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ADVANCED CRISISINTERVENTIONTRAINING
CONCETTA HOLLINGERSEXUAL ASSAULT VICTIM ADVOCATE, SPARCCFCRT REGIONAL CO-COORDINATOR, 12TH JUDICIAL CIRCUIT
FLORIDA COUNCIL AGAINST SEXUALVIOLENCESPRING 2012
CRISIS DEFINED
Crisis is self defined.
A situation/event that overwhelms normal coping mechanisms, rendering them diminished or depleted and leaving the individual unable to cope.
Affects the physical, behavioral, cognitive, emotional, and psychological of the individual, family unit, community, or other group experiencing the crisis.
What is a crisis today, may not be a crisis tomorrow.
CRISIS INTERVENTION
WHAT IS CRISIS INTERVENTIONHow is it defined?What is the purpose?What is the value?
CRISIS INTERVENTION DEFINED
To influence the client and the crisis in an effort to stop, subdue, or diminish the effects of the crisis situation.
Time-limited counseling approach utilized during the crisis period.
Specific focus and goals.
PURPOSE AND VALUE Educate about common
crisis reactions Provide
professional/peer validation
Defuse emotional overload caused by crisis reactions
Focus on positive coping and rebuilding a sense of safety and hope
Assess whether people need referrals for post-trauma counseling
Provide understanding of disorganized thoughts about trauma and provide methods for organizing thoughts (developing narrative)
Address what survivors are experiencing now and what they may experience in the future
TIME DURATION OF CRISISINTERVENTION Minutes, hours, days,
weeks, months…
Various opinions: 6 weeks (Myer, 2002) 6-8 weeks (Parad &
Parad, 1990) Duration of situation
(NOVA, 2002)
When the client is no longer focused on the crisis situation
When the clients coping abilities have been re-established to an equal or higher functioning level than pre-crisis
CRISES RELATED TO SEXUAL VIOLENCE
CRISES RELATED TO SEXUAL VIOLENCE
Immediate aftermath of attack
Immediate medical care
Injunctions for Protection
Reporting to law enforcement
Court proceedings
Medical follow ups First GYN visit Getting an abortion
Anger at Facebook Financial struggles Media coverage of
sexual violence Break up from a
relationship Release of perpetrator
from jail or prison sentence
Traditional Crises Related to SV
Non-Traditional Crises related to SV
CRISIS INTERVENTIONOr Mental Health Counseling?
THE SIMILARITIES ANDDIFFERENCES OF CRISISINTERVENTION ANDCOUNSELING
ADVOCATE
As defined by dictionary.com: to speak or write in favor of; to support or defend.
Many definitions can be found – legal advocate, medical advocate, political advocate, sexual assault advocate, victim advocate...
…YOU decide what kind of advocate youare going to be!
COUNSELING
Internal worth Congruency Santaro’s definition: to help better understand
and problem solve; the ultimate goal is often to help people recognize and accept their own internal worth and to integrate learned behaviors to be congruent with who they are and who they project
SIMILARITIESCrisis Intervention and Counseling
SIMILARITIES
Seek factual information
Assist in formulating plans of action
Preparation and prediction of future obstacles
Enable victims to design and accomplish goals.
Set boundaries Non-judgmental Active Listeners
Emotional support and validation
Assess needs – link to appropriate information or referrals when needed
Respond compassionately in emotionally charged situations
Recognize limitations. Focus on victim’s
interests rather than their own agenda
DIFFERENCESCrisis Intervention Advocacy and Counseling
DIFFERENCES
Crisis Intervention Theories and Models
Empowerment focus Accompany victims
through crisis situations –court, medical, etc.
Focus on presenting problem, i.e. abuse
Systems understanding and advocacy, i.e., medical/judicial/legal, etc.
Variety of Theories and Models
Not necessarily empowerment focused
Deals with pre-crisis and post-crisis impact
Focus on underlying issues
Not necessarily familiar with systems
Not necessarily there to “support and defend” client
Focus on congruency, self-worth, mood, etc.
ADVOCACY COUNSELING
EXTENDED CRISIS INTERVENTION MODELS
TRADITIONAL CRISIS INTERVENTION Single session/response Tangible, active crisis Easily identified needs Survivor may be primary or secondary Examples:
Responding to the ER Accompanying survivor to a deposition Answering an emotional hotline caller
NON-TRADITIONAL CRISIS INTERVENTION Multi-session response Crisis is tangible and active, but needs may not
be as “readily” identifiable Survivor may be primary or secondary Examples:
News story Sandusky/Penn State Case
E-triggers Facebook
Release of perpetrator from jail or prison
TERMINATION AND FOLLOW UP (Parad and Parad)
Begin the first time you see a client
May remain flexible Depending on what your
agency can provide Impacted by systems
impacted in the crisis Law Enforcement
Investigation Criminal Justice System Medical Follow Ups Anniversary Dates
Planned follow ups, in person allow: An “open door” policy
and reminder that centers are available for crises related to the victimization
Afford centers an opportunity to gain feedback on crisis outcome
Assess for any needed post-trauma referrals and/or implementation of such referrals
A TRIAGE ASSESSMENT MODELRick A. Myer
Three Dimensions
Time-LimitedSingle-Issue Treatment
Assistance should lead people toward developing or mobilizing the resources needed to restore them to their previous level of functioning
(James and Gilliland, 2001, as cited by Myer)
“Stay with or schedule appointments with a person long
enough to ensure physical and psychological safety.” (Myer, 2001)
TIME-LIMITED DIMENSION (MYER, 2001)
Duration of not more than 6 weeksCrisis worker may meet with a client once
or several timesAppointments may be a few minutes to a
few hours Appointments should be tailored to help the
person regain a sense of psychological equilibrium and self-protection
Concerned with physical and psychological safety
TIME-LIMITED DIMENSION (MYER, 2001)
Action oriented approach
Be concerned about physical safety and psychological well-being Be alert to clients who are vulnerable to
manipulation Be alert to clients who are not capable of self care
Be wary of clients who are “dependant”
“The more severe the reaction to the crisis situation, the more active the crisis worker must be.”
SINGLE-ISSUE DIMENSION (MYER, 2001)
Treatment addresses a specific issue… And attempts only to resolve that concern
Only symptoms of the crisis situation are relevant
Crisis worker must be disciplined in constantly focusing on the immediate needs and avoid getting side-tracked
SINGLE-ISSUE DIMENSION (MYER, 2001)
Must be focused on setting and maintaining realistic goals. Limited in scope, relating only to reactions of the crisis
as relevant
The outcome of crisis intervention is not major transformations, it is the successful navigation of the crisis situation
Other issues that are identified should be discussed at the end of crisis intervention where the crisis worker can provide appropriate referrals or switch to a more traditional therapeutic role with the client
TREATMENT DIMENSION (MYER, 2001)
First-order intervention “Psychological First Aid” Given on site by whomever is the first on scene Goal is to re-establish immediate coping and provide
support
Second-order intervention Crisis intervention Integration of the experience into client’s lives by
developing new coping skills, adapting to the crisis, or both
Conducted by professionals in the human service field
TREATMENT DIMENSION (MYER, 2001)
Treatment is focused on clients returning to a pre-crisis level of functioning
Integration of the experience into client’s lives by developing new coping skills, adapting to the crisis, or both
Anticipatory Guidance Education on crisis experience
AFFECTIVE REACTIONS (MYER, 2001)
Affect Emotional reaction Expression of emotion or feeling, causing emotion or
feeling
Sharing client’s pain Premature cessation of the expression of feeling is
harmful Closing off or ignoring emotional reactions may
result in long-term mental health issues
AFFECTIVE REACTIONS (MYER, 2001)
Identification of reactions Affect vs. Mood Verbal and Non-Verbal behaviors
related to affect Voice Quality Utilizing Questions Reports of Others
COGNITIVE REACTIONS (MYER, 2001)
Cognitive Thinking Mental process of perception, memory, judgment, and
reasoning
Listen and avoid imposing your own perception Or the perceptions you have encountered in other
clients’ experiences
The cognitive piece is often neglected by crisis workers Affective and behavioral pieces are more tangible and
often more prominent
BEHAVIORAL REACTIONS (MYER, 2001)
Behavioral Actions Acting, reacting, conduct
Finding out what the client has been doing since the crisis
Crisis workers tend to make 2 false assumptions Clients know how to resolve the behavior Prematurely interpreting the meaning of behavior
Be direct regarding behavior when needed
BUILDING A 3 MODEL CRISIS INTERVENTION APPROACH
INDIVIDUALITY
3 MODEL CRISISINTERVENTIONAPPROACH
Session 1 Intake/Assessment Crisis Intervention Identify Primary
Concern Identify goals of client
Build Plan for Future Sessions Identify coping
mechanisms for client to begin to employ
Clarify Agency Services and Boundaries
Session 2 check in on coping skills Work on primary
concern/goals Check in on coping
mechanisms – what is working, what is not; brainstorm where needed
Review first meeting Review COW if needed
Session 3 Check in on primary
concerns/goals Review 2nd meeting Identify LTSR, resources,
utilizing center in the future
Provide referrals, if needed
TERMINATION OF SESSIONS
It is okay to prepare your clients for the termination of your sessions with them from the very beginning. “Kathy, I am really glad that you came in
today. I would like to plan on this being the first of four meetings that we have to discuss your situation. We can adjust that as needed.”
“Kathy, today is the last of our three meetings and we have accomplished a lot. How are you feeling about this as our last meeting? Remember, we are always here for you for questions or if something else arises that we can help you with.
TERMINATION OF SESSIONS
This assists in taking away the anxiety of “losing support” suddenly and without notice. A client might believe that he/she only gets to see you once, others might believe they get to see you indefinitely.
This sets your boundaries and shows that there can still be flexibility if the need arises.
Always, always remind them that they can come back for support any time they need it, or if another incident of domestic violence occurs, etc.
CINDY
Cindy comes to your office after a recent visit with her sister. During their visit, Cindy
wanted to address the childhood sexual assault she and her sister experienced at the hands of their father. Her sister refused to allow the discussion and event denied the abuse ever
happened. Since Cindy came back 3 days ago, she has been very tearful and angry. Cindy
has been experiencing nightmares and flashbacks since she returned. Cindy stated
she “wants to write a letter to her sister confronting her about what happened.”
During session 2, Cindy comes in straight after work where she had a very “intense” fight with her new boss. She has been at this job for 3 weeks. Cindy is so upset you can barely understand her at first. Once she can speak more clearly she tells you about how her boss accused her of something she did not do. Cindy contemplates whether this job is the right one for her. You assess two things immediately: 1) Cindy is in no state for you to termination the session; 2) It is clear she is in no state or mood to discuss her original reasons for coming in.
During session 3, Cindy wants to discuss how her boyfriend has not been supportive of her during the issue with her new boss. She also wants to continue discussing the stress of this job and whether or not she wants to stay after what happened last week. When you attempt to bring up the original reason Cindy came in (the letter to her sister) and she states “I don’t really want to talk about that.” You try to explore the reasons for this and she simply states “I was just upset. I don’t want to get into it with her; if she wants to deny it, that’s her problem, not mine.” She then goes back to talking about her stress at work.
JADA
Jada is a 14 year old female who was brought to you by her parents; this was a referral from her therapist after
Jada disclosed that she was recently assaulted over Winter Break by a classmate. Jada stated her therapist is
a family counselor and does not feel her information is confidential and was not comfortable discussing the rape with her. Jada tells you she is overwhelmed, angry, and
sad. She states that she and her mother “do not get along, especially lately” because her parents are having martial
issues. Jada relies mostly on her best friend and her boyfriend for support. One of the things she brings up a few times is that now when she passes the perpetrator in
the halls, she puts her head down, looks away or does other things to feel “invisible” and she is not used to this –
she is used to “walking tall.”
During the 5th session (of a 6 session format) Jada tells you she has been “cutting” as an emotional release. As you are planning coping skills to combat the cutting, she asks you “What’s the point?” When you explore further, she means “what’s the point of life?” She has a detailed plan and access to the means she states for completing suicide.
Session 6 is the first interaction you have had with Jada since the Baker Act from session 5 – and was intended to be the last session. Jada states that she is feeling better about living and glad that she went. Jada states that the rape is no longer her primary concern. As the advocate you recognize that there are many other life factors that Jada is dealing with – limited support system (her best friend is moving out of state and she now has limited interaction with her boyfriend), distraught family system (her mother and father are divorcing – her mother cheated on the father with a family member of Jada’s boyfriend), and her grades are becoming slightly – though not concerningly - impacted so she has been trying to focus more on school. Jada states she is now able to “walk tall through the halls” and even “looked him straight in the eyes last week.”
Anne
Anne is a 34 year old female who comes into the office after an “incident at the Salvation Army from a few weeks
ago.” Anne stated the Salvation Army Social Services recommended she come to SPARCC to deal with after
effects of the “incident.” Anne discloses that the incident involved her being inappropriately touched by another person staying at the Salvation Army – she cites that it
was not a “big deal” but has been bringing up issues related to previous rapes she has been through. Anne is most concerned with “why” she keeps “bringing this on
herself” and wants to know how to change it. Anne discloses that the first attack on her was when she was 8 years old – she was molested by her friend’s grandfather and firmly states “I know it was my fault. I know I must
have done something for him to have done that to me.
During the 1st session with Anne, you realize one of her main issues stems from many years of guilt from the molestation at 8 years old. You explore this topic with her – asking her to build a picture of what her 8 year old life was like. Anne discloses her “home was not a home, it was dark, scary, and lonely.” She clarifies that her home was not abusive, but that her mother was always working or with men (most often away from the home) and her two older sisters were “much older” and were unconcerned with her “in general.” The friend she had whose grandfather molested her “was the first person who seemed like she wanted me around and so I spent all summer there.” The first molestation occurred 2 months after she had been going there and went on for about 2 months after it started.
Session 4 is scheduled to be your last session. Anne has reviewed the 4 most significant sexual violations her life in regards to “fault.” She states that she has some clarity and a better understanding of not being to blame for the attacks when she was 8, 11, and 14. She states that she continues to struggle with not blaming her self for the attack when she was in her 20s and for living with an abusive husband for over 10 years – she states she often is torn about returning to him. Anne has shared that her self-esteem is very low and sometimes she is “depressed” over all these “issues” in her life. She is very grateful for her time with you and wants to continue seeing you.
PRACTICAL ACTIVITIES
Web of Sexual Violence
