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Crisis Counseling
What is Crisis Counseling?
What is Crisis and Emergency Care?
Who Provides Crisis Intervention?
What should you advise people in crisis?
What are various methods to manage crisis?
What is a crisis hotline?
What it's like to call the Crisis Helpline?
Do I need to be "in crisis" before I call?
How does the Crisis Helpline help people who call?
Do you give advice?
Is talking to a telephone counselor kind of like going to therapy?
Who are your counselors? What kind of training do they have?
What is crisis counseling?

Therapist: What would you like to talk about today?
T: Would you like to talk about those thoughts?
Do you want to tell me about the nightmares?
Do you want to talk about it?
What are you feeling?
What do you notice going on in your body?
Where do you notice the tension?
What happens if you stay with that sensation?
Would you like to try something that might make this process easier?
What is it?
How are you doing?
What do you see there?
What is it like? What do you notice?
How is it that you have been able to go on this far? How have you been able to do it?
What the survivor is experiencing:
Acute Distress

a) Physical symptoms
? Injuries
? General Soreness
? Loss of appetite and/or nausea
? Disorganized sleep patterns (nightmares, screaming in sleep, insomnia, too much sleep)

b) Emotional symptoms
? Fear
? Humiliation
? Degradation
? Guilt
? Shame / Embarrassment
? Anger
? Mood-swings
? Crying
? Replaying rape
? Sadness

One person might be deeply affected by an event, while another individual suffers little or no ill effects.

The purpose of crisis counseling is to deal with the current status of the individual dealing with a crisis. Chronic exposure to stress or trauma can lead to mental illness, so it is important that crisis counselors have the skills and knowledge to help clients cope with current stressors and trauma.

Crisis counseling is not intended to provide psychotherapy, but instead to offer short-term intervention to help clients receive assistance, support, resources, and stabilization.

Crisis counseling is intended to be quite brief, generally lasting for a period of no longer than a few weeks. It is important to note that crisis counseling is not psychotherapy. Crisis intervention is focused on minimizing the stress of the event, providing emotional support and improving the individual’s coping strategies in the here and now.

Crisis counseling is not long term and is usually no more than 1 to 3 months. The focus is on single or recurrent problems that are overwhelming or traumatic. If a trauma or crisis is not resolved in a healthy manner, the experience can lead to more lasting psychological, social and medical problems. Crisis counseling provides education, guidance and support. Crisis Counseling is not a substitute for individuals who need and are not receiving intensive or long term psychiatric care. Crisis counseling may involve outreach, work with in a community and is not limited to office appointments.

Like psychotherapy, crisis counseling involves assessment, planning and treatment, but the scope of is generally much more specific. While psychotherapy focuses on a wide range of information and history, crisis assessment and treatment focuses on the client’s immediate situation including factors such as safety and immediate needs.

While there are a number of different treatment models, there are a number of common elements consistent among the various theories of crisis counseling.

Assessing the Situation

The first element of crisis counseling involves assessing the client’s current situation. This involves listening to the client, asking questions and determining what the individual needs to effectively cope with the crisis. During this time, the crisis counseling provider needs to define the problem while at the same time acting as a source of empathy, acceptance and support. It is also essential to ensure client safety, both physically and psychologically.

Education

People who are experiencing a crisis need information about their current condition and the steps they can take to minimize the damage. During crisis counseling, mental health workers often help the client understand that their reactions are normal, but temporary. While the situation may seem both dire and endless to the person experiencing the crisis, the goal is to help the client see that he or she will eventually return to normal functioning.

Offering Support

One of the most important elements of crisis counseling involves offering support, stabilization and resources. Active listening is critical, as well as offering unconditional acceptance and reassurance. Offering this kind of nonjudgmental support during a crisis can help reduce stress improve coping. During the crisis, it can be very beneficial for individuals to develop a brief dependency on supportive people. Unlike unhealthy dependencies, these relationships help the individual become stronger and more independent.

Developing Coping Skills

In addition to providing support, crisis counselors also help clients develop coping skills to deal with the immediate crisis. This might involve helping the client explore different solutions to the problem, practicing stress reduction techniques and encouraging positive thinking. This process is not just about teaching these skills to the client, it is also about encouraging the client to make a commitment to continue utilizing these skills in the future.

Suicidal intent, acute risk of violent behavior, severe loss of emotional control, and gross impairment in thinking ability are examples of emergencies.

Crisis counseling is not giving advice. Crisis counseling is providing structure, support and information necessary for callers to clarify their situations and develop their own solutions.

I have been feeling concerned about you lately.

Recently, I have noticed some differences in you and wondered how you are doing.

I wanted to check in with you because you haven't seemed yourself lately.

Questions you can ask:

When did you begin feeling like this?
Did something happen that made you start feeling this way?
How can I best support you right now?
Have you thought about getting help?

What you can say that helps:

You are not alone in this. I’m here for you.
You may not believe it now, but the way you’re feeling will change.
I may not be able to understand exactly how you feel, but I care about you and want to help.
When you want to give up, tell yourself you will hold off for just one more day, hour, minute — whatever you can manage.

Crises
(pl. ) of Crisis
During crisis counseling, __________ workers often help the client understand that their reactions are normal, but temporary. While the situation may seem both dire and endless to the person experiencing the crisis, the goal is to help the client see that he or she will eventually return to normal functioning.

What is Crisis and Emergency Care?

Emergency respite care is an important service in the caregiver support plan because unexpected and urgent situations may develop quickly. Depending on the needs of the family or caregiver, emergency respite care can range from a few hours of care to more extended periods.

The Goals of Crisis intervention are to

Mitigate the impact of an event
Facilitate a normal recovery process, where normal people are having normal reactions to abnormal events.
Restore adaptive functioning.

Who Provides Crisis Intervention?
What are various methods to manage crisis?
Crisis hotline
Crisis intervention
Crisis communication
CrisisChat
http://www.crisischat.org/faq/
Mobile Crisis Team
http://www.nyc.gov/html/doh/html/cis/cis_mct.shtml
Crisis Counseling Guide

Crisis Counseling Guide

Age-Related Reactions of
Children to Disasters

If an emergency/disaster occurs, it is important to recognize normal reactions of children to the event. Reactions of children are generally age related and specific. This section provides an overview of normal reactions within determined age groups and helpful hints for enabling children to cope with the disaster-precipitated stress. Also included is a list of symptoms which may warrant referral to a mental health professional.


COURSE STRUCTURE

The course is divided into eight lessons as follows:

1. Nature and Scope of Grief and Bereavement
2. Stages of grief
3. Grief and Children
4. Grief and adolescents
5. Adjustment to Bereavement
6. Abnormal Grief
7. Preparing for Grief and Bereavement
8. Future outlook and long-term grief

WHAT YOU WILL DO IN THIS COURSE

o List euphemisms for dying.
o Consider factors that can help set the conditions for the good death
o Discuss the ways that a wake or funeral service can be of help to mourners.
o Discuss contemporary attitudes toward death in society and how they affect the treatment of dying.
o Describe the stages of grief.
o Explain why people pass through different stages at different times and not in a particular order.
o List mechanisms available to help a counsellor support someone who is grieving.
o Describe ways in which children might respond to grief.
o Explain why different children respond to grief in different ways.
o Describe counselling strategies for supporting the grieving child.
o Research how adolescents respond to grief.
o Outline counselling strategies for supporting the grieving adolescent.
o List suicide prevention strategies.
o Explain in general how we adjust to loss.
o List some dangers of loss.
o Describe some alternatives for loss recovery.
o Research how bereavement affects survivors.
o Describe some abnormal responses to grief, and how they are determined to be abnormal.
o Describe some treatment methods for assisting a person suffering from abnormal grief.
o Briefly describe symptoms of PTSD
o Discuss socio-cultural perspectives in preparing for grief and bereavement.
o Research physiological and psychological effects of separation and loneliness in the aged.
o Describe some effects of long term grief.
o Outline some long term counselling support strategies.
o Compare effective and ineffective support for people going through grief and loss.

Disaster may strike quickly and without warning. These events can be frightening for adults, but they are traumatic for children. During a disaster, your family may have to leave their home and daily routine. Children may become anxious, confused or frightened. As a parent, you will need to cope with the disaster in a way that will help children avoid developing a permanent sense of loss. It is important to give children guidance that will help them reduce their fears. Ultimately, you should decide what's best for your children, but consider using these suggestions as guidelines.

Key Concepts

  • Children experience a variety of reactions and feelings in response to a disaster and need special attention to meet their needs.
  • The two most common indicators of distress in children are changes in their behavior and behavior regression. A change in behavior is any behavior the child exhibits that is not typical for them. For example, an outgoing child may become very shy and withdrawn. Regression is where past behaviors occur, such as thumb sucking or baby-talk.
  • Children may experience a variety of reactions and feelings based on their age. Helpful hints for coping with these reactions are listed.

Reactions to disasters may appear immediately after the disaster or after several days or weeks. Most of the time the symptoms will pass after the child readjusts. When symptoms do continue, most likely a more serious emotional problem has developed. In this case, referring the child to a mental health worker who is experienced in working with children and trauma would be necessary.

Reactions by Age Groups

Preschool (1-5 years)

When faced with an overwhelming situation, such as a disaster, children in this age range often feel helpless and experience an intense fear and insecurity because of their inability to protect themselves. Many children lack the verbal skills and conceptual skills needed to cope effectively with sudden stress. The reactions of their parents and families often strongly affect them. Abandonment is of great concern for preschoolers, and children who have lost a toy, pet, or a family member will need extra comfort.

Typical Reactions:

  • Bed-wetting
  • Fear of the darkness or animals
  • Clinging to parents
  • Night terrors
  • Loss of bladder or bowel control, constipation
  • Speech difficulties (e.g., stammering)
  • Loss or increase of appetite
  • Cries or screams for help
  • Immobility, with trembling and frightening expressions
  • Running either toward an adult or in aimless motion
  • Fear of being left alone; of strangers
  • Confusion

Helpful Hints:

  • Encourage expression through play reenactment
  • Provide verbal reassurance and physical comforting
  • Give frequent attention
  • Encourage expression regarding loss of pets or toys
  • Provide comforting bedtime routines
  • Allow to sleep in same room with parents until the child can return to their own room without the post-disaster fear

School Age (5-11 years)

The school-age child is able to understand permanent changes or losses. Fears and anxieties predominate in this age group. Imaginary fears that seem unrelated to the disaster may appear. Some children, however, become preoccupied with the details of the disaster and want to talk about it continuously. This can get in the way of other activities.

Typical responses:

  • Thumb sucking
  • Irritability
  • Whining
  • Clinging
  • Aggressive behavior at home or school
  • Competition with younger siblings for parental attention
  • Night terrors, nightmares, fear of darkness
  • School avoidance
  • Withdrawal from peers
  • Loss of interest and poor concentration in school
  • Regressive behavior
  • Headaches or other physical complaints
  • Depression
  • Fears about weather; safety

Helpful Hints:

  • Patience and tolerance
  • Play sessions with adults and peers
  • Discussions with adults and peers
  • Relaxed expectations at school or at home (temporarily)
  • Opportunities for structures but not demanding chores and responsibilities at home
  • Rehearsal of safety measures to be taken in future disasters

Preadolescence (11-14 years)

Peer reactions are especially significant in this age group. The child needs to know that his/ her fears are both appropriate and shared by others. Helping should be aimed at lessening tensions and anxieties and possible guilt feelings.

Typical Responses:

  • Sleep disturbance
  • Appetite disturbance
  • Rebellion in the home
  • Refusal to do chores
  • School problems (e.g., fighting, withdrawal, loss of interest, attention seeking behaviors)
  • Physical problems (e.g., headaches, vague pains, skin eruptions, bowel problems, psychosomatic complaints)
  • Loss of interest in peer social activities

Helpful Hints:

  • Group activities geared toward the resumption of routines
  • Involvement with same age group activity
  • Group discussions geared toward reliving the disaster and rehearsing appropriate behavior for future disasters
  • Structured but undemanding responsibilities
  • Temporary relaxed expectations of performance
  • Additional individual attention and consideration

Adolescence (14-18 years)

A disaster may stimulate fears concerning the loss of their families and fears related to their bodies. It threatens their natural branching away from their family because of the family's need to pull together. Disasters disrupt their peer relationships and school life. As children get older, their responses begin to resemble adult reactions to trauma. They may also have a combination of some more childlike reactions mixed with adult responses. Teenagers may show more risk-taking behaviors than normal (reckless driving, use of drugs, etc.). Teens may feel overwhelmed by their emotions, and may be unable to discuss them with their families.

Typical Responses:

  • Headaches, or other physical complaints
  • Depression
  • Confusion/poor concentration
  • Poor performance
  • Aggressive behaviors
  • Withdrawal and isolation
  • Changes in peer group or friends
  • Psychosomatic symptoms (e.g., rashes, bowel problems, asthma)
  • Appetite and sleep disturbance
  • Agitation or decrease in energy level
  • Indifference
  • Irresponsible and/or delinquent behavior
  • Decline in struggling with parental control

Helpful Hints:

  • Encourage participation in community rehabilitation work
  • Encourage resumption of social activities, athletics, clubs, etc.
  • Encourage discussion of disaster experiences with peers, family, and significant others
  • Temporarily reduce expectations for level of school and general performance
  • Encourage but do not insist upon discussion of disaster fears within the family setting

Referral to a Mental Health Professional

Following a disaster, people may develop Post-Traumatic Stress Disorder (PTSD), which is psychological damage that can result from experiencing, witnessing, or participating in an overwhelmingly traumatic (frightening) event. Children with this disorder have repeated episodes in which they re-experience the traumatic event. Children often relive the trauma through repetitive play. In young children, distressing dreams of the traumatic event may change into nightmares of monsters, of rescuing others or of threats to self or others.

PTSD rarely appears during the trauma itself. Though its symptoms can occur soon after the event, the disorder often surfaces several months or even years later. Parents should be alert to these changes:

  • Refusal to return to school and "clinging" behavior, shadowing the mother or father around the house;
  • Persistent fears related to the catastrophe (e.g., fears about being permanently separated from parents);
  • Sleep disturbances such as nightmares, screaming during sleep and bed-wetting, persisting more than several days after the event;
  • Loss of concentration and irritability;
  • Behavior problems, i.e., misbehaving in school or at home in ways that are not typical for the child;
  • Physical complaints (stomachaches, headaches, dizziness) for which a physical cause cannot be found;
  • Withdrawal from family and friends, listlessness, decreased activity, preoccupation with the events of the disaster.

Professional advice or treatment for children affected by a disaster-especially those who have witnessed destruction, injury or death-can help prevent or minimize PTSD. Parents who are concerned about their children can ask their pediatrician or family doctor to refer them to a child and adolescent psychiatrist. (The American Academy of Child and Adolescent Psychiatry. www.aacap.org/factsfam/disaster.htm)

Tips for Parents

Children often imitate their parent's behavior. When parents have coped well with the situation, there is an excellent chance the children will also cope well. When problems are kept hidden and not discussed openly, children may interpret this to mean that something dreadful is going on, often even worse that it really is.

How Parents Can Help Their Children Cope

  • Hug and touch your child often.
  • Reassure the child frequently that you are safe and together.
  • Talk with your child about his or her feelings about the disaster. Share your feelings too. Give information the child can understand.
  • Talk about what happened.
  • Spend extra time with your child at bedtime.
  • Allow children to grieve about their lost treasures; a toy, a blanket, their home.
  • Talk with your child about what you will do if another disaster strikes. Let your child help in preparing and planning for future disasters.
  • Try to spend extra time together in family activities to begin replacing fears with pleasant memories.
  • If your child is having problems at school, talk to the teacher so that you can work together to help your child.

Children depend on daily routines: They wake up, eat breakfast, go to school, play with friends. When emergencies or disasters interrupt this routine, children may become anxious. In a disaster, they will look to you and other adults for help. How you react to an emergency gives them clues on how to act. If you react with alarm, a child may become more scared. They see our fear as proof that the danger is real. If you seem overcome with a sense of loss, a child may feel their loss more strongly.

Children's fears also may stem from their imagination, and you should take these feelings seriously. A child who feels afraid is afraid. Your words and actions can provide reassurance. When talking with your child, be sure to present a realistic picture that is both honest and manageable. Feelings of fear are healthy and natural for adults and children. But as an adult, you need to keep control of the situation. When you are sure that danger has passed, concentrate on your child's emotional needs by asking the child what is uppermost in his or her mind. Having children participate in the family's recovery activities will help them feel that their life will return to "normal." Your response during this time may have a lasting impact.

Be aware that after a disaster, children are most afraid that-

  • the event will happen again;
  • someone will be injured or killed;
  • they will be separated from the family;
  • they will be left alone.

Advice for Parents: Prepare for Disaster

You can create a Family Disaster Plan by taking four simple steps. First, learn what hazards exist in your community and how to prepare for each. Then meet with your family to discuss what you would do, as a group, in each situation. Next, take steps to prepare your family for disaster such as: posting emergency phone numbers, selecting an out-of-state family contact, assembling disaster supply kits for each member of your household and installing smoke detectors on each level of your home. Finally, practice your Family Disaster Plan so that everyone will remember what to do when a disaster does occur.

Preparations

  • Develop and practice a Family Disaster Plan. Contact your local emergency management or civil defense office, or your local Red Cross chapter for materials that describe how your family can create a disaster plan. Everyone in the household, including children, should play a part in the family's response and recovery efforts.
  • Teach your child how to recognize danger signals. Make sure your child knows what smoke detectors, fire alarms and local community warning systems (horns, sirens) sound like.
  • Explain how to call for help. Teach your child how and when to call for help. Check the telephone directory for local emergency phone numbers and post these phone numbers by all telephones. If you live in a 9-1-1 service area, tell your child to call 911.
  • Help your child memorize important family information. Children should memorize their family name, address, and phone number. They should also know where to meet in case of an emergency. Some children may not be old enough to memorize the information. They could carry a small index card that lists emergency information to give to an adult or babysitter.

After the Disaster: Time for Recovery

Immediately after the disaster, try to reduce your child's fear and anxiety.

  • Keep the family together. Your first thought may be to leave your children with relatives or friends while you look for housing and assistance. Instead, keep the family together as much as possible and make children a part of what you are doing to get the family back on its feet. Children get anxious, and they will worry that their parents will not return.
  • Calmly and firmly explain the situation. As best as you can, tell children what you know about the disaster. Explain what will happen next. For example, say, "Tonight, we will all stay together in the shelter." Get down to the child's eye level and talk to them.
  • Encourage children to talk. Let children talk about the disaster and ask questions as much as they want. Encourage children to describe what they are feeling. Listen to what they say. If possible, include the entire family in the discussion.
  • Include children in recovery activities. Give children chores that are their responsibility. This will help children feel they are part of the recovery. Having a task will help them understand that everything will be all right.

You can help children cope by understanding what causes their anxieties and fears. Reassure them with firmness and love. Your children will realize that life will eventually return to normal. If a child does not respond to the above suggestions, seek help from a mental health specialist or a member of the clergy.  

What should you advise people in crisis?

Say things like:

"That sounds really difficult."
"Is there anything I can do to help?"
"It sounds like you're in real distress."
"It sounds like you're having a crisis."
"It sounds like you're very upset."
"I hear how awful that must be for you."
"I'll bet that brought up some difficult feelings."
"It's okay to cry."
"I'm here for you."
Ask them to report the problem and call again if they feel distressed.

Top 19 Things NOT to Say (or do) to Someone in Crisis

1. Tell them to stop thinking about the past.
2. Use what they are saying as an invitation to talk about how bad you're feeling.
3. Tell them that everything happens for a reason.
4. Walk away, hang up the phone, or laugh.
5. Tell them how strange/foolish/crazy they are to feel or think such things.
6. Interrupt them to tell a funny story about your cat.
7. Tell them they couldn't possibly be feeling or doing or thinking whatever they just told you.
8. Tell them that their feelings are silly, meaningless or inappropriate.
9. Tell them to "pick themselves up by the bootstraps" and get on with life.
10. Try to cheer them up by telling jokes or uplifting stories.
11. Offer them a drink (alcoholic).
12. Tell them how much better you would have handled the situation.
13. Tell them that whatever they're upset about or whatever they have experienced is God's will.
14. Dramatize their pain by being shocked at everything they say.
15. Give them unsolicited advice.
16. Pretend they're not really in crisis and change the subject.
17. Tell them that they're letting their imagination run wild.
18. Compare what they're telling you to other people you know who are crazy, hospitalized, manic, schizophrenic, and/or dead (especially when they've committed suicide).
19. Tell them that someday they'll look back at this and laugh.

What different types of crisis counseling are offered at the Crisis Center? Telephone counseling tailored to specific age groups (Kids, Teens, Adults, and Seniors). Face-to-face counseling for rape survivors. What are the requirements that must be met before making an application? You must have a genuine interest in helping others. Crisis Line, Senior Line and Rape Response applicants must be a high school graduate at least 18 years old. Teen Link and Kids Help Line applicants must be at least 16 years of age. You must not be currently receiving services provided by any Crisis Center program. Rape Response volunteers must also have access to reliable transportation and carry automobile liability insurance. If the applicant is a sexual assault survivor, they must be emotionally ready to assist other survivors and be no less than a year past their own assault/abuse experience. What are the typical types of crisis situations encountered with telephone counseling? For Kids: Friendship, boyfriend or girlfriend, boredom, loneliness, homework, school, and parents. •For Teens: Friendship, dating, grades, social pressures, and sexual issues. •For Adults: Dating, separation, divorce, family conflicts, alcohol and drug abuse, physical or mental abuse, sexual abuse, financial problems, and suicide. •For Seniors: Death, loneliness, reassurance, and financial problems. How are rape survivors supported by the Crisis Center? Immediate one-on-one support for rape survivors. Immediate medical examination and treatment at our Sexual Assault Nurse Examiner (SANE) facility or at a local Birmingham area emergency room. Rape Response volunteers stay with the victim until they are discharged from the medical facility, providing emotional support and practical information. Ongoing face-to-face counseling services (also available for the survivor's immediate family). Group counseling services. Legal advocacy. Community education. Who staffs the Crisis Center? Full-time counseling professionals and community volunteers, representing a cross section of our community, including the legal, teaching, mental health and engineering professions, as well as retirees, students and homemakers. How are volunteers selected? A prospective volunteer must first complete a volunteer application. After the application is received and reviewed, an informal 30 minute interview is then scheduled and completed. How are volunteers trained? Extensive training is provided for all volunteers. Crisis, Kids, Teen and Senior telephone counselors receive approximately 30 hours of classroom training. In addition, three 4-hour sit-in sessions are required, where trainees monitor actual calls being received by an experienced volunteer. Rape Response volunteers receive approximately 30 hours of classroom training. A visit to our on-site Sexual Assault Nurse Examination or (SANE) facility is also required. Do I have a choice of an assignment? During the initial interview, applicants may select which of the center’s programs they prefer (Kids' and Teen, Adult, Senior, or Rape Response). What if I have a difficult call or a call that is overwhelming to me?