Section 12: Crisis Intervention
UCLA
Give me some examples
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Form groups of 4-6.
Agree on 3 examples of crises faced by
your staff
What made these crises challenging to
deal with?
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Things to Consider When
Facing a Crisis
Things to Consider…
Are you safe?
 Are other clients safe?
 Is the client in crisis safe?
 Can I handle this?
 What other resources do I need?
 How do I feel better after it’s over?
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Are you safe?
Protecting your safety is protecting the
safety of the client
• If they hurt you
• They will no longer feel safe,
• They will no longer be able to
receive treatment from your
agency
• Putting your safety first is in the best
interest of the client.
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Keeping yourself safe…
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The Office Setup
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Be conscious of where you are in the office
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Counselor
Client
Counselor
Client
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Keeping yourself safe…
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The Office Setup
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Be conscious of where you are in the office
Be aware of ways of asking for help
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Keeping yourself safe…
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Personal Style
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Be careful not to reflect negative emotional
states
Watch your body language
Stay calm and keep you voice tone low and
soft
Be careful not to stand over or lean into
patient
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Keeping yourself safe…
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If none of that works…
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Get out
Take a break
 Leave the office
 Leave the building
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Get help
Call a supervisor
 Call a colleague
 Call the police
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Things to Consider…
Are you safe?
 Are other clients safe?
 Is the client in crisis safe?
 Can I handle this?
 What other resources do I need?
 How do I feel better after it’s over?

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Are other clients safe?
Where is the crisis happening?
• If other clients are observing, they may
not feel safe
• We do not want to contribute to the
chaos of their lives
• They want to have confidence in
their environment.
• A crisis with one client may lead to a
crisis with another
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Keeping other clients safe…
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Remove the situation to a quiet,
safe place. This will help to:
Calm the participant (and you)
 Protect confidentiality
 Protect other clients from direct harm
 Protect other clients from “helping”
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Things to Consider…
Are you safe?
 Are other clients safe?
 Is the client in crisis safe?
 Can I handle this?
 What other resources do I need?
 How do I feel better after it’s over?

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Is the client in crisis safe?
Is the Client a danger to:
• Self?
• Others?
If danger = being aggressive, follow
recommendations above
If danger = killing self or others, follow
recommendations above AND make sure they get
assessed.
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What is a Suicide/Homicide
Assessment?
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If you think that someone wants to kill
him/herself or someone else, they must be
evaluated.
If risk is significant, they may need to be
hospitalized
 If risk is minimal, a plan needs to be developed
in case feelings get worse.
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Risk factors
 Common psychiatric risk factor leading to suicide
 Depression*
 Major Depression
 Bipolar Depression
 Alcohol and Drug abuse and dependence
 Schizophrenia
 Other psychiatric risk factors with potential to
result in suicide
 Post Traumatic Stress Disorder (PTSD)
 Eating disorders
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Risk factors for Suicide
Symptom Risk Factors During Depressive Episode
 Desperation
 Hopelessness
 Anxiety/psychic anxiety/panic attacks
 Sudden change in mood
 Aggressive or impulsive personality
 Has made preparations for a potentially
serious suicide attempt or has rehearsed a
plan during a previous episode
 Recent hospitalization for depression
 Psychotic symptoms
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Risk factors
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Major physical illness-especially recent
Chronic physical pain
History of trauma, abuse, or being bullied
Family history of death by suicide
Drinking/Drug use
Being a smoker
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Symptoms and Danger Signs
Warning Signs of Suicide
Danger
 Talking about suicide.
 Statements about hopelessness, helplessness,
or worthlessness.
 Preoccupation with death.
 Suddenly happier, calmer.
 Loss of interest in things one cares about.
 Visiting or calling people one cares about.
 Making arrangements; setting one's affairs in
order.
 Giving things away, such as prized possessions.
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Symptoms and Danger Signs
Warning Signs of Suicide
Warning Signs
 Observable signs of serious depression
 Unrelenting low mood
 Hopelessness
 Anxiety
 Withdrawal
 Sleep problems
 Increased alcohol and/or other drug use
 Recent impulsiveness and taking unnecessary risks
 Threatening suicide or expressing strong wish to die
 Making a plan (giving away possessions, obtaining
other means of killing oneself)
 Unexpected rage or anger
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Assessment of Suicide
History
 Influences
 Lethality
 Psychological Organization
 Evaluation of Risk Potential
 Recommendations
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Crisis Intervention: CASE STUDIES
 The following two case study exercises
present crisis scenarios. Please break out into
groups of 2-4 and carefully read each
scenario, then write down your response as
counselor. You will then share your responses
to the class.
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Exercise 1
Case Study 1: Farida

Farida is a 25-year old Ritalin and Valium addict with 3
months of sobriety, whom you have been seeing once a
week. When she walks into your clinic today, she appears
forlorn and acts withdrawn. She refuses to answer your
open-ended and closed-ended questions. Finally, she
mutters, “My husband is seeing another woman and he told
me he is leaving me. Without him, my life isn’t worth living
anymore. I just want to go to sleep and not wake up.” What
do you do?
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Exercise 2
Case Study 2: Mariam
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Mariam is a 32-year old heroin addict who comes to
your clinic for a scheduled appointment. She has not
used drugs for 1 month. Today she seems
uncharacteristically happy and in a calm, almost
content state. You know she has tried to commit
suicide 3 times in her past. When you ask her if she
has had any thoughts of suicide lately, she responds,
“Oh, I don’t know…maybe once or twice. No big deal.”
Describe your next steps.
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