Principles of Crisis Intervention 2023 | Counselor Continuing Education

Unlimited CEUs $59 at AllCEUs.com we're going to start by defining crisis of  course identifying the six basic threats and   how they relate to crisis we'll discuss some of  the characteristics of Crisis examine cultural influences and behavior explore the safer model  and identify 10 principles of Crisis Intervention so what is a Crisis crisis happens when people  are facing an untenable obstacle to goals and people's life cycles are significantly disrupted  now that doesn't necessarily mean ju

st having those two things doesn'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 um used to  get completely overwhelmed when something would would break at the house and it would  just throw he

r for a loop and she'd have panic attacks and it was it was unpleasant  um for her and and it was really stressful for somebody else something goes bad at the house  they just call up a repairman and bada bing it's done so we don't want to assume that everybody's  crisis or crises are the same oh lovely um so one of the things we need to consider when  we're looking at crisis is when we're getting ready to intervene with someone what is it that  we need to know about them in order to effectively

um what's the word I'm looking for effectively uh um 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 an introvert and they're in a  situation where they feel like everybody's looking at them that could escalate this the situation so  we want to be aware of what situations are going to um exacerbate the crisis and what things can  we do t

o help mitigate anything that's going on and reduce the stress in the immediate moment the  next thing we want to think about is how do 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 um point A to point B sort of thing they're  probably more

sensing um 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 picture we're focused on this one aspect right now which  may really suck don't get me wrong um but let's look at the bigger picture about what's going  on and eventually you'll get there the if you're working with somebody who's intuitive they may be  seeing the bigger picture but mi

ssing the details so this one event happened and this is how it's  going to affect my life and yada yada 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 um 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 um  then you might want to focus towards 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 obviously 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 that's not appropriate but

you might start talking about um 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 tell 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 stru

cture and like to know how things are going to play out some things some people  are a little bit more spontaneous and that's okay um when you're creating a an action plan for them  what are you going to do in an hour what are you going to 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 t

he later versions or 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 helpful 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 while they're talking so if an extrovert doesn't have somebody  to bounce ideas off of they may f

eel very stuck whereas an introvert needs some downtime they need  some quiet time where they can think and get their thoughts together then 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 it is New Year's

right now and a lot of people made New Year's  resolutions and they're trying to change something and it's going to get a little uncomfortable  now crisis doesn't have to be something where somebody's 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 causes that 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  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 on uncomfortable I want to continue this change but let's figure  out how I can do it and make it work for me one thing we need to recognize though is while  there is this present presence of opportun

ity 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 up opportunities at them and  make getting them to 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 a an opportunity for 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 um each block is built and balancing  on one another and there's you know a certain Dynamic holding everything  together when crisis happens you know generally it's not somebody woke up in the  morning and everything is perfect and then um you kno

w something happens and things  are not perfect anymore and they're in crisis generally there have been things  leading up to it isolation loss of friends um changes in job maybe 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 um 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 going to be an adjustment period  same thing when you bring in a new baby you know and 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 run 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 parents may not have been sleeping for two or three months  because baby's not sleeping through the night yet so the

re's a lot of things that build up on  each other and you know parents may not have had any respite from from Junior I know God love him  my my oldest he 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 um so there was a lot of things going into it  um you know when he got 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 there's other things 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 cog

nitive distortions and you know everybody's against me nobody understands and  gently challenge those challenge those thoughts as they as they um come up and as appropriate but  we definitely want to validate how people are feeling if they feel like everybody's against  them right now I'm not going to tell them no there's there's got to be somebody for you you  know I'm going to validate that wow you know you must feel like you're pretty isolated if if  everybody's against you and it's exhaustin

g um and precipitating events May impact many  different areas of life so things that happen like like I said bringing home a new baby that's  a precipitating event that can end up causing a crisis if Junior gets sick um because it impacts  physical people aren't getting enough sleep it may impact nutritional probably not eating as well  as they could because you know they're taking care of baby may impact social I don't know about you  when my when my children were infants there were periods wh

en they were really young that getting a  shower was you know a luxury especially getting a shower by myself without having a little baby in a  in a carrier right outside so there were a lot of different ways that having 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 um that  ended up resulting in or leading up to this place where the person feels c

ompletely hopeless  and helpless generally there's 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 um 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 of

f you know maybe there's a downturn in the economic stuff um 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 and what are your options now let's look  at those options if you do thi

s you know and I'm thinking the television hostage situations or  whatever obviously that makes the situation worse um with somebody who you know has lost their job  if they don't start applying for new jobs if they feel defeated and they don't want to go out and  and do that again I get that I totally 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 do you ne

ed to do what are some things that steps 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 um so you're required to do something either  go back to the way things were if possible or change if a 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 going to stay in that crisis state choosing to act is still a  choice so if somebody breaks up from a long-term relationship or 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 really 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 o

r they can choose to start working on those issues and dealing with the grief so  we want to look at what choices do you have yeah 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 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 um so that may precipitate some sort of a crisis The Empty Nest you know if 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 Toten 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 stereotypic

al 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 um so people may try to recapture some of the  things that they missed out on or accomplished some of the things on their bucket list  they haven't gotten to yet other crises chronic illness or or pain such as HIV  fibromyalgia if somebo

dy is diagnosed with some sort of paralysis that will precipitate  a crisis their life is going to change I had my hand in a cast for six weeks and you  know that's not really 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 a ordeal yes you can get around it an

d there are adaptations you can  make 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  of 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 um your potentially other aspects of your physical  health you know there's a lot of ways that these kinds of diagnoses um

may impact a person so we  want to look at you know what are all the ways that you're paying from that accident you had  last year is affecting your life and what are your options the same is true if a spouse has  a chronic illness and then you throw in there um caregiver exhaustion and the need for respite  so if a spouse has a chronic illness it will affect your socialization patterns it will likely  affect your some of your physical stuff you know you may worry so you have more stress relate

d  illnesses you may not sleep as well whatever it is so we want to look at all those things and  the situational crises these 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 doesn'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 um uh 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 A Mental Health crisis so we want to look at exacerbatin

g and mitigating  factors and vulnerabilities when we're trying to get a pulse on what's going on with this  person are there pre-existing mood issues was the person already depressed anxious if so  about what mentally and cognitively if they're in this situation what is that critical inner voice  telling them is that critical in her voice saying I knew you were going to 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 about with  the person about whether they believe them negative perceptions when they're looking and  if everything they see looks like Doom and Gloom um 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 head space and  see how they're seeing this cur

rent situation and once you start to understand how they're seeing  it and what they're hearing in their own 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 you know if everybody always leaves me or nobody can be counted on  okay you know file that away then later

when you're talking about no 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 um and if they don't have anybody that that's  okay you know we can start brainstorming where we might find those people 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 obviously have significant back pain and they have to sit they can't stand for  very long or maybe it's their knees I don't know um 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 low blood sugar or  dehydration we don't think real clearly when we're dehydra

ted 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 so

mething to eat  offer them something to drink help them feel how much you care 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 um you  know and we want to look not only at is it doing what it's supposed to be doing to the degree we  need it to do it but we also w

ant 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 really ugly you know they it can have 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 t

o figure out if they've got people they can rely  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 and what are their values and you know

any of these questions we can  start talking talking to them about you know maybe they're a really honest person um and they feel  like people should be honest okay so that's one of your values um and 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 w

ay 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 um but we also want to look at are there things spiritually that can help  give this person comfort in 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 ar

e  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 the immediate  situation look around what visual auditory triggers or auditory triggers might be there um  if there are people cheering them on if there are you know cheering them on or 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 any

thing 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 t

hey will hold on to those beliefs that they had for fear of losing face  they may act out more if there's an audience so try to remove that audience try to make it  as a calm and of an environment as possible remember the fear and anchor rip anger represent  responses to some kind of a threat so when we're listening to what's going on and what led up  to this and how it's impacting them listen to fears of the unknown I don't know how I'm going  to feed my kids okay well let's talk about that um

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 for  them saying you know people will hate me or you know I can't look my family in the face  now isolation nobody's there for me failure obviously you know what that's going to sound  like and threats of death and when I'm talking about that the threats I'm really talking abou

t is  did they feel like their life was in danger or do they feel like there is imminent danger to them  obviously we're going to consider suicidal and 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  basically have the following goals equilibrium and stabilization we want to  remove reinforcers for any aggressive behavior and identify reasons for the per

son to calm down  and please don't tell people to calm down most of the time and occasionally that'll work probably  um but most of the time if you tell somebody to calm down what's going to 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  um so calm down is probably not the right thing um but we can identify you know I really want to  help you I need I need you to slow down a little bit so I can understand everything that's goin

g on  that's saying calm down without saying calm down um 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 see the big picture or if they're over generalizing to that big  picture help them see the details help them see what parts they do have control over  psychosocially we want to assess internal and external factors that could be making  this worse from physical to mental health to cogn

itive and help them choose and identify  or identify and choose workable alternatives now when we're doing this you're you're balancing  temperament and crisis and trying to figure out what's going on let's just add another layer  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 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 and stoic  or they may do something completely different but those are kind of the three points along the  continuum we don't unless you know that person really well you probably can't predict how they're  going to react to something so being aware of that when you're working with somebody from a different  culture or maybe from your 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 uh webinars a lot o

f 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 in the best interest  of yourself you know try to find that dialectic language is not always interpreted in the sa

me  way so don't use colloquialisms and even things like the word depression doesn'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 a an interpreter if they need you know time for  prayer whatever it is remember that past history certainly does impact current events um so if  they are a oppre

ssed 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 um 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 model stabilize makes sense acknowledge what's going on facilitate  understanding encourage adap

tive coping restore functioning and refer as needed because we can't  do everything so so ensuring safety is the part of stabilize 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 one of the things when I have hi

ghly 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 remove bystanders because an  audience may add Fuel and reframe the situation with the client not being bad the client is  struggling the client feels out of control they're not bad maybe they made an unfortunate decision  or an unfortunate choice but they're a good person stabilized through assessin

g the ABCs  what is their effective State and this is different than this is not the cognitive ABCs what is their effective 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  or 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 some

thing  where somebody is really uncomfortable acknowledge you want to define the problem  and seek help from the client in understanding what's going on listen to the person's  um orientation in order to figure out whether you want to pair it or or identify  their feelings or start out with Solutions um so one of the things that uh we're looking at  here is if somebody is a 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 and then are they visual auditory or kinesthetic so let's talk about  what are what are you seeing what are you hearing what are you feeling what can you do empathize to  see the problems the client does ask open-ended questions and pay attention to their verbal and  non-verbal messages you know obviously 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 clients feelings are the clients 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 there own your own feelings when you're facil

itating  understanding you know you may stop and say I'm confused here or I'm feeling really frustrated it  feels like we've been going over the same thing for an hour and 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 too be aware of transference and counter transference  reactions you know what do you represent to that person that they may be transferring onto you  do you represent the the um the system do

you represent someone that's helpful do you represent  a mother figure or whatever it is um 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 have the need to rescue convey understanding preferably not by saying  I understand but by using good paraphrasing and please don't assure the person that everything's  going to be all right 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 provide positive reinforcement for  positive behaviors if they start calming down and 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 act s

o  we want to ask the person what does this rich and meaningful life look 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 reduce tunnel vision to or increase Focus to things that are meaningful to the person so you  might say something like this is really 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 um what how  can you alter your thinking to not see this as destroying you or or however they're seeing it and restore 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 law a sense  of a loss of control and obtained commitment with a search assertion statements 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 um make sure with permission obviously that 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 good refer to medical and Psychiatric Services as  needed you know

if chronic pain is part of the problem that's contributing to what's going  on 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 it part of it is uncontrolled pain so we may need to refer for  medical stuff and obviously if they've got other if they ha

ven'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 refer 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 um 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 g

roups the survivors  of suicide um depression anxiety divorce substance abuse there are support groups for  everything contact your local Nami for mental health groups you can also contact your  local United Way information and referral they 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 sor

ts of things a lot of times um 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

really 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 or two of 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 um have have help  boards that people volunteer to help out church members United Way information and referral and  sometimes in depending on your community there ma

y be vouchers that they can get for temporary  respite care child uh 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 in order to do that we need  to know what equilibrium looks like for them crisis by its very definition is a  state of extreme an

xiety you know um 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  we're generally dealing with is 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 a state to hear them understand what's going  on with them it may not be this particular thing it may be the F

allout from this particular  thing I remember I was watching One show um oh I can't remember the name of it right now  um but hostage negotiation situation this guy had uh 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 um nuances helpless stop the client reestablish  equilibrium what can they do to help them feel like they're not spinning anymore what 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 l

ong-term goal what's you know maybe they they want to get their house back  if they had their house foreclosed on okay getting a house is probably a that that's a 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 fight

ing against a mountain identify environmental and social supports and  social supports are obvious you know what things what what people in your environment can help you  and it may be friends it may be family but it also may be resources such as uh Social Services food  stamps um Red Cross you know what other supports are out there that can help you manage this if a  person's house burned down the Red Cross is really 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 re-establishing  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 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 going to do tomorrow all right please call me tomorrow after  you do that first thing and tell m

e how it went which will encourage them if they feel  accountable so to speak to you if they've got to report in on it it will encourage them  to take action if they're not willing to do it you may find that they are apprehensive about  calling and and doing whatever it is they may feel um not okay about calling certain facilities  or 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 themselves or maybe they do

n't know how they don't  have a car anymore because their car got totaled and they have to um 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 acknowledge  the issue facilitate understanding

so you know you acknowledge what's going on that they're  in crisis yada yada and then you start developing an understanding of what led up to it  and what the possible options are then encourage adaptive coping in order to help start restoring  functioning and that shouldn't be or it should be and refer because most of the time since  crisis is complicated it's not just one thing there's no Panacea when you refer 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 may be another clinician or it may be somewhere like the Red Cross or a church  that can help them out to get their needs met 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 choic

es 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 it's actually 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  emotionally we want to look at things that make them happy what can help them get restored  to happiness mentally what factors do they have you know what can we help them focus on how  can w

e help them change their thinking in order to mitigate the crisis physically how can  we help them mitigate this crisis are 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 proximally 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 igate that crisis be more calming be more supportive be more restorative  and spiritual factors um you know I'm Catholic so I can speak more to those and and Christian  factors than I can to other religions but um all religions have some sort of um  sense of connectedness and and control by a higher power people who are not religious are  also very spiritual though so encouraging them to look at w

hat 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 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 exacerbate  or mitigate 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 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 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 hap

pened 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 him and go here do this 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 are some things