HELPING SKILLS FOR LOSS AND CRISIS

Lecture 6

CATEGORIES OF STRESSORS AND CRISIS

SEVERE LOSS ( EXTERNAL FACTORS) Bereavement Unemployment Disaster Surgery Imprisonment Disability War seperation Terrorism Crimes against person
2

INTERNAL DISTRESS
Hopelessness Despair Depression Post-traumatic stress Bad drug reaction Suicide implusses

TRANSITIONAL STATES
Job changes / retirement Relocation Family conflict / divorce Family member absent illness.

LIFE TRANSITION
Sense of loss is experienced as a spectrum of feelings from uneasiness to depression and helplessness. Stage 1: Transition is change characterised by discontinuity and a break with the past. Feeling of shock and disorganization. It brings out strengths and coping skills from the person life experiences. Stage 2 : Expression of feeling sometimes of anguish and relief. Sometiomes denial of feeling. Im ok this isnt so bad. The length of sadness and depression varies with the persons and loss events. Experience of denial and minimization of the loss. Experience of sadness : losing self-esteem, self-blame, catastrophic fears of the future and sense of helplessness. Stage 3 : Final acceptance of change and planning for the future; taking whole of a new way of life and letting go of the past.; emerging optimism, functional problem solving skills and personal goals for future.

STRESS
A stress reaction is physiological tension and persistent choice conflict. Feels under pressure to reduce tension and achievement comfort or equilibrium. Client must be helped to an awareness of the nature and power of stressors in their lives. Need to learn self help skills and counselors support.
6

CRISIS
A state of disorganization in which helpees face frustration of important life goals or profound disruption of their life cycles and method of coping with stressors. Are temporary. Result in distress and disfunction. Involve of loss of coping capacity. May have long-term negative or positive consequence.
7

DESPAIR, INTENSIVE GRIEVING

State of giving up Stop trying Feel rejected Grieve- normal reaction to severe loss of significant person

STAGES OF DEALING WITH GRIEF Accepting the grief work process. Expressing the feeling of grief. Dealing with the memory of the deceased. Readjusting to the new environment without the deceased. Building new relationship.
9

STRATEGIES FOR HELPING IN CRISES

Use of emotional support through close contact, reassurance and listening to feelings. Changes in environment ; taking the person to a safe and quiet place with nurturing and understanding people. Changes in the persons perception of the problem. Timing. The earlier the help after the crisis event, the more likely the positive outcome.
10

STEPS IN CRISIS INTERVENTION

1.Determine the current conditions of the person, the nature and severity of the crisis. An estimation must be made of the degree of risk or danger before emergency action is taken in a case such as a suicide threat: how much disruption the person is experiencing, the strength and coping skills and what options are open.

11

2. Decide on the type of help most needed at the moment based on an appraisal of the coping skills and resources of the person such as support group or a friend. What personal strength are available to help restore the person to a minimum level of functioning. The put the needed help in order of priority.
12

3.Act in a directly helpful way. Counselor help the person to vent present feelings of fear, guilt or anger. Counselor assists the person in expanding options for actions, help in mobilizing their self defense mechanism and coping skills.. Through suggestions the helper opens new possibilities for action and new relationships with people including referral to a specialist for intensive counseling. The main goal is to get the person back to a precrisis level of responding, not to work towards personality change or higher level of growth.
13

MULTIPLE IMPACT SUPPORT STRATEGY

Teams of agencies and specialists generally are involved, each making an impact at the appropriate time and sequence. For example a family in crisis that is given a minimum of two days intensive round-the-clock attention ia a residential or family service setting rather than in an agency, office or the familys home. The family has the advantage of new environment, a team medical-socialpsychological approach, an individualised help in the form of interviews and groups.
14

BUILDING AND MAINTAINING HOPE

Hopelessness, despair and depression are common components of stress and crisis, people depend heavily on helpers to deal constructively with these conditions. Hope is the main antidite to despair and a source of relief from tension dan frustration from unmet goals and uncertain future. Hope is basely largely on inner strength, esp. cognitive skills. Early religious training and spiritual resources developed over the years is very helpful.
15

GENERAL STRATEGY TO HELP PEOPLE IN CRISIS

1. 2. 3. 4. Expression of feelings Cognitive integration Mobilization of resources Action

16

SUPPORT STRATEGIES
1. Crisis Center: Helpee faced with continuing stress response expressed as suicide attempts, drug abuse, assault. Supported by community chests, private foundations or public fund. Ex.: Drug crisis clinic, rape relief, travellers aid, suicide prevention centers.Helpers: medical personnel, psychologists, volunteers, social workers. 2. The halfway House :utilizers a strategy facilitating transition from the crisis center or treatment facility to real life.Semiprotected residential atmosphere where coping mechanism and personality strengths can be developed before the helpee faces the demands of the real world. 3. Strategy of Renewal and Growth: Identifying strengths in people, helping them to be aware of these strengths and then helping them to develop a plan for releasing these growth potentials.

17

4. Treatment Center: Vary from total environmental

control of the conventional hospital, day-care center and community mental hygiene clinic to small homelike residential center. Focus on drug rehabilitation, alcoholic abusers which provide psychological counseling and medical treatment.

5. Therapeutic Counseling Strategy: Focus could be on how to change behavioral habits and the environments that shape their behaviour and solving personal problem. Comfort derives from mastery over self and the environment. 6. Consoling Strategy: Religious strategy may be a mean of managing grief so that helpee can move quickly through the healing process to new levels of growth, strength and meaning in life.

18

SKILLS FOR SUPPORT AND MANAGING CRISIS

1. Contacting Skills: eye contact, touch and hugging.The decision to touch depends on the context and structure of the helping relationship, as well as on local customs and legal constraints. Reassuring Skills: a method of verbally assuring helpees about the consequences of their actions and feelings. You are competent, You can solve your problem, You can feel better. Use verbal reassurance mainly to reduce distress through facts and predictions.Use reassurance sparingly as a reinforcing agent to encourage continuing behaviours. Relaxing skills: Through direct suggestion, simple focussing and breathing counting inhaling and exhaling slowly. Yoga induces relaxation too. Centering skill cluster: Centering methods are used to help people who feel frustrated, out of tune or even at war with themselves through progressive awareness process, strength analysis, reviewing growth experience and reviewing peak experiences.
19

2.

3.

4.

Progressive Awareness Process.

Helper asks helpee to close their eyes, get comfortable and breathe slowly and deeply. Then the helper goes through a few suggestions to guide their awareness to the center of being. Your body is part of you..but your body is not the total you. What else is there? You have feelings; there are part of you..but your feelings are not the total you. What else is there? You are a thinking being; you have ideasbut your thought is not the total you. You have a center where all of these parts of you come together, a center of your being where you experience peace, wholeness, strength..; this centre is an important part of you
20

Strength Analysis
The helper asks helpee to focus on their strong points and to list them out loud. It may be a matter of only three or four points, but they are usually sufficient to start helpees thinking of their positive qualities. The list of strengths with specific examples, comes from the helpees survey of his or her life experiences.
21

Reviewing Growth Analysis

A method of asking the helpee to focus on pleasant or unpleasant experiences ( the more recent the better) that have had a profoung effect on growth. The helpees focus here must be on events that had positive outcomes. This process leads to reexperiencing feelings long outside of awareness.

22

Reviewing Peak Experiences

Peak experiences means life experiences usually short and infrequent, when the person is aware of intense pleasure, exhilaration, joy and fulfillment. Recalling and focussing on such experiences can be rewarding in terms of comfort and satisfaction.
23

 One of the characteristics of people in crisis is a narrowing of perception, that is they see very few solutions and alternatives. Suicide is my only way out. The help goals are to facilitate a realistic perception of the crisis event, provide support to reduce the tensions associated with the srisis or conflict, consider all the coping alternatives, then make a commitment to action to achieve resonable equilibrium, integration and future growth.
24

5. DEVELOPING ACTION ALTERNATIVES

6. Referring Skills
Know the community resources. Explore helpees readiness for referral. Be direct and honest about your observations of their behviour that led you to your suggested referral. It is advisable to discuss the possibility of referral with the referral agency before the problem become urgent. Determine what other persons have had contact with this helpee. Inform the parents of your recommendations and obtain their consent and cooperation. Let the helpee or the parent make a new appointment. Do not release information to any referral source without permission from the helpee or their parents in the form of a signed release. Maintain the relationship until the referral is complete and a new relationship is begun.

25

7. RENEWING OR BUILDING SUPPORT SYSTEM

Identify who is currently in the network. List functions the network serves for the helpee. List the names of the helpees network members on a sheet of paper. Examine each support member critically in terms of contribution to the helpee. Decide where changes must be made to strengthen the raltionship, renew old contact, add new members with new functions or delete members from the helpees network. Determine skills the helpee may need to carry out skill such as assertive of social skills.
26