Healthcare Training Institute - Quality Education since 1979
Psychologist, Social Worker, Counselor, & MFT!!

Section 1
Track #1 - Common Denominators Assessment

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Welcome to the Home Study Course sponsored by the Healthcare Training Institute, homestudycredit.com.  This course deals with crisis intervention techniques.

Our primary intent for this home study course is to provide quality education to foster your professional growth.  The Institute has provided quality education since 1979.
 
We appreciate that you have chosen us as a vehicle for you to earn your Continuing Education Credit.

The purpose of the course is to assist you in increasing your knowledge regarding how to treat patients, clients, etc. dealing with crisis intervention.  As each case study is given, if the concepts seem to be applicable to your situation, I encourage you to turn your CD player off and make a few notes regarding the application of the principle to your setting.  However, these notes are for your purposes only and are not to be sent to the Institute.  Also each track is very content dense.  So feel free to replay the track to review the content either for your own purposes, or if you feel appropriate play the track in an individual or group session for client education.  Also permission is granted to reproduce this CD.  We encourage you to duplicate and give copies of this CD to colleagues, clients, etc. as you deem appropriate. We feel the information on our CD's is valuable.  Thus, we have an interest in distributing CD's in as many ways as possible, to benefit the greatest number of people, who have a need and are receptive to this practical information.

The questions in your Answer Booklet are sequential and deal with the section of content that preceded it.  For this reason, to facilitate the answering of each question, you might read the question from the Answer Booklet prior to listening to that CD track.  By knowing what the question is ahead of time, you will then know the content to listen for that contains the answer.  So just a hint, after you write down the answer to a question in your Answer Booklet, read on to the next question in order to give you a “heads up” to listen for the content that contains the answer to the next question.

Merely write the correct letter on the corresponding blank line in your answer booklet. Each answer is only used once. Keep in mind there is nothing tricky or hard about these questions.  They are merely intended to verify the playing of this CD.

For the purpose of brevity, most generally, I will use the term “therapists” or “mental health professional.”  However, don’t let these terms deter you from applying the concepts to your situations.  When you hear the word “therapists,” if your job title is social worker, psychologist, marriage and family therapist, mental health counselor, professional counselor, resident director, program assistant, etc. merely substitute the appropriate term that is the most meaningful to you. In short, don’t let my use of the term “therapists” cognitively set you off track from hearing the content because your job title is school counselor, for example.  I will also use the term “client” for the purposes of brevity.  However, if you deal with patients, residents, students, consumers, etc., transpose “client” for the term that is the most meaningful to you in your work setting. 

On this CD set we will discuss such topics as: Common Denominators Assessment, interviewing in crisis intervention, smooth-focus phrasing techniques, the 1-2-3 technique, a 3-step model for telephone crisis calls, crisis groups, client equilibrium, sociocultural issues, the Small Control technique, crisis counseling following rape, treating a prematurity crisis, Terrible Name Monitoring, the essential versus nice technique, and the magic rescuer technique.

So  let’s get started

On the rest of this track, we will discuss two factors concerning identifying a crisis.  These two factors are definitions of crisis, and key elements of crisis.  We will also discuss the common denominators assessment tool.

To begin discussing the process of helping clients in crisis, I would like to spend the rest of this track reviewing the basic definitions for assessing hallmarks of a client in crisis.

As you know, a first factor in identifying a crisis is understanding working definitions of the term crisis itself.  Perhaps the most commonly quoted definition of crisis comes from Caplan, who indicated, a state “provoked when a person faces an obstacle to important life goals that is, for a time, insurmountable through the utilization of customary methods or problem solving.”  Crisis according to Caplan is characterized by the fact that for the client, the circumstances of the crisis situation are such that her or his usual ways of solving threatening problems are not working.  Therefore, according to Caplan, crisis refers to the individual’s reaction to the situation, rather than the situation itself.  

A crisis might also be defined by a precipitating event, although clearly not all crises will have precipitating events clearly defined.  According to Freeman, there are five distinctive categories of precipitating events.  These five categories are:

1.  object loss, the threat of object loss, or the loss of the opportunity to restore objects
2. loss of previous sources of help
3. a client becomes so identified with another that the inability to distinguish between his or her own state and the other’s produces a crisis
4. a surge of “unmanageable impulses,”
5. a threat to current adjustment

A second factor in identifying a crisis are the key elements of a crisis.  One of these key elements is that although identifying a precipitating factor is very helpful, the presence or absence of such an event is not a safe indicator of crisis.  According to Getz in his book “Fundamentals of Crisis Counseling,” this is because some clients are unable to determine just what has happened to throw them off course, or they may be unwilling to share a private experience.  Unwillingness to share this precipitating event may be due to resistance, embarrassment, or the fear of punishment.  However, as you have experienced, the precipitating event need not be clear at first for successful therapy to take place.

Getz also points out that an additional key element in identifying crisis is using caution in attempting too specifically to defining a crisis and establish the potential crisis’ confirmation to all of the diagnostic criteria.  Clearly, if a client envisions him or herself in crisis or intense stress either in reality or in fantasy deserves attention.  It goes with our saying, while diagnostic criteria of course are valuable, in the end the client and therapist must determine what constitutes a crisis for that specific client. 

I frequently use the Common Denominators Assessment technique as a guideline to help identify clients in crisis.  The five factors in this assessment technique are based on the work of Miller.
These five factors are:

1. The time factor: general consensus among therapists is that a crisis is acute rather than chronic.
2. Marked changes in behavior: the individual or group therapy is obviously less effective than usual.  Client activity is mainly related to attempts to discharge inner tensions, there are successive trial and error abortive attempts to solve the problem without apparent success.  Constructive behavior decreases, and frustration mounts.  It is usually at this time that scapegoating and excuse giving occurs.
3. Subjective aspects: The person experiences feelings of helplessness and ineffectiveness in the face of what appears to be insoluble problems.  There is a perception of threat or danger to important life goals the client has and this is accompanied frequently by anxiety, fear, guilt, or defensive reactions.
4. Relativistic Aspects: Although there are common crisis situations, such as the death of a loved one, the loss of a job, or a sudden disabling accident, the individual’s perception of threat and of a crisis is of course unique to her or him.  What may constitute a crisis for your client may not constitute a crisis for another individual or group.
5.  Organismic tension.  The client in crisis will experience generalized physical tension which may be expressed in a variety of symptoms, including those commonly associated with anxiety.  These reactions may be immediate or temporary, or they may constitute a long-term adjustment to the crisis situation itself.

Think of a client in crisis whom you are currently treating.  Do the five factors in the common denominators assessment technique fit her or him?

On this track, we have discussed two factors concerning identifying a crisis.  These two factors are definitions of crisis, and key elements of crisis.  We have also discussed the common denominators assessment technique.

QUESTION 1
What are Freeman’s five categories of precipitating events to a crisis? To select and enter your answer go to Answer Booklet.