The hybrid model of crisis intervention model would help provide a flexible approach to help Rita. This model is helpful in breaking the situation down into stages so that the crisis worker does not become overwhelmed or overlook an important factor in resolving her situation. Rita displays numerous issues, and it will be important for the crisis worker to prioritize them. The first 2 tasks in the hybrid model are especially important in helping Rita. The first 2 tasks are to predisposition/engage with the client and to define the crisis (James & Gilliland, 2013). This learner’s first goal is to prepare Rita for crisis intervention and to build a rapport with her. This learner would want to show Rita that she is there to help her. This can be especially helpful when the client has experienced negative encounters with mental health services on law enforcement. The author will not make progress with Rita or other clients until she builds a bond with the client and works past any resistant behaviors that are displayed.
Another important part of assisting Rita is defining the crisis. In Rita’s case study, there are numerous issues that need to be resolved. A few of the issues that the author observed are: domestic violence altercations with Ayesha, Rita exhibiting symptoms of depression, conflicting relationship dilemmas with Ayesha and Sam, and to help Rita resolve negative attention-seeking behaviors. It would be easy for the author to lose sight of the crisis if she did not utilize the hybrid model. However, it is also important that the learner defines the problem from the client’s point of view (James, 2013). At the same time, she has to prioritize Rita’s safety. The author defines the main problem in this case study as: domestic violence that is happening to Rita. She would work to assess what it would take to ensure Rita’s and her children’s safety (physical and psychological). First, she would provide resources about temporary shelters, and resources for Rita to receive personal counseling for herself and the children. The main goal is to get Rita in a safe environment where the other issues can be addressed after ensuring everyone’s safety. The learner would try to follow-up with Rita the next day to help her receive counseling. When giving crisis intervention services, the crisis worker normally only has time to address the immediate crisis, but not all of the underlying issues. She can provide Rita with resources that can help address them, but must use the hybrid model to address safety issues.
The Sidran Institute and the National Center for PTSD are both wonderful resources to learn about PTSD. The National Center for PTSD specifically has a section for the general public and a section for clinicians. The Sidran Institute (2000) informs us that PTSD is most likely to occur after a sexual assault (Sidran Institute, 2000). It can occur after any traumatic experience. The National Center for PTSD (2015) describes cognitive behavioral therapy as an appropriate treatment for PTSD (National Center for PTSD, 2015). The learner was really impressed by the different videos and resources that they provided on their website.
Use of the DSM to diagnoses PTSD
The issue with previous editions of the DSM is that they had only certain emotions (ex. Fear) that would fit the diagnosis of PTSD. Resick & Miller (2009) acknowledged that fear is only 1 of many emotions clients may experience when exhibiting PTSD symptoms (Resick & Miller, 2009). The DSM also has not recognized complex PTSD as a separate designation (James & Gilliland, 2013). This learner hopes that future editions of the DSM expands on PTSD, and includes a separate section on diagnosing children with PTSD since they display different symptoms.
Determining whether an individual might have acute stress disorder or PTSD
The length of time could differentiate between the 2 disorders, and acute stress disorder can be a precursor to PTSD. Ponniah & Hollon (2009) also states that acute stress disorder could lead to a person having PTSD (Ponniah & Hollon, 2009). If the individual has a stress reaction occur immediately after the event that usually indicates acute stress disorder. On the other hand, PTSD indicates impairment that has persisted with the individual awhile after the event has passed, and triggers continue to bother them in their life.
Diagnosis affecting the interventions used
The most common interventions that are used for PTSD are: trauma-focused cognitive behavioral therapy and eye movement desensitization and processing (EMDR). Support groups are also another helpful tool, especially for clients who work in stressful occupations. They can learn from each other and know that someone does understand what they are going through. CBT has also been shown to be effective for acute stress disorder (Ponniah, 2009). The diagnosis would change the interventions that are used because PTSD normally requires more sessions and interventions over a longer time period. EMDR is a commonly used with PTSD, but not with acute stress disorder. Ethically, we need to pick culturally appropriate assessments for the client because it can inadvertently harm the client’s treatment. Also, EMDR and CBT may not work for every client, so we need to be flexible about using other interventions.
James & Gilliland (2013) describe psychological autopsies as, “Compiling detailed postmortem mental histories following suicides or deaths that were equivocal” (p.237). A psychological autopsy is designed to provide more information about what could have led to the suicide. When an individual completes a suicide attempt, the friends and relatives are left with many unanswered questions. This method can be helpful in providing some closure and answers to them. Psychological autopsies are meant to help survivors learn to cope with the suicide and to help lessen the guilt that they experience (James, 2013).
This method can be extremely helpful to help Handley’s coworkers come to terms with his death. The learner liked how the crisis worker used a structured process to work with them. When death occurs unexpectedly, it can be comforting for the grieving co-workers to experience some structure even if it is only momentary. This method can help them process the loss that they are experiencing. The textbook (2013) states that a psychological autopsy is, “A variation of a grief debriefing procedure” (p.240). This is the reason the learner feels this is appropriate for this situation is because the co-workers need an opportunity to grieve and process their emotions.
Comparing and psychological autopsy and CISD
The purpose of both of these is to debrief clients going through trauma situations. Mitchell (n.d) defines CISD as, “A specific, 7-phase, small group, supportive crisis intervention process” (p.1). The psychological autopsy that was used in Handley’s example is similar to CISD as they both used stages, and the autopsy used 6. Both are also adapted for crisis management situations. On the other hand, CISD is more of a chance for individuals to vent and discuss their feelings and emotions. Psychological autopsy is meant to not only debrief, but also collect information about the suicide. It can provide some answers that the survivors needs answers to so that they can progress in the grieving process. It has multiple purposes in the intervention process, whereas CISD is specifically for debriefing groups after a trauma. Both CISD and psychological autopsy intends to help the clients work through the immediate emotional aftermath of the trauma.
James, R.K., & Gilliland, B.E. (2013). Crisis intervention strategies (7th ed). Belmont, CA: Cengage Learning.
N.A (2015). PTSD: National Center for PTSD. Retrieved from: Capella
Ponniah, K., & Hollon, S. (2009). Empirically supported psychological treatments for adult acute stress disorder and posttraumatic stress disorder: A review. Retrieved from: Capella
Resick, P., & Miller, M. (2009). Posttraumatic stress disorder: Anxiety or traumatic stress disorder. Retrieved from: Capella
N.A. (2014). What is Posttraumatic stress disorder. Sidran Institute. Retrieved from: Capella
Mitchell, J. (n.d). Critical Incident Stress Debriefing. Retrieved from: Google