Crisis Intervention

Front 1

Ego strength is:

a) how proud and self-centered the person is

b) the amount of energy available to overcome PTSD

c) the ability to understand the world realistically and act upon it to get one's needs met

d) all of the above

e) none of the above

Back 1

C

Front 2

An example of effective coping behaviour is:

a) learning to accept that oneself cannot be trusted in crisis situations

b) learning to master the problem as it comes to you as a whole

c) mastering feelings where possible

d) none of the above

Back 2

C

Front 3

Caplan believed that all of the following are characteristics of effective coping behaviour EXCEPT:

a) actively exploring reality issues

b) trusting in oneself

c) freely expressing feelings

d) none of the above

Back 3

D

Front 4

The idea of growth and optimism comes from which theory?

a) Behaviourism

b) Psychoanalytic

c) Cognitive

d) none of the above

Back 4

C

Front 5

Suicide Prevention became wildspread in the:

a) 1800s

b) 1960s

c) 1990s

d) 1980s

Back 5

B

Front 6

The cognitive-behavioural theories have contributed which of the following to crisis intervention?

a) Interpretive techniques

b) The problem solving model

c) The exploratory model

d) All of the above

e) None of the above

Back 6

B

Front 7

Caplan's list of effective coping people includes the ability to invoke help from others.

Back 7

T

Front 8

Discuss the trilogy definition of a crisis.

Back 8

1. Precipitating event

2. subjective distress

3. coping fails

Front 9

Describe how a crisis can be both an opportunity and a danger

Back 9

Danger- no crisis intervention, non-adequate coping mechanisms, lowered functioning/psychosis/suicide

Opportunity- seeks help, grows and develops from the challenge of dealing with a precipitating event

Front 10

How does someone become crisis prone?

Back 10

Crisis prone person doesn't use proper coping mechanisms, continually ends up at lower levels of functioning until ego strength is completely depleted

Front 11

What are Caplan's 7 characteristics of effective coping people?

Back 11

1. actively exploring reality issues and searching for information

2. freely expressing both positive and negative feelings and tolerating frustration

3. actively invoking help from others

4. breaking problems into manageable bits and working through them one at a time

5. being aware of fatigue and pacing coping efforts while maintaining control in as many areas of functioning as possible

6. mastering feelings where possible, being flexible and willing to change

7. trusting in oneself and others and having a basic optimism about the outcome

Front 12

When might medication be useful for someone in a crisis?

Back 12

When subjective distress needs to be immediately reduced because it is too great, temporary relief

low ego strength, history of mental health problems

Front 13

How is stress different from a crisis?

Back 13

stress- a person experiences negative event and negative emotion, doesn't experience impairment in functioning because they have coping skills

Front 14

Discuss the history of crisis intervention from the 1940s to the 21st century

Back 14

-1942: Coconut Grove, nonprofessional counselling

-1946-1964: baby boom, increase in birth problems

-1950s: Psychotropic medication, deinstitutionalization of mentally ill people

-1957: Short-Doyle Act

-1963: Community Mental Health Centers Act

-1960s: professional journals re: suicide/crisis intervention, professional counselling

-1960s-1970s: grass-roots movements, paraprofessionals

-1970s-1980s: professionalization of mental health, licensed counsellors, long-term counselling

-1980s-1990s: return to crisis intervention, community mental health

Front 15

Contributions of Psychoanalysis

Back 15

-finite psychic energy

-ego strength

Front 16

Contributions of Humanism

Back 16

-client potential

-reflective/empathetic techniques

Front 17

Contributions of Existentialism

Back 17

-responsibility/choice

-anxiety is normal

Front 18

Contributions of Cognitive-Behavioural Approaches

Back 18

-behavioural problem-solving model

-person's cognitive view of the problem

-homework, follow-up

Front 19

Contributions of family systems model

Back 19

-change makes people anxious

-why pathology is so common in families, why change takes so long (people prefer stability)

Front 20

How did the intro of psychotropic medication and the deinstitutionalization of the mentally ill influence current crisis intervention and provision of mental health services?

Back 20

-mentally ill could be managed on an outpatient basis

-led to Community Mental Health Centers Act, provision of mental health care to less severe cases

-short term crisis intervention

Front 21

"Duty to Warn" came from

Back 21

The Tarasoff Case

Front 22

In which stage of cultural sensitivity is culture distracting from clinical effectiveness?

a) unawareness of cultural issues

b) heightened awareness of culture

c) burden of considering culture

d) towards cultural sensitivity

Back 22

C

Front 23

Mexican-American families are most likely to be:

a) disengaged

b) matriarchal

c) enmeshed

d) none of the above

Back 23

C

Front 24

African Americans and Asian Americans usually prefer to deal with counsellors in a problem solving model

Back 24

True

Front 25

Etic issues refer to those behaviours that are particular to a specific culture or subgroup

Back 25

False

Front 26

Emic issues refer to universal culture behavior

Back 26

False

Front 27

When MUST a counsellor breech confidentiality?

Back 27

-elder abuse

-child abuse

-when a client is dangerous towards others

Front 28

When MAY a counsellor breech confidentiality?

Back 28

-signed waiver, continuity of health care, to provide supervision, access of records to court, health insurance claims, when a person is a danger to themselves

Front 29

How might countertransference affect crisis intervention?

Back 29

interferes with ability to be calm, objective, and client-focused

Front 30

What are the symptoms and causes of burnout?

Back 30

-symptoms: dizziness, nausea, headaches, fatigue, palpitations, shortness of breath, cognitive impairment, major depression, panic disorder, psychosomatic illness, social withdrawal, substance abuse, deterioration of family and social relationships

-causes: disillusionment, tedium, low positive feedback, human tragedies, unpredictable danger, mass hysteria, fear of environments

Front 31

What are effective methods of lessening burnout?

Back 31

fun with teammates, work discussions, peer cohesion, social support, more time in direct contact with consumers, control over time at work, control over workload, ability to organize own work, recognition of quality of care, clarity over role at work

Front 32

Describe one behaviour pattern typical of:

Asian-Americans

African-Americans

Mexican-Americans

Back 32

Asian-Americans: Shame and obligation

African-Americans: distrust of society

Mexican-American: ataque de nervios

Front 33

What are the stages that a counsellor goes through when becoming culturally sensitive?

Back 33

1) unawareness of cultural issues

2) heightened awareness of culture

3) burden of considering culture

4) movement toward cultural sensitivity

Front 34

What issues might a gay man face when coming out?

Back 34

inner battle with 'deviance'

shame

fear of rejection

fear of unknown reactions

losing home/job/respect

Front 35

Which basic attending skill is probably the most powerful tool in creating an empathetic environment?

a) clarifying

b) reflection

c) summarization

d) open-ended questions

Back 35

B

Front 36

What is the purpose of using basic attending skills?

Back 36

to develop rappot and let client know that counsellor is concerned and respectful

Front 37

Give three examples of open-ended questions.

Back 37

How have you been feeling?

What have you done?

What is your sadness like for you?

Front 38

Provide a reflective statement for:

a) anger

b) sadness

c) joy

d) fear

Back 38

anger- You sound frustrated

sadness- I see tears in your eyes

joy- You seem to be smiling a lot.

fear- You sound afraid.

Front 39

Describe each of the following:

a) reframing

b) educational statement

c) empowerment statement

d) validation statement

Back 39

reframing: defining a situation differently from the way the client interprets it

educational statement: factual information about the crisis

empowerment statement: present client with choices, personal power

validation statement: telling the person that their feelings are normal and understandable

Front 40

Compare and contrast Kubler-Ross' stages of death and dying and Worden's task of mourning

Back 40

Stages:

1) denial and isolation (Task 1. Accepting reality of loss)

2)anger

3)bargaining (Task 2- Experience Pain of grief)

4) depression

5) Acceptance (Task 3- adjusting to new environment)

(Task 4- withdrawing energy and reinvesting)

Stages: fixed sequence, "need" to go through each, lack of empathy

Tasks: not timed, no sequence, action by bereaved, work towards goal

Front 41

What are some special needs of a parent who has lost a child to death?

Back 41

-lost dream of future

-weakened marriage/ parent-child relationships

-father can't express emotions

-societial norms (3 days leave--losing job)

-shortened attention span

-need to talk/be listened to/changing needs

-don't inhibit talking about child

Front 42

What are some issues that children face when their families become blended?

Back 42

-loyalty issues

-guilt over bonding with another adult

-stepparent's rules/expections

Front 43

Describe the 4 stages of successful mourning

Back 43

1. Accepting Reality of Loss: getting over denial, permanence

2. Experiencing Pain of Loss: crying/yelling/ruminations, moving past avoidance

3. Adjusting to Environment without deceased: coping on own, taking over roles, develop new skills

4. Withdrawing Emotional Energy from Deceased and Reinvesting: overcome guilt, love others, no time limits, can talk/think about deceased without pain

Front 44

5 symptoms of PTSD

Back 44

-feelings of detachment

-numbing of feelings

-sleep difficulties

-intense fear/feelings of helplessness

-difficulty concentrating

Front 45

5 causes of PTSD

Back 45

-being in combat/war zone

-personal/family vicitimization

-surviving natural disaster

-experiencing manmade disaster

-sudden, unexpected death of a loved one

Front 46

Describe the phases of community disaster

Back 46

1. heroic- emotions are strong, lots of help provided/altruism, high energy/motivation

2. honeymoon- shared experiences, anticipate help, community groups

3. disillusionment- people return to greed/jealousy/selfishness, utopia doesn't happen, bitterness when help doesn't come/aid leaves

4. reconstruction- need to rebuild, live independently/accept responsibility

Front 47

How should critical incident debriefing proceed?

Back 47

-listening & empathizing

-spend time with victim (support/reassurance of safety)

-encourage talking to others/accepting help

-help tolerance of other's irritability, redefine priorities/refocus energy

-encourage functioning, maintain health

-actively seek info

-support groups

Front 48

During middle childhood, the major role changes going on for the child deal with:

a) bonding

b) stagnation

c) success and failures

d) all of the above

Back 48

A

Front 49

What is a need of most teens that is thwarted and leads to self-destructive behaviours?

Back 49

independence, autonomy, nurturance

Front 50

Discuss the developmental stages and possible interventions for a crisis in each.

Back 50

1. infancy-> father fails to nurture->encourage open communication, educate on need for involvement

2. toddler->overcontrolling parents->educate parents about need of toddler to have power over self

3. preschool->child is overly agressive/competitive and can't share/cooperate->teach parents how to help child submit while still feeling worth

4. childhood->child fails to master social/physical/academic skills-> encourage child to develop competence in something

5. adolescence->parents fail to listen->teach parents active listening, empathetic understanding

6. young adult->parents fail to let go/overcontrol->help parents to grieve loss, focus on new involvements

7. middle adult->failure of marital bonds after child leaves-> marital counselling, increase marital interactions

8. mature adult->anger/shame about dependence on family->family therapy to address feelings and communicate needs

Front 51

What are characteristics of teens with eating disorders?

Back 51

1. highly emotionally reserved/cognitively inhibited

2. prefer routine, orderly, predictable environments, react poorly to change

3. show heightened conformity/deference to others

4. avoid risk/react to stressful events with strong distress

5. focus on perfectionism, negative self-evaluation, fear of adulthood

Front 52

Who is considered one of the founding fathers of modern suicidology?

a) Freud

b) Farberow

c) Caplan

d) Lindemann

Back 52

B

Front 53

A good strategy for a middle risk suicide client is:

a) support comments

b) no suicide contract

c) family suicide watch

d) all of the above

Back 53

D

Front 54

Psychotic decompensation is:

a) a state of increased energy

b) a state of active delusions and hallucinations

c) a state of increased independence

d) none of the above

Back 54

B

Front 55

Farberow's work with suicide began with WWII veterans

Back 55

TRUE

Front 56

10 questions a crisis worker should ask during a suicide assessment

Back 56

1. Have you thought of killing yourself?

2. How often...

3. How badly do you want to die (scale 1-10)

4. Do you perceive suicide as weak or strong?

5. Do you have a suicide plan

6. Do you have the means

7. When were you thinking of doing it?

8. Have you given things away?

9. Have you made any attempts in the past?

10. Has anyone close to you committed suicide in the past?

Front 57

Effective crisis intervention for high-risk suicide client

Back 57

involuntary/voluntary hospitalization

possible medication

Front 58

Effective crisis intervention for middle-risk suicide client?

Back 58

-written no suicide contract

-increased contact

-family watch

-medication evaluation

-brief voluntary hospitalization

-find out what stopped them, encourage living for that

-reframe/support

Front 59

Effective crisis intervention for low-risk suicide client?

Back 59

-supportive crisis intervention

-verbal no-suicide contract

-maintain regular contact throughout crisis intervention

Front 60

5 things a crisis worker should explore with possible homicidal client

Back 60

1. active or passive engagement in violent/dangerous behaviour

2. stating that they will go through with violent/dangerous behavior

3. a plan to follow through

4. means to follow through plan

5. background of violent/dangerous behavior

Front 61

How is the mental status exam useful for a crisis worker?

Back 61

- helps determine if someone is psychotic, gravely disabled, a danger to self, or a danger to others

-structured to describe a person's current state of mind

Front 62

What are the categories of the MSE

Back 62

appearance, attitude, behaviour, speech, mood & affect, through process, thought content, perception, cognition & orientation, insight, judgement

Front 63

How is self-mutilative behaviour different than suicide?

Back 63

-sometimes no suicidal intent

-main purpose to regulate emotional or physiological experiences

-impulsive disorder: prevalent in a variety of emotional/personality disorders

Front 64

What is bullying and how should we intervene?

Back 64

Bullying is aggressive behaviour that is intended to cause distress or harm, involves a power imbalance, and occurs repeatedly over time

Intervention:

-schoolwide climate to discourage bullying

-survey students to find out nature/extent/attitudes of bullying

-train staff to recognize and response to bullying

-develop consistent rules against bullying

-review + enhance disciplinary code against bullying

-discuss bullying issues in the classroom

-integrate bully-prevention across curriculum

-provide counseling (individual and group) to bullied children

-provide counseling to bullies

-involve parents in prevention

-use teachers and staff to increase knowledge and motivation

Front 65

The unemployment rate is on the rise.

Back 65

False

Front 66

What are some issues a person faces when he or she loses a job?

Back 66

-loss of identity/social life

-huge portion of time that used to be spent at job is now spent looking for a job (exhausting)

-perceived loss of control

-loss of status (esp. in high-level jobs)

-financial challenges

Front 67

Hallucinations

Back 67

false sensory perceptions.

-auditory: schizophrenia

-visual/tactile: substance-abuse withdrawal

-gustatory/olfactory: organic brain disorder

Always indicative of a serious illness, you should consult a doctor

Front 68

Psychotic Decompensation

Back 68

-state of being out of touch with reality

-symptoms: delusions, hallucianations

-usually happens after stopping medications or at beginning of first schizophrenic episode

-also associated with BPD and paranoid disorders

-usually requires involuntary hospitalization

Front 69

Calibration

Back 69

range of allowable behaviours in a family

Front 70

Counteraction

Back 70

-behaviours that family members engage in when trying to stop a family member behaving outside of family rules

Front 71

differentiation/individuation

Back 71

process where a young adult establishes a mature identity and capacity for intimacy needed to assume adult roles/responsibilities

Front 72

disengagement

Back 72

when parents do not relate to their child in a nurturing manner and the child feels little support or belonging

Front 73

enmeshed

Back 73

when an individual lacks separateness from others with whom they have an emotionally intense relationship

Front 74

evolutional crises

Back 74

normal stages that a family experiences as it evolves through life span of members. Crises come from having to adjust to formation of subsystems: marital, parental, sibling, grandparent

Front 75

homeostasis

Back 75

steady, stable state of a family which is maintained when family members adhere to the family rules and roles (both verbal and non-verbal)

Front 76

runaway

Back 76

a family in crisis

Front 77

hypervigilance

Back 77

state of preparedness and anxiety that often occurs after being personally attacked

Front 78

logotherapy

Back 78

psychotherapy by Victor Frankl when a client is encouraged to actively explore meaning in their lives and behave in ways to work toward a more meaningful existence (finding meaning in crisis)