Common Client Issues in Counselling An Australian Perspective Crisis

86 Crisis CLAIRE AND CLAIRE ABSTRACT This chapter provides a foundation for understanding the nature ofa crisis , how a person may be impacted by a crisis , and the models , processes , and strategies a crisis counsellor uses to assess and intervene when people in crisis seek help and support . With an emphasis on how crisis intervention differs from other counselling interventions , a case study is provided with the aim to help the reader reflect on and apply relevant crisis models of assessment and intervention learned in this chapter . Further differentiation is made between crisis stressors resulting in exposure to a traumatic event and ongoing traumatic stress responses requiring term counselling , psychiatric services , or specialised mental health intervention . Due to the nature of crisis work , there is a high prevalence of burnout and stress in this field . As such , counsellors working in crisis work need to practice , regular clinical supervision , and the continuing maintenance of the counsellors general health and wellbeing . Learning Objectives Describe the nature of crisis . Identify the types of crisis . Recognise and understand common emotional , physical , behavioural , and cognitive reactions of people in crisis . Analyse the major theories underpinning crisis counselling interventions . Examine the importance and role of the therapeutic relationship within crisis counselling . Apprehend the ethical implications and professional issues of crisis intervention . Identify trauma definitions , assessment , and treatment approaches . Identify and reflect on your own personal history and experiences of crisis , including responses . Recognise and understand the impact of crisis counselling work on the counsellor and the need to implement practices and stress management strategies . INTRODUCTION We live in a world where millions of people are confronted with events each year that they can not cope with or resolve on their own and , therefore , will often seek help from counsellors . Examples of events include natural disasters such as , sexual assaults , terrorist attacks , the death 86

87 of a loved one , a suicide attempt , domestic violence , relationship breakdown , retirement , promotion , and demotion , change in school status , pregnancy , divorce , physical illness , unemployment , and more recently , a world pandemic . These situations can be a turning point in a person one of growth , strength , and opportunity or health decline , dysfunction , and emotional illness ( Roberts , 1995 Roberts , 2005 et , 2009 ) When people experience a crisis , it is the support they receive during and immediately after the crisis that often plays a crucial part in determining the impact ofthe crisis on their lives ( France , 2014 ) Therefore , it is imperative crisis counsellors have the understanding , skills , and knowledge to offer a term intervention that assists people in crisis to cope , stabilise and receive the support and resources they need . WHAT IS A CRISIS ?

When a person experiences a crisis , they experience severe disruption of their psychological equilibrium and are unable to use their usual ways of coping . This then results in a state of disequilibrium and impaired functioning ( Lewis Roberts , 2001 Roberts , 2005 ) Because the person is unable to draw on their everyday methods during a crisis , and there is a sense of diminished control over the events and limited options , they may experience confusion or bewilderment ( Hendricks , 1985 , 1995 ) Crisis states are temporary , lasting from hours through to an estimated six weeks , as the body can not sustain being off balance or in a state of disequilibrium , indefinitely . Resolving a crisis effectively may take some months , and this may involve learning new skills , the situation differently , or adapting to the new situation . Because people may resolve the crisis in a or adaptive manner , some may be impacted by various mental health conditions such as depression , substance abuse , or stress disorder ( Roberts , 2005 ) There are four types of crises that a person may experience and include developmental crisis or crisis in the life cycle ( adjustments to transitions such as ageing , parenting ) situational crisis ( sexual assault , natural disaster , car accident ) existential crisis ( inner turmoil or conflicts in relation to the way a person lives their life , and views of their meaning and purpose ) systemic crisis ( the impact of colonisation on our First nations people or the 2009 Victorian Black Saturday ) James , 2008 ) CRISIS IS IN THE EYE OF THE BEHOLDER It is important to note the difficult task of defining a crisis . This is due to the subjectivity of the concept . Although the main reason for a crisis is usually preceded by a traumatic or hazardous event , it is imperative to realise that the individuals perception of the event and their inability to cope with the event are two other conditions to consider . Focusing only on the event suggests that one can categorise a crisis but that all people may respond in the same manner to a particular event . Thus , it is not the actual event that activates a crisis state , but how a person interprets or perceives these events , how they cope , and the degree to which they have access to social resources , that determine how they respond . In other words , crisis is in the eye of the beholder ( et , 2009 Martin , 2020 ) This perception is influenced by several factors in a person life , such as , biological , gender , culture , attachment style , previous life experiences , social context , personal values , level of resilience , influences , availability of social support , previous trauma , and history of major mental illness ( 201 Roberts , 2005 ) It is also important to understand that people who are reacting to a crisis are not necessarily showing pathological responses but normal crisis responses to an abnormal event ( Bateman , 2010 et , 2007 james , 2008 )

88 PRINCIPLES AND CHARACTERISTICS OF CRISIS The following principles and characteristics help to create an understanding of the nature of a crisis , and emphasise not only the important work of a crisis counsellor but the values and philosophical assumptions that need to guide their practice crisis embodies both danger and opportunity for the person experiencing the crisis crisis contains the seeds of growth and impetus for change crisis is usually time limited but may develop into a prolonged crisis if the person experiences a series of stressful situations after the crisis crisis is often complex and difficult to resolve a crisis experiences of crisis in their personal life may greatly enhance their effectiveness in crisis intervention quick fixes may not be applicable to many crisis situations crisis confronts people with choices emotional disequilibrium or disorganization accompany crisis the resolution of crisis and the personhood of crisis workers interrelate ( James , 2008 , 19 ) Learning activity . How do you think your previous life experiences of crisis may increase your effectiveness as a crisis counsellor ?

What personal qualities do you possess that may enhance an intervention that you use with a person who has experienced a crisis ?

What are the risks of having unresolved crisis experiences as a counsellor , and how might this impact your effectiveness in crisis work ?

COMMON REACTIONS TO A CRISIS Listed here are some of the common reactions a person might experience , which are normal responses given the abnormality of the event they have experienced .

CRISIS 89 Table Common reactions to a crisis Physical Emotional headaches disbelief , shock , feeling numb . exhaustion , fatigue ' sleeping helplessness and hopelessness . anger , tY hot or cold sensations ' Shame loss of appetite or increase in appetite ' breathing difficulties nausea trembling , heart palpitations Behavioural Cognitive ' Subdued flashbacks of the event ' Withdraw confusion and disorientation ' Crying dreams and nightmares about the event increased use and drugs . poor memory avoidance of the reminders of the trauma . in making , decisions unable to express emotions . to Concentrate unmotivated , not wanting to go to work Table content sourced from et , 2021 ) used under a BY licence and et , 2013 ) used under a licence . Learning activity Imagine your life on a timeline from when you were born up until today . On this timeline , plot the most important or critical events ( positive or negative ) in your life that were turning points or changed you in some way . Looking at the critical events on your timeline , which events would you see as a crisis ?

How did those events change you ?

WHAT IS CRISIS COUNSELLING ?

Crisis counselling is an immediate response to people experiencing overwhelming events and may prevent the potential negative impact of psychological trauma . It focuses on the here and now , dealing with the immediate presenting needs at the point of crisis , and providing emergency psychological care to assist in helping the person return to an adaptive level of functioning ( 2000 et , 2007 ) The key goals that underpin crisis counselling and models are meeting the person who is experiencing a crisis where they are at assessing and monitoring the person level of risk assisting them in mobilising of resources stabilising ( by reducing distress improved or restored adaptive functioning ( where possible ) Roberts , 2005 )

THE DIFFERENCE BETWEEN CRISIS COUNSELLING AND OTHER COUNSELLING INTERVENTIONS Crisis counselling is different to the provision of ongoing therapeutic support . Because crisis counselling offers strategies to prevent damage during and immediately after the person has experienced a crisis or devastating event , it requires that the counsellor be more active and directive than usual ( James , 2008 ) Ongoing counselling may follow on from crisis to ensure the improvement of a person mental health and wellbeing , but this is not the goal of crisis counselling . Instead , the goal is to provide a responsive and timely intervention to return a person to previous levels of functioning through the implementation of mobilising necessary resources , including the facilitation of links to these resources ( 2000 ) Given crisis counselling is the implementation of a measure of support , it is often referred to as brief intervention or brief therapy . The timeframe for crisis counselling is between six to ten weeks and is guided by specific relevant models , guiding principles , and actions ( Hendricks , 1985 ) Case study A crisis You are part of a mobile service team who travels to a area to provide support to individuals , families and emergency services workers affected by the recent . You arrive at a regional town that has just been devastated by catastrophic . A recovery centre has been set up at the local town hall and 700 individuals and families are presently seeking support at this recovery centre . You are assigned to Brett ( 35 ) a cattle farmer whose property , livestock , and beloved dog were lost in the fires . Brett is a cattle farmer on his family property . Within the first few minutes of meeting him , you observe that recalling these events for him results in constant tearfulness , and a questioning ofwhat he could have done to be more prepared to have a different outcome . Brett explains that he has not slept in several days , and if he does sleep , he has nightmares . He also expresses to you that he does not know what the future holds for him now . Brett explains that he can not focus for very long because he finds it difficult to believe this has happened to him . You observe that Brett appears to be numb and detached and unable to articulate his narrative in a linear and clear manner . Brett explains that he feels concerned for his ten employees who are no longer able to support their families . He also mentions that recently he went through a divorce which he felt devastated by at the time . Learning activity . From Brett reactions , what suggests that he is experiencing a crisis ?

What is the contributing factor that disrupts Brett equilibrium most ?

is it the nature of the crisis event itself or the way Brett responds ?

Are there any risk factors to consider in Brett case ?

TRAUMATIC STRESS , CRISIS , AND TRAUMA The term crisis is not interchangeable with traumatic stress and trauma . and ( 2003 ) explain a person is in a crisis state when they have experienced a situation or event and they have been unable to cope with it by utilising their usual coping mechanisms to lessen the impact of the event . This results in the person entering a state of disequilibrium ( Roberts , 2005 ) Traumatic stress is when a crisis or event , such as child abuse , rape , combat trauma , and catastrophic natural disasters , overwhelms normal coping skills and is perceived as ( Reid , 2002 )

91 Trauma can be defined as an experience of extreme stress or shock that was , at some point , part of life ( 2014 ) It is adaptive and normal for a person who has been exposed to a traumatic event to exhibit some anxiety in the early stages as this enables them to maintain vigilance as a way to increase safety . Others may feel numb after being exposed to a traumatic event . This is also an adaptive and normal response as insulation is provided to a person psychological system after the traumatic event ( McNally et , 2003 ) Those who do experience a traumatic injury can suffer from consequences that impact them physically , cognitively , emotionally , and financially ( et , 2021 ) It is common for acute stress symptoms to be experienced after a traumatic event . When a person is exposed to a threat , neurotransmitters and hormones inform a physical response . The sympathetic nervous system is activated through a series of interconnected neurons that initiate a fight or flight response . The body releases glucose and adrenalin , increases heart rate and respiration , and remains in a state of high alert to manage any additional threat . At this point in time , the person is trying to make sense of their experience and is often feeling afraid and vulnerable as they attempt to rationalise whatjust occurred . Anxiety , loss of appetite , irritability , sleep difficulties , concentration difficulties , and can occur whilst in this physiological state . and Graham ( 2011 ) further explain that a person can have recurrent and involuntary memories of the traumatic event . A heightened state of arousal makes it difficult for them to respond normally , make decisions , and complete paperwork to link them to resources . Walsh ( 2007 ) explains that most people adapt and cope and therefore do not suffer disturbance . STRESS DISORDER Ongoing therapeutic support is required if a person continues to experience feelings of helplessness , intense fear or horror , the traumatic event , or emotional numbness . Norris et al . 2002 ) identified ongoing support to include counselling or psychiatric services , or specialised mental health intervention . People generally possess enough resilience to circumvent the development of trauma symptoms that inform a formal trauma diagnosis , such as stress disorder . The classifies as an anxiety disorder that can develop after exposure to a traumatic event ( American Psychiatric Association APA , 2022 ) 2002 ) reported that 57 of the Australian population reported a lifetime experience of a specified trauma . There are four different categories can be clustered into ( recurrent of the traumatic event in the form of intrusive thoughts , nightmares , or flashbacks ( numbing and avoidance of stimuli ( and reactivity and ( alterations in and mood ( APA , 2022 ) THE ORIGINS AND DEVELOPMENT OF CRISIS COUNSELLING INTERVENTIONS The research and development of crisis intervention originates in the 1940 when the reactions of people whose loved ones had died in a fire at a nightclub in Boston in 1943 were recorded and studied by psychiatrist Erich and his colleagues ( 1944 ) Another psychiatrist , Gerald , expanded on this work and developed a model of crisis reactions ( or phases of reactions that a person in a crisis may experience ) which have formed the foundation for later contributions from theorists in crisis counselling . 1961 , 1964 ) describes these phases as follows Phase increase in tension and distress from the event Phase there is an escalation in the disruption of the person life as they are stuck and can not resolve the crisis quickly Phase the person can not resolve the crisis through their usual methods Phase the person resolves the crisis by mental collapse or deterioration , or they partially resolve it by adopting new ways of coping . 1963 ) stage model of developmental crises and Roberts ( 1995 ) crisis intervention

92 model have led to the development of numerous crisis intervention models , particularly in the last two decades . focus was on World War II veterans disconnect from their culture together with the confusion associated with the traumatic war experiences rather than focusing on men suffering from repressed conflicts . assessed that veterans were experiencing confusion of identity about what they were and who they were in direct opposition to the lens of repressed conflict being used during this time period . CHARACTERISTICS OF THE CRISIS COUNSELLOR The crisis counsellor ability to remain calm and simultaneously avoid subjective involvement in the crisis is crucial . This means that crisis counselling may not be suitable for every counsellor ( Shapiro , 1996 ) A crisis counsellor should communicate in a manner that is patient , sensitive , and compassionate . Other characteristics and behaviours include warmth , understanding and acceptance , being available but not intrusive or controlling , trustworthy , empathic , caring , displaying effective listening skills , encouraging the person seeking appropriate referrals and support , and being able to maintain confidentiality ( Bateman , 2010 Rainer Brown , 2011 , 2003 ) The crisis counsellor aims to establish a therapeutic relationship as they do in general counselling , however in crisis counselling , they do so in a shorter period . Other crisis intervention skills include encouragement , basic attending and listening skills , reflection of emotions , and instilling hope ( 2007 James , 2008 ) KEY CRISIS INTERVENTIONS As mentioned previously , crisis intervention provides the opportunity for the crisis counsellor to help facilitate an independent process with the client by promoting them as the agent in their life and assisting them to identify and utilise their own resources ( France , 2014 ) When determining if crisis intervention is the most relevant intervention , several categories are to be considered . These include a cumulative effect the impact on a person their family and community the unexpectedness and duration of the event or situation and a person level of control over the event or situation ( Hendricks , 1985 ) CRITICAL INCIDENT STRESS DEBRIEFING Developed in 1974 Mitchell , critical incident stress debriefing ( or psychological debriefing is a supportive crisis intervention process that was initially used with small groups of first responders such as firefighters , paramedics , and police officers to help them manage their reactions and

93 distress following their exposure to a traumatic event ( Mitchell , 1983 ) Over time , became an intervention used with groups outside of emergency services , such as hospitals , businesses , schools , community groups and churches . However , although is used extensively , current research shows mixed results for the use of this intervention with some findings suggesting that it is ineffective in preventing stress disorder ( symptoms and even contributing to the worsening of symptoms in individuals who received this type of intervention ( 2003 ) The next section will address assessment in crisis intervention followed by an outline of two key crisis interventions , Roberts model of crisis intervention and psychological first aid , and an application of these interventions to Brett case . ASSESSMENT IN CRISIS INTERVENTION The responsibility of the crisis counsellor is to conduct a structured assessment in a timely and responsive manner to assess whether psychological homeostasis has been disrupted , there is evidence of dysfunction and distress , and usual coping mechanisms are not able to be utilised . Assessment is ongoing throughout the intervention process and allows the crisis counsellor to evaluate the person affective and cognitive state , and behavioural functioning . By assessing these three areas , the crisis counsellor can evaluate and monitor how adaptively or the person is functioning , including whether they are a danger to themselves or others , and then apply the most appropriate intervention ( James , 2008 ) Listed below are examples of what a crisis counsellor is looking for across the three domains when assessing people who have experienced a crisis Do they appear to be emotionally overwhelmed or severely withdrawn ?

Is what they are saying coherent and logical or are they not making sense ?

When observing their behaviours , are they pacing ?

Are they having difficulty breathing ?

Are they able to sit calmly ?

Are they unresponsive ?

When people express suicidal ideation or have a plan to suicide , it is crucial to conduct a rapid suicide risk assessment which includes gathering information by inquiring about the following How long they have been having suicidal thoughts ?

Have they made any suicide attempts in the past ?

Have they recently sought help ?

Do they have a plan to suicide ?

If they do have a plan , do they have access to the means to carry out this plan ?

Further information and guidelines on suicide risk assessment can be found at the end of this chapter in the Recommended referral and resources list section . There is also a specific chapter in this book related to suicide .

94 phone counselling and support There is a range of organisations in Australia that provide support for people who are in crisis and need to talk to someone about their distress . Due to their convenience , accessibility , and relative anonymity , these are a common form of crisis support . Lifeline Australia 13 11 14 1300 22 4636 Australia 1300 78 99 78 Kids Help Line 1800 551800 1800 737 732 ROBERTS CRISIS MODEL Roberts ( 1995 , 2005 ) model of crisis intervention is a based , systematic , and structured model used for crisis assessment and intervention . It is a common model used by crisis counsellors to help people build and restore their ways of coping and improve their skills that a crisis may evoke . With a focus on strengths and resiliency , these sequential stages can be applied to a broad range of crisis situations and are as follows plan and conduct a thorough assessment including , danger to self and others , imminent danger , lethality make psychological contact , establish rapport and rapidly establish the collaborative relationship by showing genuine respect for the individual and having a attitude identify major problems or the dimensions of the problems including the precipitating event encourage exploration of feelings and emotions including active listening , reassurance and validation generate and explore alternatives including untapped resources and new coping strategies develop and formulate an action plan plan and leave the door open for booster sessions which may occur three to six months later ( Roberts , 2005 , PSYCHOLOGICAL FIRST AID Identified as the first level of care , psychological first aid is an model that provides emotional and practical support to individuals , groups , and communities impacted by a natural disaster , catastrophic event , traumatic or terrorist event , or another emergency situation ( Australian Red Cross Australian Psychological Society , 2010 et , 2007 ) The aim of psychological first aid is to help people

95 reduce their initial symptoms , have their current needs met , and support them in implementing adaptive coping strategies . Psychological first aid meets the following four basic standards . Consistent with evidence and research on risk and resilience following trauma ( that is , informed ) Applicable and practical in field settings ( compared with a professional office somewhere ) Appropriate for developmental levels across the lifespan ( there are different techniques available for supporting children , adolescents , and adults ) Culturally informed and delivered in a flexible manner , as it is often offered by members ofthe same community as the supported individuals ( et , 2007 ) Psychological first aid is based on the understanding that , just as natural disasters , catastrophic events , traumatic or terrorist events , or other emergency situation differ vastly from each other , so do the psychological reactions of individuals , groups and communities experiencing them . Because some of these reactions can interfere with an individual ability to cope and manage the crisis , psychological first aid can help in their recovery . Psychological first aid has five basic elements that are to promote . safety calmness ( connectedness hope ( et , 2007 ) Case study Crisis Roberts model of crisis intervention Using Roberts ( 2005 ) model as an intervention with Brett , your first step is to conduct a psychosocial and lethality assessment . As he tells his story to you , you need to gather information such as whether he has any emotional support , any medical needs , how he is coping , and whether he is currently using any drugs alcohol . Assessing any imminent danger and ascertaining whether Brett may be at risk of suicide is also a priority in this initial stage , Although in this case , Brett may not talk about having suicidal thoughts ( suicidal ideation ) or have a suicide plan , he does say , I do know what the future holds for me now , which at this point would prompt a probing question in checking what he means . It would be important to consider other risk factors , such as previous mental health issues , being socially isolated , or recently experienced a significant loss ( for example , Brett has recently divorced which may be a risk factor in his case ) The second stage is about building rapport with Brett which you may have established already from taking the time to be present and hear his story in the assessment stage . This stage is crucial in developing a therapeutic relationship with Brett and , therefore , it is important you show a genuine interest in his story , respect and accept him , and also display fundamental qualities and characteristics of a crisis counsellor as discussed earlier in the chapter . Crisis intervention is focused on the major problems , so in this next stage , you are wanting to find out why Brett has sought help now . This might seem obvious as you might assume it is the devastation of the fire , This may not be the priority issue , therefore , at this point you are not only finding out about the event that was the last straw but you are also helping Brett prioritise the problems to work through . It is important that you gain an understanding of why those problems make it a crisis for him . In stage four of this model ( encourage exploration of feelings and emotions ) you are actively listening to Brett

96 story , allowing him to express and vent his feelings , and giving him the opportunity to articulate what it is about the situation that is making it difficult for him to cope . You may challenge some of his responses by giving him correct information and his statements and interpretations about the situation , Generating and exploring alternatives ( stage ) can be tricky as the timing needs to be appropriate to help Brett explore options in moving forward to resolve the crisis . If you have established rapport , listened to his story , and Brett feels heard and understood , he may be more open to this , A strategy may include asking Brett , How have you coped in the past when you been through a crisis and felt the same way you do . Stage six includes implementing an action plan to address some of the problems he has identified , for example , making an appointment with his general practitioner regarding the poor sleep patterns he is experiencing . This stage also involves asking questions that may help Brett make meaning from the crisis such as , Why did this happen ?

What does it mean ?

What are the alternatives that could have been put in place to prevent the event ?

Who was involved ?

and What responses to the crisis potentially made it worse ( cognitively and ) Roberts , 2005 ) The final stage is planning to follow up with Brett two to six weeks later in order to evaluate if the crisis is being resolved , and to also check his physical and cognitive state , how his overall functioning is , any stressors and how he is handling them , and any referrals to external agencies such as housing , medical , legal etc . You may also schedule a booster session a month after this crisis intervention has been completed . Psychological first aid The application of psychological first aid to the case study requires an expansion of the five core principles of psychological first aid . In your immediate work with Brett , the intervention includes efforts to reduce his distress by modelling calm , and making Brett feel safe and secure identify and assist Brett with his current needs establish a human connection with Brett facilitate Brett social support help Brett understand the disaster and its context help Brett identify his own strengths and abilities to cope foster belief in Brett ability to cope give Brett hope assist with early screening for Brett needing further or specialised help promote adaptive functioning in Brett get Brett through the first period of and uncertainty set Brett up to be able to naturally recover from an event reduce the chance of stress disorder for Brett ( Australian Red Cross Australian Psychological Society , 2010 , 11 ) Brett is a independent Australian male farmer who may believe that expressing emotions or feelings is a sign . et al . 2003 ) explain that when an individual believes they are weak , going crazy or believes there is something wrong with me , an effective strategy in the intervention is to and reassure Brett you are neither sick nor crazy you are going through a crisis , and having a normal reaction to an abnormal situation , It is important to remind Brett that he is safe in order to minimise his vigilance . Promoting calm for Brett , immediately after his rural town was devastated by catastrophic bush fires , can assist Brett to foster positive emotions . It is advisable to intervene and limit Brett exposure to media coverage as this may trigger negative emotional states . The challenge

97 for you is to convince Brett that he does not need to be as vigilant and limit media exposure as all day exposure is too much ( 2001 ) THE CRISIS COUNSELLOR AND In their book , The Resilient Practitioner , and ( 2016 ) offer their insights and research on burnout and compassion fatigue for those in the helping profession and emphasise the importance of implementing strategies in its prevention . Given the demands of the work of a crisis counsellor and the risk of vicarious , protective and proactive approaches are imperative in the sustainability and vitality of a career where one is working intensely with human suffering and adversity . Tools and approaches , such as frequent supervision , high commitment to , creating a personal balance of caring for self and caring for others , and directly confronting stressors at work and at home , and ensuring that one has enriching relationships and activities outside of the work environment , are essential components in professional wellness and in the prevention of burnout and compassion fatigue ( et , 2014 , 2016 ) Learning The development of a plan can assist the crisis counsellor in supporting their wellbeing , reducing stress , and sustaining positive mental health in the . List five strategies that you might use to promote and enhance your mental health and wellbeing Counsellor reflections Due to the nature and intensity of the role , crisis counselling may not be a suitable specialisation of counselling for every counsellor . Based on my experience , this type of work requires a counsellor to have the ability to remain calm and operate in a systematic and rational manner whilst assessing a client level of instability and distress . Building rapport quickly with a client facing a crisis is vital to the effectiveness of the intervention , which highlights again how important it is for the crisis counsellor to show acceptance , empathy , and genuineness to the client . Working as a frontline crisis counsellor is demanding , and , therefore , it is imperative that ongoing support and clinical supervision are received to minimise and manage compassion fatigue and vicarious trauma . Additionally , I have found that a strong commitment to such as mindfulness , yoga , and muscle relaxation have reduced stress and burnout over the years . CONCLUSION This chapter has provided a brief foundation for intervening with people who have experienced a crisis . With a primary focus on psychological first aid and Roberts model of crisis intervention , and an application of these models to a case study , this chapter has covered the essentials in understanding the nature and types of crisis , the common reactions of a person who has experienced a crisis , and the impact of ongoing traumatic stress responses that require counselling intervention . A list of other supports available , referrals and resources are included at the end of this chapter for your information and further reading .

98 RECOMMENDED REFERRAL AND RESOURCES LIST Australian Psychological Society Psychological first aid . This resource is a useful guide to supporting people affected by a disaster . The guide provides an overview of the implementation of best practices in psychological first aid as an immediate intervention following a traumatic event or disaster . Suicide risk assessment . Working with the suicidal person Clinical practice guidelines for emergency departments and mental health services ( Department of Health , Melbourne , Victoria , 2010 ) Guidelines for integrated crisis and care in emergency departments and other acute settings ( 2017 ) Other Resources for telephone and online crisis support Life in Mind Australian suicide prevention services . Standby Support after suicide . and telephone support . Other counselling resources Psychological first aid This video provides information on the application of psychological first aid to assist individuals to reduce stress symptoms and assist in meeting an basic needs and identify resources to aid in a healthy recovery , immediately following a crisis , such as a personal crisis , natural disaster , traumatic event or natural disaster . GLOSSARY OF TERMS compassion state of feeling emotional and physically exhausted from helping people who are distressed or traumatised resulting in a diminished ability to show compassion or empathise time of intense difficulty or danger in a state of increased alertness where one is sensitive to surroundings action or process of intervening how counsellors can implement theories state of mental or emotional strain or tension resulting from adverse or demanding circumstances fundamental truth or proposition that serves as the foundation for a system of belief or behaviour or for a chain of reasoning done , felt , or thought in response to a situation or event suicidal of wanting to take one own life or suicide plausible or scientifically acceptable general principle offered to explain a hypothesis or belief therapeutic to the consistent and close association that exists between the counsellor and client . This is also known as a therapeutic alliance . deeply distressing or disturbing experience vicarious symptoms that a counsellor may experience as a result ofthe ongoing exposure to trauma stories from their clients REFERENCE LIST , A . 2014 ) Building resilient practitioners Definitions and practitioner understandings . The Work , 44 ( American Psychiatric Association . 2022 ) Diagnostic and statistical manual of mental disorders . Text revised ( Australian Red Cross and Australian Psychological Society . 2010 ) aid An Australian guide . Bateman , 2010 ) The interface between trauma and grief following the Victorian Clinical interventions beyond the crisis , The Bereavement , 13 ( 48 .

99 , Reid , 2002 ) Post trauma intervention Basic tasks . Brief Treatment and Crisis Intervention , 2003 ) Critical incident stress management ( Benefit or risk for emergency services . Emergency Care , Solomon , 2003 ) Exposure to terrorism , mental health symptoms , and coping behaviors among a nationally representative sample in of the American Medical Association , 290 ( 1961 ) An approach to community mental health . and . 1964 ) Principles psychiatry . Basic Books . Department of Health , Melbourne , Victoria ( 2010 ) Working with the suicidal person Clinical practice guidelines for emergency departments and mental health services . 2003 ) When stress constitutes trauma and trauma constitutes crisis . The continuum . Brief Treatment and Crisis Intervention , 1963 ) Childhood ( Norton . 2000 ) Crisis intervention A review . of Emergency Mental Health , France , 2014 ) Crisis intervention A handbook of immediate person help ( Charles Thomas Pub . 2001 ) The role of positive emotions in positive psychology The theory of positive emotions . American Psychologist , 56 , 1985 ) Crisis intervention . Charles Thomas . Das , A , Rosario , Arain , Price , Bulger , A . 2021 ) outcomes and outcome measures after injury the National Trauma Research Action Plan ( scoping review . journal of Trauma and Acute Care Surgery , 90 ( Watson , Bell , Bryant , Layne , Solomon , 2007 ) Five essential elements of immediate and mass trauma intervention Empirical evidence . Psychiatry , 70 ( 2009 ) People in crisis Clinical and diversity perspectives ( Martin , 2020 ) Prepare for recovery Approaches for psychosocial response and recovery . journal of Business Continuity Emergency Planning , 13 ( vey , 2007 ) Intentional interviewing and counseling Facilitating client development in a multicultural society ( ames , 2008 ) Crisis intervention strategies ( ames , A . 2008 ) Crisis counseling . In , Johnson ( Encyclopedia ( Vol . Sage . 1944 ) and management of acute grief . American journal of Psychiatry , 101 , 2011 ) Understanding crisis therapies An integrated approach to crisis intervention and traumatic stress . Jessica Publishers . Roberts , 2001 ) Crisis assessment tools The good , the bad and the available . Brief Treatment and Crisis Intervention , 2021 ) Feelings , thoughts , and behaviors during disaster . Qualitative Health Research , 31 ( McNally , Bryant , A . 2003 ) Does early psychological intervention promote recovery from posttraumatic stress ?

Psychological Science in the Public Interest , Mitchell . 1983 ) When disaster strikes the critical incident stress debriefing Medical Services , A . 2001 ) Assessment for crisis intervention A triage assessment model .

100 Norris , Watson , Diaz , 2002 ) disaster victims speak Part I . An empirical review of the empirical literature , Psychiatry , 65 ( 1995 ) Use of humour in crisis intervention . Families in Society of Contemporary Human Services , 76 ( Rainer , Brown , 2011 ) Crisis counseling and therapy . Roberts , Ed . 1995 ) Crisis intervention and cognitive treatment . Sage . Roberts , 2005 ) Bridging the past and present to the future of crisis intervention and crisis management . In Roberts ( Ed . Crisis intervention handbook Assessment , treatment , and research ( Oxford University Press . Roberts , 1995 ) Foundation skills and applications of crisis intervention and cognitive therapy . In Roberts ( Ed . Crisis intervention and cognitive treatment ( Sage . Roberts , 2005 ) The crisis intervention model A road map to goal attainment , problem solving and crisis resolution . Brief Treatment and Crisis Intervention , 2002 ) Trauma and posttraumatic stress disorder in Australia Findings in the population sample of the Australian National Survey of Mental Health and Wellbeing . Australian New Zealand journal of Psychiatry , 36 ( Jacobs , Layne , Watson , 2007 ) Psychological first aid . journal of Mental Health Counseling , 29 ( Shapiro , 1996 ) Goals and practical considerations in outpatient medical crises intervention . Professional Psychology Research and Practice , 27 ( Silva , 2014 ) Engaging touch movement in somatic experiencing trauma resolution approach . International University for Graduate Studies . 2016 ) The resilient practitioner Burnout and compassion fatigue prevention and strategies for the helping professions . 2013 ) Longitudinal course of physical and psychological symptoms after a natural disaster . European journal of , Article Walsh , 2007 ) Traumatic loss and major disasters Strengthening family and community resilience . Family Process , 46 ( Graham , 2011 ) Promoting positive adaptation in adult survivors of natural disasters . journal , 10 ( 2003 ) The integrated model of crisis intervention Overview and application . The Counselling Psychologist , 31 ( 239 . AUTHOR INFORMATION Claire , Family Dispute Resolution , Cert IV TAE , Reg . 21971 , Accredited Supervisor ( Claire is currently the National Clinical Advisor at an Australian organisation that supports young people and their families who have been impacted by chronic illness . With over 15 years experience in education , counselling and organisational development roles , Claire is passionate about coming alongside people , building trust and transparency , and supporting them to grow their skills and build capability . She is a clinical counsellor , accredited supervisor , an endorsed mental health practitioner , and certified family

101 dispute resolution practitioner who holds a Master of Counselling , a Graduate Diploma in Management , and a Bachelor of Education . Claire ( with Distinction ) assessment Case management ) Statutory child protection ) Dip ( Dip ( Just ) Train Assess ) Claire has been working in the child protection industry within the government and NGO sector for 15 years , and has gained expert experience , knowledge , and skills in the child protection and foster care systems . She has worked with biological parents , foster and kinship carers , and children who have experienced harm , abuse , trauma , grief and loss , attachment disruptions , mental health issues , and behaviour and conduct problems . Claire has provided crisis intervention in refuges , providing specialist support , and safe and secure accommodation for women and children escaping domestic and family violence , as well as providing specialist trauma counselling for people who have experienced domestic and family violence , and sexual assault . Please reference this chapter as , 2023 ) Crisis . In , Machin du ( Common Client Issues in Counselling Perspective . University of Southern .