Crisis Intevention Midterm

Front 1

A crisis can be an opportunity because...

Back 1

A person can grow from the challenge of dealing with the precipitating event.

Front 2

What best describes a crisis?

Back 2

A precipitating event occurs, subjective distress is experienced, coping fails.

Front 3

Ego strengths refers to...

Back 3

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

Front 4

The cognitive key refers to...

Back 4

The meaning given to the precipitating event.

Front 5

Not an example of effective coping behaviors...

Back 5

Learning to stifle emotions and contain them.

Front 6

Crisis intervention was first developed with what population?

Back 6

Survivors of a night club fire.

Front 7

Who is known as the "Father of Modern Crisis Intervention"?

Back 7

Gerald Caplan

Front 8

The concept of finite psychic energy comes from which theory?

Back 8

Psychoanalitic

Front 9

The idea of growth and optimism comes from which theory?

Back 9

Humanistic

Front 10

Carl Rogers and his person-centered counseling has contributed much in the way of?

Back 10

-Listening skills
-Reflective skills
-Rapport building.

Front 11

An example of dual relationship would be:

Back 11

-Sex with a client
-Being friends with a client
-Dating a client.

Front 12

A crisis worker must break confidentiality in case of:

Back 12

-Elder Abuse
-Child Abuse
-Intent to murder someone

Front 13

Which is a dimension of burnout?

Back 13

Emotional Exhaustion

Front 14

Who owns the privilege of the communications spoken in a counseling session?

Back 14

The Client

Front 15

Paraprofessionals:

Back 15

Have been an integral part of providing crisis intervention.

Front 16

In which stage of cultural sensitivity does the therapist consider culture as distracting from clinical effectiveness?

Back 16

Burden of considering culture.

Front 17

Mexican-American families are more likely to be:

Back 17

Enmeshed

Front 18

"Coming out" refers to:

Back 18

A gay person disclosing his homosexuality to friends and family.

Front 19

Shame and obligation are two emotional issues for which ethnic group?

Back 19

Asian-Americans

Front 20

Racism probably affects which ethnic minority the most?

Back 20

African-Americans

Front 21

Which is considered the most effective way to invite a client to talk?

Back 21

Open-ended questions.

Front 22

When a client is presented with choices and is encouraged to take back power, the counselor is providing a/an:

Back 22

Empowering Statement.

Front 23

The most important part of the coping phase of crisis intervention is:

Back 23

Encouraging the client to develop new coping ideas.

Front 24

Which is an example of a 12-Step group?

Back 24

Cocaine Anonymous

Front 25

Exploring cognitions is vital because:

Back 25

-Preceptions about the precipitating events are the key to understanding the crisis
-Thoughts about the crisis must be changed in some way
-The person's beliefs are strongly related to subjective distress

Front 26

Formula for Understanding the Process of Crisis Formation

Back 26

1. Precipitating Event Occurs (What triggers the event?)
2. Perception of Event leads to Subjective Distress (Causes you to feel bad)
3. Subjective Distress leads to Impairment in Functioning
4. Coping Skills Fail to Improve Functioning

Front 27

Formula to Increase Functioning

Back 27

1. Alter/Change Perception of the Precipitating Event and Offer Coping Strategies
2. Subjective distress will be lowered
3. Functioning level returns to previous level or higher

Front 28

Crisis as Danger and Opportunity

Back 28

OPPORTUNITY: with help, counseling intervention, the individual survives the crisis with increased coping skills, emotional growth, and resources which prepare him for future stressors

DANGER: Without help, the individual may return to a lowered level of functioning by use of the ego defense mechanisms or remain nonfunctional via suicide, homocide, or psychosis

Front 29

Definition of a CRISIS

Back 29

Experiences a stressor perceived as threatening which leads to subjective distress and impairment in functioning. Coping methods fail.

Front 30

The Crisis Prone Person

Back 30

1. Experiences a stressor perceived as threatening which leads to subjective distress and impairment in functioning. Coping methods fail
2. State of disequilibrium ensues for 4-6 weeks
3. No intervention/ help is sought
4. Individual uses ego strength to deny, repress, dissociate from the meaning of the precipitating event and subjective distress and functions at a lowered level
5. Individual unprepared emotionally to cope with future stressors and easily enters into crisis states when faced with potential precipitating events.

Front 31

Caplan's 7 Characteristics of Effective Coping Behavior

Back 31

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 down into manageable bits and working thorugh 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 oneselfand others and havinga basic optimism about the outcome.

Front 32

Cognitive Key

Back 32

The perception a person has of the precipitating events that led to subjective distress. The crisis worker must identify the perception if he or she is to help the client change it and thereby increase functioning.

Front 33

Curvilinear Model of Anxiety

Back 33

Model showing that anxiety has the potential to be either a positive or negative influence for someone in crisis. Too much anxiety may overwhelm the person and lead to lowered functioning. However, moderate anxiety may offer an opportunity for growth and transition from one stage of life to another or may motivate the person to grow from the experience of trauma. People who have no anxiety tend not to be motivated to make any changes at all.

Front 34

Ego Strength

Back 34

The degree to which people can see reality clearly and meet their needs realistically. People with strong egos usually cope with stress better than people with weaker egos.

Front 35

Precipitating Event

Back 35

An actual event in a person's life that triggers a crisis state that can be either situational or development.

Front 36

Crisis

Back 36

A state of disequilibrium that occurs after a stressor (precipitating event). The person then is unable to function in one or more areas of his or her life because customaryy coping mechanisms have failed.

Front 37

Coping Methods

Back 37

The behaviors, thinking, and emotional processes that a person uses to handle stress and continue to function.

Front 38

Crisis Prone

Back 38

The condition that persists when people fail to grow from a crisis experince and instead deal with the crisis state by using ego defense mechanisms. They will be crisi prone because their ego strength will be weakened, leaving them unable to cope with future stresses.

Front 39

Danger and Opportunity (Definition)

Back 39

Dichotomy associated with a crisis. A crisis can be an opportunity when the person grows by developing new coping skills and altering perceptions. It can be a danger when the person does not seek help and instead copes with the crisis state by using defense mechanisms, resulting in a lowered functioning level and possibly psychosis or even death.

Front 40

Developmental Crisis

Back 40

Normal transitional stages that often trigger crisis states, which all people pass through while growing through the life span.

Front 41

Functioning Level

Back 41

The way a person behaves socially, occupationally, academically, and emotionally. The functioning level is impaired when a person is in a crisis. The goal of crisis intervention is to increase functioning to precrisis levels or higher.

Front 42

Material Resources

Back 42

Tangible things such as money, transportation, clothes, and food. they constitute one determinant of how well a person is able to deal with a crisis.

Front 43

Personal Resources

Back 43

Determinants of how well a person will deal with a crisis. They include intelligence, ego strength, and physical health.

Front 44

Situational Crisis

Back 44

Unexpected traumas having a sudden onset that impair one's functioning level.

Front 45

Social Resources

Back 45

A person's friends, family, and coworkers. The more resources one has, the better one will weather a crisis.

Front 46

Stress

Back 46

A natural, though trying part of life. A reaction to difficult events usually involving feelings of anxiety. Stressful events do not become crises if a person can cope with them and functioning is not impaired.

Front 47

Subjective Distress

Back 47

Painful and uncomfortable feelings experienced by a person in crisis.

Front 48

Triology Definition

Back 48

The three-part approach to understanding what a crisis is, including the precipitating event, subjective distress (caused by cognitions), and , usually, failure to cope, which leads to lowered functioning.

Front 49

Two Key Figures in Crisis Intervention

Back 49

-Gerald Caplan
-Eric Lindermann

-Created the Wellesley Project as a result of the Cocunut Grove fire in Boston, 1942 (Caplan)

- Preventitive psychiatry emphasized early intervention to minimize psychological impairment; grief work (Lindemann)

Front 50

1950's through 1960's

Back 50

-Introduction of psychotropic medications such as thorazine and lithium began the process of the deinstitutionalization of the state hospital mentally ill patients
-Short-Doyle Act funded community mental health centers throughout the country

Front 51

1960's through 1970's

Back 51

-Suicide prevention
-Journals and scientific research about crisis intervention and suicide
-Grass roots movement lead to the creating of non-profit agencies and use of paraprofessionals
-Colleges created counseling programs

Front 52

1980's through 1990's

Back 52

-Managed care
-Brief therapy was more cost effective
-Emphasis on crisis intervention, all mental health workers would provide case management and short term care

Front 53

21st Century

Back 53

-Bills still pending in cogress about the rights of the mentally ill
-Funding at federal level is minimal
-California trend is to create new programs for mental health care (Prop. 63 has passed) this creates thousands of jobs and facilities for mentally ill
-Crisis intervention still the preferred mode by all funding sources

Front 54

Timeline in the Development of Crisis Intervention

Back 54

1942: Coconut Grove Fire / Use of Non-Professionals to counsel grief reactions

1946-1964: Baby Boom / Grief reactions to stillbirths and miscarriages

1950's: Discovery of Psychotropics / deinstitutionalization of the Mentally Ill

1957: Short / Doyle Act

1963: Community Mental Health Act / JFK Assasination

1960's: Journals about suicide prevention and crisis intervention, increase in professional studies in couseling

1960-1970: Grassroots movements, non-profit agencies, use of paraprofessionals

1970-1980: Increase in college counseling programs, professionalization of mental health, movement toward longer mental health counseling

1980-2000: Managed Care takes over the medical field, including mental health, return to crisis intervention in private and public mental health services

Front 55

Contributions from other Modalities

Back 55

PSYCHOANALYTIC APPROACH
*Psychic energy is finite and limited. We can only handle so much stress and then something gives for a period of time until coping skills are learned or defense mechanisims are utilized
* An individual's past experiences will determine how current experiences are dealth with and how a crisis will be resolved

EXISTENTIAL APPROACH
*Humans are responsible for decisions and capable of self-awareness and choice
*Anxiety is a normal part of the human condition and impetus for growth

Front 56

Contributions from other Modalities (cont..)

Back 56

HUMANISTIC APPROACH
*Humans are capable of self-directed growth and htere is hope and optimism about life struggles being manageable.
*A genuine relationship with a counselor where empathy is shown is vital to therapeutic change

COGNITIVE APPROACH
*Human emotions and behavior is related to cognitions and perceptions about our experience
*Helping an individual to alter cognitions when a crisis state is therapeutic

Front 57

Contributions from other Modalities (cont...)

Back 57

BEHAVIORAL APPROACH
*Brief, goal oriented counseling which is directed at changing behaviors which are maladaptive to normal funcitoning

FAMILY SYSTEMS APPROACH
*Runaways in a family is analogous to a crisis in an individual in that normal counteractive mechanisms don't work to return to homeostasis
*Solution oriented therapy aimed at helping families adjust to transitions in family member's development cycle

Front 58

Brief Therapy

Back 58

-Not the same as crisis intervention
-Clients explore past patterns of behavior and how these prevent successful lifestyles and choices
-More explorative rather than structed
-Time limited, but not focused solely on the crisis

Front 59

The ABC Model of Crisis Intervention

Back 59

*A: Developing strong rapport

*B: Identifying the nature of the crisis and altering perceptions

*C: Offering coping skills

Front 60

ABC Model

Back 60

One way to structure crisis intervention that includes (A) developing and maintaining contact, (B) identifying the problem, and (C) coping

Front 61

Behavioral Problem-Solving Model

Back 61

Approach focusing on goal setting, problem solving, and brainstorming alternatives

Front 62

Brief Therapy (Def)

Back 62

May be confused with crisis intervention, but focuses on changing longer-standing behavior patterns rather than on only the current precipitating event

Front 63

Cocunut Grove Fire

Back 63

Nightclub fire in 1942 in which over 400 people died, leaving many survivors in crisis; considered one of the major events leading to the development of crisis intervention as a form of mental health treatment

Front 64

Cognitive Approaches

Back 64

Approaches focusing on a person's perceptions and thining processes and how these lead to crisis states

Front 65

Community Mental Health Centers Act of 1963

Back 65

Legislation enacted during the Kennedy administration directing all states to provide mental health treatment for people in crisis

Front 66

Critical Incident Debriefing

Back 66

A process of helping victims of natural disasters and other unexpected trauma deal with loss and stress reactions

Front 67

Existential Theory

Back 67

Theory from which crisis intervention took the ideas of choice and anxiety. The crisis worker believes that anxiety can be a motivator for change and encourages the client to master anxiety realistically by making choices and accepting responsibility for the choices.

Front 68

Grass-Roots Efforts

Back 68

Upward movement from local groups that led to the c reation in the 1960s and 1970s of many agencies to meet the needs of various populations not being helped by traditional governmental agencies

Front 69

Grief Work

Back 69

Crisis intervention largely intervention largely based on working with survivors and family members of victims of the Cocunut Grove fire. It was with this population that Caplan and Lindemann learned how to conduct short-term interventions

Front 70

Health Maintenance Organizations (HMOs)

Back 70

The current trend in health insurance. These organizations focus on maintaining health rather than curing illness. The orientation of mental health care under this style of management is definitely crisis intervention

Front 71

Humanistic Approach

Back 71

Model using a person-centered approach is developing rapport with clients; counselor uses basic attending skills to focus on the inheritent growth potential in the client

Front 72

Lindemann, Eric

Back 72

Worked with Gerald Caplan on the Wellesley Project and helped create crisis intervention as it is known today; recognized for his contributions to grief work

Front 73

Paraprofessionals

Back 73

Originally community volunteers. BEcause of the tremendous number of clients needing help at the same time after the Cocunut Grove fire, it was necessary to employ community volunteers who were n ot professionally trained to conduct crisis intervention session. These paraprofessionals became part of many agencies in later decades.

Front 74

Psychoanalytic Theory

Back 74

An approach considered the opposite of crisis intervention but with certain ideas useful for the crisis worker. The notion that we have only a certain amount of psychic energy to deal with life stressors lead us to keep our clients proceeding at a slow pace so they don't deplete this energy. Also, ego strength is a useful concept, as shown in Ch. 1

Front 75

Strategic Family Therapy

Back 75

An approach for treating the entire family when a crisis affects any or all members. It is brief and oriented toward solving problems and reaching goals. It is largely based on systems theory.

Front 76

Structural Family Therapy

Back 76

Focuses on the boudaries and roels of family members and the crises that arise when families must adjust to c hanging roles because of normal evolution.

Front 77

Systems Theory

Back 77

Useful in understanding families in crisis. The idea is that family is a self-regulating system and that when any member behaves outside the norms, other members cope with counteraction. When counteraction (coping) fails, a runaway develops in the family dynamics. This runaway is a crisis and often requires the intervention of a family counselor

Front 78

Wellesly Project

Back 78

Develop by Caplan and Lindemann, the first organized attempt at introducing crisis intervention into a community

Front 79

The Need for Ethics

Back 79

-Clients in crisis are vulnerable and easy to exploit and manipulate
-Crises may bring out feelings and inappropriate behaviors in counselors
-Provides an acceptable standard of behaviors among mental health practitioners

Front 80

Use of Paraprofessionals

Back 80

-Crisis work began with nonprofessional mental health workers
-Many don't accept this because they are unaware of the history of crisis intervention
-Often work in nonprofit settings in multidisciplinary team models

Front 81

Self-Awareness and Countertransference

Back 81

-Counselors should be aware of their own emotions, values, opinions, and behaviors
-Should not impose one's values on clients
-Countertransference occurs when counselor's past unresolved issues interfere with objective and apppropriate care of a client

Front 82

Dual Relationships

Back 82

-Counselors should have only one relationship with a client: the therapeutic one
-No sexual, romantic, friendships, business, or social relationship allowed
-Why? Power differential between client and counselor exists

Front 83

Confidentiality

Back 83

-All disclosures by clients are private and counselors many not share information with anyone except supervisors
-The legal counterpart is called Privileged Communication, and the client owns it in court

Front 84

Exceptions to Confidentiality

Back 84

1. Elder abuse and disabled adult abuse reporting
2. Child abuse reporting
3. Duty to warn (Tarasoff Case)
4. Client signs waiver and gives permission to breech confidentiality
5. Client sues counselor in court of action

Front 85

Informed Consent

Back 85

-Clients have rights to understand nature of counseling situation
1. Must give consent for treatment
2. Must understand any risks and benefits of treatment
3. Must consent voluntarily and terminate voluntarily

Front 86

Supervision and Training

Back 86

-Unlicensed counselors must work under supervision of licensed counselors
-License counselors must participate in on-going continuing education
-May not work with clients unless one is qualified through training or experienced

Front 87

Three Dimensions of Burnout

Back 87

1. Lack of personal accomplishment

2. Emotional Exhaustion

3. Depersonalization and deinviduation of clients

Definition of Burnout:
"A syndrome of physical and emotional exhaustion, involving the development of negative self concept, negative job attitudes, and loss of concern and feelings for clients."

Front 88

How To Prevent Burnout

Back 88

-Talk with co-workers
-Go see your own therapist
-Engage in healthy lifestyle, eat, exercise, have fun and play

Front 89

Stages of Becoming a Multiculturally Sensitive Therapist

Back 89

1. Unawareness of cultural issues. Does not take into consideration an individual’s cultural, ethnic, & religious background as related to the problem.
2. Heightened awareness of cultural issues but feels unprepared to utilize this knowledge with a client.
3. The burden of considering culture. Able to utilize knowledge of cultural diversity but feels overwhelmed with the task and how to implement. Perceive all problems as relating to culture.
4. Toward cultural sensitivity. Able to be sensitive to cultural diversity yet also able to view problems as universal issues as well.

Front 90

Issues Faced by Three Ethnic Groups

Back 90

Mexican-Americans:
-Enmeshed family structure
-Language Barriers
-Different Levels of Acculturation
-Strong Catholic Religion Focus

African-Americans:
-History of racism dating back to slavery
-Group with the most salient differences from mainstream group
-Distrust of Mainstream Institutions
-Clergy as traditional support system when in crisis

Asian-Americans:
-Shame and Obligation
-Rigid family roles and structures
-Counseling should be problem focused and formal

Front 91

People with Disabilities

Back 91

-Physical or mental impairment that substantially prevents or restricts the ordinary course of human development and accomplishments.
-Often viewed as weak, dependent, abnormal and inferior.
-Americans with Disabilities Act (ADA) challenges discrimination against disabled

Front 92

Subgroups Within the Disabled Population

Back 92

-Disabled elderly: intervention must be holistic. Alzheimer’s dementia are stressful for entire family
-About half of the elderly suffer from at least one severe disability
-Mentally disabled people
-Also protected by the ADA
-Include disorders such as major depression, bipolar disorder, schizophrenia, panic disorder, obsessive compulsive disorder, anxiety disorders, and PTSD.

Front 93

Subgroups Within the Disabled Population (cont..)

Back 93

-Developmentally disabled people
-Mental retardation, cerebral palsy, epilepsy, autism
-Rights are a big issue
-Living to be elderly now
-Need extensive and complex treatments

Front 94

Interventions

Back 94

-Crises occur because helpers often do not know what to do
-Need support systems
-Case management
-Collaboration
-Must change societal reactions from fear, repulsion, anxiety, embarrassment and avoidance to meaningful relationships

Front 95

Gays, Lesbians, Bisexuals and Transgenders (GLBT's)

Back 95

-Gay: typically refers to male homosexuals
-Lesbians: female homosexuals
-Bisexuals: male or females who are attracted to same sex and opposite sex partners
-Transgenders: People who feel that they were born the wrong gender and change from male to female or female to male

Front 96

Issues with GLBT's

Back 96

-Suicide
-Fear of being discovered
-Family crises because expectations won’t be met
-Coming out
-Sex-change surgery

Front 97

Suicide

Back 97

+Myths:
-Discussing suicide will make client more likely to attempt
-Suicide threats don’t need to be taken seriously
-Suicide is an irrational act
-Suicide tendencies are inherited
-Once someone thinks of suicide, it never goes away
-Suicide is always impulsive

Front 98

Facts and Statistics

Back 98

-1 out of 59 individuals in the U. S. has been affected by the suicide of someone close to them
-Rates have remained stable over the past 40 years
-About 40,000 people commit suicide and almost 800,000 attempt
-Males more likely than females to successfully complete suicide
-Females more likely to attempt, but not be successful
-Psychiatrists have the highest rate of all professions
-Suicide occurs within the first 3 months of improvement from an episode of depression

Front 99

Facts and Statistics (cont..)

Back 99

-15-19 year olds: 2nd highest cause of death, car accidents are the main cause
-25-30% of alcoholics will attempt suicide
25% of schizophrenics will attempt
-25% of dysthymic disorders will attempt, 12 out of 100,000 will succeed

Front 100

Clues and Symptoms

Back 100

-Giving things away and putting things in order
-Writing a will
-Withdrawing from usual activities
-Preoccupation with death
-The recent death of a friend or relative
-Feeling hopeless, helpless, and worthless

Front 101

Clues and Symptoms (cont..)

Back 101

-Increased substance abuse
-Displaying psychotic behaviors
-Verbal hints, “I’m no use to anyone, what’s the point?”
-Agitated depression
-Living alone

Front 102

Managing Clients Who Are A Danger to Others

Back 102

-Must keep in mind the Tarasoff decision and duty to warn
-Must determine if danger is due to a mental disorder (eg. Hearing voices)
-Must assess for client’s potential for really harming others
-Some have impulse control problems

Front 103

Assessment

Back 103

1. Is the client actively or passively engaged in violent or dangerous behavior now?
2.Does the client state s/he is going to carry out violent/dangerous behavior?
3. Does client have a plan?
4. Does the client have the means?
5. Does the client have a background of violence and dangerous behavior?
6. Has the client acted on plans for violence in the past?

Front 104

Stages of Becoming a Multiculturally Sensitive Therapist

Back 104

1. Unawareness of cultural issues. Does not take into consideration an individual’s cultural, ethnic, & religious background as related to the problem.
2. Heightened awareness of cultural issues but feels unprepared to utilize this knowledge with a client.
3. The burden of considering culture. Able to utilize knowledge of cultural diversity but feels overwhelmed with the task and how to implement. Perceive all problems as relating to culture.
4. Toward cultural sensitivity. Able to be sensitive to cultural diversity yet also able to view problems as universal issues as well.

Front 105

Issues Faced by Three Ethnic Groups

Back 105

Mexican-Americans:
-Enmeshed family structure
-Language Barriers
-Different Levels of Acculturation
-Strong Catholic Religion Focus

African-Americans:
-History of racism dating back to slavery
-Group with the most salient differences from mainstream group
-Distrust of Mainstream Institutions
-Clergy as traditional support system when in crisis

Asian-Americans:
-Shame and Obligation
-Rigid family roles and structures
-Counseling should be problem focused and formal

Front 106

People with Disabilities

Back 106

-Physical or mental impairment that substantially prevents or restricts the ordinary course of human development and accomplishments.
-Often viewed as weak, dependent, abnormal and inferior.
-Americans with Disabilities Act (ADA) challenges discrimination against disabled

Front 107

Subgroups Within the Disabled Population

Back 107

-Disabled elderly: intervention must be holistic. Alzheimer’s dementia are stressful for entire family
-About half of the elderly suffer from at least one severe disability
-Mentally disabled people
-Also protected by the ADA
-Include disorders such as major depression, bipolar disorder, schizophrenia, panic disorder, obsessive compulsive disorder, anxiety disorders, and PTSD.

Front 108

Subgroups Within the Disabled Population (cont..)

Back 108

-Developmentally disabled people
-Mental retardation, cerebral palsy, epilepsy, autism
-Rights are a big issue
-Living to be elderly now
-Need extensive and complex treatments

Front 109

Interventions

Back 109

-Crises occur because helpers often do not know what to do
-Need support systems
-Case management
-Collaboration
-Must change societal reactions from fear, repulsion, anxiety, embarrassment and avoidance to meaningful relationships

Front 110

Gays, Lesbians, Bisexuals and Transgenders (GLBT's)

Back 110

-Gay: typically refers to male homosexuals
-Lesbians: female homosexuals
-Bisexuals: male or females who are attracted to same sex and opposite sex partners
-Transgenders: People who feel that they were born the wrong gender and change from male to female or female to male

Front 111

Issues with GLBT's

Back 111

-Suicide
-Fear of being discovered
-Family crises because expectations won’t be met
-Coming out
-Sex-change surgery

Front 112

Suicide

Back 112

MYTHS
-Discussing suicide will make client more likely to attempt
-Suicide threats don’t need to be taken seriously
-Suicide is an irrational act
-Suicide tendencies are inherited
-Once someone thinks of suicide, it never goes away
-Suicide is always impulsive

Front 113

Facts and Statistics

Back 113

-1 out of 59 individuals in the U. S. has been affected by the suicide of someone close to them
-Rates have remained stable over the past 40 years
-About 40,000 people commit suicide and almost 800,000 attempt
-Males more likely than females to successfully complete suicide
-Females more likely to attempt, but not be successful
-Psychiatrists have the highest rate of all professions
-Suicide occurs within the first 3 months of improvement from an episode of depression

Front 114

Facts and Statistics (cont..)

Back 114

-15-19 year olds: 2nd highest cause of death, car accidents are the main cause
-25-30% of alcoholics will attempt suicide
25% of schizophrenics will attempt
-25% of dysthymic disorders will attempt, 12 out of 100,000 will succeed

Front 115

Clues and Symptoms

Back 115

-Giving things away and putting things in order
-Writing a will
-Withdrawing from usual activities
-Preoccupation with death
-The recent death of a friend or relative
-Feeling hopeless, helpless, and worthless

Front 116

Clues and Symptoms (cont..)

Back 116

-Increased substance abuse
-Displaying psychotic behaviors
-Verbal hints, “I’m no use to anyone, what’s the point?”
-Agitated depression
-Living alone

Front 117

Managing Clients Who Are A Danger to Others

Back 117

-Must keep in mind the Tarasoff decision and duty to warn
-Must determine if danger is due to a mental disorder (eg. Hearing voices)
-Must assess for client’s potential for really harming others
-Some have impulse control problems

Front 118

Assessment

Back 118

1. Is the client actively or passively engaged in violent or dangerous behavior now?
2.Does the client state s/he is going to carry out violent/dangerous behavior?
3. Does client have a plan?
4. Does the client have the means?
5. Does the client have a background of violence and dangerous behavior?
6. Has the client acted on plans for violence in the past?

Front 119

Intervention

Back 119

-May need involuntary hospitalization
-Must report to police if deemed violent to another
-May teach clients ways to contain violent urges through anger management groups.
-Medication may be useful if client shows severe psychiatric symptoms
-Antisocial disorders may be cases to refer to law enforcement
-Informing clients that therapists are required by law to report abuse helps control impulses

Front 120

Danger to Others

Back 120

Condition in which a client is deemed to be a threat to others. At this time, counselors must breach confidentiality and report their ocncers to the police and/or the intended victim. This is called the "duty to warn"

Front 121

High-Risk Suicidal Clients

Back 121

Clients who have a plan, the means, and the intent to commit suicide; they cannot be talked out of harming themselves. Hospitalization is often indicated for such clients.

Front 122

Involuntary Hospitalization

Back 122

Detaining clients against their will in a psychiatric facility for evaluation and observation when they have been deemed a danger to themselves, others, or are gravely disabled because of a mental disorder

Front 123

Low-Risk Suicidal Clients

Back 123

Clients who have pondered but never attempted suicide. These clients have adequate support systems and can usually be treated as outpatients. Therapy and educational interventions are encouraged.

Front 124

Means

Back 124

The actual physical implement, pills, or action that a suicidal person uses to kill himself or herself.

Front 125

Middle-Risk Suicidal

Back 125

Clients who have been thinking about suicide and feel depressed. These clients probably still have some hope, but they might also have a suicide plan. A no-suicide contract works as well for such persons as does a suicide watch. Crisis intervention should be intense and frequent.

Front 126

No-Suicide Contract

Back 126

A formal written or verbal contract between the client and the crisis worker in which the client makes a commitment to speak to the counselor before harming himself or herself. It is considered an effective intervention for low-and middle-risk clients.

Front 127

Plan

Back 127

A blueprint for action that clients have devised for killing themselves.

Front 128

Psychotic Decompensation

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A state in which the client is out of touch with reality and shows symptoms such as delusions and hallucinations. This often happens when a schizophrenic patient stops taking medidcation or at the beginning of a person's first schizophrenic episode. The state can also be associated with bipolar disorder and paranoid episode. This person ususally requires involuntary hospitalization.

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Suicidal Ideation

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The cognition component of suicide, the thinking involved.

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Suicide Assessment

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A process in which the crisis worker asks a series of directive questions to ascertain the seriousness of a clients's suicidal intent and ideation. It includes identifying various risk factors, a means for suicide, a plan for suicide, and reasons for wanting to harm oneself.

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Suicide Watch

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Observation by family or friends of those who are at middle risk of hurting themselves. Someone stays by the client's side 24 hours a day to ensure that the person does no harm to himself or herself. Suicide watches are also conducted in psychiatric facilities for high-risk clients.