal diagnosis or assessment instruments • Goal: to assist client with pre-crisis • Equilibrium • Mobility

14. TERMS • Equilibrium (emotion or mental balance/stability) • Disequilibrium (Lack or destruction of balance/stability) • Mobility (autonomous change or coping of moods, conditions, influences) • Flexible and adaptable • Immobility (Not capable of mobility)

15. ASSESSMENT HELPS DETERMINE: • Severity of crisis and client functioning • Client’s current emotional status • Client’s alternatives and resources • Client’s level of lethality • How well counselor is doing in assisting client to equilibrium and mobility

16. CLIENT FUNCTIONING • Affective State (feeling or emotional tone) • Out of control, withdrawn, detached, overemotional, etc. • Behavioral Functioning (activity level) • The sooner the better • Cognitive State (thinking patterns) • Realistic, consistent, rational, exaggerating, etc. • Able to positively reframe

17. ASSESSMENT FORMS • Often take up too much time • May be inappropriate for client level of functioning • TAF (Triage Assessment Form) • Fairly rapid and valid • Versions • Law enforcement • Students • Civilians

18. PSYCHOBIOLOGICAL ASSESSMENT IN CRISIS • Evidence that neurotransmitters play a role in affective, behavioral, and cognitive functioning during (and sometimes after) crisis • Can cause residual and long term changes • Impact of mental health medication • Impact of legal and illegal drugs

19. REQUIRING COUNSELORS TO ATTEMPT TO ASSESS: • Prior trauma • Psychopathology • Use, misuse, or abuse of drugs • And is there a correlations with the current crisis/problem • Referral may be needed

20. ASSESSING EMOTIONAL FUNCTIONING • Duration of Crisis • Acute/situational (one time/short term) • Chronic (recurring, long-term or transcrisis) • Current reservoir of emotional stamina • Helplessness, hopelessness, ‘no future’ • Clients Ecosystem variables • Communication system, cultural mores, accessibility, economic status, etc • Developmental Stage

21. FACILITATIVE AFFECTIVE ASSESSMENT • Data gleaned about the client are used as a part of the ongoing helping process.

22. ASSESSING ALTERNATIVES/RESOURCES • List of referral resources • Brainstorming • Realistic options • Impediments to progress? • Institutional, social, vocational, personal strengths or support systems =people

23. SUMMARY OF ASSESSMENT • Taking available information and making meaningful sense out of it. • Quickly evaluate • Be flexible • Assessment is central and continuous process • Continue until pre-crisis state is obtained • Even then, in many cases…. Only the acute phase is then over!

24. LISTENING SKILLS • Open-ended questions • Closed-ended questions • Restatement and Summary clarification • Owning Feelings (counselor focus) • Disowned statements and pretending • Conveying understanding (of situation) • Value judgments (of situation) • Positive reinforcement (of behavior) • Personal integrity and setting limits • Assertion statements

25. 9 BASIC STRATEGIES • Creating Awareness • Facing denied, repressed feelings, thoughts and behaviors • Allowing Catharsis • Allowing full feelings, venting, talking, crying in safe environment (caution: best for those who struggle with feelings) • Providing Support • Validations, affirmation, without dependence

26. 9 BASIC STRATEGIES (CONT.) • Increasing Expansion • Broaden vision, reframe narrow views, gain new perspective • Emphasizing Focus • Find specific, realistic, manageable components and options (narrow out-of-control thoughts) • Providing Guidance • Providing direction, knowledge, resources to

27. 9 BASIC STRATEGIES (CONT.) • Promoting Mobilization • Activate client internal/external resources to generate coping skills and problem solving abilities • Implementing Order • Helps client with organization and prioritization, for logical thought • Providing Protection • Safe guarding clients from harmful, feelings, behaviors, and thoughts

28. CLIMATE OF HUMAN GROWTH • Communicating Empathy (sensing client feelings) • Communicating Genuineness (realness) • Communicating Acceptance (caring, unconditional positive regard)

29. COMMUNICATING EMPATHY 5 Techniques • Attending (looking, acting and being attentive) • Verbally empathic understanding • accurately hearing and understanding the core feelings • Accurately communicating that understanding to the client • Reflection of feelings – uncovering feelings • Caution with getting too deep • Stay in here and now

30. COMMUNICATING EMPATHY (CONT.) • Non-verbal communication of empathic understanding • Picking up on unspoken cues, messages, and behaviors • Silence • Thinking time for the client and counselor

31. NOT COMMUNICATING EMPATHY • sympathy (taking on the clients feelings) • distancing (when you don’t know what to say) “funeral home counseling”

32. COMMUNICATING GENUINESS • Fully oneself • Honest • Congruent • Awareness of self, feelings, and experience

33. COMMUNICATING GENUINESS 5 Essential Components • Being role free (genuine in life and counseling) • Being spontaneous (free without impulsiveness) • Being non-defensive (not feeling attacked) • Being consistent (talk agreeing with action) • Being a sharer of self (appropriately)

34. COMMUNICATING ACCEPTANCE • Care for and fully accept clients, even when doing things contrary to beliefs and values • Put aside personal needs, values and desires • Allowing client to accept self

35. CRISIS WORKERS ‘ACTING’ MODES • Nondirective Counseling • Client has as much control as they can handle • Counselor: Questioning and listening • Collaborative Counseling • Partnership with client in evaluating the problem, generating alternatives, and implementing steps • Counselor: catalyst, consultant, facilitator, support • Directive Counseling • Client is too immobile to cope with crisis • Counselor: Definer and developer of plan, guides and leads

36. KINDS OF IMMOBILE CLIENTS • Immediate hospitalization due to chemical use or organic dysfunction • Severe depression and cannot function • Severe psychotic episodes • Severe shock, bereavement or loss • Anxiety is high where they cannot function • Out of touch with reality • In danger to self or others

37. THESE KINDS OF IMMOBILE CLIENTS • Often apt to be suicidal • Or homicidal • Not ready to be collaborative • Not ready for nondirective counseling “Counselor must be ready to make accurate and objective assessment of the client’s level of mobility.”

38. STRATEGIES FOR CRISIS WORKERS • Recognize Individual Differences (avoid stereotyping, taking for granted) • Assess Yourself (values, limitations, burnout etc.) • Safety for all (you may need to ask for help) • Provide Client Support (with assertiveness if needed) • Define Problem Clearly (focused, practical, accurate, problem-solving viewpoint)

39. STRATEGIES FOR CRISIS WORKERS (CONT) • Consider Alternatives (broaden views – workable and realistic) • Plan Action Steps – to regain control of life (short and doable) • Use clients coping strengths (may need to be identified, explored and reinstated) • Attend to Client’s Immediate needs (contacts, appointments, venting, etc.)

40. STRATEGIES FOR CRISIS WORKERS CONT) • Use Referral Resources (keep a ready list) • See Page 92 • Develop and use Networks (professionals, community, government, etc) • Get a summarized verbal commitment (positive and definite)