Counselor's role in emergency teams
Interview with an Emergency Professional
Emily deals with different crises on a daily basis. She specializes in helping sexual assault survivors and suicide attempt survivors. She cautioned the learner that she will have to be adequately prepared for trauma work because that is an important aspect of being a counselor. Dupre, & Echterling, & Meixner, & Anderson, & Kielty (2013) also say that it is very common for counselors to work with clients that are in a current state of crisis (Dupre, Echterling, Meixner, Anderson, & Kielty, 2014). In many cases, we have to be able to make quick decisions when a client is in crisis. Emily states that it is important to be decisive and calm especially when dealing with a client that is expressing suicidal ideation. Being indecisive can make a crisis situation that is already difficult worse and she says that many times clients can sense fear in crisis workers. Showing fear when a suicidal client is in crisis can lead them to not trust the crisis worker, which is essential for any crisis situation to be resolved.
We also discussed awareness about trauma and crisis intervention. Many individuals are not aware of how trauma can negatively impact a person’s mental health status (Andrew & Kendra, 2012). The YWCA strives to provide trauma-specific services, which provides interventions that are designed to deal with the trauma that the client is experiencing. Grounding is a common intervention that is used with trauma survivors. This technique is helpful to help the client regain equilibrium. The goal is to get the client to focus on where they are at as far as in the present moment instead of the dissociations or negative memories from the trauma that they are experiencing. Many times the trauma is the only thing that the person can focus on even though it is really traumatizing for them to constantly relive it. Many times they will need us to reassure them that they are safe and that it is ok to let the trauma go.
Emily discussed a situation where a rape survivor called the crisis hotline and threatened to commit suicide. The client expressed that she had a plan to commit suicide and had a gun to shoot herself. She said that she had the gun in her hand, and had hit the limit about the amount of stress that she was experiencing. Emily normally would first ask the client if they were safe and assess lethality, but it was clear that the client’s physical safety was at risk. Then, she worked to convince the client to put the gun down by using validation/reflection of feelings, and at the same time signaled to her supervisor that she needed to trace the call to get the client’s address. When Emily was working to talk the client out of committing suicide, her supervisor was busy alerting 911 to go to the client’s residence. Dupre (2014) states, “Counselors working with clients in crises must manage multiple tasks; they must rapidly assess an unstable situation, respond in a clinically sound and ethical manner, and ensure the safety of everyone involved in the situation”(Dupre et al., 2014, p. 82). Emily emphasized the importance of staying calm during the crisis, and letting go of the Superwoman/Superman complex. Too many individuals enter the crisis intervention field seeking to help everyone and be the hero, but Emily said that is what contributes to workers burning out. One of the hardest things that she has witnessed is watching volunteers for the SART team and crisis hotline suffer vicarious traumatization because they either did not maintain proper self-care, or they inherited the superwoman/superman complex. Emily knows that she has to lead by example and gave the learner several suggestions that she uses to maintain proper self-care. She reads for pleasure, enjoys going to the movie theater occasionally, and enjoys walks on the beach. Sometimes it is as simple as taking a hot relaxing candle lit bubble bath after a particularly stressful work day but she always tries to take at least 10 minutes a day for self-care.
Another important aspect of Emily’s job is creating awareness and educating others about sexual assault and suicide. Many instances, the stigma continues because individuals may see rape as a gender issue where only females can be raped. She helps create literature that addresses stigma about suicide and sexual assault. Emily also helps design the curriculum that is used for the sexual assault advocacy-training program, and one of the training sessions is dedicated to having a male sexual assault victim speak about his experience. She states that it is important for volunteers and interns to see that there are male sexual abuse survivors even if the statistics or numbers on them might be small. She also states the importance of educating others on why sexual assault does not end up getting reported, and how the numbers of reporting are even smaller for male survivors. Planning the curriculum for the advocates is one of the favorite aspects of her job because she loves being able to educate others about a topic where many in society are commonly misinformed. Emily stated that when she first started working for the YWCA, her boss described an emergency plan that ideally delineated responsibilities among all of the employees during a crisis situation. She cautioned the learner that a good emergency plan is detail oriented and inclusive of all of the crisis that they are likely to face (Na, 2011). The majority of emergencies that they get are suicides or domestic violence situations where the survivor is an immediate crisis. Although the YWCA is designed primarily for sexual assault, they may or may not see a survivor right after the assault occurs. The YWCA offers counseling services, which survivors can utilize regardless of, whether the assault happened recently or if they were triggered and experienced trauma symptoms from an assault that occurred years ago. SART calls or visits occur when they receive a telephone call from the local hospital where the survivor was brought in to be seen. When they receive the call from either the forensic nurse or another hospital worker, then they send an advocate out to the hospital to provide immediate support for the survivor. Emily emphasized that support depends on the needs of the survivor in that current time and place. Some might need emotional support while others may be more stoic or laugh about the trauma because that is the only way they can deal with it in that moment. Some survivors might need a blanket or something to eat, and the advocates’ role is to be there and support them in that moment. The SART team is important in that it provides crisis intervention to sexual assault survivors during a time that they need it most. The goal is for the advocate to be there when there is police questioning because in many cases they can inadvertently retraumatize the survivor.
In many instances, Emily sees clients that have numerous issues. For example, she might see a rape survivor who has been self-medicating with illegal drugs and might present with symptoms of PTSD or another psychological disorder. She advised that all aspects contributing to the immediate crisis needs to be addressed, if at all possible. If the PTSD symptoms and substance usage is not addressed, the client may regress and go through continuous crises. Stabilizing a survivor when they are intoxicated can be very challenging if not close to impossible. Emily stressed that when the learner engages in this line of work, keeping the book filled with resources is important for those types of situations. At the end of the interview, she emphasized the importance of making self-care a way of life. She says that too many counselor burnout because they fail to maintain adequate self-care.
As it relates to emergency plans, Emily agrees with the Planning Guide that plans need to be cohesive and all-inclusive. The Planning Guide (2003) states, “Until mental health, health, and emergency management make coordinated planning a priority, little will happen” (N.A, 2003, p. 6). The learner remembers Emily saying that we could have detailed emergency plans, but if everyone does not work together then the plan will not be effective. She noticed that when egos get in the way, emergency plans tend to fall apart. It is important to always acknowledge and respect other professionals input in regards to the crisis. We can always learn from one another, and professional development grows when an individual is able to acknowledge this. When an individual is in crisis, the spotlight should not be focused on an individual’s ego. The goal should be to lessen the crisis.
Emily mentioned that it is important to take into account what resources are available when making an emergency plan. Sometimes people overlook the availability of certain resources that may not be available in certain areas. The Planning Guide (2003) also acknowledges that emergency plans need adequate resources in order for it to flourish (Na, 2011). It is also important that everyone knows their role, and does not overstep their assigned role. Pestka & Hatteberg & Larson & Zwygart, & Cox, & Borgen (2012) says that educating each profession is important in ensuring success within the emergency plan (Pestka et al., 2012). Individuals cannot succeed alone in an emergency plan, and everyone’s contribution is important. Emily stressed the importance of working as a unified group with 1 goal in mind: To lessen or stop the immediate crisis.
Emily said that her favorite aspect of the emergency plan is being able to collaborate and work with others in different professions. She described an emergency situation where she worked with the paramedics to stabilize a suicidal client that was receiving counseling services at the facility. Emily recalled feeling relieved that she had assistance to get the client stabilized in that situation. She remembers having to work with the paramedic to get them to go get checked out at a hospital. She also says she used reframing to ensure the client that she does not view them as crazy because they experienced suicidal ideation. Instead, she told them that she was concerned about their safety and anyone that was facing the issues that they had described might need a little bit of assistance to help them work through it. She normalized the situation and it also helped the paramedic to stay calm in that situation. Emily said that it was important that she respected the contribution and skills of the assisting paramedic, and they did that in return. She could not stress enough the importance of someone being willing to be a team player as an important aspect of crisis intervention.
Counselor Responsibilities in Emergency Management
As counselors, we are responsible for understanding the effects of trauma and are able to use counseling skills in a crisis situation. Smith, Tremethick, & Clocklin (2005) states, “ During a disaster, psychological health interventions have been reported to affect the severity of conditions such as post-traumatic stress disorder” (Smith, Tremethick, & Clocklin, 2005, p. 49). We have to be knowledgeable about PTSD and acute stress disorder because they are common in trauma situations. It is crucial to be cognizant about the physiological effects of trauma on the human body. As counselors, we must be able to display empathy. Validating and reflecting feelings are important counseling skills that may be needed in a crisis. We are equipped to use skills that other professionals are not trained to use. Pestka (2012) declares, “Nurses in non-psychiatric settings frequently are expected to provide care to patients with mental health and behavior management issues (Pestka et al., 2012, p. 335). The problem is expecting them to provide services in a capacity that they are not trained to be competent in.
We are able to provide mental health services by debriefing other professionals. Although that is typically the role of the supervisor, if we are trained to do so, we may be needed in that role. We also are responsible for knowing that PTSD symptoms present differently in adults and children, and adjust our interventions accordingly. Smith (2005) states that children might regressive behaviors when in trauma (Smith et al., 2005). We may also be needed to take charge in a crisis situation when an individual’s mental health is the main presenting issue.
Counselors are also responsible for considering culturally competent interventions. Crisis intervention occurs all over the world and that increases the need for us to be culturally competent. Goodman & West-Olatunji (2009) declares that cultural competence is an important aspect of effective crisis management (Goodman & Olatunji, 2009). We have to be considerate of the fact that Americanized interventions are not likely to be very effective with different cultures. To reflect deeper, if crisis occurs worldwide, then there is no reason that crisis intervention strategies or techniques should be one sided. Westernized concepts will not work with differing cultures that might see mental health and different issues differently than how it is viewed in American society.
In order to be an effective crisis counselor, they will need to be knowledgeable in crisis intervention techniques such as the ABC model. However, we need to be cognizant of knowing when it is appropriate to use certain interventions. Crisis counselors have to have the patience to be able to handle working with trauma clients. Goodman (2009) says “Becoming a culturally competent crisis counselor means becoming more self-aware and being able to reflect” (p. 459). Reflecting on previous crisis situations can help us learn how to improve and grow in similar situations we might encounter in the future.
A lot of people overlook the skill of being able to work well with other people but that is an important skill to have. It is impossible to be an effective crisis counselor if a person does not have the ability to work with people. We collaborate with the client that is in crisis to help them get through the trauma that they are experiencing. Crisis counselors are trained to establish a therapeutic alliance and help the client in an emergency situation. We also need to have knowledge about the chain of command in a crisis. Bargaining/negotiation is another important skill that might be needed during a crisis. A skilled negotiator knows when to concede and when to give in. There may be times where we need to negotiate with a client that is expressing suicidal ideation, especially when they have a plan and the means to carry the plan out. Bargaining and negotiating can be a very time consuming process, and it is important for the crisis worker to stay as rested and calm as possible during the situation.
Emily stated during the interview that the more education a counselor has going into the crisis and counseling fields, the better it is for that individual. She also states that getting hands-on practice with a lot of the concepts and interventions that are taught is important so that the learner can gain experience practicing them. However, she also acknowledged that there is nothing like actually utilizing the interventions once the learner starts actually working in the field. Emily encouraged the author to consider pursuing a doctorate’s degree once she starts working in the field because learning is always a continuous process and she feels that more education can only help benefit the learner in the future. Emily also stated the importance of maintaining adequate supervision because crisis work tends to be very draining. Supervisors tend to see things that we may not be able to reflect and see in ourselves, and it is very important to have someone else there to assess our performance.
Another skill that is necessary for this field is self-reflection. Emily said that crisis work will help us to learn about ourselves and our capability to give to others. By giving to others, she did not mean giving everything to clients without maintaining our own wellness. What she meant was our capability to give within well-maintained boundaries. It takes skill and practice to know how to give without overextending ourselves to clients. She said she has seen advocates wanting to give survivors rides from the hospital, and that puts their own physical safety into jeopardy. She had to help develop guidelines that the YWCA imposes to help protect the sexual assault advocates from themselves. While it is natural to feel empathetic with clients in those situations, it can become very easy to overextend ourselves. That is why constant self-reflection is necessary to make sure advocates are maintaining wellness and know and understand themselves so they can see if they are equipped to work in that line of work. Emily said that some people are just not meant to work in the crisis intervention field, and it is important to be able to reflect and come to that conclusion.
Having and continually developing listening and counseling skills cannot be overstated. The individual needs to be able to put those skills into use at any moment, and be able to pull them out like a trick out of a rabbit hat. Continuing education can help keep individuals current on new intervention and skills that are brought into the field. Displaying empathy is a technique that everyone can use, and should always be used regardless of the crisis situation. Survivors need to feel like someone understands and is willing to help them in their time of need. A rape survivor might be experiencing a myriad of emotions when an advocate visits them on a SART call and displaying empathy could be the one mechanism that can help the advocate build trust and a therapeutic alliance with them. If an advocate shows up to the scene and looks bored or disengaged, then that could potentially revictimize the survivor. They might already have experienced secondary victimization from the police or other sources and if they feel or sense that the advocate isn’t fully engaged with them that may make them resistant to receiving services in the future. It can also leave them a negative impression of the agency and of the counseling field as a whole.
In conclusion, the learner had the opportunity to conduct an interview and learn about the crisis intervention field. She got to reflect on the importance of crisis intervention techniques, and the roles that crisis counselors play. This course project gave the learner the opportunity to think about crisis intervention and see how it can be impactful in real life. The learner reflected on this and throughout this course, she connected with the material presented but writing this project has really helped her to connect deeper what she learned about crisis intervention this quarter. She enjoyed learning more about the YWCA and their mission to empower individuals and educated others about sexual assault…
Dupre, M., Echterling, L., Meixner, C., Anderson, R., & Kielty, M. (2014). Supervision experiences of professional counselors providing crisis counseling. Counselor Education & Supervision. Retrieved from Capella Library
N.A (2003). Mental Health All-Hazards Disaster Planning Guidance. :
Na (2011). Emergency planning guidelines for campus health services: An all-hazards approach. Journal of American College Health, 59. Retrieved from Capella Library
Pestka, E., Hatteberg, D., Lawson, L., Zwygart, A., Cox, D., & Borgen, E. (2012). Enhancing safety in behavioral emergency situations. Medsurg nursing. Retrieved from Capella Library
Smith, S., Tremethick, M., & Clocklin, G. (2005). Disaster response. . Retrieved from Capella Library