Introduction: Crisis Counseling: Strategies and Interventions to Safely Manage Clients — A Lecture
Dr. Harry Keene’s lecture will focus on the crises of lethality and addiction, and on diagnosis and treatment of problems for both clients and counselors. He tells attendees to keep their minds on their roles and their perceptions and biases.
Learning from Crises (10:07)
Dr. Keener talks about his first client, a suicidal and homicidal woman; he was unprepared. There are different types of crises. There are opportunities to grow and change in dealing with crises, but there is danger in getting tunnel vision.
Crisis Management (10:10)
In crisis counseling there is a sense of urgency and a need for safety, showing calmness and confidence, and building trust quickly. The techniques for dealing with people in crisis are to listen, to reflect their feelings, to clarify and summarize what they are saying, and to instill hope.
Keeping Clients Safe (14:09)
People in crisis feel like they do not have any power and control, so aggression and suicide become ways to take control. Counselors need to build rapport with clients to de-escalate them from crises. Dr. Keener refers to assessment resources counselors can use and talks about managing clients in an outpatient setting.
Suicide Statistics (14:34)
Suicide can become a fixed pattern in a family. Looking at statistics of who is most likely to commit suicide can help determine who is most at risk. There is an absence of suicide statistics on LGBTQ populations and veterans. Determining whether drug overdoses are suicides is difficult.
Risk Factors (17:34)
Legal, ethical, and moral issues affect crisis counselors, particularly in regard to legalized assisted suicide. There are several risk factors to take into account regarding assessment and liability issues. Risk factors to focus on are lack of meaning and purpose in life, distorted thinking patterns and impulsivity, and dichotomous thinking
Tools and Resources (09:50)
There are protective factors that counselors can identify to promote and develop in clients. Counselors should be aware of resources for dealing with post-suicide trauma and assessment of suicide risk. They should talk openly about suicide myths with clients and gather risk assessment information with intake.
Suicide Prevention Strategies (09:54)
Trust your gut when dealing with at-risk clients, but follow your company procedure. Talk with the client to de-escalate the crisis. If they will not stay or voluntarily go to the hospital, call the police. Follow a process of engagement, determine risk and protective factors, assess risk, and create documentation.
Legal Issues (13:36)
Confidentiality laws protect mental health workers. If the client presents a danger to someone, professionals are mandated to tell authorities and potential victims, but they do not have to tell the client that they reported on him or her. If a client harms himself, a mental health worker may be held responsible.
Aggressive Behavior (10:05)
Health care workers can become victims of aggression from clients. Aggression can be cause by static factors that cannot be changed or dynamic factors that can be controlled. Young males statistically are most prone to violence.
Identifying Aggression (16:48)
An attendee brings up the problem of violence from families and associates of clients. Mental health care workers should be aware of early signs of agitation in clients and begin verbal de-escalation. Clinics should create plans and systems to deal with angry clients, including design of physical space.
De-escalation Techniques (16:49)
Show an aggressive client that you are confident and can help them using techniques of de-escalation. Manage your own feelings when dealing with angry clients. Physical restraint should be used as a last resort. There are different kinds of aggression and appropriate techniques should be used to diffuse them.
Dealing with Risk (11:38)
Clients who suffer from delusions can put themselves and others at risk. Statistics show less hospital beds, but a stronger court system for psychiatric patients. Law enforcement has a bigger role in helping deal with aggressive, homicidal, or suicidal clients. Mental health workers should consider getting personal liability insurance.
Being Prepared (15:13)
Mental health workers should regularly look at their caseloads and see who is most at risk. Coordination between different public entities and more police having crisis intervention training has had positive outcomes. Long-term therapy and termination of counseling can lead to anxiety and depression and mental health workers should be proactive in assessing risk factors.
Personality Disorders (10:04)
Individuals that suffer from personality disorders have skills deficits that can be changed through counseling or drug therapy. These disorders are often diagnosed with gender bias. Those with narcissistic personality disorder are very difficult to work with in therapy.
Legal Concerns (12:09)
Confidentiality is protected by state law - with special exceptions regarding child and adult abuse and neglect. Dr. Keener relates two cases where practitioners failed to report sexual abuse. He suggests keeping detailed progress notes in the event a client files a complaint.
Crisis of Addiction (13:45)
With increased rates of drug abuse, there are increased risk factors regarding suicide. Drug abuse may underlie mental health disorders and an accurate diagnosis cannot be made. For clients with substance abuse problems one should consider various options for treatment and recovery.
Medication Management (13:34)
Mental health counselors need a baseline knowledge of the six classes of psychotropic medicines. Many clients do not know what their diagnoses, treatment plans, and goals are and what medications they are taking. It is Important to know what medications one’s clients are taking.
Working with Medications (19:15)
The chemical imbalance theory of mental health is only partially supported. A combination of lifestyle changes, counselling, and medication can be helpful in managing depression. Counselors should talk with clients about normal effects and side effects of medicines and issues about getting off them.
Benefits and Risks (17:30)
Treatment with antidepressants can restore brain-derived neurotrophic factor level, which is a marker of depression. Long-term-use of antidepressants can cause side effects leading to depression and crisis situations. Antipsychotics and mood stabilizing drugs can also have risky side effects.
Risks of Medications (18:17)
Other classes of drugs used in mental health therapy—anti anxiety drugs, cognitive enhancers, stimulants, sedatives, and hypnotics—present short and long-term risks.
New and Old Therapies (11:03)
Medications can be important for managing mental health issues, but there can be problems with medication compliance. There are new drugs and new applications of older drugs that have proved successful with mental health diseases. Magnetic and electro therapies should be considered when other therapies do not work.
Because of a high rate of misdiagnosis, mental health care professionals should learn much about their clients. Dr. Keener tells of how his father’s condition was misdiagnosed for years. A 1973 study revealed a huge problem with misdiagnosis. Standards for measuring ADHD can result in misdiagnosis.
Appropriate Therapies (18:50)
Non-compliance, self-medication, substance abuse, and medical issues can lead to health risks and crisis situations. Mental health workers should look to appropriate drug therapies, non-medical therapies, and lifestyle changes that are successful for clients’ wellness.
Professional Crisis (09:21)
Mental health and human service workers have increasing rates of mental health issues, leading to ethical and legal issues. Dr. Keener describes cases of a mental health worker with alcohol abuse problems and others who had sexual relations with clients.
The causes of burnout are excessive workloads, issues of control, lack of reward, and absence of a supportive community. Added stressors are compassion fatigue, vicarious trauma, empathy and responsibility. Support and supervision from the workplace, a good work/life balance, and self-care are ways to avoid it.
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