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Chapter 10: Prevention and Crisis Intervention Services
Chapter Overview
The authors examine intervention models, methods of crisis management, and crisis intervention
strategies as a basis for responding in an ethical and long lasting way to crisis situations. The authors
discuss suicide as a response to crisis and concepts relating to death, dying, and other trauma.
Multicultural and ethical issues are explored with regard to working with underserved populations.
Key Words
Beneficience – A principle of bioethics that asserts an obligation to act for the benefit of others.
nonmaleficence, a principle of bioethics that asserts an obligation not to inflict harm intentionally.
Social Justice – That all persons, irrespective of ethnic origin, gender, possessions, race, religion, etc, are
to be treated equally and without prejudice.
Social Action - Individual or group behavior organized toward social reform.
Advocacy - Active support of an idea or cause etc.; especially the act of pleading or arguing for
something.
Postvention - Support service actions that are taken after a suicide has occurred to help family, friends,
coworkers, or others cope with the loss.
Cyberbullying - Using the internet, cell phone, or other devices that are used to send, and post text or
images, to hurt or embarrass another person.
Bullycide - Suicide influenced by bullying and depression.
Multiple Choice Questions
1. Everly’s Crisis Intervention Principles state that crisis intervention techniques should consider
a) location, population, and readiness for intervention.
b) event, population, and immediacy to situation.
c) event, population, readiness for intervention, and client.
d) location, population, and client.
2. The most important crisis intervention skill is
a) communication
b) assessment
c) timing
d) the Intervention Model
3. Which of these is not part of the Resistance, Resilience, and Recovery Model?
a) Emotional immunity
b) Realistic understanding
c) Positive Cognitions
d) Stabilization
4. Crisis Intervention and Brief Counseling are similar in which way?
a) Both are temporary interventions
b) Both are focused on traumatic experiences
c) Both work to restore homeostasis to the client
d) Both are appropriate for severe responses to situations
5. To be effective crisis interventionists, mental health counselors need to have a thorough
understanding of
a) models and theories relevant to crisis intervention.
b) emotional and cognitive developmental models.
c) dynamics associated with critical incidents .
d) a. and c. only
e) All of the above
6. Which psychiatric disorder has the highest mortality rate to suicide?
a) Depression
b) Bipolar Disorder
c) Substance Abuse
d) Anorexia Nervosa
e) None of the Above
7. Who proposed the Interpersonal-Psychological Theory of Suicide (IPTS)?
a) Aaron Beck
b) Thomas Joiner
c) Durkheim
d) Edwin Shneidman
e) Marsha Linehan
8. The suicide prevention cycle includes which of the following?
a) Prevention, assessment, and intervention
b) Prevention, intervention, and postvention
c) Assessment, intervention, and postvention
d) None of the above
9. No-suicide contracts
a) have not been demonstrated to reduce suicide.
b) have questionable efficacy.
c) do not provide protection against liability.
d) are not recommended with certain populations.
e) All of the above
10. The process of cognitive restructuring with a suicidal client involves
a) exploring the client’s suicidal belief system.
b) suggesting the client reflect on poor judgments in the past.
c) efforts to solicit risk and protective factors.
d) assessing the client’s access to crisis management and emergency services.
e) None of the Above
11. What are the 5 stages of grief in Kubler-Ross’s model?
a) Denial, Apathy, Hopelessness, Acceptance, Integration
b) Denial, Anger, Bargaining, Depression, Acceptance
c) Denial, Anger, Apathy, Bargaining, Acceptance
d) Denial, Apathy, Hopelessness, Depression, Acceptance
e) None of the above
12. In crisis assessment, the first stage generally involves
a) identifying a plan for client safety.
b) directing the client to nearest shelter.
c) identifying the problem.
d) determining the client’s resources of people who can assist.
e) a. and b. are both correct
13. An important consideration for work with very recent trauma survivors is that
a) providing multiple details about trauma may be retraumatizing for the client
b) the counselor needs to observe the client for indications of dissociation
c) the counselor should be prepared to use grounding techniques to help center and focus
the client
d) sharing details about the trauma when and how the survivor is ready may be empowering.
e) All of the above
14. The purpose of the ASERVIC Spirituality Competencies are to
a) guide counselors in choosing religious affiliations that match the ACA and ASERVIC
missions.
b) provide ethical guidelines for counselors in attending funerals and other issues related to
client death and dying.
c) guide counselors in providing answers to client questions about God, religion, and other
spirituality-related matters.
d) support counselors in clarifying their own belief systems while supporting clients in their own
worldviews.
e) All of the above
15. As a strategy for addressing the needs of underserved communities, the authors
recommended that counselors
a) implement evidence-based practices with a cultural knowledge of the needs of marginalized
groups
b) develop new counseling theories that are specifically focused on marginalized groups
c) apply cognitive-behavioral therapy consistently, following the established protocols
universally with all clients
d) only practice with cultures to which we have previously been exposed
e) None of the above.
Activities
1. Consider a time when something unpleasant happened to you that for which you were unprepared.
Journal your responses, with regard to vulnerability, safety, emotional reaction, meaning, and sense of
support.
2. Have students independently write about what aspects of speaking about suicide and engaging with
suicidal clients they fear most, then have them write about the aspects of suicide and its prevention and
intervention they believe they are already or will be comfortable with. Next, have students break into
small groups and discuss the two lists they created in anticipation of working with suicidal clients. The
more quickly and frequently you get students to say the word “suicide” and discuss it among peers, the
more likely they will become comfortable interfacing with clients (and colleagues) about this clinical
emergency.
3. Consider what you’ve read about the process of assessment, and the populations who are underserved
by rape crisis and domestic violence services. With that in mind, choose an underserved population and
identify at least one research or practice-based article that addresses crisis assessment with this
population. In a 4- to 5-page paper, include an overview about the population, the types of crises that the
article discussed, the problems identified by the article (such as lack of reporting, poor preparation for
crisis workers, etc.), and a recommended intervention that could be carried out to address the need.
Outline specific action-steps that you believe you could carry out in addressing this need.
4. One of the most challenging experiences for new counselors is to recognize that not all problems can
be fixed, and that counseling is not a process that will consistently be a happy ending. In the protection of
client confidentiality, counselors often are not able to attend the funeral of a client, thus depriving them of
an important cultural ritual that others in the client’s life are able to experience. Identify at least one
resource that discusses counseling work with people who are terminally ill and dying. Consider this with
the other information discussed in this chapter. With that in mind, identify in a 4- to 5-page paper your
own process for maintaining wellness during the passing of a client. Describe three strategies that you
will employ to care for yourself through this experience.
5. Have students research a recent disaster, crisis, or traumatic event that has received significant media
attention. Have them analyze the event using two different theoretical conceptualizations. Then apply an
intervention model. Ask students to be specific with how they would implement the model.
6. Have students locate three articles on legal and ethical issues related to working with suicidal clients.
Ask them to write a brief paper comparing and contrasting the articles in an effort to become more
familiar with these aspects.
7. Part of our effort as instructors is to help students recognize the real-world experiences of crisis
assessment. Engage the students to describe their strengths and barriers in this work, focusing attention on
the ability to respond flexibly to clients who can be in any of a variety of situations, and how they will
manage the stress of “not knowing” what the next call will be, the challenges of keeping people calm
while seeking information, and the need to quickly find community resources. For a group exercise,
provide students with the assignment to research community resources in a particular crisis area (either
that they pick or that you assign). Have them prepare a presentation for class that demonstrates
knowledge of the client crisis, area resources that serve this client population, specific skills needed by
crisis workers with this client population, and ideas for advocacy to improve services offered to the
population.
Discussion Questions
1. Students and new counselors are often very fearful of facing issues of death and dying in their future
clinical work. This will be true of working with clients who are dying, as well as bereaving clients.
Students often anticipate feeling helpless in supporting a person through what they see as an unworkable
problem. One of the clearest ways to address this is to talk openly about how they expect these counseling
relationships to present. Open up a student dialogue that centers around activities that they see as their
biggest barriers in counseling on death and dying issues; or the challenges of working from within a client
belief system about death and dying that may be different from the student’s own. Have the students
identify how they might utilize a client strengths-based approach in identifying client resources and
strategies for healing.
2. Choose one of the following continuations of the case of Tracy to answer the questions:
As a member of the university’s Critical Incident Stress team, you are called out to work with the
students.
A. You approach Tracy, who is clearly upset. She is crying and repeating the same statement, “That is all
I owned, all of my work, I don’t even have money to go home.”
B. You approach Tracy, who is subdued. You ask her how she is doing and she states, “I have been better.
I am just so thankful that everyone got out. Everything I lost is replaceable.”
Questions:
• How will you help support her in the immediate response and 2 weeks later?
• Which model will you use to intervene and why did you choose that model?
3. Understanding theories related to suicide is important in helping counselors to understand the context
of the suicidal mind and suicidal thinking. Select two theories that appear to conform to your own
theoretical approach to counseling and compare and contrast them, identifying those portions of the
theories that mesh with your approach and those portions that are potentially in conflict with your
approach. How might you adjust your approach to mitigate the conflict? How will you infuse theories
into your practice in working with suicidal clients?
4. As described, different cultures can treat death and dying very differently. How is death conceptualized
within your culture? Is there a particular grief ritual that is followed? How do people generally treat their
relationship with the deceased after death? What are the most significant support strategies that you see
for grieving people in your culture? What do you see people in your culture most needing, but not
getting?
Multiple Choice Questions – Answer Key
