Crisis Intervention Counseling

14 Essential Tools for Professional Crisis Interventionists

Posted on by Joseph Gerard

Crisis training for emergency response professionals is critical to better save lives and give appropriate response to the situationWritten by Veronica Turner.

Professional crisis interventionists are the unsung heroes, the knights in shining armor who step in when life throws a wrench in the works.

In a world that can change in the blink of an eye (lesson learned from COVID-19), these professionals have their work cut out for them. They need to be ready for anything, from emotional meltdowns to biohazard nightmares.

This guide will take you on a tour of the essential tools and resources that every crisis interventionist should have in their toolkit. From the physical tools that help in managing emergencies to the skills and resources that underpin their practice, we’ve got it all covered.

Who Exactly Are Professional Crisis Interventionists?

Professional crisis interventionists are a versatile team of specialized individuals, armed with the knowledge and skills needed to tackle emergencies. Picture them as savvy conductors enabling the harmony of calm amidst the discord of crisis.

These experts come equipped with a plethora of skills, from psychological savvy to the acute ability to assess and de-escalate volatile situations swiftly.

Often hailing from backgrounds in social work, psychology, or emergency services, they stand as the steady heartbeats amid pandemonium. Their roles may vary – some might guide individuals through mental health crises, while others coordinate responses to natural disasters.

Regardless of the crisis, these professionals bring unwavering hope and resilience, connecting individuals and resources to sail through even the stormiest of times. With compassion at their core and pragmatic strategies in their toolbox, interventionists transform chaos into tranquility, crafting trails toward safety and hope amidst the darkest of circumstances.

Four Essential Tools for Professional Crisis Interventionists

Crisis intervention is a high-pressure field where the right tools can be game-changers. Let’s delve into these pivotal tools that allow interventionists to work their magic.

  1. Communication Devices

In the digital age, communication is king. Trusty smartphones or radios are the lifelines for interventionists, connecting them with teammates, emergency services, and vital resources.

These gadgets ensure smooth information flow, facilitating rapid decisions in crucial moments. They also serve as vital documentation tools, capturing evidence, and managing follow-ups. It’s like a trustworthy courier, ensuring vital messages reach their destination promptly and clearly.

  1. Personal Protective Equipment (PPE)

To knights, it’s armor. To interventionists, it’s PPE. When charging into bio-hazardous environments or dealing with violent individuals, PPE is the interventionist’s armor, shielding them as they face the frontlines of the crisis.

The PPE ensemble can include gloves, masks, goggles, and protective clothing. They provide a protective wall, freeing the interventionists to focus on the prevailing crisis without concern for their safety.

Mastery of PPE usage extends beyond wearing the gear; it also involves knowing how to use it correctly and efficiently.

  1. First Aid Kits

Life is full of surprises, and in crisis scenarios, a first aid kit can indeed be a life-saver. Often, interventionists find themselves in situations demanding immediate medical attention, and a well-stocked first aid kit can be a powerful ally.

Brimming with essentials such as bandages, antiseptic, pain relievers, and more, these kits enable interventionists to handle minor injuries and stabilize individuals until professional medical help arrives.

But the first aid kit is more than just a box of medical supplies. It’s a beacon of hope, a silent promise of help when needed.

  1. De-escalation Techniques

Words can be powerful tools when tensions run high. De-escalation techniques are the verbal artillery interventionists use to diffuse tense scenarios and restore peace.

These techniques masterfully employ active listening, empathy, and articulate communication to diminish stress and anxiety.

Imagine a situation teetering on the edge of meltdown. With their verbal skills, an interventionist can gently steer them back to a state of balance. It’s like watching a skilled conductor seamlessly bring harmony to disharmony.

De-escalation techniques are an art, honed through continuous learning and experience. They truly exemplify the interventionist’s ability to connect on a human level.

Five Resources for Professional Crisis Interventionists

Professional crisis interventionists rely on key resources to enhance their skills, ensure effective support, and stay informed in the ever-evolving field of mental health care.

  1. Suicide Cleanup Services

Occasionally, those in the field of crisis intervention are confronted by the painful residues of human despair. In the wake of suicides or traumatic events, suicide cleanup services emerge as an invisible helping hand, restoring affected areas to safety and sanitation.

Staffed by experts in handling biohazards and other risks, these services embrace a stance of respect and compassion, allowing our brave interventionists to focus on providing human support, freeing them from the worry of physical cleanup.

Viewed in this light, suicide cleanup services become a key link in the chain of responsibility, bringing practical aid at difficult times.

  1. Crisis Hotlines

Crisis hotlines, like the National Suicide Prevention Lifeline (U.S.) or the Crisis Call Center, exist as a beacon for those lost in a sea of distress, delivering instant aid and guidance. These lifelines are often the first port of call recommended by interventionists seeking additional resources.

Manned by skilled professionals who possess both a kind ear and practical wisdom, these hotlines are a 24/7 cornerstone of support. When the world seems pitch black, a hotline call can light a candle of hope, mapping a route to safety and healing.

  1. Peer Support Networks

Peer support networks are the collective heart of those who have walked similar paths, providing a nurturing environment for open sharing and healing. These networks offer interventionists a wellspring of wisdom, which they can share with those in their care.

Participating in a peer support network can also be a journey of personal growth and self-nourishment for interventionists. By forging connections with comrades in the field, they gain fresh viewpoints and comprehensive strategies for their practice.

Embodying the strength of unity, these networks remind interventionists that they are not solitary warriors in their quest.

  1. Professional Associations

Professional associations serve as a guiding compass for crisis interventionists, unfolding a treasure chest of resources, and opportunities.

These organizations offer gateways to vital training, research, and networking opportunities, helping interventionists stay informed and connected.

Membership serves as a navigation tool, shepherding interventionists through the labyrinth of their career, providing a sense of belonging and an oath to uphold the highest standards of service.

  1. Continuing Education Programs

The realm of crisis intervention is ever-fluid, and keeping pace with its streams is crucial. Continuing Education Programs are the fountains of knowledge that quench interventionists’ thirst to expand their skills and stay prepared to tackle new challenges.

These programs cover a broad field, from groundbreaking improvements in mental health care to inventive intervention strategies. By partaking in continuous learning, interventionists demonstrate their pledge to lifelong intellectual growth and professional development.

In a field where the chips are always down, continuing education is a life raft, empowering interventionists to deliver the finest care and support.

Five Skills Every Professional Crisis Interventionist Must Possess

Navigating turbulent situations requires expertise. Here are five essential skills every crisis interventionist must excel in to effectively support individuals in distress.

  1. Empathy and Compassion

Grappling with individuals at their most vulnerable, crisis interventionists must learn to join them in their emotional arena, extending understanding and support without judgment.

Empathy paints a picture of the world through their lens, fostering trust and rapport. Compassion fuels the drive to extend warmth with sheer sincerity.

These qualities form the backbone of effective crisis intervention, enabling professionals to sow seeds of positive change in their wards’ lives.

  1. Communication Skills

Communication, the bedrock of successful crisis intervention, should flow clearly and persuasively, ensuring the message hits home.

Interventionists must master the art of listening, catching hidden cues that disclose the needs and fears of those they assist. This skill enables personalized and effective guidance.

Robust communication skills are a powerful weapon, fortifying relationships, and spurring positive outcomes.

  1. Problem-Solving Abilities

The world of crisis intervention is a puzzle box – no two challenges are identical. Interventionists must be quick on their feet, analyzing complex conundrums and crafting creative solutions.

Problem-solving is a dance of critical thinking, resourcefulness, and adaptability, requiring swift and knowledgeable reactions to unexpected situations. This skill is indispensable for sailing the unpredictable waters of crisis work, assuring an effective response to any storm.

  1. Resilience and Self-Care

The emotional rollercoaster of crisis intervention necessitates formidable resilience and self-care. Interventionists must find equilibrium amidst the tempests of their profession while fostering their well-being.

Resilience emboldens interventionists to rebound from stumbles and stay true to their path. Self-care practices like mindfulness, exercise, and peer support, provide a stabilizing anchor, preventing burnout.

  1. Cultural Competence

In our colorful world, cultural competence is a must-have skill. Interventionists need to perceive and respect the cultural tapestries of those they aid, making their approach sensitive and inclusive.

Cultural competence is a lesson in self-awareness, communication adaptability, and openness to learning. It enables interventionists to forge trust with individuals from different cultural landscapes, nurturing positive interactions.

Parting Thoughts

As a crisis interventionist, you are the guiding force that soothes troubled minds, providing thoughtful support and care. The resources and skills discussed are your allies in this noble journey. Embrace them to amplify your impact.

For those keen on broadening their horizons further, make use of professional associations and continuing education programs. Whether you’re a seasoned pro or a rookie, remember, every day offers a new learning opportunity in the profound world of crisis intervention.

References

  1. What is a Crisis Intervention Specialist – Virginia Commonwealth University (https://onlinesocialwork.vcu.edu/blog/crisis-intervention-specialist/)
  2. Crisis Intervention Specialist: Essential Skills and Training – AIHCP (https://aihcp.net/2024/07/15/crisis-intervention-specialist-essential-skills-and-training/#🙂
  3. Crisis Intervention Resources – Spondylitis.org (https://spondylitis.org/resources-support/support-resources/crisis-intervention-resources/)

 

Author Bio: Veronica Turner is a health and lifestyle writer with over 10 years of experience. She creates compelling content on nutrition, fitness, mental health, and overall wellness.

 

 

Please also review AIHCP’s Crisis Intervention Certification programs and see if it meets your academic and professional goals.  These programs are online and independent study and open to qualified professionals seeking a four year certification

Crisis Intervention and the ABC Model

Posted on by Mark Moran

Crisis intervention is an important part of mental health services that seeks to help and stabilize people during times of serious emotional distress. When individuals face intense challenges, the need for quick and effective help becomes very important, as prompt support can change the outcome of a crisis. The ABC Model of crisis intervention provides a clear structure for professionals to understand and meet the immediate needs of those in crisis. This model involves three steps: A (Achieving contact), B (Boiling down the problem), and C (Coping). Each step is meant to help clarify the client’s situation and empower them to take back control. By using the ABC Model, professionals can assess the urgency of their client’s emotional distress and use strategies that build resilience and encourage positive coping methods, which can lead to better mental health results.

Crisis Intervention Specialists utilize the ABC model to help individuals find orientation after crisis

Please also review AIHCP’s Crisis Intervention Specialist Certification.

A.    Definition of crisis intervention

Crisis intervention is an important process meant to help people who are having severe emotional and psychological issues, so they can find their balance again. This method usually includes looking at the situation, understanding immediate needs, and checking available resources to provide support. Professionals use various techniques that fit the person’s needs, creating a feeling of safety and empowerment when times are tough. Since crises upset personal balance, quick intervention is important to prevent lasting psychological damage. The success of crisis intervention can be significant; it not only eases immediate pain but also lays the groundwork for further healing and strength. By using structured methods like the ABC model, professionals can assess the issue, find coping strategies, and help individuals move toward positive solutions. Ultimately, grasping the meaning and range of crisis intervention highlights its importance in maintaining mental health and improving quality of life during difficult situations.

B.    Importance of effective crisis intervention

During crises, the ability to act well can greatly affect both personal well-being and the stability of society. The need for quick response during crises is highlighted by the rise in childhood challenges impacting mental health, which can cause long-lasting harmful effects if not quickly addressed. The American Academy of Pediatrics notes that having safe, stable, and nurturing relationships (SSNRs) helps reduce toxic stress in children, promoting resilience and better coping with future challenges (Andrew S. Garner et al., 2021). In workplaces, especially in the hospitality sector, good crisis intervention is important for keeping employees safe and meeting health standards. Research shows that a clear psychological plan can improve compliance and protect both staff and the community during emergencies (Xiaowen Hu et al., 2020). Ultimately, effective crisis intervention is key to changing individual paths and building healthier, more resilient communities.

C.    Overview of the ABC model

The ABC model is an important framework in crisis help, focusing on a clear method to meet emotional and psychological needs during tough times. This model has three main parts: Activating Event, Beliefs, and Consequences. First, an activating event causes emotional reactions, which leads people to think about their beliefs regarding the situation. This belief system greatly affects the emotional and behavioral outcomes that come next. Knowing this link helps professionals help individuals change their thoughts for better coping methods. Also, using the ABC model in crisis help is vital, particularly in fields like hospitality, where following health and safety rules is very important. For instance, a study shows that good communication and management can lead to employees really following safety rules, demonstrating how the ABC model can improve how organizations handle crises ((Xiaowen Hu et al., 2020)).

II.  Understanding the ABC Model

In crisis help, the ABC Model gives a clear way to meet urgent needs and build strength. This model focuses on three main parts: feelings, actions, and thoughts that people have during a crisis. Knowing these parts helps workers to improve conversation, respond to feelings, and spot unhelpful behaviors that slow down recovery. For example, the use of artificial intelligence and large data sets to find and track the mental effects of crises is similar to how health markers show health levels in medicine. This shows that an in-depth understanding matters in both fields. By using new technologies, mental health workers can improve their responses, focusing on emotions and choices. In the end, using the ABC Model helps with quick crisis fixes and gives people tools for long-term coping, highlighting its important role in modern therapy.

A.    Explanation of the ABC model components

The ABC Model of crisis intervention has three main parts: Affection, Behavior, and Cognition. Affection means showing emotional support to people in crisis, creating a safe and understanding space for open talks. This emotional bond is important because it helps set the stage for the next steps in intervention. Behavior involves what both the person in crisis and the helper do; it looks at harmful actions that might make things worse and supports healthier choices. Lastly, cognition is about helping the person change how they think and see the crisis, which builds resilience and promotes positive problem-solving approaches. This complete method not only deals with current issues but also gives people skills for managing themselves in the future, with the goal of restoring their sense of control and well-being. All these parts together build a solid framework for good crisis intervention.

B.    Historical development of the ABC model

The ABC model’s history is important to know for its use in crisis help. It started in the 1970s by Albert Ellis and was later changed by people like Gerald Caplan, who focused on a methodical way to handle psychological crises. This model aimed to provide quick assistance to those in distress, concentrating on using resources and ways to cope. Over the years, the model has changed a lot, with its main ideas being updated to include new research and methods. For example, with climate change making mental health risks worse, there is a greater need for thorough plans that combine risk evaluation with crisis help, similar to what is proposed in studies of financial stability and sustainability (Simon Dikau et al., 2021). Additionally, the use of technology and data-driven strategies, as seen in responses to recent pandemics, shows that the ABC model remains important for addressing modern crises effectively (Israel Edem Agbehadji et al., 2020).

C.    Application of the ABC model in crisis situations

In crisis intervention, the ABC model is a key structure for grasping and addressing the needs of people in tough situations. This model focuses on three parts: Activating events, Beliefs, and Consequences, which help professionals respond to crises. For example, during the COVID-19 pandemic, health emergencies brought enormous stress and uncertainty, making the ABC model very useful. When hospitality workers faced health risks and operational issues, knowing their beliefs about safety protocols helped improve their compliance with these protocols ((Xiaowen Hu et al., 2020)). Likewise, stakeholders used advanced computing methods to predict and handle crises well, showing how belief systems are important for responses. Overall, the ABC model not only gives a clear method for crisis intervention but also builds resilience in challenging times, highlighting its importance in modern crisis management ((Israel Edem Agbehadji et al., 2020)).

III.             Phases of Crisis Intervention

Crisis specialists help individuals through the phases of crisis until at a pre crisis level

The crisis intervention process happens in separate steps, each important for dealing with the individual’s immediate issues and helping them recover. The first step focuses on figuring out the crisis, where the helper identifies what is happening and how serious it is. This step gives important details and makes sure the intervention is suited to the person’s specific situation. After this assessment, the next step is about building trust and creating a supportive space. This part is essential, as it helps the individual feel comfortable to communicate and be more open to the process. In the end, the intervention results in creating and putting into action a specific plan aimed at solving the crisis and encouraging long-term stability. By carefully going through these steps, crisis responders can really enhance results and support individuals in taking back control of their lives, highlighting the key ideas of the ABC model of crisis intervention.  These steps show how crucial a structured method is in crisis intervention. For example, as seen in healthcare studies, knowing patient histories and building trust are critical for effective help (Mitchell S.V. Elkind et al., 2020). Likewise, research from clinical studies shows that systematically evaluating patient needs can lead to meaningful improvements in health results, especially when dealing with crises (George W. Sledge et al., 2019).

A.    Assessment of the crisis situation

In dealing with a crisis situation, doing a full assessment is very important for good intervention. The first step is to find out the urgent needs and problems faced by people or groups affected by the crisis. For example, during the COVID-19 pandemic, the sudden school closures harmed more than one billion learners, causing major learning interruptions and access issues ((Edeh Michael Onyema et al., 2020)). This crisis not only slowed down learning but made existing inequalities worse, showing the need for specific responses. In health crises, advanced breast cancer (ABC) also brings big management challenges, with many patients facing a poor prognosis ((Fátima Cardoso et al., 2018)). Understanding these details helps practitioners focus on solutions that deal with both immediate and root issues, making sure that the responses are not just immediate but also aim to deal with the unique problems caused by the crisis in a lasting way. Therefore, a complete assessment is key to any good crisis intervention plan.

B.    Development of a crisis intervention plan

A complete crisis intervention plan is important for handling and reducing crises in different areas like healthcare, business, or communities. This plan should start with a careful look at the situation, figuring out the main causes of the crisis and checking the resources available for help. This step includes looking at market conditions and reviewing internal abilities, similar to anti-crisis financial management ideas that focus on prevention and managing risk (I. Zaichko et al., 2024). After the assessment, the plan should set out clear goals, using the ABC model to make interventions clear and often relying on evidence-based practices to shape the response. Since crises can grow quickly, acting promptly is vital, along with ongoing monitoring and feedback loops to adjust plans as needed. The end goal is not only to fix current problems but to build resilience, making sure organizations can learn from the crisis and set up systems to avoid future issues (Rifat Zahan et al., 2024).

C.    Implementation of intervention strategies

To make interventions work well, a clear and organized method must be used that looks at what each person in crisis needs. Using frameworks like the ABC model of crisis intervention—Assessment, Building rapport, and Coping strategies—can help professionals plan their actions. For example, during the COVID-19 pandemic, many families reported more stress in parenting and a drop in mental health, with two out of five parents showing signs of major depression (40.0%). This points to the need for focused support systems ((Shawna J. Lee et al., 2020)). By recognizing this situation, interventions can be adjusted to improve how parents manage stress while also looking after children’s emotional health. Additionally, teamwork among different professionals from various areas, as shown by researchers in global health, highlights the need to bring together diverse viewpoints in crisis intervention strategies ((Thomas Unger et al., 2020)). This all-encompassing method leads to better long-term results for people in crisis.

IV.            Effectiveness of the ABC Model in Crisis Intervention

In looking at how well the ABC Model works in crisis intervention, it is important to think about how it has a clear way to deal with immediate emotional and psychological needs. The ABC Model stands for Achieving Contact, Boiling the Problem Down, and Coping. It effectively helps practitioners set up a safe place for people who are having a tough time. This model focuses on understanding the specific situation of the crisis, which helps in creating a response that fits. For example, the ongoing issues from global crises like the COVID-19 pandemic have greatly affected mental health and access to resources. The ABC Model shows it can adapt to these complicated situations, focusing on communication and practical solutions (Edeh Michael Onyema et al., 2020). Additionally, as situations change, using technology in interventions allows for a wider reach and more involvement, showing the model’s relevance in today’s world, which is often unstable. This is similar to what is seen in Alzheimer’s disease, where early help can lessen long-lasting suffering (Michael DeTure et al., 2019).

Crisis Intervention Specialists are able to help others through crisis via the ABC Model

A.    Case studies demonstrating the ABC model’s success

Many case studies show how well the ABC model works in crisis intervention, proving it gives organized help in tough situations. A notable example is a case with COVID-19 patients, where the model improved communication and understanding of patients’ emotional and mental needs during the pandemic chaos (Israel Edem Agbehadji et al., 2020). In this case, clinicians used the ABC model to look at the triggers, actions, and results related to patients’ experiences, which led to specific interventions that enhanced patient cooperation and overall health. Moreover, another study pointed out how this model effectively dealt with the long-term impacts of COVID-19, emphasizing the need for ongoing support and adjustment to patients’ changing needs (Chen Chen et al., 2020). These results not only highlight the flexibility of the ABC model but also confirm its key role in providing caring, effective crisis intervention in different situations.

B.    Comparison with other crisis intervention models

When assessing how well the ABC model of crisis intervention works, it’s important to compare it to other well-known models like Psychological First Aid (PFA) and the Crisis Development Model (CDM). The ABC model focuses on looking at a person’s feelings, actions, and thoughts to help stabilize a crisis. In contrast, the PFA model puts more emphasis on providing emotional support and ensuring safety right after a traumatic event. This approach aims to give practical help while promoting a sense of connection and normal life. The CDM, on the other hand, highlights the importance of understanding how people behave in a crisis, providing a clear way to predict and manage situations as they escalate. These models showcase various methods for handling crisis intervention, yet the ABC model stands out for its focus on evaluating and addressing emotional and thinking processes. As seen in discussions about stress in parents and the well-being of children in crisis situations, knowing about different intervention models can improve practitioners’ ability to work effectively in various scenarios (Shawna J. Lee et al., 2020)(Chen Chen et al., 2020).

C.    Limitations and challenges of the ABC model

The ABC model is a basic framework in crisis intervention, but it has limits and problems. A major issue is that the model depends on how individuals in crisis are judged, which can lead to different views on what they need. This can be a big problem for people with serious mental health issues, like during the COVID-19 pandemic, when rising parental anxiety and depression changed how children’s wellbeing was seen (Shawna J. Lee et al., 2020). Moreover, the model might miss external factors that add to someone’s crisis, like economic difficulties, making intervention less effective. Recent research shows that there is a need for broader approaches that use new technologies, such as artificial intelligence and big data, to better spot and predict crises. These technologies could help fix some of the ABC model’s shortcomings (Israel Edem Agbehadji et al., 2020). If the model does not change, it may struggle to deal with the complicated nature of real-life crises.

V.  Conclusion

Please also review AIHCP’s Crisis Intervention Specialist Program

In summary, handling crises well is very important for dealing with the complex problems that come up in tough situations. The ABC model is a method that helps professionals look at, react to, and aid in recovery for people who are in distress. This model not only considers the urgent emotional and psychological needs of individuals but also includes key plans for long-term health. The recent disruptions in many fields due to the COVID-19 pandemic, such as the negative impacts on education and the hospitality industry noted in studies, show that quick and informed responses are essential ((Xiaowen Hu et al., 2020); (Edeh Michael Onyema et al., 2020)). Putting strong crisis plans and clear safety measures in place creates workplaces that encourage compliance and flexibility among employees and other stakeholders. Therefore, by using models like ABC, professionals can handle crises better, ensuring that those affected get the help they need to regain their balance and return to normal.

A.    Summary of key points discussed

When looking at crisis intervention, especially using the ABC model, several key discussions highlight its role in providing psychological support. The model focuses on how lab medicine and psychological tests have changed over time, enabling professionals to better address the pre- and post-intervention stages, which are often prone to mistakes (cite33). This change stresses the need for careful focus on assessment and intervention processes to ensure a well-informed approach to client care. Moreover, the guidelines for engaging with individuals with disabilities stress the importance of fairness and respect in assessment methods, fostering a more inclusive approach that improves intervention results (cite34). In summary, these points together confirm the ABC model’s position as an organized approach in crisis situations, promoting a thorough and caring method for intervention that emphasizes client well-being and informed choices.

B.    Future implications for crisis intervention practices

As society deals with challenges from global crises, it is important to look at and improve crisis intervention methods. The results related to the COVID-19 pandemic show a key future need: organizations must create a space that encourages strict adherence to health and safety rules among workers, which is especially important in fields like hospitality that depend on in-person interactions (Xiaowen Hu et al., 2020). Moreover, the education system’s experiences during the pandemic indicate that being able to adapt to technology will be essential for handling crises, which highlights the need for strong digital systems and training for teachers and students to enable effective distance learning (Edeh Michael Onyema et al., 2020). These points suggest that future crisis intervention methods should be adaptable, combining technology and mental preparedness to ensure resilience against unexpected issues. By focusing on these areas, organizations can better equip themselves for upcoming crises, protecting their employees and the communities they support.

C.    Final thoughts on the importance of the ABC model in crisis situations

In crisis intervention, the ABC model is an important framework that aids professionals in how they respond. It focuses on three steps: Achieving contact, Boiling down the problem, and Co-constructing a plan. This model offers a clear method that helps during confusing times. It helps interventionists build a connection quickly while understanding key parts of a person’s crisis, making sure the response fits their specific needs. Additionally, the ABC model encourages teamwork between the helper and the person in crisis, fostering a feeling of control and empowerment. The strength of this model lies in its organized approach and its ability to adapt, which makes it a crucial tool for dealing with the complex emotions and behaviors people face in difficult times.

Please also review AIHCP’s Crisis Intervention Specialist Program and see if it meets your academic and professional goals.  The program is online and independent study and open to qualified professionals within human services, first responses, healthcare and chaplaincy.

References:

  • Gregory C. Chow (2018). China’s economic transformation. ANU Press eBooks. https://doi.org/10.22459/cyrd.07.2018.06
  • Siân Robinson, Jean‐Yves Reginster, René Rizzoli, Sarah Shaw, J. A. Kanis, Ivan Bautmans, Heike A. Bischoff‐Ferrari, Olivier Bruyère, Matteo Cesari, Bess Dawson‐Hughes, R Fielding, Jean‐Marc Kaufman, Francesco Landi, Vincenzo Malafarina, Yves Rolland, Luc J. C. van Loon, Bruno Vellas, Marjolein Visser, Cyrus Cooper, Nasser M. Al‐Daghri, Sophie Allepaerts, Jürgen M. Bauer, Maria Luisa Brandi, Tommy Cederholm, Antonio Cherubini, Alfonso J. Cruz‐Jentoft, Alessandro Laviano, Stefania Maggi, Eugène McCloskey, Jean Pétermans, Ronenn Roubenoff, Ricardo Rueda (2017). Does nutrition play a role in the prevention and management of sarcopenia?. Volume(37), 1121-1132. Clinical Nutrition. https://doi.org/10.1016/j.clnu.2017.08.016
  • Rifat Zahan, Nathaniel D. Osgood, Rebecca Plouffe, Heather Orpana (2024). A Dynamic Model of Opioid Overdose Deaths in Canada during the Co-Occurring Opioid Overdose Crisis and COVID-19 Pandemic. Volume(21). International Journal of Environmental Research and Public Health. https://www.semanticscholar.org/paper/d489c619f3c73aded47165d20f01b5b1989d0827
  • I. Zaichko, Dmytro Riznyk, Nataliya Pavlenko (2024). ANTI-CRISIS FINANCE MANAGEMENT: STRATEGIES AND TOOLS FOR OVERCOME CRISIS SITUATIONS. Black Sea Economic Studies. https://www.semanticscholar.org/paper/8690bbc425fe17479a3d7ee8b877100bbb8b6a1b
  • Andrew S. Garner, Michael W. Yogman (2021). Preventing Childhood Toxic Stress: Partnering With Families and Communities to Promote Relational Health. Volume(148). PEDIATRICS. https://doi.org/10.1542/peds.2021-052582
  • Xiaowen Hu, Hongmin Yan, Tristan Casey, Chia‐Huei Wu (2020). Creating a safe haven during the crisis: How organizations can achieve deep compliance with COVID-19 safety measures in the hospitality industry. Volume(92), 102662-102662. International Journal of Hospitality Management. https://doi.org/10.1016/j.ijhm.2020.102662
  • Israel Edem Agbehadji, Bankole Awuzie, A.B. Ngowi, Richard Millham (2020). Review of Big Data Analytics, Artificial Intelligence and Nature-Inspired Computing Models towards Accurate Detection of COVID-19 Pandemic Cases and Contact Tracing. Volume(17), 5330-5330. International Journal of Environmental Research and Public Health. https://doi.org/10.3390/ijerph17155330
  • Christoph B. Messner, Vadim Demichev, Daniel Wendisch, Laura Michalick, Matthew White, Anja Freiwald, Kathrin Textoris‐Taube, Spyros I. Vernardis, Anna-Sophia Egger, Marco Kreidl, Daniela Ludwig, Christiane Kilian, Federica Agostini, Aleksej Zelezniak, Charlotte Thibeault, Moritz Pfeiffer, Stefan Hippenstiel, Andreas C. Hocke, Christof von Kalle, Archie Campbell, Caroline Hayward, David J. Porteous, Riccardo E. Marioni, Claudia Langenberg, Kathryn S. Lilley, Wolfgang M. Kuebler, Michael Mülleder, Christian Drosten, Norbert Suttorp, Martin Witzenrath, Florian Kurth, Leif Erik Sander, Markus Ralser (2020). Ultra-High-Throughput Clinical Proteomics Reveals Classifiers of COVID-19 Infection. Volume(11), 11-24.e4. Cell Systems. https://doi.org/10.1016/j.cels.2020.05.012
  • Simon Dikau, Ulrich Volz (2021). Central bank mandates, sustainability objectives and the promotion of green finance. Volume(184), 107022-107022. Ecological Economics. https://doi.org/10.1016/j.ecolecon.2021.107022
  • Shawna J. Lee, Kaitlin P. Ward, Olivia D. Chang, Kasey M. Downing (2020). Parenting activities and the transition to home-based education during the COVID-19 pandemic. Volume(122), 105585-105585. Children and Youth Services Review. https://doi.org/10.1016/j.childyouth.2020.105585
  • Fátima Cardoso, Elżbieta Senkus, A. Costa, Efthymios Papadopoulos, Matti Aapro, Fabrice André, Nadia Harbeck, B. Aguilar Lopez, C.H. Barrios, Jonas Bergh, Laura Biganzoli, C.B. Boers-Doets, Maria João Cardoso, L.A. Carey, Javier Cortés, Giuseppe Curigliano, Véronique Dièras, Nagi S. El Saghir, Alexandru Eniu, Lesley Fallowfield, P.A. Francis, Karen A. Gelmon, S. Johnston, Bella Kaufman, Smruti Koppikar, I.E. Krop, Musa Mayer, Gertrude Nakigudde, B.V. Offersen, Shinji Ohno, Olivia Pagani, Shani Paluch–Shimon, Frédérique Penault‐Llorca, Aleix Prat, H.S. Rugo, G. W. Sledge, Danielle Spence, Christoph Thomssen, D.A. Vorobiof, B. Xu, Larry Norton, E.P. Winer (2018). 4th ESO–ESMO International Consensus Guidelines for Advanced Breast Cancer (ABC 4). Volume(29), 1634-1657. Annals of Oncology. https://doi.org/10.1093/annonc/mdy192
  • W. Lance Bennett, Steven Livingston (2018). The disinformation order: Disruptive communication and the decline of democratic institutions. Volume(33), 122-139. European Journal of Communication. https://doi.org/10.1177/0267323118760317
  • M. Salinas, Ruth Torreblanca, Eduardo Sanchez, Á. Blasco, E. Flores, M. López-Garrigós (2024). Managing laboratory test ordering: a challenge in the new laboratory medicine model. Volume(5), 236 – 247. Advances in Laboratory Medicine. https://www.semanticscholar.org/paper/a5dd0d0722afcacf512037d9c343fd25edc144e0
  • S. Hanson, S. Bruyere, Anjali J. Forber-Pratt, Jennifer Reesman, Connie Sung (2023). Guidelines for assessment and intervention with persons with disabilities: An executive summary.. The American psychologist. https://www.semanticscholar.org/paper/d3a1e4c332d60d9f3da674a049416520e2a7da67
  • Edeh Michael Onyema, Chika Eucharia Nwafor, Faith Ayobamidele Obafemi, Shuvro Sen, Fyneface Grace Atonye, Aabha Sharma, Alhuseen Omar Alsayed (2020). Impact of Coronavirus Pandemic on Education. Journal of Education and Practice. https://doi.org/10.7176/jep/11-13-12
  • Michael DeTure, Dennis W. Dickson (2019). The neuropathological diagnosis of Alzheimer’s disease. Volume(14). Molecular Neurodegeneration. https://doi.org/10.1186/s13024-019-0333-5
  • Mitchell S.V. Elkind, Robert A. Harrington, Ivor J. Benjamin (2020). The Role of the American Heart Association in the Global COVID-19 Pandemic. Volume(141). Circulation. https://doi.org/10.1161/circulationaha.120.046749
  • George W. Sledge, Masakazu Toi, Patrick Neven, Joohyuk Sohn, Kenichi Inoue, Xavier Pivot, Olga Burdaeva, Meena Okera, Norikazu Masuda, Peter A. Kaufman, Han Koh, Eva‐Maria Grischke, Pierfranco Conté, Yi Lu, Susana Barriga, Karla Hurt, Martin Frenzel, Stephen Johnston, Antonio Llombart‐Cussac (2019). The Effect of Abemaciclib Plus Fulvestrant on Overall Survival in Hormone Receptor–Positive, ERBB2-Negative Breast Cancer That Progressed on Endocrine Therapy—MONARCH 2. Volume(6), 116-116. JAMA Oncology. https://doi.org/10.1001/jamaoncol.2019.4782
  • Chen Chen, Guiju Gao, Yanli Xu, Lin Pu, Li Wang, Liming Wang, Wenling Wang, Yangzi Song, Meiling Chen, Linghang Wang, Fengting Yu, Siyuan Yang, Yunxia Tang, Li Zhao, Huijuan Wang, Yajie Wang, Hui Zeng, Fujie Zhang (2020). SARS-CoV-2–Positive Sputum and Feces After Conversion of Pharyngeal Samples in Patients With COVID-19. Volume(172), 832-834. Annals of Internal Medicine. https://doi.org/10.7326/m20-0991
  • Thomas Unger, Claudio Borghi, Fadi J. Charchar, Nadia Khan, Neil R Poulter, Dorairaj Prabhakaran, Agustín J. Ramiréz, Markus P. Schlaich, George S. Stergiou, Maciej Tomaszewski, Richard D. Wainford, Bryan Williams, Aletta E. Schutte (2020). 2020 International Society of Hypertension global hypertension practice guidelines. Volume(38), 982-1004. Journal of Hypertension. https://doi.org/10.1097/hjh.0000000000002453

Suicide and Crisis of Lethality

Posted on by Mark Moran

Crisis Intervention specialists deal with an array of issues.  Usually issues of self harm, harm of others and suicide are a very common theme.  In crisis, logical thinking and hope are erased and the person can sometimes do things out of character that are very lethal in nature.  Understanding suicide, suicide assessment, prevention and intervention are key components of helping individuals in crisis not make a permanent and fateful decision.

Suicide is rarely a conscious choice but one with emotional and mental implications that remove one from a state logical thinking

It is critical for crisis counselors, grief counselors, pastoral care givers and ministry, licensed mental health professionals, as well as those in healthcare to have a strong training and educational background in suicide and crises of lethality.  AIHCP offers certifications in Grief Counseling but also in Crisis Intervention to help train members in those fields with the additional knowledge and abilities to handle crisis of lethality.

Suicide

While in the past, AIHCP has offered blogs, as well as video content on the nature of suicide, this particular blog will focus on the crisis element of it.  It will identify suicidal signs, assessments, but also focus on intervention in particular.

James points out that a person in suicidal crisis is engaged in an expressive act of homicide where emotional state looks to reduce psychological pain (2017, p. 203).  According to statistics, James point out that 600, 000 to 100, 000 suicides are attempted each year in the United States and 30, 000 to 60, 000 die each year in those attempts, with 19, 000 permanently injured (2017, p. 204).  While different groups within the US  have different rates of suicide as compared to others, the leading group is older white males.

Theories surrounding suicide share many common features but also have different emphasis on certain reasons why one attempts to kill oneself.  Freud’s psychodynamic theories saw suicide as a reaction of some inner conflict with external stressors (James, 2017, p. 206).  Erickson saw reasons for suicide correlated with developmental issues that prevented the person from advancing and reaching certain goals in life.  Individuals who become stagnant and unable to develop sometimes choose suicide as an option to escape (James, 2017, p. 206).   Escapist theory views suicide as the only way out of a bad situation during fight or flight.  Within this theory, individuals feel they fell short, blame themselves, focus on narrow deficits only, and only see a view of perfectionism that if not met can only end in suicide due to the hopelessness perceived (James, 2017, p. 206).   Hopelessness remains a common theme in all situations where the person feels they have no power over the situation.

Another important theory was developed by Edwin Shneidman, the founder of suicidology.   In understanding suicide he measured one’s psycheache or pain in the mind, one’s perturbation or the degree of the pain, and the press or stress due to external factors (James, 2017, p. 206),   With the combination of these things, Shneidman saw how psycheache frustrates  or blocks psychological needs leading to hopelessness and suicide and reaching the state of critical mass to activate suicide.

Durkeim in the 19th Century proposed the sociological theory which looks at a person’s connections to society and how social norms and society based on a person’s integration with those norms plays a large role.  Egoistical suicide refers to one’s lack integration with any group.  Anomic suicide refers to when economic and financial systems of society break down all around the person.  Altruistic suicide refers when a person commits suicide for cultural reasons or the perceived better good according to the society.  Fatalistic suicide refers to if a person is an intolerable or unescapable situation such a concentration camp (James, 2017, p. 207).  According to Van Orden interpersonal states are also key in the mind of those contemplating suicide.  Suicidal individuals may acquire capability by decreasing innate fear of pain and death gradually.  In their personal views, they perceive themselves as burdensome to others as well as failing to belong to anyone or find attachment to anything (James, 2017. p. 207).   Existentialism and meaning also play an important role in suicide theory.  Ideas on death, existential isolation, meaning and meaningless in making sense of the world and the freedom of existentialist thought to make choices all play a role in the construction of existentialist thought.    When challenges to existence and death are overwhelmed and an existentialist anchor is lost, then many individuals can fall into hopelessness without any reason to exist (James, 2017, p. 208).

Another interesting theory follows a basic suicide trajectory model based on various risk factors that correlate with suicide.  This includes, biological, substance abuse history, genetic predispositions, gender, self esteem, psychological maladies, cognitive thinking and environmental stressors (James, 2017, p. 207).    Psychology also points to imbalances within the brain, neurochemical reactions that do not allow a person to better respond to a situation (James, 2017, 208).

From these theories and multiple other ones, one has a better understanding that suicide is rarely a free choice but is committed in a state of emotional turmoil without true cognitive reasoning.  This is why so many religious views on suicide as a choice or sin have been replaced with a better recognition that most if not all are victims of it.

Characteristics of Suicidal Individuals

For the most part, those thinking of suicide exist in an acute state of crisis or a chronic state of depression that leads to certain characteristics that manifest emotionally, socially, mentally and physically.

Many suicidal individuals suffer from depression or hopelessness. Please also review AIHCP’s Crisis Intervention Certification

Situationally, individuals face an endurable pain they cannot overcome.  A stressor frustrates the psychological need (James, 2017, p. 209).  Hence situations involving trauma, death, loss, finances, relationship or anything that creates a perceived unbearable loss appears.  Motivation wise, individuals look to seek a solution and that solution entails to remove the stressor via cessation of consciousness.  Accompanied with this are the affective emotions of hopelessness and helplessness.  Cognitively, individuals see solutions in a very narrow scope with out any alternatives to think their way out of the situation.  Relationally, an individual wishes to communicate intent and find mutual justification in it and acknowledgement of that right to do so.  Serially, characteristics reveal a long history of trying everything else but no other option remains (James, 2017,p. 209).

Within these characteristics of the suicidal mind, it important to dismiss certain myths that distort.  First, one needs to dismiss fears of discussing suicide as if it will cause it.  In fact, discussing suicide and being very upfront is key.  Second, one needs to dismiss the notion that those who say they will commit suicide rarely carry through with it.  In fact, many who say they are contemplating are very high risk of attempting it.  To the individual suicide is perceived as a very rational act.  Third, individuals who commit suicide are insane.  Most who commit or attempt suicide are only acutely affected with emotional issues.  Fourth, suicide is only impulsive.  In fact, most suicides are planned and plotted outside acute crisis.  Fifth, suicide is painless.  Many suicides can be very gruesome and some go awry and very wrong.  Sixth, suicidal thoughts are rare.  In fact, they are more common than one may think with 8.3 million have some type of suicidal ideation (James, 2017. p. 212).

Suicide Assessment is Key

Assessment is critical in saving a life.  While some crisis specialists deal with suicidal individuals in an acute and heated moment, many suicides are well planned and plotted.  Counselors need to be aware of the possibility and assess the lethality

James points out that there are a variety of verbal clues, statements and written letters.  As well as behavioral clues such as self harm or isolation.  Also situational clues that involve death of another person, financial woes, loss job, or divorce should be acknowledged.  In addition, syndromatic clues such as depression, hopelessness and unhappiness with life can play key indicators in possible suicidal.  This is why it is so important to also ask someone in assessment (2017, p. 212).

Another tool to utilize is PATHWARM.  This  is an acronym from the American Association of Suicidology.  It utilizes the letter within the acronym to better identify various warning signs.  Within the acronym is: Ideation, Substance Abuse, Purposefulness, Anxiety, Trapped, Hopelessness, Withdraw, Anger, Recklessness and Mood.

There are many, many assessment keys, questions, or triages one can utilize.  We will briefly go over a select few.

First, the basic clinical interview is essential in determining suicidal ideation.  Within it is a long laundry list of observations and questions.  Here are a few: Does the person exhibit suicidal intent or tendencies?  Does the person have a family history of suicide?  Does the person have past suicide attempts? Does the person have a specific plan?  Has the person experienced a death recently? Does the person have a history of drugs and substance abuse? Does the person display radical changes in mood and behavior?  Does the person display hopelessness?  Has the person experienced past trauma?  Has the person discontinued medication?  Does the person exhibit extreme emotions?  Has the person faced financial troubles or loss of job?  Does the person feel threatened?  Does the person see everything as all or nothing?  Does the person feel as if he or she does not belong? Does the person struggle with identity and self esteem?  Does the person have access to firearms?  Has the person explored suicide through online search or literature?  Has the person not seen a medical professional within the last 3 to 6 months? (James, 2017, p. 215).

SIMPLE STEPS is another acronym that can utilized in assessment during interview. Again it emphasizes the importance of asking the question are you thinking of killing oneself?  Within the acronym are the following points.  Suicidal? Ideation? Method? Pain? Loss? Earlier attempts? Substance abuse? Troubleshooting for alternatives? Emotions? Parental history? Stressors? (James, 2017, p. 216-17).  This triage captures the basic essence again of all assessment in that it asks the difficult question and looks to identify potential lethality and danger of a plan.  Not all cases may present an immediate acute threat while others may require immediate intervention and reference to medical professionals or notification of authorities and family.

Suicide Intervention

In intervention, whether in acute setting or discussing possible plans of a person to commit suicide, professionals need to not judge the person, or demean the person’s perceived tragic nature of life.  Instead, crisis professionals are encouraged to gain an understanding, form a bond and offer alternative options.

The Three “I”s are essential to know if looking to defuse suicidal situations.  The person feels the situation is inescapable, intolerable and interminable (James, 2017,p. 218).  Hence it is important to help the person feel secure, less painful, and offer hope with solid solutions.   When a person is facing crisis, they may feel there is no other way out and may need alternatives presented and applied to the situation.  In addition, the crisis counselor may try to help the person reframe the situation with attributes of CBT to see the situation from a different light.  The crisis counselor must also help the individual face the pain and discover that is not forever.  Helping focus on not so much the lethality but the perturbation of the person can help the person see more clearly, utilize problem solving abilities, and offer alternatives to the current issue.  Addressing stressors and helping the person see hope is the biggest key.  At this core, Crisis Management looks to help the person plan a response to suicidal issues (James, 2017, p. 222).

Those in suicidal ideation need alternatives and options. They need to know the there is escape and an end to the pain that involves not ceasing consciousness

In counseling, professionals should help clients reframe.  This involves not only a new line of thinking but also validating emotions and discussing future suicidal behaviors and how to counter them.  It is important to help the person learn real problem solving skills for issues but also address teaching individuals how to cope with pain and emotions in better ways.  In addition, counselors can help clients find better social connections to prevent isolation as well as play an important role in life coaching with positive thoughts, plans and goals.  Importantly as well, a counselor should obtain from the person a no harm commitment through a suicide “Do not Harm Contract” or “Stay Alive” contract which the individual signs.  It is important to let the person know he or she is not alone and can reach out or call when certain triggers may appear that seem unbearable (James, 2017, p. 227)>  In some cases, calls to the authorities may be needed, or a person may need observed for a period of time before the crisis has subsided.

Conclusion

Suicide is not simply a call for help but a true crisis situation that demands attention.  Through warning signs, assessment and proper intervention, crisis counselors can save lives.  It is also important to note that suicide is not something rationally chosen but one that is mentally and emotionally chosen when in a illogical state of mind.  Hence negative social stigmas need removed and professionals as well as society need to see these individuals who attempt or complete suicide as victims.  This is why it is so important to be educated on the subject and listening and observing with empathy for those who shows signs of suicidal ideation.

Please also review AIHCP’s Crisis Intervention Program and see if it meets your academic and professional goals.  The program is online and independent study and open to qualified professionals seeking a four year certification.  Counselors, first responders, clergy and other mental health professionals can play a key role crisis intervention and saving lives from suicide.

 

Resources

James, R & Gilliland, B. (2017). “Crisis Intervention Strategies”. (8th). Cengage

Additional Resources

Clay, R. (2022). “How to assess and intervene with patients at risk of suicide”. APA. Access here

Are you thinking about suicide? How to stay safe and find treatment. Mayo Clinic.  Access here

Ryan, E. & Oquendo, M. (2020). “Suicide Risk Assessment and Prevention: Challenges and Opportunities”. Psychiatry Online. Access here

Suicide and suicidal thoughts. Mayo Clinic.  Access here

Suicide Prevention Tools for Public Health Professionals. CDC.  Access here

988 Life Line  Access here

 

 

 

 

 

Crisis Counseling Vs Traditional Counseling Settings

Posted on by Mark Moran

Obviously crisis counseling is sometimes on the scene of the event.  It is emotional first aid that attempts to restore equilibrium and mobility to the person.  It is short term in its plan and it briefs the individual and carries through necessary tasks to help the person return to pre-crisis state.  It also looks to help the person find orientation and resources to help avoid future crisis and find resolution to what caused the crisis reaction.

Crisis specialists who arrive on scene have an entirely different approach to counseling than long term counselors in mental health

In this blog, we will look at crisis counseling in settings where intake occurs and how counselors work to help individuals leave the state of crisis.  In these cases, the individual is brought in by the police, or rescue and the person requires mental care until able to be released.  These types of counseling sessions differ greatly from traditional counseling settings.  They still are not long term but they do look to alleviate crisis as much as any work on the scene itself.  In addition to reviewing these types of crisis counseling settings, we will look at the efforts to better concert the police with mental health professionals in ensuring mutual safety of first responders and those in crisis.

Please also review AIHCP’s Crisis Intervention Specialist Program, as well as its Substance Abuse Specialist Program for qualified professionals in Human Services and first response.

Crisis Counseling in Facilities

Many mental health community centers are equipped to handle walk-ins, police escorted individuals in crisis, family admitted or social service recommended cases (James, 2017, p. 100).  Like the crisis specialist in the field and on the scene, these professionals provide the same type of de-escalation model to help the person find equilibrium and mobility.  They can also keep the person a few days if necessary and later coordinate with case managers to ensure the person receives continued observation, medication, or future counseling.  Some facilities are 24 hour facilities, while others have emergency call centers beyond the regular hours (James, 2017, p. 102).

Upon entry into a facility, a person is assessed across the range of the triage scale to determine if someone is mildly or severely impaired.  For more severe cases, a senior technician is called upon to help the person.  Crisis specialists will also try to receive a case history of the person to better determine the onset of crisis.  If mental pathology is present, a psychiatrist may be called to better meet the needs of the person (James, 2017, p. 100).   James also references that those who face more severe mental fragmentation will be committed until safe to self and others (2017, p. 100).

The initial intake interview is a key process where questions and basic crisis intervention tasks can be completed.  If the person is appraised negatively with a high level of lethality as well as drug use, then the person will need to stay longer.  The clinician or team following the intake interview, prepares a disposition that describes the case as well as suggestions for treatment.  In some cases, the facility will supply the person with a psychological anchor.  This refers to a professional who will serve as their case worker, advocate or contact person (James, 2017, p. 101).  In some cases, the individual will need short term disposition which meets the immediate physical needs of food, water or shelter.  The Department of Family Services plays a big role with social workers to ensure the proper government entities meet the needs of the person.  However, sometimes, long term disposition occur where the person needs long term care plan which includes counseling abd  medication to help the person deal with future issues and crisis (James, 2017, p. 101).

Crisis and Short Term Vs Counseling and Long Term Cases

Since crisis is about mental and emotional first aid that looks to stop emotional bleeding, its goals and procedures to reach those goals differ greatly from long term counseling and cases.  James lists numerous differences between these two types of mental health models.  In regards to the initial tasks themselves, there is a large difference.  Crisis counseling looks to ensure client safety and assess lethality initially, while long term looks to prevent future problems.  Where crisis counselors look in the first task to form a bond with the person in crisis, long term counselors look to correct issues with sound and tested evidence based treatments.  Where crisis counselors help the person define the immediate problem, long term counselors help provide systematic support for that problem.  Where crisis counselors provides support to help calm the person in crisis, long term counselors help facilitate growth in the healing process.  Where crisis counselors look to help those in crisis see alternate options and develop a plan, long term counselors look to re-educate and help clients express and clarify emotions.  Where crisis counselors resolve with commitment to plan and follow up, long term care counselor continue treatment with resolving issues, accepting realities, reorganizing attitudes and working on maximizing intellectual resources to deal with issues (2017, p. 98).

Those admitted into crisis centers are facing affective, behavioral and cognitive issues that are preventing proper emotional balance and coping. These facilities face different types of intake individuals who face acute crisis

Crisis intervention specialists utilize diagnosis via the triage method looking at the affective, behavioral and cognitive issues on the spot and face to face, while long term counselors work with a detailed case history as well as observation throughout a period of time with most patients not experiencing a state of acute crisis.  Where crisis specialists treat acute trauma and help to stabilize, long term counselors look at the underlying causes for issues over an extended period of time.  Where a crisis specialist’s plan is to meet the immediate physical and emotional needs to stabilize a person, a long term counselor’s plan is a comprehensive effort that covers time and numerous personal and social environments that looks to help alleviate a non acute issue. (James, 2017, p. 98). Hence crisis intervention specialists deal with individuals who are affectively in an impaired state, cognitively unable to think logically and behaviorally out of control and pose a threat to themselves and others, while a long term counselor deals with individuals not in impairment emotionally and is able to think and socially behave (James, 2017, p. 99). This means that crisis professionals whether on the scene, or in a facility helping a person in crisis are working at a mental emergency level where decisions and observations must be quicker and plans may need be adjusted quickly due to safety issues (James, 2017, p. 99)

Types of Issues with Crisis

Obviously dealing with those in crisis requires quick thinking and assessment but it also entails dealing with individuals who are a lethal threat to self and others, as well as many times on multiple types of drugs.  Crisis professionals deal with chronic mental illness, acute interpersonal problems due to relationships and other social factors, and combinations of both (James, 2017, p. 97).  While long term care counselors deal with these type of issues, usually the person is not actually intoxicated, or in a state of mania, or suicidal with gun in hand during a session.  Many crisis counselors deal with an array of acute issues that include those who are constantly in a transcrisis state that can be activated at any moment.  Those facing multiple stressors or anxiety or depression can easily fall into a state of acute crisis in these cases.  In addition to transcrisis, many individuals in chronic crisis will face regression and fall back into old issues that led to crisis.  Others may face issues with possible termination of future sessions with counselor since the counselor has become an anchor (James, 2017, p. 108).  In addition to dealing with those in transcrisis, many counselors deal with individuals with addiction issues and psychotic breaks with reality.  One common type of malady that corresponds with crisis in Borderline Personality Disorder.  This disorder prevents the person from past trauma to achieve stable moods from hour to hour, day to day or month to month.  They can erupt into anger or sadness over minor things they perceive as slights.  Many are also impulsive, self destructive, confused with goals, unable to maintain self esteem, possess suicidal ideation, and have destructive choices in relationships (James, 2017, p. 111). Obviously this type of disorder is a chaotic recipe for crisis calls for the police and later mental health intervention.

These types of issues can lead to big problems with counselors and those in crisis as well as those who offer long term counseling.  It can lead an array of issues where the client is suicidal, deals with abuse, or problems with finances or the law, as well as one who frequently misinterprets a therapist’s statements, reacts strongly to advice, fears resistance and follow through of treatments, as well as transgressing professional boundaries with calls and insults (James, 2017, p. 111).   James points out that when dealing with individuals in chronic crisis or facing other mental maladies, one needs to set ground rules that apply for everyone.  Sessions need to start and end on time. Sessions need to be void of threats.  Everyone speaks for oneself and is fully heard.  Everyone faces all issues discussed and does not have the option to abruptly leave.  The session will not include gaslighting or avoiding the subject.  No one is to arrive drunk or intoxicated.  The crisis counselor or counselor will not take sides.  Time will be respected outside the office and the needs of other clients will not be dismissed for another’s immediate demands (James, 2017, p. 114).  Obviously dealing with those that face multiple issues and chronic crisis is a heavy task.  It involves professionalism, boundaries and sometimes a place to vent for the counselor afterwards.

Crisis Facilities and Law Enforcement

Since the closing of mental asylums in 1963, law enforcement and prisons have picked up the slack of dealing with those in mental crisis.  This has led to many unfortunate incidents of police shootings, or police brutality cases.  While most police officers and law enforcement are good people, the job of dealing with those in mental crisis is exhausting and can trigger a sane individual into actions not normal for fear of safety of self or frustration.  Most police historically have dealt with criminals in the true sense.  Upon apprehending of a thief, the thief understands to drop the weapon or the stop.  Unfortunately in heated situations of mental crisis, people sometimes cannot emotionally understand or comprehend orders.  Due to equilibrium and immobility of a person in crisis, an officer has to show constraint and avoid authoritative and aggressive commands or he/she may escalate the situation.   Some officers are not able to handle this type of mental health interaction but modern policing requires it.  As more and more unfortunate death by cop whether intentional or intentional occurs, the more police need trained in crisis intervention and de-escalation.  Police officers who cannot handle this adjustment either need to find a new profession or soon risk the chance of ending up in prison, sued, or fired themselves.

Police are responding more and more to crisis calls than merely criminal calls. They need to be trained in how to help individuals face crisis to avoid future fatalities

James mentioned the change in policing from instrumental crimes to more expressive crimes where officers are required to adjust their approach in dealing with the person in crisis (2017, p. 102).  James illustrated one of the first joint task teams of law enforcement and mental health and crisis centers with the Memphis Police Department in 1987 (James, 2017. p. 103).   The Crisis Intervention Team or CIT was designed to train police when dealing with those in crisis as well as to coordinate with mental facilities instead of prisons.  James pointed out that the model was not just about training police but also to help create better coordination with the mental health community and consumer advocates promoting mental health awareness (2017, p. 104).  James pointed out that the program covered 40 hours of CIT training that covered cultural awareness of mental illness, substance abuse, developmental disabilities, treatment strategies and mental health resources, patient and legal rights in crisis intervention, suicide intervention, use of mobile crisis teams, education on psychotic meditations and effects, verbal defusing and de-escalating techniques and education on borderline personality disorder and other mental issues (2017, P. 105).

According to James, the program has been a success and a model for other law enforcement agencies in other communities and cities.  Within its first 16 months of operation in 1987 to 1988, Memphis CIT trained officers responded to 5, 831 mental disturbance calls, transported 3, 424 cases to proper mental health facilities without patient fatality (2017, p. 106).   In the 20 and more years since, more calls are received to the hotline differentiating crime and mental crisis and there has been a reduction in the use of force and more individuals being sent to mental facilities instead of jail (James, 2017, p. 106).

This is an important issue and the success shows that modern policing can meet the needs of mental crisis.  Some departments also receive additional aid from social workers, chaplains and other crisis professionals on calls related to mental disturbance.  This does not mean that danger and risk exists both for the person in crisis as well as the first responders but it does reduce the chance for unnecessary and tragic fatality.  This should be an issue every person cares about because anyone can become a victim of crisis and police when called need to be able to de-escalate and not escalate.

Conclusion

Crisis intervention care is not for the faint of heart.  It requires quick thinking and decisions which need to be adjusted on the fly as danger and possible death loom with every call.  Crisis cases whether on scene or in a facility deal with acute crisis.  Individuals are facing dis equilibrium and immobility.  They are affected emotionally, behaviorally and cognitively.  This leads to a different type of response than long term care.  Crisis counselors understand the different nature of their calling and profession. In addition, mental health facilities, the public, and police are all beginning to incorporate better crisis response to negate police brutality or illegal shootings of those in crisis.  This involves understanding that modern policing is more about arresting bad guys but also helping sick people find balance and the proper treatment.

Please also review AIHCP’s Crisis Intervention and Substance Abuse Specialist Programs

Please also review AIHCP’s Crisis Intervention Specialist Certification as well as its Substance Abuse Specialist Certification.  Both programs are online and independent study with mentorship as needed.  The program is open to qualified professionals in law enforcement, healthcare, mental health, human services and chaplaincy.

 

 

 

 

 

 

 

 

Source

James, R. & Gilliland, B. (2017). “Crisis intervention Strategies” (8th).  Cengage

Additional Resources

Crisis Centers by State and U.S. Territory.  Access here

Crisis Text Line. Access here

If You or Someone You Know is in Crisis and Needs Immediate Help.  National Institute of Mental Health.  Access here

National Hotline for Mental Health Crises and Suicide Prevention.  NAMI.  Access here

988 Suicide & Crisis Lifeline. Mental Health America.  Access here

Tich, B. (2023). “What Works in De-Escalation Training”. National Institute of Justice. Access here

Zeller, S. & Kircher, E.  (2020).  “Understanding Crisis Services: What They Are and When to Access Them”. Psychiatric Times.  Access here

 

 

 

 

 

Crisis Intervention and Assessment of Those in Crisis

Posted on by Mark Moran

Those in crisis require different kinds of counseling than those in short and long term care counseling.  Those in crisis have emotional and mental wounds that are intensely bleeding from within leading to sometimes lethal and dangerous decision making.  Individuals feel lost and without purpose with no light at the end of the tunnel.  Hence those in crisis lose cognitive and mental capabilities to make safe and logical decisions.  This requires on site mental first aid and de-escalation.  Those in EMT, police, FEMA, as well as chaplains and social workers who work with law enforcement approach those in crisis as mental first responders.  One does not know what to expect and the job can definitely be dangerous due to the unexpected behavior of those in crisis.  Individuals trained in crisis hence provide emotional and mental first aid and look to stabilize individuals from a mental and emotional way.  This blog will look at the basic steps of Crisis Intervention and the role of assessing individuals in crisis.

Crisis Intervention professionals assess and implement plans to stabilize the person in crisis

Please also review AIHCP’s Crisis Intervention Specialist Certification and see if it meets your academic and professional goals

Hybrid Model of Crisis Intervention and Steps

Various models of Crisis Intervention look to examine the best psychological way to understand the state of crisis and how to help an individual reach pre-crisis state.  Crisis professionals all agree that those in crisis experience disequilibrium  as opposed to equilibrium and immobility as opposed to mobility (James, 2017, p. 48).  Disequilibrium refers to lack of emotional stability, balance or poise within an individual (James, 2017, p.48) and immobility refers to the state of a being that is unable to autonomously change or cope or respond to different moods, feelings needs, conditions that require adaptation (James, 2017. p. 48).  Hence it is the duty and vocation of the crisis professional to help individuals again find balance and ability to cope with the crisis inducing situation.  The crisis professional is not again present to help resolve the issues causing the crisis itself but only present to help the person again find ability to cope with the situation in the heat of the moment.  The crisis professional can then guide the person to appropriate resources and support to face the problems that created the conditions for crisis to occur.  This involves various steps and procedures to help a person in crisis stabilize and find balance again.  However, James warns that those in crisis are ones to follow steps but in reality are far more chaotic.  With this in mind, these steps serve as a checklist or guidebook that can be adapted, or repeated, or reused as necessary within the process until the person again finds state of mind.

The Hybrid Model serves as a way for crisis professionals to help de-escalate the situation and help a person find pre-crisis state through seven steps.  The first step is predispositioning/engaging and initiating contact (James, 2017, p. 50).  This essential task sets the table and emotional response between anyone in crisis, whether one is facing little impairment or facing extreme emotional impairment.  This step involves the crisis professional introducing him/herself and attempting to form some type of bond or understanding.   When a person is in intense crisis, approach is key.  An aggressive approach can turn the person to self harm or harm of others or also increase agitation within the mind.  Trained police officers who approach someone in a mental breakdown who approach with more calmness and articulation are far better able to de-escalate as opposed to officers who approach as angry, aggressive or authoritarian.  Many times, police escalate the situation of a person in crisis by challenging, commanding, or threatening.  A person in crisis will not respond logically or calmly to these types of approaches.  The best way is to introduce oneself calmly without threatening (James, 2017, p. 50).  Within this initiation of contact, police or crisis professionals should attempt to learn the name of the person and also clarify one’s intentions in what the person in crisis should expect to happen next.  Calm, clear and precise articulation can help break the ice and begin the process of de-escalation as opposed to making the situation worst.

The second task involves exploring the problem.  This involves understanding the problem from the current context of the individual in crisis (James, 2017, p. 51).  Key to helping and understanding requires core listening skills that encompass empathy and genuineness (James, 2017, p. 51).  In this way,  the crisis specialist examines the situation as a detective.  H/she not only assesses the person (which we will review in the second part of the blog), but he/she also looks for clues about the current problem and addresses the person’s issue as how he/she is experiencing it.  If a person is experiencing a breakdown, the crisis professional will discuss why the person is upset and reinforce understanding of why the situation is bad but also why it can be fixed.  In addition to the person, the crisis professional will also see all the other issues surrounding the current issue, such as interpersonal issues, or other environmental issues and understanding how they fuel the current crisis.

The third task involves providing support.  The crisis specialist, police or chaplain on the scene can provide support via continued empathetic dialogue.  This includes letting the person know he/she is not alone and that the crisis specialist is a person who cares about he or she and that the crisis professional is present to help the person receive the support necessary (James, 2017, p. 52).  This type of reassurance can help a person find some stability.  Many individuals facing natural disasters will need those simply initial words of support to help them find some peace and calm after being completely overwhelmed.  The crisis professional can supply psychological support, logistical support which leads the person to basic survival needs, such as food or water or shelter, social support which includes activating and discovering family, friends, coworkers or church, and information support which can include resources the person can access to find help (James, 2017, p. 53).   Sometimes a person in crisis will need to be reassured that there is support before he/she will accept help from someone or leave a potentially dangerous situation.  A crisis professional can help alleviate the hopelessness by asking and promising the help one needs.  Of course, safety is a huge concern during these discussions.  When weapons or erratic behavior exist, crisis specialists are at risk.  Whether its a violent person in the street, a person threatening to shoot oneself with a gun in hand, the crisis specialist needs to assess, utilize the proper safety guidelines and also the backup present when hoping to diffuse and talk to individuals in a state of crisis.

The fourth task involves helping the person find alternatives to the current mode of thinking (James, 2017, p. 54).  Sometimes rational ideas or different ways of viewing a crisis can help a person find some logic or some hope in finding pre-crisis state.  This involves asking about situational supports the client has had in the past involving family or friends who can help, as well as offering coping mechanisms that include actions, behaviors or resources that can help the client in the temporary crisis.   In addition, offering positive reframing of the current and temporary situation can help the client or person in crisis think more clearly.  A crisis professional can offer a variety of solutions or alternative to the one in crisis to view the situation differently (James, 2017, p. 54).   This ultimately involves a serious examination of the person’s realistic options within the current crisis situation.

Crisis Intervention counselors and specialists on scene look to help the person find emotional balance and mobility to cope with the short term problem through a series of tasks

The fifth task is to create a plan.  Usually these plans are short goal but they offer order in the chaos for the person in crisis.  The crisis professional offers certain ways of proceeding forward and meeting immediate and short term needs of the person.  This type of grounding helps the person find some anchor in the chaos and that there are plans available to escape the crisis.  This is important for individuals who may have lost a home to hurricane or a person who lost his or her job, or a person who is going through a divorce and lost his or her children. The crisis professional helps the person find order and some control (James, 2017. p. 55).  The person should feel part of the plan and have autonomy within it.

The sixth and seventh tasks involve obtaining commitment on part of the person to follow through on the plan and then following up with the client within a few hours, or even days to ensure the person is still on the right path (James, 2017, p. 55-57).  Commitment shows the person understands and comprehends the plan and also gives the person a sense of empowerment.  Follow up is key to ensure the person still understands the plan and is meeting with the necessary agencies or persons to permit the plan to blossom.   This also shows that the crisis professional cares and wants the person to be able to find permanent success following a crisis.  This is important for anyone who lost a job or home and needs to contact certain groups, as well as those who were suicidal are committing to the plan of getting the help they need.

A similar model is referred to as the Robert Model.  This involves assessment of the situation and person regarding lethality.  Following assessment, involves rapport with the individual as found in the Hybrid model.  Following rapport, identifying the problem and crisis and then exploring the emotions is addressed.  Alternative options and plans are then addressed with follow up.  As one can see, most models share a similar 7 step procedure that involves assessments, making contact, understanding the situation and giving options to de-escalate and help the person return to precrisis state with followup.

Interaction with Those in Crisis

Within the first task of initiating contact, it is crucial to establish trust and a bond with those experiencing crisis.  Whether a person is brought to a mental health facility in a state of crisis, or arriving upon a scene, basic interaction with communication and listening skills are important.  As they are in any counseling, particular ways crisis counselors speak and listen can play a big role in de-escalating a situation.  Open ended questions are important that request descriptions of the situation such as “Please tell me” or “Show me” can help a person open up and communicate the crisis.  In addition open ended questions that focus on plans of the person such as “What will you do?” can help make the person in crisis think.  Expansion questions can help broaden the story by simply stating, “Tell me more” or questions that look to assess the situation.  For most cases, “why” questions should be avoided since they provide opening for illogical defense.  While it may attempt to allow one to understand, it also allows the person to intellectualize and defend why one is doing something that one should not do (James, 2017, p. 74).  Close ended questions are used for more focus and quicker responses.  They can obtain specifics, obtain commitments, and help focus on the issue at hand. Crisis counselors can also apply basic counseling skills that involve restatements of what the person feels as well as summaries of how the person is acting.  Sometimes, restating and summarizing can allow a person in crisis to see the insanity of his/her state of mind.

In crisis, crisis professionals many time utilize owning or owning of feelings (James, 2017, p. 75).    Utilizing “It” statements in what is to be done, or how one feels can help the conversation become more intimate and less confrontational as “we”.  The person in crisis has only the professional to discuss, when “I” is utilized.  Such as examples of ” I understand” . It is important not to falsely understand when one does not. In these cases, one should ask for clarification.  Assertion statements are also useful when telling the individual what you expect and how you want someone to do something for one’s own safety.  In these statements, specific actions are asked in the particular moment with “I” statements.  In addition, it is important to offer positive reinforcement when applicable while working a person through crisis.  Compliment the person who is able to breathe smoothly or who is starting to show control of emotions (James, 2017, p. 77).

In addition to various statements that can help create bonds and trust, as well as de-escalation, counselors need to listen with empathy and genuineness (James, 2017, p. 78).  This involves empathetic listening for clues and acknowledging what the person is saying, but also understanding it while helping to guide the person to better options.  It is not patronizing but serious listening and response to what is being related by the person in crisis.  If the person in crisis understands that the counselor is acknowledging fears and taking what the person feels as serious, then respect can exist and the person in crisis will be more listening to reason and statements from the counselor.  Through this, sometimes, a counselor can help create awareness of the situation during reflection of what the person in crisis is stating.  Sometimes, restating the problem via good listening and offering a clear awareness of the difficult situation can be a great aid for the person.  Sometimes, it is also important to allow the person in crisis to talk.  One needs to allow sometimes for the person to talk, express, swear, curse, rant or mourn before reason can be restored (James, 2017, p. 80). In crisis intervention counseling this is referred to as catharsis.  Ultimately, listening and communicating involves empathy with the client in crisis.  It involves proper attending, verbal communication, reflecting feelings, and utilizing nonverbal cues and silence as a way to show empathy (James, 2017, p. 82).

Throughout the tasks, especially when discussing emotions, alternatives and plans, the crisis specialist needs to also promote expansion of the client’s tunnel vision of the temporary moment and open possibilities.  This helps the client see the overall picture (James, 2017, p. 81).   Sometimes during these phases and tasks, crisis counselors can also help individuals focus on the immediate issue.  Many times individuals in crisis will spiral out of control and discuss multiple stressors that are not present.  The crisis counselor can help partition, decompartmentalize and downsize client’s fears and stressors (James, 2017, p. 81).   In addition, counselors during interaction need to know how to supply guidance and help implement order.  Those in crisis and chaos depending on their level of impairment need direction and guidance.  Finally, crisis counselors need to assure those they are working with that they are safe.  “I” statements that assure safety and meeting of physical needs can help a person in crisis become more secure and open to de-escalation (James, 2017, p. 81).

Again, simplified, the basic ABC’s of Crisis Counseling merely involves achieving a relationship, breaking down the problem and committing to a plan of action.  Identifying what activated the event, understanding the beliefs associated with it and the consequences surrounding it.  This involves helping the person again find mobility and equilibrium throughout that process and utilizing the skills listed above in that process and also understanding the affective, behavioral and cognitive states of the person.

 

Assessment in Crisis Intervention

The tasks in helping a person find balance and mobility again are essential in crisis intervention.  One of the initial observations during the first contact with a person in crisis is assessment of the person.  Crisis Intervention offers a variety of assessment tools and charts to help EMT, police, chaplains and social workers to better able assess a person’s threat to oneself and others.  Most assessment covers affective and emotional states, behavioral states and cognitive states.  It is also important to assess whether a client has been in crisis before or if this is merely an isolated acute situation or if the person is chronic crisis with common re-entry (James, 2017, p. 69).  Chronic, long term and transcrisis can all play roles in the persons limitations on resources and resiliency.

Affective states refer to one’s current mood.  Hence any abnormal or impaired mood can show signs of crisis upon the scene.  A person may seem over emotional  or severely withdrawn.  The behavioral functioning can also be important in assessing.  The crisis professional observes the doing, acting and behavior of the person on scene (James, 2017, p. 58).  Finally the cognitive state of the person in crisis in important in crisis.  The crisis professional reviews the thinking patterns and thoughts of the person in crisis.

These three observations detail the ABC model of affective, behavioral and cognitive states (James, 2017, p.58).   The Triage Assessment system and chart lists a series of questions that look at affective, behavioral and cognitive issues as well as supplying a chart to access severity of crisis (James, 2017. p. 59-64).  A person’s affective state will include observing if the person is on medication or not, under a substance, experiencing psychosis or paranoid or any other mood related or physical appearances.  A person’s behavioral state is ranked based on if the person is defiant, aggressive, reckless, suicidal, or violent.  From a cognitive state, observations include if a person is uncooperative, impulsive, hysterical, confused or unresponsive (James, 2017, p. 60 & 68).

The Affective, Behavioral, and Cognitive scales help assessment with the worst score totaling 30.   Important labels include  no impairment and minimal to low, moderate, marked and severe.  Stable moods are contrasted moods devoid of feeling, behaviors are rated from socially appropriate to behaviors that intensify crisis, and decisions are ranked from considerate of others to decisions that are clear and present danger to self and others (James, 2017, p. 61-62).  Ratings are based off of a 1 to 10 model of each facet of affective, behavioral and cognitive.   Within affective, one rates anger, fear and sadness.  Within behavioral, one rates approach, avoidance and immobility.  Within cognitive, one ranks current transgression, perceived future threat and past reflection on loss.  In addition, there exists observation questions regarding the person that looks at if the person is on or off medication.  Individuals who rate within 3 to 10 total points within assessment are considered minimal impairment and need little direction and can self direct.   Those with ratings of 11-15 require some guidance and direction.  Those with a score of 16 to 19 are indicative of a person losing more and more control of the situation.   Those with scores at 20 are potentially entering into harms way and need intense direction to avoid a lethal range, while those in the upper 20 scores have entered into a lethal range and lethality is present (James, 2017. p. 66).

Conclusion

Please also review AIHCP’s Crisis Intervention Specialist Program and see if it meets your academic and professional goals

Crisis Intervention is a structured response to pure and utter chaos.  It is mental first aid.  While structured it is adaptable and adjustable.  Those who are experienced and talented utilize the core concepts and adjust and adapt in the moment.  The seven tasks to help a person find balance and mobility are key as well as assessing low impairment and high impairment cases within one’s affective, behavioral and cognitive abilities.  Those in crisis intervention whether in police, EMT, social work, mental health, and chaplaincy require empathy, patience and skill to safely deal with those who are harmful to self and others.

Please also review AIHCP’s Crisis Intervention Specialist Program.  Qualified professionals can earn a four year certification to help them within this field.  Whether working at a crisis center or trained professionals on the scene, the certification can help give academic and core information that can aid others attempting to work in this high stress but high rewarding field.  The program is online and independent study with mentorship as needed

 

 

 

Resources

Bengelsdorf, H., Levy, L. E., Emerson, R. L., & Barile, F. A. (1984). A crisis triage rating scale: Brief dispositional assessment of patients at risk for hospitalization. Journal of Nervous and Mental Disease, 172(7), 424–430. Access here

James, R & Gilliand, B. (2017). “Crisis Intervention and Strategies” (8th). Cengage.

Marschall, A. (2023). “How a Crisis Intervention Provides Mental Health Support”. Very Well Mind. Access here

Myer, R. A., Lewis, J. S., & James, R. K. (2013). The introduction of a task model for crisis intervention. Journal of Mental Health Counseling, 35(2), 95–107.  Access here

Roberts, A. & Ottens, A. (2005). “The Seven-Stage Crisis Intervention Model: A Road Map to Goal Attainment, Problem Solving, and Crisis Resolution”. Brief Treatment and Crisis Intervention. Access here

 

 

 

 

 

A Closer Look at Crisis Intervention

Posted on by Mark Moran

Crisis Intervention is a specialty field that is on the battlefield itself.  It is the first aid of those in initial emotional pain and mental disorientation.  It involves emergency workers, fire, police, paramedics, but also trained professionals in social work, chaplaincy and mental health.  These individuals go to the distressed whether the situation is individual or collective at a local or state level.  They meet the emotionally distressed at their home, whether it is due to violent crime, rape, murder, suicide, or sudden death, or to sites where national disasters such as hurricanes have wiped out a person’s home, or to terrorist or shooting sites where communities are left without meaning.  Crisis Intervention Specialists look to help individuals find sanity in the insanity and help equip them with the necessary immediate physical, mental, emotional and spiritual care needed to access and find direction.  They are not long term specialists for trauma but the first mental health responders to crisis itself.

Those in crisis intervention look to stabilize the person and help them regain emotional balance and the ability to cope when things personal or local disaster strikes

Crisis Intervention stems back the very first Suicide phone line in 1906 and the need for it was escalated with the infamous Coconut Grove Nightclub fire of 1942 (James, 2017, p. 3).   The crisis emergency became more apparent with the Community Mental Health Act of 1963 that closed asylums and referred those with mental issues to local mental health services (James, 2017. p. 3-4).  Unfortunately, without observation, most suffering from mental trauma, addiction, or minor mental health became the problem of law enforcement and many now find themselves in prisons.  The constant and sometimes fatal interactions with mentally unstable individuals with police have led to multiple unfortunate deaths which have called for better mental health accountability by society as well as police training in crisis intervention.  With the awakening of post Vietnam PTSD among veterans, addiction, as well as women rights and abuse, the need for crisis intervention grew even more.  Today it is a must in a society with many mental maladies that lead to acute instance of crisis.

AIHCP offers a four year certification for those interested in a Crisis Intervention Specialist Certification

What is Crisis?

Crisis definition while sharing key qualities is defined by many mental health professionals.  According to James there are a variety of instances that constitute crisis.  People can face crisis when obstacle to life goals seems to insurmountable that it leads to despair and disorganization in life.  People can face crisis when a traumatic event occurs that totally usurps one’s life and life narrative.  People face crisis when a person has no response for the problem or immobilizes them and prevents them from moving forward.  People face crisis when fall into anxiety, fear, shock and distress about a disruption in life.  People face crisis a loss of psychological equilibrium and emotional instability and imbalance result.  People face crisis when they enter into an acute emotional situation arising from external sources that one has temporary inability to cope with or deal with.  People face crisis with extraordinary events of disaster and terror or rapidly building stressors that upset the homeostatic balance of the person’s life creating a vulnerable state (2017, p. 9).

James  also gives a more precise definition accumulating the above ideas of crisis.  He refers to crisis  as the “perception or experiencing of an event or situation as intolerable difficulty that exceeds the person’s current resources and coping mechanisms.  Unless the person obtains relief, the crisis has the potential to cause severe affective, behavioral, cognitive malfunctioning up to the point of instigating injurious or lethal behavior to oneself or others (2017, p. 9)”.

Types of Emergencies

Behavioral emergencies when situations escalate to a point of immediate intervention to avoid death or injury (James, 2017. p. 9).  This can include suicide intervention, homicides , lethal situations, abuse, rape, or any type of violent interpersonal behavior.  It can be direct or indirect. Sometimes these emergencies occur due to accidents without intent of injury but injury or life risk occurs.  In other cases, they can be a product of emotional reaction

Another type of emergency is referred to systemic emergencies that affect organizations, communities or nations.  James defines a systemic emergency as a “when a traumatic event occurs such that people, institutions, communities and ecologies are overwhelmed and response systems are unable to effectively contain and control the event in regard to both physical and psychological reactions to it (2017, p.11)”.  These can include natural disasters such as hurricanes, tsunamis, earthquakes or tornadoes, as well as terrorist actions, or public shootings.  Within all crisis is the possible of it spreading.  The term metastasizing crisis is utilized to explain how crisis can outgrow one person and spread to another or how one local crisis can spread to a larger reason.  Crisis Intervention teams and emergency response units look to contain crisis through primary prevention as well as secondary intervention policies to prevent as well as minimize.

In all of these cases, the presence of danger exists. Things can change quickly and there are no quick fixes  In most of these crises, individuals are faced with choice or no choice.  Many are unable to make a choice without help but choosing to do something shows ability to respond and react.  Whether an individual is negatively effected by a crisis depends on their individual makeup.  Any human being can be victim of a crisis but how one responds depends on interior and exterior characteristics of both the person and the the type of emergency.  Resiliency plays a key role in whether one in crisis events and emergencies will go numb, or emotionally instable and uncapable of response.  Ultimately beyond exterior and interior sources of a person, it is ultimately one’s perception of the crisis that has a stronger influence than the actual event itself (James, 2017, p. 11-12).

 Types of Crisis and Transcrisis States

Within these types of emergencies, there exist numerous types of crisis to the individual.  Individuals can suffer from developmental crisis as a result of change throughout life that produces abnormal responses of crisis.  Such examples can include the birth of a child, college, a midlife crisis, or even aging (James, 2017, p. 18).  In addition to developmental crisis, individuals also face situational crises that are uncommon or extraordinary as to result in inability to respond or cope.  Existential crises are far deeper reaching and reach the core of the person’s belief system.  Finally, ecosystemic crises involve acts of nature, or human causes evils or disasters that affect individuals or communities (James, 2017. p. 18).

Individuals can experience many different types of crises.

While it is the job of the Crisis Intervention Specialist to help individuals again find balance during crisis, sometimes individuals carry baggage of unresolved issues and current stressors can trigger past unresolved trauma.  This is referred to as transcrisis states that can emerge.  These states can also occur due to a variety of mental issues ranging from development and unfilled duties, to repressed trauma,  as well as addiction which can lead one into crisis when faced with other issues.

James  notes however that transcrisis state should not be confused with PTSD which is an identifiable disorder linked to a specific trauma (2017, p. 13). While those with PTSD may be in a transcrisis situation, transcrisis by itself is more vague and due to multiple issues and stressors.  The state is one that is residual and reoccurring and always capable of catching fire with a stressor that overflows the cup of the person’s mental abilities.

Basic Crisis Intervention Theories

Lindermann introduced the first basic concepts of Crisis Intervention with his research from survivors from the Coconut Grove Nightclub fire but he focused more solely on normal grief reactions and adjustments to the loss.  Caplan, later would view the whole of the traumatic event as crisis beyond grief and loss.  Caplan listed the the basic qualities of crisis and adjustment to crisis involving disturbed equilibrium, grief therapy, grief work and restoration of equilibrium (James, 2017, p. 14-15).

Other systems would expand on this basic theory and address certain aspects of psychology of one or more over the other.  This included various systems.  First, psychoanalytic theory applied the idea of expanded crisis theory beyond general systems that surround the person to also include the individual’s subconscious thoughts and past emotional experiences and how they relate to the current crisis (James, 2017, p. 15).   Systems theory instead of looking within the person, emphasized analyzing the interrelationships and interdependence of individuals in crisis or the event and how needs were met within those systems.  Via aid and assistance, one can lessen the crisis to the individual or family (James, 2017, p. 16).  Ecosystems theory places more emphasis on the macrosystem involving the person, family or community and the interrelated  elements and how change to one aspect can lead to disarray for the whole (James, 2017, p. 16).   Adaptational Theory focuses on a persons adaptive or maladaptive coping strategies and how good coping will alleviate the crisis sooner than maladaptive reactions. Hence the focus is on how one copes with the issue in a healthy way (James, 2017, p. 16).  Interpersonal theory focus on internal locus of the person and the ability to reshape and reframe and find optimism.  It is based on empathy and listening as well as the ability to help individuals find confidence that will ultimately defeat the crisis state (James, 2017, p. 17-18).  Finally, Developmental theory analyzes how ones development in life has prepared or not prepared an individual for future crisis (James, 2017, p. 18)

Crisis Intervention Models

The three primary models in crisis intervention are the equilibrium model, the cognitive model and psychosocial transition model.

Different models approach crisis from different angles. Please also review AIHCP’s Crisis Intervention Specialist Certification

The Equilibrium model is based off Caplan and identifies crisis state as an emotional and mental imbalance.  Their abilities to cope and meet the needs of the crisis are overwhelmed and require assistance in finding equilibrium as opposed to disequilibrium.  The goal is to help individuals find balance (James, 2017, p. 19).

The Cognitive model looks to correct faulty thinking in crisis regarding the events surrounding the crisis.   The goal is to help the individual become aware of their faulty thinking, reframe and change their views or beliefs about the situation.  They are very much connected with CBT (James, 2017, p. 19).

The Psychosocial model states that individuals are a product of their genes, social influences and social environment.  When crisis arrives, professionals look to help individuals identify internal behaviors and moods as well external factors which are preventing the individual from utilizing resources or workable alternatives to the crisis at hand (James, 2017, p. 19).

A large part of all models is helping individuals again be able to cope with the problem at hand.  Hence the term Psychological First Aid was coined for crisis intervention (James, 2017, p. 20-21).  Like stopping the bleeding of the wound, crisis intervention specialists, first responders, emergency relief, social workers, and chaplains are trained to help individuals by meeting basic needs so the person can regain pre-crisis state. US Department of Veteran Affairs, among many, list the most important steps in psychological first aid.  Some of these issues also deal with supplying basic safety and security, including shelter and food when necessary as part of basic Maslov needs.  Basic Psychological First Aid includes proper contact and engagement which is non-intrusive and compassionate.  It should include a sense of safety and comfort.  It needs to help stabilize if needed the individual from a mental perspective.  It needs to gather information for the needs of the individual and then giving practical assistance for those needs.  Furthermore, it entails connecting the individual with social supports such as family, friends as well as informing the individual how to cope with stress and help the person continue to function.  Finally, it involves securing for the individual future contacts for aid and help with various services for their particular issue or mental health. (James , 2017, p. 21).

Within this first aid model, the ACT model can play as key guide.  One needs to access the problem and understand the needs of the person, connect the person to social support systems and to identify any traumatic reactions or possible future disorders.

Conclusion

Crisis comes in many forms and is universal to all humanity but different people react differently to crisis.  Some may lose emotional balance and equilibrium and need immediate care.  Those in emergency services, chaplaincy, social work, or disaster relief need to understand the nature of crisis and how to help individuals in the moment regain that emotional equilibrium.  While different crisis range and different models exist to help others, crisis intervention is similar to emotional first aid in that it looks to stop the immediate emotional bleeding and help the person again regain control of the situation and be able to cope.  While this only deals with the first phase of a long recovery, like all emergency and acute situations, it is vital for many to be able to survive the initial blast of crisis at during different times.

Please also review AIHCP’s Crisis Intervention Specialist Program

Please also review AIHCP’s Crisis Intervention Specialist Program and see if it meets your academic and professional goals.  The program is online and independent study with mentorship as needed.  The program is and to qualified professionals seeking a four year certification who work in human services,  mental health and healthcare professionals, social work, chaplaincy, nursing,  emergency call centers, first responders, and disaster relief teams.

Resource

James, R. & Gilliland, B. (2017). Crisis Intervention Strategies (8th)”. Cengage

Additional Resources

Boscarino, J. (2015). “Community Disasters, Psychological Trauma, and Crisis Intervention”. Published in final edited form as: Int J Emerg Ment Health. 2015. National Library of Medicine. Access here

Ford, J. D. (2021). Essential elements of crisis intervention. In J. D. Ford, Crises in the psychotherapy session: Transforming critical moments into turning points (pp. 63–79). American Psychological Association. Access here 

Valeii, K. (2024). “Psychological First Aid: How It’s Used”. Very Well Health.  Access here

Wang, D & Gupta, V. (2023). “Crisis Intervention”. National Library of Medicine. Access here

“What to Do In a Crisis”. NAMI. Access here

 

 

 

Pastoral Crisis Intervention

Posted on by Mark Moran

While AIHCP offers a Pastoral Thanatology Certification which aims at end of life and death counseling and spiritual care, pastoral care goes beyond merely helping individuals face the crisis of death, but it also stretches out throughout life where multiple pastoral and crisis events occur.  Grief counseling, Christian counseling, as well as Stress Management and Anger Management are all key tools to help individuals face the problems of life, but crisis itself involves bandaging the bleeding wound and stabilizing the person emotionally and mentally.  A person is crisis is facing a confusing and emotional imbalance that one’s coping strategies temporarily are unable to handle.   The following can lead to immediate disorientation, loss of sense, and intense emotional outbreaks associated with sadness, anger, or hopelessness.   In essence, ” for an individual, crisis is the perception or experiencing of an event or situation as intolerable difficulty that exceeds a person’s current resources and coping mechanisms (James, 2017, p. 9) “. For some in crisis, foolish decisions can be made, while others, inaction or inability to act can occur.  Whether insanity and foolishness or numbness ensue, the person is in dire need of intervention to restore balance, reason and hope.  The purpose of the pastoral counselor specialized in crisis intervention is to not only help the person restore that balance but also to give spiritual aid if needed.  Chaplains and other on the scene professionals look to help these individuals in crisis find clarity and hope.

Chaplaincy plays a big role in pastoral crisis intervention.

Please also review AIHCP’s Crisis Intervention Specialist Program as well as its Pastoral Thanatology Program

Basic Crisis Intervention

Secular crisis intervention serves the most basic needs of those experiencing trauma or sudden loss.  Whether a sudden deceased family member, a violent crime, a national tragedy, or act of nature, individuals need immediate care and assistance in these dark moments. Everly points out that traditional mechanisms of crisis intervention including early intervention, social support, cathartic ventilation, problem solving and cognitive reinterpretation are all essential basics for helpers in crisis (2000, p. 139).   In addition, Mitchell looks at some of the most basic needs for those in crisis need through the acronym ASSISTANCE.  Mitchell lists the need for Assurance of individuals that individuals, or the government will help in severe crisis.  In addition, he lists Security is present and that children and families are safe if they follow directions and guides.  Structure refers to order in chaos and the structure provided by others to help again restore order.  Information refers to giving individuals in crisis, or part of disaster, the best knowledge and resources for a given crisis or disaster. Support refers to not only financial and guidance, but also mental and emotional support through crisis intervention as well as pastoral guidance.  Truth refers to not hiding important information to those victims of disaster or terrorist action but letting them know everything pertinent to a situation to avoid further panic.  Action refers to not merely thinking but also helping others in distress, whether it is the crisis counselor working with someone, or others helping a neighbor in need during disaster.  Neutralize refers to negating pessimism but pushing forward with optimism and plans.  Courage refers the inner resolve of those in crisis, disaster, or terrorist attack to move forward with renewed strength.   Crisis and Pastoral counselors can play a key role in implanting this within individuals with words of encouragement.  And finally this leads to Encouragement and being positive and pushing positive emotions and ideas with those in crisis but also fellow neighbors. (Mitchell).

Pastoral Crisis Intervention

These basic elements of helping others in crisis are core elements.  It is important to help individuals by offering hope but also helping individuals find balance and restoring pre-crisis mental and physical health to help the person find logic and reinterpretation of the event to avoid insanity and inaction.  Chaplains and other pastoral care givers who work in disaster sites, or work with police and fire can also offer another element of crisis care referred to as pastoral crisis intervention.   When individuals in crisis of a particular faith are receptive, pastoral crisis interventionists whether at a death bed, hospice, sites of violent crimes, accidents, disasters, shootings or other terrorist acts can look to help sooth the soul as well.  Everly illustrates various ways chaplains or other pastoral crisis interventionalists can apply pastoral care in crisis.  He lists scriptural education, individual and conjoint prayer, intercessory prayer, explaining worldviews, offering ventilative confession, providing faith based support, supplying ritual and sacraments, and discussion of Divine forgiveness and discussions about life and death and the afterlife (2000, p. 140).  Within this model it is also important to emphasize perceive reception for utilization of these strategies, which include receptive expectations from the person in crisis for spiritual care, or at least a receptive state of mind that is open to spiritual care, and finally not limiting it only to the person in direct crisis, but being there for other family members, police and rescue, as well as physicians, nurses and other healthcare professionals (Everly, 2000, p. 140).

Potential issues can erupt those for chaplains or other pastoral care givers.  It is essential first and foremost not to see oneself as a spreader of the particular faith one adheres to.  One is bringing spiritual comfort to those in crisis.  Chaplains in hospice or on staff for hospitals, or even prisons, or those who appear on crisis sites are there to serve all people of all faiths.  This is why they must be equipped with basic knowledges different religions, ranging from Christianity to Islam to Hinduism and Buddhism, as well as Judaism to even Taoism.  In some cases, individuals may be merely receptive to hear a caring voice.  Chaplains or those in pastoral care in crisis need to be aware of their role as bringers of peace.  If a patient or victim of crisis shares the same faith values, then such issues of universal speech of spirituality can be narrowed down theologically to the faith shared, but when not, some victims may request someone else who shares the same faith, or even wish not to discuss spirituality.  Sometimes, it is the duty of the chaplain to find a rabbi, iman or priest for a particular individual if one cannot meet the spiritual needs itself. When reception is not open, chaplains and other pastoral care givers in crisis must respect these wishes to avoid further stress and frustration within the individual.  A person who is dying, or in crisis does not need further agitation if spirituality is discussed.  Furthermore, chaplains, while present to give peace, are not equipped to offer certain faith based services to other individuals.  For example, a minister is not able to offer Last Rites but must find priest, or in other cases, chaplains should not delve into religious practices they are not trained in or go against their personal beliefs.  Such subjects should be left avoided or referred to other clergy capable and willing.

Pastoral Crisis Intervention works with receptive individuals looking for spiritual care during crisis.

Everly lists a few issues that can occur in application of pastoral crisis intervention that are important keys for chaplains and other crisis givers need to remember.  Among them, he lists failure to listen to the secular needs of an individual.  He further lists lack of a proper or structured plan when arriving upon a crisis or death scene.  He also points out the the dangers of debating religious and spiritual issues with those in crisis, or attempting to explain theological issues, or preaching to a unreceptive individual, as well as trying to convert someone (2000, p. 141).   Obviously these issues are addressed in chaplaincy training and crisis response.  Chaplains learn in CPE training that they are present to offer peace not agitation.  They are not their to convert but to help with whatever spiritual or emotional need is within the person who is in crisis or dying.   Many who are strong within their faith may feel an inner obligation to bring their faith to the individual, but this impulse must be controlled for those who do not seek it or receptive to it.  Not everyone will share the same faith, but one is called to serve all individuals and meet the unique needs of those individuals.  One does not merely serve one’s own, but serves all common humanity.

In addition, Everly lists some diagnosis mistakes that can be made with individuals in acute crisis that should be avoided.  Many times, individuals in crisis can be mistaken as depressed when it is merely grief reaction to loss.  Also, chaplains and pastoral crisis interventionists need to be aware of brief psychotic reaction vs intrusive ideation, dissociation vs intrusive ideation as well as acute cognitive impairment vs severe incapacitation (2000, p. 141).   Ultimately, many individuals need to be referred later to licensed counselors to deal with longer term issues after crisis.  In some cases, the counseling may only need to be at pastoral levels but in other cases, clinical counseling may be required.  Chaplains and crisis interventionists are again present to supply immediate emotional and spiritual first aid, much like an EMT who physically stops the bleeding or acute issues, while the nurses and physicians repair the long term damage.  Likewise, chaplains and crisis intervention counselors later refer those who have stabilized to the appropriate behavioral health and human service professionals.

Conclusion

According to Evenly “Pastoral Crisis Intervention is the functional integration of pastoral activities with traditional crisis intervention/emergency health services (2000, p. 141)”. With this definition, one can see the important role chaplains play in helping individuals in crisis, whether due to terrorist action, natural disaster, violent crime, sudden death, or even near death in hospice or hospital settings.  Chaplains are not to evangelize the Gospel but grant peace and spiritual presence.  In some cases, they may be called to find a representative of the person’s faith, other times, they may be working with one of the same faith, but ultimately the goal is to treat all of humanity not only one of a particular faith.  In this regard, chaplains must be trained in multi faiths and multicultural counseling competencies to better speak and help others in different faiths.  In addition, chaplains are sometimes not even called to discuss spirituality because secular individuals in crisis may not wish to speak about it.  Chaplains, especially those on crisis scenes are called to respect the wishes of others and bring calm and restoration of pre-crisis state of mind.

Please also review AIHCP’s Crisis Intervention Specialist Certification and also AIHCP’s Pastoral Thanatology Certification

 

 

 

 

 

 

 

 

 

Please also review AIHCP’s Crisis Intervention Program, as well as AIHCP’s Pastoral Thanatology Program.  Both AIHCP’s Crisis Intervention Specialist Certification and Pastoral Thanatology Certification are online and independent study with mentorship as needed.  The programs lead to four year certifications for qualified professionals.

Resources

Evenly, G. (2000) “The Role of Pastoral Crisis Intervention in Disasters, Terrorism, Violence and Other Community Crises”. International Journal of Emergency Mental Health.

James, R. & Gilliland, B. (2017). Crisis Intervention Strategies (8th). Cengage

Mitchell, J. “The Meaning of Assistance”.

Additional Resources

“National Hotline for Mental Health Crises and Suicide Prevention”. Naomi. Access here

Davies, B. (2023). “Crisis Intervention: Techniques and Strategies”.  NWA Crisis Center. Access here

Cherry, K. (2022). “How Crisis Counselors Help People Coping With Trauma”. VeryWellMind. Access here

“A Chaplain’s Role in Times of Crisis”. (2019). Christian Reformed Church” The Network.  Access here

 

 

Grief and Counseling with Asian Americans

Posted on by Mark Moran

Asian Americans, as well as those who immigrate from Asia to the West are a multicultural group that cannot be categorized completely as one group.  In many cases, the general assumption of Asian equates to those of the Orient, but Asia encompasses far more than the mere Orient Japanese, Chinese and Korean cultures, but also India and many other locations throughout the massive continent.  Hence when referring to Asian Americans, it is to be understood as Asia as a whole and not merely those of Oriental descent.  Regardless, Asian Americans share many similar traits, religious ideals and cultural and family structures.  In addition, they have also faced there own oppression at home as well as within the West and United States.  Grief counselors who wish to help Asian clients need to have a full understanding of their culture and ways of expression, in addition to understanding historical oppressions.

Please also review AIHCP’s Grief Counseling Certification and see if it matches your academic and professional goals.

The Asian American and Migrant

Asian Americans are a diverse group of individuals who share many common family structure norms. This plays a large role in their mental health and adjustment to Western culture

Like any migrant group, Asian Americans face unique challenges during acculturation, as well as unique challenges from their homeland.  Many Asians immigrated to the United States via the west coast in the 19th Century, as well as those who have fled communist and tyrannical regimes in the 20th Century.  There are numerous migrants from China, Vietnam and Korea since the mid century who fled oppressive regimes, as well as government persecution of minorities in India and Southeast Asia.   Within the West, Asian Americans have met there own discrimination especially within the United States.  In the 19th Century, many Asians were commonly mocked and ridiculed and left isolated within their own districts.  During the World War II, many Asian Americans were collected into determent camps by the US government.  Many Oriental Americans, especially of Japanese descent had to prove their American values and were treated as traitors or spies.   Even today, various racist slurs or attributed to Asian Americans of different descent and most recently, many were unjustly targeted for the spread of Covid19.

Ironically, many Asians also receive “positive” stereotypes that can also be damaging, such as the assumption all Asians are smart and receive good grades.  While education is key driving force within Asian culture, these reinforced stereotypes when applied can cause confusion and distress to the particular individual.

In addition, Asian Americans and migrants face acculturation issues within their own unique family structures  and Western society.   Asian American cultural structures place greater value on collectiveness and needs of the family.  It submits to a stronger hierarchal structure that places the individual at the need of the family. Many personal and individual decisions made by Westerners are considered family business in Asian families.  Hence obligation to family, obedience, and arrangements even in marriage are considered social necessities (Pederson, 2018. p. 122).  In addition, Asian culture emphasizes humility and modesty when speaking of self and are far less lenient with outsiders than family members in these regards.  In addition, self restraint and harmony are prized more than self disclosure and independent choices (Pederson, 2018, p. 122). With this higher respect of authority, many Asian Americans have difficult times understanding American and Western culture and its demand of freedom, pride, rebellion and personal choice.

Hence within this group, there can be a struggle between first and second generation family members as well as integration with less traditional Asian families via marriage.  This can lead to depression and anxiety for members who need their family structure and support but wish to express themselves outside the cultural norm of their family.

Counseling the Asian American

Many Asian Americans who experience better acculturation seek counseling more so than those with worst experiences.  Of course tradition, language barriers and other cultural factors can play a role in willingness to seek mental health help. Overall, Asian Americans are considered to under utilize health services (Pederson, 2018, p. 129).   Asian Americans, however, experience the same general mental issues all human beings experience despite the “model minority” stereotype (Pederson, 2018, p. 130).   Like many cultures, Asian Americans sometimes prefer a counselor of their own culture and race to help foster understanding of cultural issues.  Pederson points out that racial matches in counseling do equate to increased utilization and duration of therapy (2018, P. 134).  Racial match while able to grant better credibility within the counseling relationship is not always ideal or available and this again leads to the importance of counselors to be multicultural aware.  Of course with so much discussion about racism, many sometimes wish to turn a blind eye to race itself but turning one’s eye to race and culture ignores the fabric of the client sometimes him or herself.  Ignoring hate and removing it is the key, not denying differences that are integral to who someone is.  Hence counselors need to be aware of the differences and through this understanding be competent to bridge the cultural difference between counselor and client.  This will ultimately help population groups, such as Asian Americans, become more comfortable with a non-Asian counselor.  This involves Western counselors having a stronger understanding of authority and family structures within Asian American homes and better apply that knowledge to the counseling dynamic.  Interesting enough, it is important to discuss the counseling outcome and dynamic with Asian Americans.  Normally, Asian Americans expect answers from experts.  They wish to be told what to do and how to follow through.   The overall view for many is that counseling is directive and authoritarian. Many expect more directness in what to do (Pederson, 2018, p. 128).    This is why is it important to review expectations of mental therapy and the importance of the process of self discovery and healing instead of the counselor taking upon a role of authority.

Grief Counselors need to have multicultural competencies in Asian culture to best help clients with grief

Again noting that no two people are alike, counselors can still have a base understanding of Asian culture when working with a Asian client.  First, it is important to note that many Asians communicate in a high context style without direct or specific references (Pederson, 2018, p. 125).   In addition, many Asians do not express or communicate emotion as freely as Westerners (Pederson, 2018, p. 125).  It is important to understand this because if analyzed from a Western lens only, this may appear to be hiding feelings or pathological but in reality is merely cultural.  Other misconceptions can occur as well if a Western lens is utilized in call cases.  If an Asian client seeks parental and family advice on every issue from employment to relationships is judged as a Westerner, then diagnosis may present a maladaptive issue, while in reality, the Asian client is performing well within his or her cultural norms.  Hence it is important to have a strong understanding of the cultural emphasis of family and authority within Asian communities and how this comes into play during counseling.

One key cultural expressions within Asian communities is the issue of shame and loss of face.  The fear of shame or failure or losing face and disappointing the family can be a large motivational pull for Asian clients (Pederson, 2018, p. 124).   Feelings of shame upon one’s name and family is a large fear in collectivist cultures (Pederson, 2018, p. 124).  Hence shame can play a role in loss, grief, as well as decisions.  One may live an unhappy personal life at the expense of a living a life that spares shame upon the family name. In addition to shame and loss of face, many individuals within Asian cultures are pushed to perfection and fear failure.  The more perfectionist the family structure, the far greater stressors for the individual to succeed at all costs (Pederson, 2018, p. 127). In addition to fear of shame, or depression and anxiety associated with perfectionist model families, counseling with Asians must also take into context high contextual communication styles versus lower contextual communication styles. Most Asians associate with non-verbal cues to express ideas.  This helps avoid confrontation or disrespect.  On the contrary, most Westerners communicate with more direct communication or low contextual communication where words are purposely used to state and communicate an issue.  This can across to an Asian as direct, aggressive, or rude (Pedersen, p. 125).

Within grief, various family structures and inner frictions can cause unresolved issues during loss and death.  Anytime a person exists within a culture that has expectations of the group over the self, as well as a restraint of emotion, one can expect possible grief reactions.  The individual may experience depression or anxiety with one’s own life choices and then when family death occurs and  also possibly feel multiple guilts if one did not do as one was told to do by the deceased.  These issues need addressed in counseling to allow for proper grieving and resolution of the loss.  When dealing with Asian clients, these issues may exist during grief and loss and may need addressed or at least explored to discover if the client’s family had such cultural norms.

Conclusion

Asian Americans or migrants are more than just South East Asia but also include India and outlaying areas.   The culture for the most part is very family and collectivist orientated with emphasis on respect of authority.  Family plays a key role in decisions.  Shame also plays a key role in keeping members of the culture to performing their duties to the family.  Counselors need to be aware of the cultural dynamics when working with individual clients.  Pending on acculturation and family dynamics, different Asian clients will vary in how they respond to Western ideals.  Regardless, grief and loss can still be impacted within family structures that dismiss emotional expression and individual freedom.  Resentment and anger can build up and play a role later in loss and grief.

Helping different cultures acculturate yet maintain identity is key. Please also review AIHCP’s Grief Counseling Certification

Please also review AIHCP’s Behavioral Therapy Certifications for Human Service Professionals as well as Healthcare Professionals. In particular, please review AIHCP’s Grief Counseling Certification and see if it matches your academic and professional goals.  The program is online and independent study and open to qualified professionals.   In particular, for those who are already certified grief counselors, please review AIHCP’s specialty Grief Diversity Counseling Program.

 

 

 

 

 

 

 

 

Reference

Pederson, P. et al. (2018) “Counseling Across Cultures” Cengage

Additional Resources

Huizen, J. (2021). “Asian American mental health stigma: Why does it exist?”. Medical News Today.  Access here

Nagayama Hall, G. et al. (2011). “Culturally-Competent Treatments for Asian Americans: The Relevance of Mindfulness and Acceptance-Based Psychotherapies”. Clin Psychol (New York). Author manuscript; available in PMC 2012 Sep 1.  National Library of Medicine.  Access here

Cherry, K. (2023). “17 Mental Health Resources For Asian Americans and Pacific Islanders” Very Well Mind.  Access here

Misun Kormendi, N. (2021). “Asian American mental health during COVID-19: A call for task-sharing interventions” SSM Ment Health. 2021 Dec; 1: 100006.. National Library of Medicine. Access here

 

 

 

 

 

Grief Counseling and Immigration: Needs of the Migrant

Posted on by Mark Moran

Migrant populations are becoming more and more increasing in the West and this has had a large impact on Grief Counseling as well as other forms of mental therapy.  Throughout numerous blogs, we have discussed the immigration factor for population groups of Asian, African, and Hispanic groups, but the general and universal need of the immigrant and the acculturation process is a unique process within itself.  Whether from Eastern Europe or South East Asia, there are general considerations to take into account for counseling migrants.  Of course, for some population groups, the cultural shock and change are far greater as the cultures differ, but there still remains a general shared story for any traveler in a foreign land.

While some may paint the immigration story to America as perfect, the reality is somewhere in between

Please also review AIHCP’s multiple behavioral health and counseling certifications for Human Service and Healthcare professionals in the areas of Grief Counseling, Stress Management, Crisis Intervention, Anger Management, Life Coaching and Christian or Spiritual Counseling.

The Immigrant

For a nation that prides itself upon taking upon the world’s ragged and poor, the welcoming arms of the Statue of Liberty has not always been so welcoming.  As a nation built upon migrants and the concept of social melting pot, there ironically has existed a counter effort to maintain its Anglo-roots.   WASP and Nativist movements have existed within the US since the early 19th Century as an attempt to keep America White, Anglo, Saxon and Protestant.  Social agitation to Irish immigration, Italian immigration, Asian immigration and African freedom, as well as discounting of the rights of the original inhabitants, the Native Americans, have always been a priority for these racist groups.   Whether in regards to restriction of rights, rewriting history, or national intimidation tactics, the Nativist Movement within the United States has always had a minor audience that wished to keep America Anglo Saxon, or at least European.   This has led to countless cases of intimidation and hate against migrants.  This was especially true in the 19th Century at the hands of the Know Nothing Party and its attempts to suppress Irish Catholics.  Later, the KKK would take up the effort to intimidate not only African Americans recently freed from slavery, but also to all immigrants ranging from Jews and Asians to Catholics and Irish.  Unfortunately, even today, the anti-immigration rhetoric is powerful.  In 2024, our nation still exhibits racist tactics against migrants at the border as well as against Haitians accused of eating pets in Ohio.

Dehumanizing is the key part of any rhetoric.  Hispanics at the border are labeled as cartel thugs, rapists and criminals or Haitians are accused of eating pets.  These dehumanizing attempts are part of the play book of the racist.  It was done to the Jewish people in Europe and to the African American peoples during slavery.  The moment the individual is dehumanized, one is able to rationalize and justify their horrendous activity.   Downplaying the migrant is also key in the playbook of the Nativist.  Pederson points out that migrant faces various myths that attempt to make them appear as threats to the average American.  First, he points out the myth migrants have low education and little skills.  On the contrary, most migrants consist of 47 percent of the US. top academic positions within doctorate levels.  Secondly, Pederson points out that migrants are painted as threats to taking American jobs.  The reality is migrants make up about 15 percent of the American workforce. As for the jobs taken, many are low level entry positions or farming.  In fact, migrants make up 75 percent of farming jobs for fruit and vegetables, contributing to 9 billion in federal taxes and 75 billion in earnings.  Third, many label migrants as undocumented, but the reality is two-thirds of all migrants are documented.  Finally, many push the myth that a stronger border is needed to prevent invasion.  This has been suggested due to the terror attacks and security issues but while this is important, most migrants are not a threat and more focus should be to making those who are illegal into becoming legal and productive individuals, especially since so many are actually born here as children or existing on expiring visas (2018, P. 324-325).  Again, the Nativist myth that migrants are invaders are the larger myth at play here.  Border security is crucial but if the reason is due to fear of migrants, then the wrong emphasis on the wrong security issue is being emphasized to the detriment of a population group.  Unfortunately, the Nativist Movement is strong and alive again in the United States and it is something that must be addressed in the future years.

Migrant Issues in the United States

Acculturation varies upon the culture extremes between the country of origin and the host nation but also upon not just the culture but the individual.  So again, issues for one, may not exist for another.  One cannot in counseling assume one thing exists and another does not but must investigate each individual’s unique situation.  With that understood, one can still give a general and likely list of issues that can exist for a migrant during acculturation.

Migrants face different stories in their immigration and also face additional stressors within the host nation

First it is important to note that some migrants are here voluntarily, while others have had no choice.   One migrant may arrive for a better life and education or job chances, while others may be fleeing persecution, revolution or famine and disaster (Pederson, 2018, p. 323).  Obviously these two extremes present different mindsets when counseling a migrant. Hence the refugee migrant will have a far more traumatic experience than someone who has travelled to the United States or the West for opportunity.  The refugee faces various cases of potential PTSD, subjugation to relocation, detention facilities, lost family members as well as trying to adjust to a new culture, language and basic survival itself (Pederson, 2018, p. 326).  Some prior to arrival to the United States may have been tortured, abused, raped, falsely imprisoned or during time in refugee camps faced unclean sanitary conditions resulting in health issues and malnutrition (Pederson, 2018, p. 326).  Some may also experience survivors guilt issues along with PTSD.

Merely the psychosocial adjustment for forced migrant or voluntary migrant is difficult.  New schooling, or new jobs or new homes can all take time to adjust for anyone.  Merely relocate to another house across town and one is merely stressed, much less moving from an entirely different culture and nation to a new and foreign place.  The first 1 to 2 years constitute a crucial period for migrants as they attempt to find a foundation in life with basic survival (Pederson, 2018. p. 329).  This involves finding stable income and food, housing and jobs.  Many migrants who are refugees do no have the luxury as well as those who immigrated voluntarily to choose a destination.

During acculturation, migrants will experience the phenomenon of culture shock.  Some may integrate, others may not, others may gradually adjust, but the stresses of one culture clashing with another can have big affects on the individual as well as one’s family dynamics.  Pederson lists four phases that exist within culture shock.  The first is likened to a tourist who sees different and new things about a place and finds excitement regarding the differences.  The second phase can be a turning point, where the individual becomes dissatisfied or even disorientated to the change.  The third phase involves adjustment or re-orientation.  Finally, one reflects a degree of adaptation in managing cross cultural transitions (2018, p. 306-307).  Culture shock itself can manifest also in various physical ailments such as headaches, cognitive impairment, stomach issues, reduced energy and fatigue (Pederson, 2018, p. 307).  Mentally, it can lead to anxiety, depression and overall stress (Pederson, 2018. p. 307). Culture shock is a big part of acculturation depending on the culture and the person.  It is in essence an objective and subjective balance that varies from person to person, yet it is something that many migrants face due language barriers, challenges within the family due to external pressures, and racism within the host nation.

Counseling the Migrant

Whether a international student, a refugee, forced or chosen visitor, the migrant faces issues that sometimes are dismissed from the behavioral and mental health aspect.  Many migrants do not understand or wish to partake in the mental health services available due to cultural differences regarding counseling and expressions.  Pederson points out that many migrants will first seek what is comfortable and familiar to them when facing emotional issues.  Many turn to traditional forms of medication or services from their home culture.  In addition, many migrants feel the Western system of care is incapable of addressing their issues due to cultural barriers.  They also feel uncomfortable due to various language barriers that can make it difficult to communicate issues.  Finally, many are unable to find locations where services are provided due to their relocation itself (2018, p. 328-329).

Counselors need to be multi cultural proficient to help migrants from different places

Due to the wide variety of migrant cultures, counselors are called to multicultural proficiencies and practices (Pederson, 2018. p. 336).  In helping migrants, there is a multi model phased process to help migrant clients.  The first phase should involve education regarding mental health practices and interventions.  This will help eliminate any misconceived notions about the process and help the client and migrant understand the process.  Many cultures may have different ways of expressing and discussing issues.  This is why it is so pivotal to address how mental health works, however this does not mean the client’s cultural ideas and methods of healing are dismissed.  Within the second phase, traditional healing and other cultural aspects are taken into account.  The counselor learns and understands how the migrant from a particular culture expresses and migrant’s needs of family or traditional healing methods. In the third phase, counselors help migrants regain cultural empowerment within their environment.  This not only involves discussing mental issues with the migrants, but also focusing on daily issues and helping the migrant find services that meet everyday needs.  It is sometimes critical to focus on helping stabilize the migrant’s daily life before helping the migrant with his/her mental issues.  Part of this not only involves discussing daily problems but also addressing issues of racism and micro aggressions.   The final phase, it not only final, but also incorporated throughout the counseling process.  This phase involves the counselor as acting as a social advocate and as one pushing for basic human rights of the migrant (Pederson, 2018, p. 337-339).

Hence, counselors are not only helping migrants with grief, loss, relocation, but also a host of other adjustments that occur within the transitional period.  Many of the issues related to the immigration can sometimes become secondary to the new acculturation process itself.  The numerous stressors to change of environment can become overbearing to anyone, much less someone who may be fleeing a war torn nation.  Hence counseling migrants presents a whole new level of complications than the basic citizen.

Grief Counselors may be working on the pain and loss of home, family and way of life with a migrant, but also have to deal with an array of stressors arising from the acculturation process and its many demands.  This can lead to complications within grief as well.  In fact, many migrants may be dealing with traumatic grief itself.

Conclusion

Migrants face a unique challenge than other target groups.  First, they are not born within the host nation and face a more drastic change and acculturation process.  Second, they face greater discrimination and third, many are refugees and are forced into relocation due to famine, disaster or war.  Many face mental issues from the relocation and in addition face acculturation issues in the host nation.  Grief Counselors, Licensed Counselors, Social Workers or pastors need to understand not only the culture of origin but also the general pain of the migrant.  There obviously will be objective and subjective elements to each story, but counseling is definitely needed for many migrants who have faced atrocity and now face new discriminations within the host nation.  Unfortunately for many migrants, counseling can be a difficult process due to cultural differences, language and lack of access to it.

Please also review AIHCP’s multiple behavioral health certifications, especially, the Grief Counseling Certification.  The program is online and independent study and open to qualified professionals in both behavioral health as well as healthcare itself.  Please review and see if the Grief Counseling Program meets your academic and professional goals.

Reference

Pederson, P. et. al. (2018). “Counseling Across Cultures”. Cengage

Additional Resources

Line, A. (2022). “Considerations When Counseling Immigrants and Refugees” NBCC. Access here

Hodges, H. (2020). “Going To Therapy Can Be Hard, Especially For Immigrants — Here’s How To Start”. NPR. Access here

Tan. J. & Allen, C. (2021). “Cultural Considerations in Caring for Refugees and Immigrants”. National Library of Medicine. Access here

Moncrieffe, M. (2023). “Specialized care for immigrants experiencing trauma is vital. Psychologists are breaking down the mental health barriers”. APA. Access here

 

 

Multicultural Counseling Video Blog

Posted on by Mark Moran

 

Multicultural counseling competency is important in counseling.  Counselors need to be diverse in understanding how culture, race , creed, age and gender play a role in how a client will respond to them.  Counselors need to be also aware of their own internal biases.  With good cultural understanding, the counseling relationship can become enhanced and help the client heal and grow.  Please review the video above to learn more about multicultural counseling,

Please also review AIHCP’s Grief Counseling Certification, as well as its numerous behavioral health certifications in Christian Counseling, Spiritual Counseling, Anger Management, Crisis Intervention and Stress Management, as well as Life Coaching, ADHD Consulting and Meditation Instructor.