by Victoria S – Approved on 25 April, 2017

1. Provide both an objective (from a source e.g. dictionary, textbook) and subjective definition (in your own words) for the following terms: “crisis” and “precipitating event.” (minimum 50 words each, excluding the objective definitions)

The Encylopedia of Mental Disorders defines crisis as “any situation in which the individual perceives a sudden loss of his or her ability to use effective problem-solving and coping skills” (“Crisis Intervention”).

Merriam-Webster defines crisis as:

“a : the turning point for better or worse in an acute disease or fever

b : a paroxysmal attack of pain, distress, or disordered function

c : an emotionally significant event or radical change of status in a person’s life <a midlife crisis>” (“Crisis”)

What these two definitions have in common is the understanding that something significant has happened to the person so that they cannot effectively manage their emotions, and possibly their reactions. Examples of this are when someone learns of the death of a loved one, or the received a diagnosis of a terminal illness. The person in crisis will often experience physical symptoms in addition to the mental symptoms. In a crisis, a person does not think rationally, and is, temporarily, unable to make reasonable decisions. They may find that they make incorrect decisions, or are unable to make a decision at all.

According to the Oxford Living Dictionary, precipitate means “Cause (an event or situation, typically one that is undesirable) to happen suddenly, unexpectedly, or prematurely” (“Precipitate”). Kennedy & Charles describe a “precipitating factor” as something which “can bring about the instant […] of a crisis” (375).

In my experience, there is a broad range of events that can precipitate a crisis. I have seen something as simple as too much red wine precipitate an event in a suicidally depressed person, or sudden, loud, noises impact someone. The death of a loved one, or experiencing an accident can also be precipitating events. Whatever the trigger, it is the thing that causes the individual to become disoriented or to lose their emotional balance.

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2. Describe at least three different categories of emergency situations and provide a clear example of each. Please ensure you include a source citation. (minimum 50 words each).

Emergency situations are classified into three different types of situations: intrapersonal, somatic, and interpersonal (Kennedy and Charles 363).

In intrapersonal emergencies, the individuals may be affected by depression, anxiety, and confusion. Kennedy and Charles point out that anxiety is very common in emergency situations and is usually in response to fear or loss of control. In some cases, individuals may become anxious when they feel that a loved one is losing control (365-366).

Depression is often associated with some form of trauma or loss – like the death of a loved one, or a drastic change in an individual’s life. Depressed individuals may also express feelings of suicide. These expressions of suicide are challenging as we do not have a good way to determine if the individual is making suicidal gestures to control their environment or other people’s behavior; or if they are having suicidal ideas, where they are planning their death (Kennedy and Charles 363-365).

Individuals with intrapersonal emergencies may also be confused. Confused individuals cannot correctly orient themselves in the situation and may have difficulty navigating or managing their environment (Kennedy and Charles 367-368).

The second type of emergencies is somatic emergencies. These are situations where an individual is experiencing a physical symptom. While it is possible that the physical symptoms are psychosomatic, there is no way for the counselor to know, without the advice of a doctor, if it is a real ailment or not. The counselor should attempt to address the physical symptom to gain clues to see if it is a result of an emotional reaction or not (Kennedy and Charles 368). Examples of a somatic situation are where the individual develops symptoms that seem to be those of a nervous system disorder, weakness, or pain (Dimsdale).

The final category of an emergency situation is interpersonal situations. In these situations, we may encounter one individual who desires for the counselor to “fix” another individual. Often, the individual comes to the counselor because they wish to avoid the idea that the behaviors might be emotionally triggered. The challenge in these situations is to understand the emotional context of the event so that we can understand what the correct response is (Kennedy and Charles 368 – 369).

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3. Describe at least five possible events or situations that may cause an individual to experience a crisis in his or her life. (minimum 100 words)

Death of a loved one: When someone dies, the individuals who remain living can go through different levels of grief. If an individual depended heavily on the deceased – for emotional, financial or other types of support – then they may experience an emotional crisis in addition to the normal grieving process.
Illness: Individuals who have been diagnosed with a terminal illness, or who are diagnosed with a chronic illness that will drastically change their lives, may experience an emotional crisis if they cannot find a healthy way to process the necessary changes to what remains of their lives.
Moving to new living or working quarters: Depending on the differences in autonomy or control between the old and new areas, moving to a new living or working location can trigger an emotional crisis. For example, an older adult who moves into a special care facility that is not in their old neighborhood may experience an emotional crisis because of the lack of a support system or familiar surroundings. An individual who changes work environments drastically – from office work to factory floor, for example – may also experience an emotional crisis if they are not able to manage the change in their environment in a healthy way.
Birth of a differently abled child: The birth of a mentally or emotionally challenged child can trigger an emotional crisis in their parents. The parents may not be appropriately prepared, supported, or emotionally or financially equipped to manage their reactions to a child who is behaving outside of their perceived norms. They may also have challenges admitting that their child is differently abled, or that they cannot handle their child on their own. These factors may contribute to the triggering of an emotional crisis.
Loss of a job: As I have experienced, the loss of a job can have a significant emotional effect on a person’s self-identification and well-being. Individuals who consider themselves to be the primary source of household income, or whose identity is linked to their employment are at risk for having a crisis upon the sudden loss of their job.

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4. Discuss how an individual’s ability to appropriately cope and/or problem solve may be affected by crisis and explain the process you would use to assist this individual. (100 words).

When an individual is experiencing a crisis, their ability to adapt and react to the environment around them is compromised. Often, the normal reactions that the individual makes do not result in the expected response, and anxiety increases. The crisis may be considered as threatening to their livelihood, or to their self-identity. The individual will respond to the changes and perceived threats with behaviors that they expect to help to protect themselves in the current, perceived, situation.

As clergy and counselors, we need to find a way to help to stabilize the situation by focusing on the individual and what they need for support. It is also up to us to understand if the individual needs additional help. Sometimes, an individual needs someone to help them regain their perspective, or to help them gain their emotional control back; and sometimes they need professional help. In those cases, it is critical that we can supportively make the correct referrals.

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5. List and discuss at least five suicide warning signs. Explain how you would respond if you were assisting an individual exhibiting one or more of these signs. (minimum 50 words each warning sign and minimum 100 words for response).

The following are some key warning signs for suicide:

Talking about suicide: Kennedy and Charles point out that 80% of individuals who attempt suicide talk about it with someone. The challenge seems to be in our ability to hear what they are saying. Sometimes the conversation may be framed in the form of a joke or talking about other individuals who suicided and have similar situations to the at-risk individual (335).
Clinical depression: Depression is one of the most common symptoms of individuals who attempt suicide. While not all individuals who are depressed consider suicide, when it is combined with additional conditions including high levels of anxiety, feelings of loss of control, or confusion, it is more likely to indicate an individual who has thoughts of suicide (Kennedy and Charles 364).
Preparing for death: Individuals who are seriously considering suicide may also take the time to put their material affairs in order. They may suddenly decide to create a will or taking steps to ensure that their funeral and financial affairs are already setup for the time of their death (“Recognize the Warning Signs of Suicide.”).
Suddenly cheering up after being depressed: If an individual who has been exhibiting feelings of hopelessness, of lack of self-worth or other signs of clinical depression, suddenly becomes cheerful, they might be planning their suicide. We should look for other reasons for the sudden change in behavior, but it is possible that the depression or lack of control was resolved by the decision to suicide (“Recognize the Warning Signs of Suicide.”).
Losing interest in things they used to care about: If individuals who normally acted as if they were engaged with the world suddenly loses that engagement, it could be a warning sign for suicide (“Recognize the Warning Signs of Suicide.”). The individual could be feeling helpless, a lack of control or self-worth, or other emotion that makes them feel unworthy of engaging in their previous interests. A high level of sudden withdrawal from the world could indicate the potential for suicide.

When assisting someone showing these signs, it is critical to support them and to avoid attempting to tell them things like “everything will be okay” – even if you disagree with their statements. Individuals who are considering suicide are usually hurting and in need of assistance and support. They do not need to be minimized or have their emotions dismissed. It is key that we actively listen to what they are saying, and ensure that they feel that we are listening to them. We can also support them by encouraging them to see a mental health professional, to call a suicide hotline, or to continue to meet with a therapist or other mental health professional if they have already started to do so. Without additional training, an ADF priest is not qualified to provide full support to individuals who are clinically depressed or suicidal. We can, however, provide support and spiritual guidance to those individuals and supplement their trained therapists, counselors or medical practitioners.

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6. Choose four of the seven common misconceptions about suicide from the list below and discuss why each is a misconception. (minimum 50 words each)

People who talk about suicide won’t really do it:

Kennedy and Charles talk about two different types of people who talk about suicide – those who have “suicidal ideas,” and those who are making “suicidal gestures.” Individuals who are making ”suicidal gestures” are attempting to control their environment by getting attention or by gaining control of others. Individuals with “suicidal ideas” are usually planning how they can achieve the suicide and are very likely to do it. Unfortunately, there is no good way for a counselor to differentiate between the two, and both types of individuals need to be responded to concerning their perceived needs (364).

Anyone who tries to kill himself/herself must be crazy:

While it is not unknown for someone with a psychotic condition to try to kill themselves, it is not the most common condition for individuals who attempt suicide. In discussing Edwin S. Shneidman’s work, Kennedy and Charles discuss the different sets of symptoms that are evidenced by individuals considering suicide. The first, and most common of these, is depression. Individuals may also be expressing the symptoms of “the defiant person” who is trying to reestablish control over their environment. Other individuals may be “dependent-dissatisfied patients” who recognize that they are dependent on someone or something but are not happy with the current situation. The final group that Shneidman mentions is the individuals with mental disorders or psychosis with hallucinations or illusions (Kennedy and Charles 337).

Talking about suicide may give someone the idea:

Stephanie Pappas debunks the myth that talking to someone about suicide may give them the idea to attempt suicide themselves. Instead, Pappas suggests that asking a depressed person if they are considering suicide may open the conversation about suicide and make the individual feel more comfortable with discussing any thoughts they may have had about suicide. This conversation may help them to seek out assistance with their emotional crisis.

After a person has attempted suicide, it is unlikely he/she will try again:

In an article in “Current Psychiatry”, Dr. Jeglic mentions that a failed attempt at suicide is a “strong predictor” of a future attempt at suicide. According to Jeglic, individuals who have attempted suicide are 38 times more likely to attempt suicide in the future than other individuals. The risk factors of depression, hopelessness, anxiety or other medical disorders can continue beyond the initial attempt at suicide, and make the individual more likely to make a second, or more, attempt.

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7. Discuss why an individual in crisis might seek an ADF clergy person for help and explain whether or not you feel this is an appropriate function for ADF clergy, why or why not? (minimum 200 words)

There are a lot of different reasons that individuals may choose to visit an ADF clergy person for help instead of going to a counselor. The most common reason that I have heard is that the individual thinks that they counselor or therapist may think that they are crazy because of the individual’s religious or spiritual beliefs. Individuals may also feel embarrassed talking with a stranger, and a clergy person may be perceived as being more understanding of their issues. There are also the cases where individuals cannot afford to seek a therapist, but understand that they need assistance. In these cases it’s very understanding that they would seek out a clergy person for help.

In an article on Psychology Today, Dr. Friedman discusses the challenges that the clergy of the major, monotheistic, religions face when they are approached by individuals in crisis. Like pagan clergy, many monotheistic clergy people are not formally trained in how to be a counselor, and find it challenging when individuals come to them for help. I think that it is important that we keep ourselves open to being approached by individuals in time of crisis or emergency, so that they feel that they have a safe place to go to. It is, however, also very important that we understand our limits and ensure that we have an appropriate list of people and organizations that we can refer these people to for help.

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8. Discuss an example of a crisis situation to which you have responded (this may be a crisis you have personally experienced or an experience in which you tried to help someone else in crisis). Reflect upon your response to the crisis in your example, and explain what you found effective, as well as how you could have improved your response to this situation. (minimum 200 words)

My most recent crisis experience was at Pantheacon in 2015. There, one of my roommates had recently lost her father and was in a depressive state as a result. She assured me that she had it under control and was staying away from alcohol as that was a trigger for her. I came back to the room one evening to discover that she had, surreptitiously, drank most of a bottle of red wine. Not much later, she started to cry hysterically. I had two other roommates, and none of us knew exactly what to do. L (the hysterical roommate) was crying about how her Father did not love her, and he left her. It got to the point where she was threatening to cut herself because she wanted to die. At this point, one of my other roommates gathered up all the sharp and pointy things in the room and removed them to one of our friends’ rooms.

Because I knew her, I knew that touch would be okay, so I tried holding her and letting her cry, but that did not seem to help. I started asking her about good memories of her Father. I knew, from previous conversations, that she did not always think that her Father did not love her, so I tried to keep her focused on the good things while still acknowledging her grief. I tried reminding her of her husband, who was not there, who loved her and needed her, and to give her a grounding back to this time and place – and a reason to stay alive. At times, she would calm down, but then something would trigger the hysteria again. My tactics were not working, so we eventually woke a Methodist Minister, who was the mother of one of my roommates, and she was able to calm L down.

S, the minister, focused on getting L out of the hysterical state by distracting her. For example, L said that her Father liked books, so S asked her what books she liked to read. It took some time, but S was able to calm L down enough that we could get L to sleep a bit. Once she was calm and slept, we encouraged her to shower and dress and consider driving home. I took L outside and sat her down by one of the redwood trees. We chatted a bit about trivial things, and I talked her through a grounding exercise until she was able to drive safely for a couple of hours to go home. After L had headed out and her husband knew when to expect her, I went to find one of my friends who is a member of the ADF Clergy to talk through what happened and my reaction to it.

If I were in that situation now, I would spend more time using the distraction technique that S did. I would focus on getting L to the point where she was no longer hysterical, and then re-enforced how she was loved and needed instead of the other way around. I think that making sure that L was grounded before she left was a good idea too. Taking that extra step to make sure that she was re-connected to the stability of the Mother Earth was good. Looking back, I was also happy that I took some time to talk to a clergy person myself. Spending all the time working with L had caused a lot of issues as she broke my trust and my hospitality. She also caused a lot of disruption for myself, my other roommates, and S. I had to put my feelings aside when dealing with L, but I still needed to deal with them when the crisis was over.

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9. Discuss how the skills required of ADF clergy in ritual, especially those which involve mitigating chaos and generating order, might relate to those necessary for appropriately responding to an emergency situation (minimum 100 words).

A lot of the skills that we learn in performing ritual are useful in emergencies. As ADF Clergy, we learn to maintain calm, to rapidly assess the situation and to organize the individuals who are involved in acting for the best resolution as part of our skills in managing ritual. It is also important that the clergyperson be able to quickly assess each individual’s skills and provide them with a role that utilizes those skills if possible.

While emergency situations often have a higher level of physical or emotional risk, similar skills are used to assess the situation, determine the best roles for individuals, and to organize the individuals involved to move towards the best resolution. Practicing these skills in a relatively safe environment of a ritual is very useful. In rituals, we also learn to listen to other individuals and work together with a team. These skills are also invaluable for working with any other people who are responding to the emergency.

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10. Compile and submit a list of mainstream resources providing crisis services available in your locality. Additionally, explore your locality for a hotline number to access emergency services and discuss the results of your search. (Please provide the following information for each resource listed a) name of resource b) contact information c) how to make a referral d) hours of operation e) specific service[s] provided by the resource). (no minimum word count)

suicidal thoughts

StarVista Crisis Intervention & Suicide Prevention Center
24-hour Crisis Hotlines

800-273-TALK or (650) 579-0350
Star Vista provides counselling for conflicts, mental health, substance abuse and trauma; provides programs to help people avoid risky behaviours; provides early intervention for families with troubled children; conducts training about the impact of behavioural and emotional issues; provides residential housing for young people who can no longer live with their families.

Teen Hotline & Website – On Your Mind.net
24-hr online Hotline 1-800-273-TALK

Monday Through Thursday 4:30 – 9:30 pm (PST) chat room http://www.onyourmind.net/

Provides an anonymous peer-to-peer phone number & chat room for Teens to ask anything and get advice from trained Teen volunteers. This is part of the StarVista programs.

San Mateo County Health System
Crisis Intervention and Suicide Hotline (800) 273-8255

National Suicide Prevention Lifeline

English & Spanish: 1-800-273-TALK (8255)

Deaf Individuals: 800-799-4889

https://suicidepreventionlifeline.org/
suicideprevention@dhcs.ca.gov

Available for Spanish & English speakers.
Chat is also available on the website for Deaf & Hard of Hearing individuals

http://www.211.org/

Dial 2-1-1 on any phone

FCC program to connect individuals with help for a variety of help including housing, crisis, food, suicidal thoughts, health, jobs, human trafficking, reentry into society, veteran assistance.

Check 211.org for coverage. 211 is supported in San Mateo County in California.

mental illness

StarVista Crisis Intervention & Suicide Prevention Center

See above for details

San Mateo County Health System

http://www.smchealth.org/bhrs/stigma

Psychiatric Emergency Services (650) 573-2662
BHRS ACCESS (800) 686-0101
Crisis Intervention and Suicide Hotline (800) 273-8255

substance abuse (addiction)

StarVista Crisis Intervention & Suicide Prevention Center

650-573-3950

Addiction to Sobriety

24-hr Hotline: 877-781-6301

Provides access to specialist counselors and drug rehabilitation programs

financial issues

Community Action Agency of San Mateo County, Inc.

(650) 595-1342

Provides food for a week and Thanksgiving/Christmas meals; funding for housing repairs

San Mateo County Food Connection (Food Stamps)

1-800-984-3663

Central Coast Energy Services

1-650-242-9474

Provides assistance for Utility bills

Second Harvest Food Bank – Food Connection

Monday – Friday, 8:00 am – 5:00 pm – 1-800-984-3663.

Provides groceries

Legal Aid Society of San Mateo County

650-558-0915 or 800-381-8898

Mon – Fri 9:00 am – 12:00 noon & 1:00 pm – 5:00 pm

www.legalaidsmc.org

Domestic Violence Collaborative helps low-income domestic violence survivors get essential protective orders and provides free limited scope representation at their restraining order hearing. New Beginnings Program provides free legal services to low-income women and teens who are survivors of domestic violence. Teen Parent Project offers representation to pregnant or parenting teens so they can leave abusers and establish stable lives.

http://www.211.org/

Dial 2-1-1 on any phone

FCC program to connect individuals with help for a variety of help including housing, crisis, food, suicidal thoughts, health, jobs, human trafficking, reentry into society, veteran assistance.

Check 211.org for coverage. 211 is supported in San Mateo County in California.

homelessness (lack of shelter, food, clothing, other basic needs)

StarVista Crisis Intervention & Suicide Prevention Center

For young people only

See above for details

San Mateo County Department of Housing Authority

Mon-Thurs.8:00 – 5:00 pm – (650) 802-3300

Provides access to low-cost housing, house sharing and landlord protection

Life Moves

http://lifemoves.org/the-problem/get-help/

The Shelter Bed Hotline 1-800-774-3583

Samaritan House (650) 347-3648

Provides housing and employment assistance to families with children, individuals who can function independently, and who live and work in San Mateo County

Website contains local contacts for other locations.

San Mateo County Center on Homelessness

Beth Falls at bfalls@smchsa.org (or by phone at 650-802-7656)

Ali Shirkhani at AShirkhani@smcgov.org (or by phone at (650) 802-7675)

Phones available during government office hours

Second Harvest Food Bank

Monday – Friday, 8:00 am – 5:00 pm – 1-800-984-3663

List of Meal sites is at http://www.shfb.org/docs/getfood/foodresources_sanmateo.pdf

http://www.211.org/

Dial 2-1-1 on any phone

FCC program to connect individuals with help for a variety of help including housing, crisis, food, suicidal thoughts, health, jobs, human trafficking, reentry into society, veteran assistance.

Check 211.org for coverage. 211 is supported in San Mateo County in California.

suspected abuse of the individual’s child(ren)

San Mateo County Human Services Agency / Child Protective Services (CPS)

24-hr Hotline: 650-595-7922 or 800-632-4615

www.smchsa.org

Responds to reports of abuse, abandonment, sexual molestation, exploitation, or neglect of children age 17 or under.

criminal victimization (victims of theft, sexual assault, domestic violence)

StarVista Crisis Intervention & Suicide Prevention Center

See above for details

Community Overcoming Relationship Abuse (CORA)

24-hr Hotline: 650-312-8515 or 800-300-1080

www.teenrelationships.org or www.CORAsupport.org
Multilingual hotline, emergency response program, emergency housing for victims/survivors of domestic violence, support groups, legal assistance. Family clinician provides therapy to families and child witnesses who have experienced domestic violence.

Rape Trauma Services (RTS)

24-hr Hotline: 650-692-RAPE (692-7273)

www.rapetraumaservices.org

Crisis counseling, outreach and advocacy services, support groups for survivors of sexual assault, their family and friends

San Mateo County Health System / Aging and Adult Service

24-hr Hotline: 800-675-TIES (800-675-8437)

www.smhealth.org

Adult Protective Services (APS) investigates and develops care plans in situations where elders or dependent adults have been subjected to or are at risk of abuse, neglect or exploitation.

Legal Aid Society of San Mateo County

650-558-0915 or 800-381-8898

Mon – Fri 9:00 am – 12:00 noon & 1:00 pm – 5:00 pm

www.legalaidsmc.org

grief (resulting from death, terminal illness, divorce or other loss)

For Teens – Teen Hotline & Website – On Your Mind.net

See above for details

Hospice by the Bay

http://hospicebythebay.org/

(415) 526.5699 or (707) 931.7299

griefsupport@hbtb.org

Provide counseling and support groups for all ages. Individual and group counseling options are available

The Dougy Center

(866) 775-5683

http://www.dougy.org/
Provides grief support resources specifically for grieving children, teens and their families. Offers an excellent selection of relevant books, brochures and suggested activities, as well as connections to nationwide centers offering grief counseling and related services.

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Works Cited

“Crisis Intervention.” Encyclopedia of Mental Disorders. Advame, Inc, 2011. Web. 30 Jan. 2017. <http://www.minddisorders.com/Br-Del/Crisis-intervention.html>.

“Crisis.” Merriam-Webster. Merriam-Webster, n.d. Web. 30 Jan. 2017. <https://www.merriam-webster.com/dictionary/crisis>.

“Precipitate.” Oxford Living Dictionary, n.d. Web. 31 Jan. 2017. <https://en.oxforddictionaries.com/definition/precipitate>.

“Recognize the Warning Signs of Suicide.” WebMD. Ed. Joseph Goldberg. N.p., 13 Aug. 2016. Web. 11 Apr. 2017. <http://www.webmd.com/depression/guide/depression-recognizing-signs-of-suicide#1>.

Dimsdale, Joel D., MD. “Overview of Somatic Symptom and Related Disorders – Mental Health Disorders.” Overview of Somatic Symptom and Related Disorders. Merck Manuals Consumer Version, n.d. Web. 04 Apr. 2017. <https://www.merckmanuals.com/home/mental-health-disorders/somatic-symptom-and-related-disorders/overview-of-somatic-symptom-and-related-disorders>.

Friedman, Michelle, MD. “Clergy as Counselor.” Psychology Today. N.p., 18 May 2015. Web. 10 Apr. 2017. <https://www.psychologytoday.com/blog/the-intelligent-divorce/201505/clergy-counselor>.

Jeglic, Elizabeth L., PhD. “Will My Patient Attempt Suicide Again?” Current Psychiatry. MDedge, Nov. 2008. Web. 10 Apr. 2017. <http://www.mdedge.com/currentpsychiatry/article/63347/will-my-patient-attempt-suicide-again>.

Kennedy, Eugene C, and Sara C. Charles. On Becoming a Counselor: A Basic Guide for Nonprofessional Counselors and Other Helpers. New York: Crossroad Pub. Co, 2001. PDF.

Pappas, Stephanie. “5 Myths About Suicide, Debunked.” LiveScience. N.p., 27 Mar. 2014. Web. 10 Apr. 2017. <http://www.livescience.com/44388-myths-about-suicide-debunked.html>.