4 hour verbal crisis de escalation

Copyright AllCEUs.com 2011. Unlimited CEUs $99 per year

Client and Personal Safety4 Hours

Dr. Dawn-Elise Snipes Ph.D., LMHC, CRCExecutive Director, AllCEUs.com


People are facing an untenable obstacle to life goals

People’s life cycles are significantly disrupted

AND

The person has no response to deal with a situation

Definition of Crisis


The unknown Loss of control or power Rejection Isolation Failure Death

6 Basic Fears


Presence of opportunity and danger◦ Change causes crisis and crisis causes change◦ Increasing anxiety can lead to violent reactions

Complicated◦ Generally does not have one simple cause◦ Precipitating events may impact many different

areas of life

Characteristics of Crisis


No Panaceas or Quick Fixes◦ May provide temporary, immediate relief◦ Ensure they do not make problem worse

Necessity of Choice◦ Making a choice requires action◦ Choosing not to act is a still a choice


Developmental◦ Normal or abnormal events causing dramatic

change Situational Crisis Existential Crisis

◦ Anxieties arising from questions of purpose, responsibility, independence, commitment

Ecosystemic Crisis◦ Disaster

Types of Crisis


Equilibrium/Stabilization Cognitive

◦ Gain control by changing thinking◦ REBT◦ Reality Therapy

Psychosocial◦ Assess internal and external exacerbating and

mitigating factors◦ Choose workable alternatives

Models of Crisis Intervention

http://www.rebtnetwork.org/whatis.html

http://www.wglasser.com/index.php?option=com_content&task=view&id=13&Itemid=28


Danger and Opportunity Time limited, but may be recurring Complex Life experiences of workers enhances their

effectiveness Crisis causes people to make choices

Important Points


There is no one “normal” range of behaviors Individuals are not necessarily the basic building

block of society Problem definitions can be interdisciplinary, even if

worker is not. Language is not always interpreted in the same way The value of independence and dependency varies

between people and cultures Not everything can be explained in a linear fashion We must accommodate the client’s needs Past history certainly impacts current events Be aware of personal assumptions

Cultural Competence


Define the problem◦ Listen to identify the person’s orientation

Feelings or solutions Visual, auditory, kinesthetic

◦ Empathize to see the problem as the client does◦ Ask open-ended questions◦ Pay attention to verbal and nonverbal messages

Verbal Crisis Deescalation


Assess (ABCs)◦ Affective state ◦ Behavioral Functioning◦ Cognitive Functioning◦ Severity of the crisis

SI/HI Intent Plan (Method, Date/Time) Means Future Plans Putting affairs in order

VCD cont…


Ensure client and personal safety◦ Physical

Remove the client from the situation (if possible) Inform client you want to help, but it is hard for you

to focus while… Propose solution that does not take away his power.

Maintain an environment free of hazards (scissors, letter openers, heavy objects)

Always maintain a clear path to the door Do not meet with clients in isolation

◦ Psychological Remove bystanders (an audience also adds fuel) Reframe the situation with client not being “bad.”

VCD cont…


Provide Support◦ Thinking Words

You are… Stuck At your wits end Out of options Out of control

◦ Feeling wordsYou feel… Overwhelmed Helpless Hopeless

VCD Cont…


◦ Seeing I see that… You look like…

◦ Hearing I hear that… You sound…

◦ Doing You want… You regret….

VCD Support cont…


Acting◦ Acknowledge the situation and/or the client’s

feelings◦ Seek help from the client in understanding what is

going on Tell me what is going on Ask open ended questions

◦ Own your feelings◦ Be aware of transference and counter-

transference reactions

VCD cont…


Convey understanding◦ Don’t say “I understand”

Provide positive reinforcement for behaviors Avoid value judgments Set limits and do not tolerate controlling or

aggressive behavior

VCD cont…


Reduce tunnel vision or increase focus Examine Alternatives

◦ Supports◦ Coping Mechanisms◦ Thinking Patterns

Promote Mobilization◦ Make plans◦ Implement Order

Obtain commitment with assertion statements◦ I need you to…

VCD cont…


Please read the following book◦ Client Safety and Crisis Intervention

Further Reading

http://books.google.com/books?id=fAFg7z93gDwC&pg=PA39&dq=client+safety&cd=1#v=onepage&q=client%20safety&f=false

http://books.google.com/books?id=fAFg7z93gDwC&pg=PA39&dq=client+safety&cd=1#v=onepage&q=client%20safety&f=false


Change causes crisis Crisis is a state of extreme anxiety It is important to “hear” the client Help the client

◦ Re-establish equilibrium◦ Identify environmental and social supports◦ Develop a plan◦ Take action

Summary


When in crisis, clients may act out against themselves or others

Ensure your office and common areas are free from potential weapons

Develop a safety plan for◦ Your exit◦ Removing bystanders/other staff◦ Aiding clients

Never make promises you cannot keep

Summary cont…

4 hour verbal crisis de escalation

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