Professional Counseling & Crisis Intervention 1

Professional Counseling & Crisis Intervention 1

Professional Counseling & Crisis Intervention:

Helping Through the Worst of Days

NAME

PROFESSOR

COURSE

DATE

Abstract

This essay presents a comprehensive discussion of the field of professional counseling, with an emphasis on crisis intervention. An overview of the history, purposes, theories, methods, and values of this field will be provided. This essay also provides a summary of two important empirical research studies recently conducted in the field and assesses the implications and applications of these studies. Further, this essay will explore the author’s interest and background in this field, and will look ahead at the professional trajectory the author intends to trace in a career devoted to helping clients and their families through the very worst of days.

Background

Professional Counseling with an emphasis in crisis intervention combines more traditional clinical models of counseling with acute and emergent care protocols. As such, a crisis intervention specialist is one who must quickly and accurately identify signs of an incipient crisis, even when those signs are hidden or latent. A number of helpful assessment tools have been developed in the field to facilitate this process, as the results of failure to act speedily and appropriately may be fatal, both to the patient and to those around him. Among the most widely used and significant of these is Roberts’ Seven-Stage Crisis Intervention Model (Roberts & Ottens, 2005). An important follow-up to Roberts methodology was the creation of the ACT (Assessment Crisis Intervention Trauma Treatment) protocol (Roberts, 2002), which was developed by Roberts in the wake of the September 11 tragedy. Counselors specializing in crisis intervention occupy a unique role in the field of psychology in that they often serve as intermediaries to further, more prolonged and intensive treatment. The practice of crisis intervention counseling informed fundamentally by insights into the mechanisms of acute trauma, as well as trauma’s more enduring aftereffects, particularly as these may give rise to psychological crises in which the potential for self-or-other-harm is real and immediate. Voluminous research in recent decades surrounding post-traumatic stress disorder (PTSD), driven by a surge of returning combat veterans, has shaped this field in profound ways, informing methods of crisis detection and acute intervention (McNally, Bryant, & Ehlers, 2003).

Theoretical Approaches

At the heart of crisis intervention is the effort to help patients and their families through the worst moments of their lives, whether this be a death, a catastrophic event, or an acute psychological crisis, such as suicidality. Crisis interventionist specialists stand in the gap in an effort to protect patients and those around them from physical harm. This is in an effort, foremost, to usher them alive through the acute and most dangerous phases of the crisis until they can become stabilized enough for further care, typically transitioning from in-patient hospitalization to outpatient clinical care.

One of the most significant theories at play in this process of stabilization is the control-mastery theory. This theory posits trauma patients both consciously and subconsciously adopt frequently destructive behaviors in an effort to prevent retraumatization. This process hyper-inflates patients’ assessment of their own role in and contribution to the traumatic event, thereby instilling in them an almost neurotic belief in their capacity to determine—and prevent—future events. However, patients’ attributions of the causes of these traumatic events are often irrational and instead, as Freud hypothesized, merely serve to revisit and perpetuate the trauma, rather than prevent it (Bush & Gassner, 1988). Professional counselors, particularly those specializing in crisis intervention, can minimize the long-lasting effects of trauma by identifying these false attributions and redirecting patients’ control-mastery impulses toward a more productive vein. Increasingly cognitive behavioral therapy (CBT) is being used to help patients learn to identify, assess, and reshape destructive thought patterns such as these.

Another significant theoretical approach employed in the field is the Gestalt theory. According to Young and Lester (2001), this approach may be particularly helpful for patients experiencing suicidal ideations. This theory, the authors suggest, provide a helpful counterpoint to more passive models of counseling, in which the therapist or physician merely reflects back the patients’ feelings and assertions. Rather, according to Gestalt theories, the counselor must play an active role in helping patients to bring subconscious traumas, fears, resentments, and desires to the surface, where they can be acknowledged and productively challenged. The success of Gestalt theory for suicidal patients in particular, Young and Lester assert, is due to the intensity of the emotions that precipitate the suicidal crisis in the first place. Gestalt theory centers upon the nature of the interaction between the organism and its environment. This suggests that when suicidal patients are challenged externally to acknowledge and confront the rage that so often characterizes suicidality, they experience better results than those who undergo the same treatment methods in a more psychologically stable state (ibid., p.66). In this instance, Gestalt theory provides the mechanism for creating the ideal therapeutic environment when the patient is most primed to benefit from it.

Research Methods

As with any scientific field, one of the most important methods of research in the field of crisis intervention is empirical observation. Researchers in the field use a variety of methods for evaluating patient behavior, disease etiology and progression, treatment protocols, and treatment efficacy. Researchers may base their observations on a small sample of a target population over a short period of time; they may observe subjects intermittently, at predetermined intervals, or they may engage in large-scale, long-range subject observation. The common factor should be, as with all scientific research, the rigorous and meticulous nature of the methods used and of the analysis of the data presented.

Literature review is also a key tool for researchers testing their hypotheses in the field. When a research does not have the resources to engage in observational or experimental research (in which subjects are exposed to the pre-determined manipulation of a variable) , a literature review is often helpful in evaluating the data at hand and comparing existing research with the practitioner’s hypothesis. Typically, literature reviews are the first step toward the development of an observational study or an experiment, but the research may stand alone, depending upon the depth and credibility of the data at hand.

Two Empirical Studies

In 2003, McNally, Bryant, and Ehlers reviewed existing literature on the impact ot early intervention on PTSD. Their assessment of the existing data yielded powerful insights into long-held assumptions about early crisis intervention and its efficacy. The authors demonstrated that the traditional method used in crisis intervention of psychological debriefing (that is, the forced revisiting and confrontation, under the counselor’s guidance, of the traumatic event shortly after it occurs) is not statistically correlated to a reduced prevalence of PTSD and may in fact be linked to increased rates of PTSD. The authors argue instead that the data suggests that a patient-led approach, one employing CBT and mindfulness techniques, is often more beneficial for the patient. Further, they suggest that intervention occurring significantly after the event may be more beneficial, in some instances, than early intervention (uncles the patient is a danger to him/herself or others). This study alters in fundamental ways prevailing assumptions about crisis intervention, at least insofar as it relates to PTSD.

Sawyer, Peters, and Willis (2013) take an innovative and informative approach in their empirical study, focusing not on the patients but on the counselors. The researchers observed a sample of master’s level counseling students enrolled in a Crisis Intervention Preparation course. The goal was to assess what relationship exists, if any, between self-efficacy and counselor therapeutic response. The authors concluded that high levels of self-efficacy were indeed correlated with a more effective therapeutic response (p. 39). This suggests a vital need for improved counselor-training in true-to-life scenarios and experiences which will build counselors’ confidence in their ability to adapt and respond to a crisis situation.

Professional Expectations and Experience

My intention is to pursue a Masters degree in Professional Counseling and to work in a therapeutic setting as a professional counselor to treat patients suffering from psychiatric and psychological disorders, as well as their families. This means that I will most likely work in a clinical or hospital setting. Further, I already have an extensive background in crisis intervention and plan to make this a primary area of specialization moving forward. I enjoy helping those who are faced with a trauma, such a loss or bereavement, or the devastation of a physical or mental health crisis, find their footing again. As a professional counselor specializing in crisis intervention, my duty will be that of a first responder of sorts, being on hand and ready to respond immediately and effectively to any crisis situation. The ability to identity the most covert signs of trouble and to respond quickly may very well save a life—or many. In addition, I must be able not only to provide the therapeutic response patients need to restabilize after a crisis, but I must also be able to ensure their continuity of care, either by providing it myself in my role as a professional counselor or by linking patients to the resources and practitioners. My job as a professional counselor specializing in crisis intervention is not only to ensure that my patients and their families survive their trauma, but that they learn to heal in the wake of the new normal, that they discover not only how to move on, but how to move forward. My task is to help them not just to survive, but to thrive.

References

Bush, M. & Gassner, S.M. (1988). A description and clinical research application of the control-mastery theory. Clinical Social Work Journal, 16(3), 231-242.

McNally, R.J., Bryant, R.A. & Ehlers, A. (2003). Does early psychological intervention promote recovery from posttraumatic stress? Psychological Science in the Public Interest, 4(2), 45-79.

Roberts, A.R. (2002). Assessment, crisis intervention, and trauma treatment: The integrative ACT intervention model. Brief Treatment and Crisis Intervention, 2(1), 1-22.

Roberts, A.R., & Ottens, A.J. (2005). The seven-stage crisis intervention model: A road map to goal attainment, problem solving, and crisis resolution. Brief Treatment and Crisis Intervention, 5(4), 329-339.

Sawyer, C., Peters, M.L., & Willis, J. (2013). Self-efficacy of beginning counselors to counsel clients in crisis. The Journal for Counselor Preparation and Supervision, 5(2), 30-43.

Young, L. & Lester, D. (2001). Gestalt therapy approaches to crisis intervention with suicidal clients. Brief Treatment and Crisis Intervention, 1(1), 65-74.