Crisis Intervention- Analysis and Application


The Community Mental Health Act of 1963 was signed into law by President John F. Kennedy in response to the questionable practices of mental health institutions.   The new law helped people suffering from mental illlness who were institutinalized in hospitals move back into their communities during treatment. It allowed for more effective psychotropic medications and treatments to be utilized and made community based care easily available for individuals suffering with mental illness.  (National Council for Behavioral Health, 2013) According to the National Alliance of Mental Heath or NAMI (2013) approximately 61.5 million Americans experience a mental illness each year.  NAMI continues to report nearly 18.1 percent of American adults live with anxiety disorders, such as PTSD, OCD, or generalized anxiety and phobias.  Post traumatic stress disorder is very common and is the root of most crisis situations, such as substance abuse and suicide.  (James & Gilliland, 2013)  This paper will focus on a case in which crisis intervention is utlized and the client displays signs of PTSD.  The paper will provide a plan of action, interpret the crisis and identify the appropriate theory that identifies the crisis.  Futhermore, the paper will use a model of assessment, intervention, and treatment and will discuss the substance abuse of the client’s family and how it affects her directly.  Lastly, the paper will consider ethical issues that may arise during the course of the crisis intervention with the client and other parties involved.


The MayoClinic (2015) has defined Post Traumatic Stress Disorder (PTSD) as a “mental health condition that’s triggered by a terrifying event; either experiencing it or witnessing it.”  Individuals who experience a traumatic event and suffer from PTSD may have difficulty coping for months or even years and the trauma will interfere with basic functioning.  Post-traumatic stress disorder is very disruptive causing the client to relieve the trauma over and over again.  Without proper coping techniques the client will attempt to avoid situations that remind them of the event and force them into nonresponsive or psychotic state when triggered.  The client may also become easily agitated, quick to anger, display extreme states of arousal, or suffer from hallucinations or reoccurring nightmares.  The Diagnostic and Statistical Manual of Mental Disorders provides specific standard criteria that should be used when classifying and diagnosing mental disorders.  (The National Center of PTSD, 2015)  When diagnosing a client the clinician should be aware of specific symptoms and behaviors such as reckless or destructive behavior which is identified in Criteria E.  Clinicians conclude that children are more at risk of suffering PTSD after being exposed to a traumatic experience, such as abuse, or witnessing interpersonal violence.  Our client, Cassandra displays behaviors that are thought to be symptoms of PTSD.  As the clinician discovers more about Cassandra’s past, it is learned that she witnessed her mother be victimized both physically and sexually by her father and grandfather and she may have been a victim of such abuse as well.  Dues to these experiences as a child, Cassandra is highly at risk for Post-Traumatic Stress Disorder.   The clinician must also identify intrusive recollections the client may be experiencing from the traumatic event.  The individual must show signs of experiencing recurrent thoughts, dreams, and flashbacks that are causing the stress.  Cassandra is a high rated candidate for Post-Traumatic Stress Disorder and has been experiencing reoccurring nightmares about her father that are causing adverse reactions such as night sweats and curling up into a ball.  Criterion C involved avoidance of associated trauma, people, and activities.  Cassandra is displaying acts of avoidance as she smiles when talking about her negative experience.  She is disassociated and displays flattened emotional response to the negative experience she shares.  PTSD symptoms must be present for an extended length of time and in this case, Cassandra has received a series of psychiatric treatments that date back to when she was a young girl. She also received psychiatric care when she attempted suicide.  The chronic stress that she suffers stems from the experiences she witnessed as a child and has caused significant duress in her personal life.  Cassandra has lost the ability to cope and continues on an emotional rollercoaster, repeating a series of emotional responses that lead back to its origin.  James & Gilliland (2013) allude that the client must effectively work through the crisis in order to avoid the rollercoaster of emotions that is prevalent in victims.



Prior to working with Cassandra the crisis worker or clinician will need to collect as much information as possible about the client.  When using the biopsychosocial method of assessment the crisis worker will gather any information that identifies the client, current psychiatric symptoms, treatment history, list of medications, and medical concerns.  It would be beneficial to determine family history including physical, sexual, and substance abuse, personal relationships, and legal or criminal history. The psychoanalytic theory gives us a better sense of Cassandra’s crisis.  This theory suggests the early childhood fixation that Cassandra has on the abuse her mother endured is causing her inert reaction to possible triggers.  A better understanding of the crisis can be achieved by reaching her unconscious troughts and the emotional experiences.  As the clinician work’s through the trauma with Cassandra it is important to maintain client safety and the safety of those around her.  The clinician will intially want to connect with Cassandra and identify any threats to safety for all parties involved.  Although, Cassandra has attempted suicide in the past and has voiced her curiosity with killing someone, there is no immediate threats as she is in the custody of law enforcement.  Once safety has been considered it will be imperative for the clinican to define the problem and establish intial support.  These are the first three steps to Gilliland’s Six Step Method of Crisis Intervention. In the final steps the clinician will work to form coping mechanisms, implement an action plan, and plan a followup session with the client.  The clinician may also utilize the Cognitive method.  This method of crisis intervention focuses on the root problem and the negative thinking that surrounds it. (James & Gilliland, 2013) The clinician will focus on changing the emotions and thoughts that Cassandra houses in response to men and physical touch.  This method is used to rewire Cassandra’s way of thinking and will help return her to a pre-crisis psychological state.  In the current state Cassandra appears to be disconnected and uncertain of the events that have occurred as she continually requests to see her boyfriend and asks if she is going to jail.  She is unaware that she has been in a brutal fight with her boyfriend and that law enforcement believes she murdered him.  She houses a lot of negative emotions due to the overwhelming number of brutal attacks physically and sexually she was forced to witness her mother endure, and expresses her desire to kill someone in her family as payback.  When her boyfriend touched her in a physical manner she correlated the touch with the abuse and responded in a way she had hoped her mother would have when her father and grandfather abused her.  Through the cognitive method the clinician will work through the trauma and rewire Cassandra’s thoughts to understand good and bad touch.  During the assessment it is determined that Cassandra is suffering from Chronic Post Traumatic Stress Disorder with the initial trauma occurring when she was a young girl.  She has links to substance abuse, violence, and factors that can be correlated with problems in personal relationships.

Plan of Action

Together Cassandra and the clinician develop short term goals that are designed to help her cope through the triggered trauma.  Cassandra will remain in the hospital for a 72 hour observation period that will allow her to be observed for any indicated suicidal thoughts and to undergo medical evaluation.  This medical evaluation will help determine any underlying mental illness.  Once discharged she will be released into police custody to face any charges that are due her for the murder of her boyfriend.  Cassandra will be monitored for any repeat suicide ideations.  Cassandra will continue treatments and individual counseling while she is in jail.


Alcohol and Chemical Dependency

Cassandra informed the crisis worker that her father was an alcoholic and her brother was addicted to heroin.  James & Gilliland (2013) suggest a correlation between chemical dependency and shared genetic traits.  These genetic traits increase the risk of antisocial personality, ADHD, and forms of conduct disorder.  Studies conducted in mice and rats determine a direct correlation of the genetic influence on substance abuse.  (Browman, Crabbe, & Li, 2000)  In this case, the inherited risk affected Cassandra and her brother differently.  Cassandra developed antisocial personality traits, where as her brother inherited the risk of being addicted to an illegal substance.  The exposure of violence and substance addiction caused the onset of Cassandra’s Post Traumatic Stress Disorder as an adult.  Cassandra is currently experiencing nightmares and is having trouble sleeping at night.   The lack of sleep is a symptom of PTSD in adults and can cause the individual to hallucinate, become irritable, and violent.  As discussed in an earlier portion of this paper, the cognitive method would be effective in processing the trauma she has experienced and help develop coping methods that will enable her to work through any future triggered events.  Assisting Cassandra in anxiety management and Eye Movement Desensitization would be effective treatments for the Post Traumatic Stress Disorder she currently suffers from.

Ethical Dilemmas

Clinicians and case workers must adhere to a strict rule of confidentiality.  They have a legal obligation to protect the client’s privacy and the right of confidentiality through privileged communication.  (James & Gilliland, 2013) The presence of outside parties during the crisis intervention interview can be considered an ethical dilemma in this case.  During the interview, law enforcement officers were present in the room, stood over the patient and listened to every personal detail that was shared.  These officers refused to leave because Cassandra was in their custody.  This is a direct violation of the client’s rights to confidentiality and is a breach of the HIPAA Security Rule.  The Office for Civil Rights enforces the HIPAA Privacy Rule.  The HIPAA rule is enforced to protect the privacy of an individual’s identifying heath record.  (U.S. Department of Health and Human Services, 2015)  Legally, anything that she shares with the crisis worker cannot be used in a court room, and should be considered private.  Prior to initiating the interview the clinician should have requested the officers to leave the room and stand outside the door.  There was no immediate danger to the client or the crisis worker, therefore there was no need for law enforcement officers to monitor Cassandra.


            Post-Traumatic Stress Disorder is prevalent in many individuals suffering from a crisis experience.  As James & Gilliland (2013) have expressed children that witness or experience a traumatic event are more likely to develop a case of PTSD as an adult.  Cassandra suffered symptoms of Chronic PTSD that stemmed from a series of abusive events that she witnessed and experienced as a young girl.  As she grew up she had trouble coping with this crisis and attempted suicide several times.  In a triggered event she attacked her boyfriend and brutally murdered him.  Through methods of intervention the clinician was able to work through the crisis and help Cassandra identify coping mechanisms that enabled her to maintain a pre-crisis psychological state.  With continued treatment and counseling Cassandra will have the ability to overcome the PTSD.  Traumatic events can change how our bodies and minds respond to triggered stressors.  The role of the crisis intervention worker is to aid the mentally ill in working through a crisis and enable them to deal with their struggles so that they can effectively live in society.



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Browman, K., Crabbe, J., & Li, T. (2000). Genetic Strategies in Preclinical Substance Abuse Research. Retrieved August 6, 2015, from

Crisis Intervention: Suicide

“On a worldwide basis, about one million people kill themselves each year, which is the equivalent of one person every 40 seconds.”  (James & Gilliland, 2013) This growing epidemic is defined by The American Psychological Association (2015) as the act of killing yourself, most often as a result of depression or mental illness.  As Cain (2014) reports, suicide in South Korea has developed at lightning speed and is considered to be the fourth leading cause of death.  In the United States, suicide accounts for about two percent of all deaths, and is considered to be the tenth leading cause of death in America. This paper will compare the suicide rates, factors leading to suicide, and the treatment options available in the countries of South Korea and The United States of America.

Over recent years, the number of suicides in South Korea have increased significantly.  In a recent article, published by the Journal of Child Psychology and Psychiatry reports an increase in South Korea between 2000 and 2009 from 4.2 to 6.9 per 100,000 adolescent males, and from 3.3 to 6.2 per 100,000 adolescent females, whereas the United States showed no change from 2000 through 2008 and remained steady at 7.6 per 100,000 adolescent males and 6.7 per adolescent females.   (Park, Cho, Kim, Kim, Yoo, & Hong, 2013)  The methods of choice for suicide also vary between the two countries.  Jumping is the most common method for suicide in South Korea by both adolescent males and females.  Adolescents in the United States choose more lethal forms of suicide, such as firearms a chosen method by adolescent males and hanging a popular method among adolescent females.  Officials in South Korea believe the media is a strong influence, inspiring adolescents to “copycat” suicide methods that are seen in movies and reported on news television.  In the United States, politicians are blaming gun laws and state that guns are too easily accessed by teens, contributing to plans conjured to end one’s life and a sea of problems.

The reasons for suicide can be complex.  Policing agencies and mental health professionals continue to follow the patterns of teens in both countries in an effort to understand why young people are tragically taking their own lives.  There is not one single cause for suicide, but there can be a plethora of reasons such as: the pressure to excel, bullying, family problems, and financial difficulty; as shared by teens that have considered suicide or have successfully carried out the act and left notes for survivors.  Students studying in South Korea are pressured to excel academically and reflect perfect grades.  The expectations forced on young people in this country can smother and suffocate them, extracting the joy out of their individual lives.  (Voices of Youth, 2011)  Bullying is also a problem that leads South Korean students to suicide.  In a world where perfection is expected on a daily basis and failure is shunned upon there is a high level of competition among the students.  When an individual does not meet the expectations he/she becomes a victim of bullying.  School violence occurs in areas in which security cameras cannot be placed, such as restrooms, and blind spots in the classrooms and often goes unreported until it is too late.  Suicide among teens in America is caused by several factors.  Depression is the leading cause of suicide in young people in the United States, affecting nearly eight million teens in North America.  Being a teen in today’s world can be confusing and often difficult to make decisions or cope with insecurities.  Everyday problems and pressures can become overwhelming and stressful.  Teens that lack coping skills can become desperate and take their own life.  Lesbian and homosexuality is another contributing factor to teen suicide in the United States.  American teens who choice to be lesbian, gay, or transgender are often bullied and rejected.  As if being a teen wasn’t confusing enough, the rejection isolates the individual and leads to suicide.

Treatment options in South Korea are very limited.  The Korean culture discourages people from seeking help for psychological issues.  The country places emphasis on correcting issues within the community and mental health facilities focus on treating patients with a mental illness.  Public school officials are in the process of designing an anti-bullying campaign that will be implemented in the near future.  The United States focuses on managing and treating teens that are considered high risk.  Case management has been effective in reducing emergency room visits, whereas treatment has proven to be more effective long term.  Teens may also undergo therapy to work through the underlying issues.  Individual therapy focuses on the teen and allows the individual to work through feelings and emotions that have led them to believe suicide is the only answer to end their emotional pain.  Family therapy is another option that is commonly used and allows the family to actively support the teen, as they learn how to cope with the problem together.  In extreme cases the teen is hospitalized and monitored in a secure facility to ensure safety.  (National Institute of Mental Health, 2009)

Suicide affects millions of teens every year, worldwide.  This epidemic is extremely complex and several factors can lead an adolescent to take their own life.  Treatment is highly effective and provides teens with the help and coping strategies that prevent re attempts.  South Korea, is a struggling country and is in the process of establishing facilities that are equipped to help patients that do not suffer from mental illness.  Suicide is a permanent solution to a temporary problem and can be prevented by educating our young people and providing them with the support they need to work through the problem.


James, R. & Gilliland, K. (2013). Crisis Intervention Strategies (7th ed). Cengage Learning Inc. Obtained from

American Psychological Association  (2015).  Suicide Retrieved July 19, 2015, from

Cain, G. (2014, March 15). Why South Koreans are killing themselves in droves. Retrieved July 18, 2015, from

Park, S., Cho, S., Kim, B., Kim, J., Yoo, H. J., & Hong, J. P. (2014). Increased use of lethal methods and annual increase of suicide rates in Korean adolescents: comparison with adolescents in the United States. Journal Of Child Psychology And Psychiatry, And Allied Disciplines, 55(3), 258-263. doi:10.1111/jcpp.12148

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Six Step Model to Crisis Intervention

Crisis intervention refers to the methods that are implemented to offer short term assistance to a victim that is suffering physical, mental, emotional, and behavioral distress.  Many trauma victims are not capable of coping with the effects of the crisis on their own accord and are in dire need of psychological assistance and support. (James & Gilliland, 2013)  Clinicians must display a series of skills that enable them to successfully support their client.   This paper will review a case study found in the Journal of Individual Psychology in which the clinician utilized Gilliland’s Six Step Model of crisis intervention and proved this method successful.

In the article titled, “Integrating Crisis Theory and Individual Psychology: An Application and Case Study”, provided by the journal we are introduced to Kate, a young adult that is currently in her second year of an undergraduate program.  Kate remains focused and strives to accomplish her educational goals and remain a prime example for her younger siblings.  Kate’s mother is very involved in her life and expects Kate to complete her degree and establish a career before focusing on building a family.  Kate feels a lot of pressure from the expectations held by her parents, specifically her mother.  These expectations have made it difficult for Kate to cope with the news of being pregnant, and shortly after the miscarriage.  In fear that she is a disappointment and shaming her family she has experienced difficulty focusing on class assignments, become withdrawn from friends and family, has trouble sleeping, and extreme anxiety.

Individuals like Kate often have difficulty in adapting to new challenges and environments.  Instead they adhere to the adaptive ways of their family upbringing; causing difficulty in coping with an uncomfortable situation.   (Parikh & Morris, 2011)  Individuals become more involved in the role they play in their family unit and the rules of the family culture, rather than themselves as an individual.  Kate’s crisis has become difficult to work through on her own based on the connection that bonds her with members of her family and her individual role.  Kate very distraught with her current situation has reached out to the counselor at the university.  Luciana, the campus counselor has been supporting Kate and helping her discover new coping mechanisms that will allow her to work through the pregnancy crisis.

Luciana has utilized the six step model in order to help Kate.  Using the six step model, Luciana focuses on listening, interpreting, and responding in a systematic manner to assist Kate in order to return her to a pre-crisis psychological state.  As we have learned from James & Gilliand (2013) we know that the six step model is split into two phases; the listening phase and the action phase.  During the listening phase, Luciana defines the problem, ensures Kate’s safety, and provides support.  In defining the problem, active listening is critical.  While defining the problem, Luciana has discovered Kate’s inner most feelings are contributing to her fear of being a bad person and helps understand what the true crisis is.  In step two, the counselor focuses on ensuring the client’s safety.  Luciana makes a professional assessment to conclude Kate is in no way harmful to herself or others.  In fact, Kate is so worried about her social role with her family and friends that she would in no way want to sadden those in her social circle.  There is also no history of suicidal thoughts or plans.  She has been cleared of any physical harm.  In step three, Luciana established herself as a support system.   This stage is critical to gain the client’s trust, as the counselor remains positive without passing judgement.  By empathizing with her client, Luciana is successful in addressing hidden fears and helps avoid social rejection.  In the action phase the counselor will actively develop a plan of action through brainstorming and commitment.  By looking at the situation and the individuals that have already stepped up to provide support for Kate during the crisis, Luciana’s able to establish an ongoing support system in Kate’s social circle. Although, the two have never spoken about the miscarriage, Kate believes her mom is aware of the situation and has been comforting Kate.   Kate is terrified of how her friends will take the news that she caused the miscarriage due to her irresponsible actions.  Luciana focuses on the same fear that Kate bestowed regarding the initial news that she was pregnant.  The friends that found out about the pregnancy were supportive.  Challenging Kate to focus on alternative responses helps prepare her for a more positive and controlled situation.  In stage five, Luciana empowers Kate, by enabling her with control of how much information she will share with her social network of close friends and family in order to work through the crisis.  Finally, Kate is able to commit to a plan of action in which she will journal each day, tell a friend about the miscarriage, thank her mother for her kind actions, and email her professors to get an extension on the assignments she has missed.

The six-step model has been an effective approach to working through Kate’s personal crisis.  Kate was able to work through her fears and evaluate alternative solutions in order to remain connected and in control of her social life.  By working through each step she was able to redefine herself and find meaningful ways to cope with the shift in her environment.

In this case study provided by the Journal of Individual Psychology we have established the success of the integrated psychological approach to crisis intervention.  The six step model by Gilliland allows clinicians to redefine problem solving and coping mechanisms empowering clients to overcome a traumatic and critical situation.


James, R. & Gilliland, K. (2013). Crisis Intervention Strategies (7th ed). Cengage Learning Inc. Obtained from

Tedrick Parikh, S. J., & Wachter Morris, C. A. (2011). Integrating Crisis Theory and Individual Psychology: An Application and Case Study. Journal Of Individual Psychology, 67(4), 364-379.

Family in Crisis

A crisis is defined by Merriam Webster (2015), as an emotionally significant event or radical change of status in a person’s life that causes trauma.  Merriam Webster continues to define crisis as a difficult or dangerous situation that needs serious attention.  The underlying characteristic of a crisis is resulting in trauma.  When something unexpected occurs it can result in traumatic reactions that affect not just the individual, but those that are in our everyday life, such as family.   James & Gilliland (2013), infer that a crisis can have “many different meanings, to different people” and the reactions can vary from people to people and event to event.   This paper will address how family can effectively deal with a family member in crisis without causing additional harm or trauma.

According to the National Institute of Mental Health (2015), tens of millions Americans suffer an emotional crisis each year.  A variety of crises can affect a family, including financial, separation, and health related crises and can test the strength and steadfastness of a family.  There is nothing that is more bothersome then seeing a loved one suffering from deep emotional pain; in fact it can be extremely stressful.  In order to intervene successfully it is imperative to remain calm and remain aware of any sensitivity.  The first step to helping someone in a crisis is to identify the signs.  One of the most common signs is a drastic change in behavior.   An individual suffering an emotional crisis may also neglect personal hygiene practices, change sleep pattern; such as excessive sleeping or not sleeping well, and they may also suffer withdrawal.  Other traumatic events such as a natural disaster or a terrorist attack can result in a crisis in a much shorter period of time.  However, most often the victim’s behavior will change gradually.  It can be found most helpful to look back over the last several months and review the changes of behavior.  Much like Merriam Webster alluded, it is ever so important not to delay and address your concerns immediately.  It is better to intervene early, before your loved one’s emotional distress becomes an emergency situation; in which they cause self-inflicted harm to themselves or others.  Once you have determined your loved one is experiencing a crisis, reaching out and providing support in a non-judgmental way is the best approach in beginning the intervention.   Addressing your concerns with a large group may be stressful and cause more trauma to the individual.  It is suggested by the American Academy of Experts in Traumatic Stress (2014) to begin a light hearted conversation one on one with the victim while leading them to open up about the distress and trauma they are experiencing.  The rule of thumb is to allow the loved one to speak while you listen without interrupting, passing judgment, or blame to the victim.

Connecting with your loved one and providing support may help your family member release negative energy and help get a handle on the emotional crisis.  In order to address the inner issues of the crisis further, you can suggest professional help with a psychologist.  Offer to be involved through each step of the process if the individual requests it.  Each person is different and how they work through the emotions with a trained therapist will also vary.  Family members can explain to a reluctant trauma victim that a psychologist has specialized training that makes them an expert in understanding and treating the underlying emotional conflict.  A therapist will teach the victim techniques that will make them skillful in dealing with the challenges as they arise in order to successfully work through uncomfortable situations and avoid trauma.

Working through an emotional crisis with a family member can be extremely stressful for everyone involved in the intervention.  The affects can be overwhelming and do not discriminate.  There may be an extreme rollercoaster of emotions that affect the family including restlessness, anger, and hopelessness.   It can be difficult when the loved one in crisis decides he/she does not need any help and may accuse you of betrayal. (Mayo Clinic, 2014)  Families may be torn apart during the crisis and may suffer extreme trauma.  It is important for families to remain focused on every day responsibilities and be prepared for a negative response to the intervention, but never give up hope.

When working through a crisis families should remain united and provide emotional support to the loved one suffering.  It can be difficult, but remaining patient and direct will help everyone manage the crisis together.  It is important to care for all personal needs including: physical, emotional, and social throughout the intervention and healing process.  Healthy families keep sound minds and are able to cope better and the road to recovery will be speedily.


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