The assignment: (3 paper APA Format)Briefly describe the second organization you chose (the organization other than the Red Cross). Explain the similarities and differences between the American Red Cross model and the other one you selected in terms of t

PreparationActionRecoveryAConceptualFrameworkforCounselorPreparationandResponseinClientCrises.pdf

Home >Social Science homework help >The assignment: (3 paper APA Format)Briefly describe the second organization you chose (the organization other than the Red Cross). Explain the similarities and differences between the American Red Cross model and the other one you selected in terms of t

Journal of Counseling & Development ■ Fall 2008 ■ Volume 86388

Practice & Theory

Earn 1 CE credit now for reading this article. Visit www.counseling.org/resources, click on Continuing Education Online, then JCD articles.

The frequency of serious client crises confronting human service professionals has escalated to such proportions that crises have been referred to as an “occupational hazard” in the professional literature. Nearly a third of all practicing mental health counselors can expect to encounter the suicide of a client at some point in their careers; nearly two thirds should anticipate a client’s suicide attempt (Schwartz & Rogers, 2004). Violent behavior in school-age children has more than doubled in the past 20 years, and the violent acts they commit have become significantly more dangerous (McAdams, 2002; McAdams & Lambe, 2003). The occurrence of severe psychiatric disorders (e.g., schizophrenia, bipolar disorder, panic disorder, obsessive- compulsive disorder) has doubled since 1985, making them the largest and fastest-growing diagnostic category for federal programs providing assistance to individuals with disabilities (Torrey, 2002). Community and school counselors often provide the first line of intervention for persons in psychological and emotional crisis and in need of specialized interventions and support methods (American School Counselor Association, 2000; Lester, 2002). Despite this, there is a curious absence in counselor preparation, certification, supervision, and ethical practice standards of a consistent or comprehensive guideline for crisis prevention/intervention and postcrisis recovery.

National and state standards for professional counseling address the need for attention to crisis preparation and ap- propriate response; however, they do not specify the type or level of attention necessary to minimize the risk of crises and maximize the effectiveness of crisis intervention and the potential for full postcrisis recovery among all those affected. For example, in its current standards for counselor prepara- tion, the Council for Accreditation of Counseling and Related Educational Programs (CACREP) specifies that counselors possess “knowledge of prevention and crisis intervention

strategies.” (CACREP, 2001, Section B.7.). The standards do not indicate what type or minimum level of knowledge and skill proficiency are necessary for effective crisis response.

In granting the National Certified Counselor credential, the National Board for Certified Counselors (NBCC) does not require counselors to be trained specifically in crisis re- sponse; rather, it specifies in its ethical code that counselors “offer only professional services for which they are trained or have supervised experience” (NBCC, 1997, p. 2). By defini- tion, the practice of professional counseling includes crisis response (U.S. Department of Labor, 2003); thus, an NBCC expectation of formal counselor preparation in crisis response is clearly implied in this ethical standard. Licensure standards for counselors vary from state to state. However, as increasing numbers of state licensing bodies align their preparatory and proficiency criteria with the CACREP and NBCC criteria, respectively, a similarly imprecise licensing standard for crisis response competency can be anticipated.

The Ethical Guidelines for Counseling Supervisors of the Association for Counselor Education and Supervision (ACES) specify that ”procedures for contacting the supervisor, or an alternative supervisor, to assist in handling crisis situations should be established and communicated to supervisees” (ACES, 1993, p. 2). The importance of supervision in client crisis response is made clear in this guideline; the specific role of supervision in crisis response is not.

National standards for ethical counseling practice are similarly nonspecific with regard to the counselor’s role in responding to client crisis response. Most applicable is Stan- dard C.2. of the American Counseling Association’s (ACA) Code of Ethics, which prohibits counselors from performing their role without adequate preparation (ACA, 2005, p. 9). Without further elaboration in the Code, a required but un-

Charles R. McAdams III and Harry J. Keener, School of Education, The College of William and Mary. Harry J. Keener is now at United Methodist Family Services, Richmond, Virginia. Correspondence concerning this article should be addressed to Charles R. McAdams III, School of Education, The College of William and Mary, PO Box 8795, Williamsburg, VA 23187-8795 (e-mail: [email protected]).

Preparation, Action, Recovery: A Conceptual Framework for Counselor Preparation and Response in Client Crises Charles R. McAdams III and Harry J. Keener

Despite increasing requirements for counselor proficiency in crisis response, there is an absence in the standards for counselor preparation, certification, and supervision of consistent criteria on which best practice in crisis prevention and intervention, and postcrisis recovery can be gauged. The authors present a conceptual framework that defines the actions required at the different phases of a client crisis and identifies potential constraints to effective counselor action that must be acknowledged and overcome at each phase.

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defined standard of acceptability has once again been set for counselors in the performance of their named responsibility in crisis response.

The Risks of Inconsistency The absence of a consistent and comprehensive conceptual framework for serious client crises in professional counseling poses a risk for the profession on several levels. Of foremost concern is that without a conceptual framework, there can be no assurance that counselors are adequately prepared to perform a core aspect of their service to clients. Recent research findings suggest that, in fact, counselors may not be prepared. For example, studies of practicing high school counselors have found that up to two thirds of these profes- sionals believe that they could not recognize a student at risk for suicide (King, Price, Telljohann, & Wahl, 2000). Surveys of practicing mental health counselors have reported similar per- centages of counselors who believe that they are unprepared to anticipate or manage violent behavior in clients, despite the high probability that these professionals will encounter such behavior (Shields & Kiser, 2003). These concerns about preparedness for client crisis response have been voiced by counselors having a wide range of education and experience (McAdams & Foster, 2000).

A second concern is an unnecessary risk of malpractice litigation. Listed among the major causes for successful mal- practice suits brought against mental health service providers in the United States is “incorrect treatment—e.g., using treatments the therapist was not qualified to perform by lack of training or experience” (American Psychological Association, 2003, p. 436). Counselor performance in crisis response is and will remain unnecessarily vulnerable to legal scrutiny until specific standards for counselor education and, subsequently, “qualifica- tion” in crisis response are more clearly identified.

A third, and often underestimated, risk is potential detri- ment to the personal and professional development of the responding counselors. In the aftermath of major crises such as a client’s suicide or physical violence, counselors have reported feelings of guilt, sadness, anger, and increased fear in dealing with at-risk clients; these feelings remained at intrusive or even debilitating levels for years after the event (LaFayette & Stern, 2004; McAdams & Foster, 2000, 2002). The risk of psychological and professional impairment has been shown to be especially great when crises occur while the counselor is a student or novice who is less able to bal- ance a sense of personal failure against limitations inherent in the counseling process (McAdams & Foster, 2002; Trimble, Jackson, & Harvey, 2000).

Fortunately, research has shown that precrisis education and rehearsal can reduce the risks of negative outcome in client crisis response. Professional “survivors” of client suicide and serious client violence have reported consistently that preparation for the crises is a prerequisite for competent intervention, coping with crisis impact, and moving forward in the professional’s

personal and professional lives (Kanel, 2003; McAdams & Foster, 2000, 2002). Some survivors who were well-prepared in advance for a crisis and supported adequately in its after- math have even reported that the impact of the experience was ultimately positive, yielding such outcomes as heightened awareness of their own limitations and general sensitization to factors that predispose individuals to experience critical inci- dents (Kleespies, 1993; McAdams & Foster, 2002). Effective preparation, thus, can be a critical factor in determining crisis outcome. This finding highlights the need for a consistent and well-informed conceptual framework for client crisis response in counseling.

The Preparation, Action, Recovery (PAR) Framework

In developing such a framework, much can be learned from the existing research literature regarding the two mental health emergencies that are dreaded most by mental health profes- sionals: client violence and client suicide (Allen et al., 2002; McAdams & Foster, 2000). Client violence has been shown to occur not as a spontaneous, isolated event, but rather as an un- folding sequence of interrelated and often recurring events of which the crisis episode is but a single part (Breakwell, 1997; Treishman, Whittaker, & Brendtro, 1971; Walker, Colvin, & Ramsey, 1995). The primary phases in this sequence or cycle of violence include (a) predisposing or precipitant events, (b) events defining the crisis itself, and (c) events specific to crisis aftermath, with each phase requiring appropriately matched counselor responses aimed, respectively, at crisis prevention, deescalation, and recovery.

Research in the area of client suicide has suggested a similar sequential progression toward crisis conditions and a need for differential assessment and intervention during each phase of the crisis, specifically onset, occurrence, and aftermath (Laux, 2002). Unique to the crisis of client suicide, however, is the irremediable loss of the client and the especially pressing need in crisis aftermath for a shift in counseling focus from client to survivor (including coun- selor) recovery. Client suicide studies have called attention to the potentially damaging impact of any serious crises on attending clinicians and to the need for varied forms of support for clinicians before, during, and after a crisis episode (McAdams & Foster, 2000). The research find- ings have prompted the development of structured models to prepare clinicians for crisis impact and assist them in personal and professional recovery (Brown, 1987b; Haley, 2004; Kleespies, 1993).

By integrating current knowledge about phase progression in mental health crises, the utility of phase-specific interven- tion coordination, and the importance of structured support for all crisis survivors, a comprehensive conceptual framework for preparation and response to client crises in counseling emerges. Specifically, the framework that we present in this article identifies mandatory counselor responsibilities for

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precrisis preparation, in-crisis action, and postcrisis recovery. It also identifies common perceptual blind spots that threaten objectivity, initiative, and ultimate success in fulfilling those responsibilities unless counselors are made aware of them. The framework stresses the importance of balanced counselor attendance to all phases of a client crisis (see Table 1).

Precrisis Preparation

The age-old boxing adage “The only punch that will send you to the mat is the one you don’t see coming!” has figurative and, in some cases, literal application to counselor preparation for responding to client crises. Reductions in crisis frequency, intensity, and impact have all been reported by counselors who were able to anticipate and prepare for crisis conditions before they occurred (Burry, 2002; Kleespies, 2000; McAdams & Foster, 2002). Unfortunately, valid and reliable methods of predicting serious client crises have yet to be discovered (Bland, 2004; Harris & Rice, 1997). Counselors simply can- not predict with any degree of certainty that a client crisis is about to unfold (Remley, 2004). Without accurate predictors of crises, all counselors should take general steps to reduce the chances of being blindsided by them. The steps include (a) acquiring accurate information about crisis epidemiology, etiology, and impact; (b) assessing risk factors associated with crisis conditions; (c) becoming informed and practiced in crisis response procedure; and (d) being clear about their own and their setting’s philosophies regarding why crises oc- cur and who is responsible for dealing with them.

Acquiring accurate information. Counselors who are aware of the prevalence of client crises in contemporary clinical prac-

tice are less likely to be shocked and immobilized when they encounter a crisis themselves (Capuzzi & Gross, 2004). Those with informed understanding of conditions that predispose for and maintain various crises are more likely to be attuned to pending crises and accurate in diffusing developing crisis dynamics. Awareness of the aforementioned physical, ethical, legal, and psychological liabilities associated with inadequate crisis response provides impetus for counselors to indepen- dently pursue greater competency in crisis handling before it is needed. In all counseling settings, instruction should be provided that informs counselors about the real potential for crises, their defining characteristics, their potential impact on all survivors, and the need for personal and professional crisis recovery (Kinzel & Nanson, 2000).

Assessing crisis risk. A variety of actuarial instruments have been designed to predict the risk of specific types of crisis situa- tions, some frequently referenced examples being the Violence Risk Appraisal Guide (Harris & Rice, 1997), the Psychopathy Checklist-Revised (Hare, 1991), and the Suicide Probability Scale (Cull & Gill, 1990). Various cyclical and ecological models are also available to guide the clinical assessment of crisis warning signs and inform professional discretion in the prediction of crisis risk and the selection of appropriate intervention methods (Foster & McAdams, 1999; Walker et al., 1995). Regrettably, existing methods of assessment have not proven to be reliable predictors of crisis risk, their assessed prediction rates rarely reaching over 40% (Bland, 2004; Harris & Rice, 1997). They have, however, provided useful knowledge about client behaviors and contexts that predispose and support crisis situations and about clinical intervention methods that have shown to be useful in crisis stabi- lization. Possession of this knowledge may not enable counselors to effectively predict and avert all client crises, but it may increase the chance that they have anticipated the potential for crisis and taken appropriate precautionary measures when predisposing conditions are assessed to be high.

Learning/practicing crisis procedures. Stressful conditions are known to facilitate a person’s performance of dominant responses (i.e., those that are second nature and performed reg- ularly) and to impede performance of nondominant responses (i.e., those familiar to them but not performed regularly; Aiello & Douthitt, 2001; Zajonc, 1965). Unless crisis responses are dominant in a counselor’s skill repertoire, they may be subject to deterioration under the increased stress of an actual crisis situation. Thus, a regular and balanced program of skills training and rehearsal is necessary to ensure that counselors know what to do in a client crisis and that they can effectively apply what they know under the duress of crisis conditions (Laux, 2002). Essential skill areas to be developed include (a) behavioral cues of pending crisis, (b) crisis deescalation and containment technique, and (c) selection and summoning of internal and external support (Foster & McAdams, 1999; Treishman et al., 1971). Answers to questions such as “What signifies a crisis?” “What is my appropriate response?” “When is it out of (my) control?” “Whom do I summon for help?” “How do I summon help?” and “What do I do after help ar-

TAble 1

The Phases and Primary Considerations in Crisis Preparation Curriculum

Phase

1. Precrisis preparation

2. Precrisis awareness

3. In-crisis protocol

4. In-crisis awareness

5. Postcrisis recovery

6. Postcrisis awareness

Primary Considerations

Acquiring accurate information Assessing crisis risk Learning/practicing crisis

procedures Clarifying personal–professional

perspectives Limits of counselor ability Limits of the counseling process Influence of personal bias Need for personal support Ensuring safety Shifting counseling priorities Adhering to protocol Maintaining flexibility Professional territoriality Intellectual–emotional fusion Performance anxiety Tunnel vision Triage Addressing loss Facilitating reinvestment Promoting change Abbreviation of recovery Inattention to denial Fear of intrusion Self-neglect

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rives?” must come quickly and accurately because a client crisis unfolds rapidly. That will only be possible if, through careful training and ample practice, the answers have become automatic for responding counselors.

Clarifying personal–professional perspectives. Disagree- ment among counseling service and support providers about why client crises occur leads to blame and finger-pointing in crisis situations, the time when cooperation and support are most needed (Lamb, Weinberger, & DeCuir, 2002). Uncer- tainty among counselors, supervisors, administrators, and external support services about how their responsibilities for crisis intervention should be shared leads to insufficient or disjointed intervention, thus threatening the quality of client service and unnecessarily placing the counselor’s and the client’s safety at risk. For effective crisis response, counseling service providers in all settings and at all levels within set- tings (e.g., direct service, supervisory, administrative) must be able to move beyond blame and accept client crises as an occupational hazard that can and will occur despite the most stringent standards for client screening and counselor exper- tise. Counselors must accept response to client crisis as an intrinsic component of their professional responsibility. They must, likewise, be confident of receiving support rather than criticism from colleagues, supervisors, and the community when they exercise that role (Spencer & Munch, 2003). That confidence is best acquired through their initiation of active precrisis dialogue with all those from whom support may be necessary if a crisis occurs.

Precrisis Awareness

Positive outcomes of even the most widely accepted crisis prevention and intervention methods will be constrained by limitations inherent in the therapeutic methods themselves and the counselors who implement them. During precrisis preparation, counselors must determine the limits of their technical and emotional readiness to deal with various crisis situations. They must also acknowledge the shortcomings of the therapeutic process in preventing and resolving all crises and the resultant need for personal and professional support at all levels of readiness.

Limits of counselor ability. Counselors who overestimate their abilities to predict and resolve crises are at risk of being caught off guard by them and, consequently, of not having necessary support services in place when they are needed (Cavanagh & Levitov, 2002). Those who underesti- mate their abilities risk overusing support services, thereby desensitizing support providers through excessive requests for assistance, and, ultimately, denying themselves and their clients adequate and timely support when it is legitimately needed (Lamb et al., 2002). As a part of crisis response preparation, counselors should explore the types of crisis situations that would exceed their current skill levels. They should also consider the types of crises that trigger levels of anxiety that are strong enough to prevent the counselor’s ef- fective use of existing skills. Guided case study examination,

crisis role-play rehearsal, and dialogue with professional “survivors” of client crises have all been shown to be useful in helping counselors distinguish, from among a variety of crisis prevention and intervention methods, those methods that they are psychologically as well as technically skilled enough to apply (McAdams & Foster, 2002).

Limits of the counseling process. Without means for reliable prediction, counselors must be prepared to acknowledge that their ultimate goal of crisis prevention, will, as often as not, go unmet (Cavanagh & Levitov, 2002). Similarly, because no form of intervention can fully address the unpredictable events of a serious client crisis, there is never an assurance of successful outcome. Counselors must be aware that the primary compensa- tion for their earnest efforts at crisis response preparation may not be successful crisis prevention and intervention. Instead, they must be prepared to settle for the personal and professional satisfaction of knowing that they have made every effort pos- sible to ensure quality care and best practice for their clients. Well-informed counselors can also be reassured that their cli- ents’ crises need not equate with personal or professional failure, but rather, reflect the complexity of clients’ difficulties and the limitations of current intervention methods to completely attend to them (Morrissette, 2001).

Influence of personal bias. Counselors with unresolved is- sues of physical violence in their own families of origin might equate all aggression with physical aggression and overreact in a verbally escalating client crisis with excessive physical control (Pope & Tabachnick, 1993). Conversely, counselors whose own upbringing has insulated them from the effects of racial and cultural oppression might overlook the significance of a minority client’s escalating frustration and anger from perceived prejudice in a seemingly minor problem situation (Corey, Corey, & Callanan, 1998). Without thorough explora- tion of their own potential sources of bias toward clients in crisis, counselors run the risk of being blinded by their own issues to the warning signals of impending client crises and of missing valuable opportunities for timely response (Foster & McAdams, 1999). Precrisis instruction in prevention and intervention methods needs to be accompanied by an emphasis on counselors becoming aware of areas in which their clinical objectivity during crisis response might be compromised by issues that they, not the client, bring to the crisis situation.

Need for personal support. Counselors with strong pro- fessional and personal support systems in place before and during their clients’ crises have been reported to experience less severe reactions to them (Brown, 1987a; McAdams & Foster, 2002; Menninger, 1991). Specifically, counselors who receive regular (weekly) clinical supervision; are afforded a legitimate voice in decision making about client care; and are able to mitigate clinical stressors through a supportive network of family, friends, and personal therapy, have been able to deal more constructively than can counselors without such support (Bernard & Goodyear, 2004; McAdams & Foster, 2000). All counselors should be aware of the importance of having sound support for themselves as they do their work in support of oth-

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ers. Counselors working with clients in crisis must be especially aware that having tangible resources for personal support may be critical to their success in addressing and recovering from a crisis situation.

In-Crisis Protocol

Four primary courses of counselor action are necessary to efficiently and effectively expedite deescalation and safe resolution in a serious client crisis. They are ensuring the safest possible conditions for all individuals involved, tempo- rarily shifting counseling priorities from long-term goals to immediate crisis resolution, adhering as much as possible to the predetermined crisis response protocol, and maintaining flexibility in response to changing crisis conditions.

Ensuring safety. The first and foremost concern in crisis response is ensuring the physical safety of everyone imme- diately involved, including the client in crisis, the counselor himself or herself, and any bystanders assessed to be at risk of harm (Dattilio & Freeman, 2000). The specific nature of action needed depends upon the nature of the crisis. In cases of suicidal ideation or other threats of client self-injury, counselor action might involve the development of a safety contract with the cli- ent; voluntary or involuntary referral of a client for psychiatric assessment or treatment; and, if psychiatric services are deemed necessary, arrangement of continuous direct client supervision of the client until referral can be accomplished (Simon, 1999). In cases of physically threatening or violent client behavior, counselor action might involve the removal from the immediate setting of the escalating client, potential victims, or furniture and other objects that could be used as weapons. Counselors may need to inform others outside the immediate setting when a client in crisis has directed viable threats of physical harm toward them. In every case, established support systems must be alerted to real or possible crises at their onset and summoned at the first indication that the crisis might escalate to a dangerous level (Hoff, 2001).

Shifting counseling priorities. At the onset of a crisis, there must be an immediate reprioritization of counseling goals, with crisis resolution becoming the first priority or foreground goal, and all other counseling goals assuming a background position until the crisis situation is resolved (Cavanagh & Levitov, 2002). Attempting to confront the emotionally charged issues underlying a client crisis during the crisis itself is akin to “adding fuel to the fire”; it serves only to heighten the client’s emotional arousal, possibly prolonging and even worsening the crisis (Kaplan & Wheeler, 1993; Treishman et al., 1971). During a client crisis, attempts at therapy must cease, and all counselor and support system energy must be focused on providing the client with firm direction to end the crisis and with clear instructions on how to appropriately do so. Pursuit of long-term counseling goals can be resumed once goals for ending the crisis have been achieved.

Adhering to protocol. Adherence to a predetermined, prerehearsed, crisis-response protocol is essential to safe and effective counselor response in client crisis situations. This

may be especially important for novice counselors who have a limited repertoire of alternatives for responding (Foster & McAdams, 1999) to such situations. Similar to the manner in which military regimen has, for centuries, provided nec- essary direction for soldiers who are disoriented by fear and confusion in battle, a well-defined crisis response protocol will provide effective direction for counselors experiencing disequilibrium and uncertainty in the face of a serious client crisis. By adhering whenever possible to a crisis intervention protocol that has been carefully planned and practiced in ad- vance of the emergency, counselors will reduce the need to act on abrupt, on-the-spot, decisions that may well be impaired by the urgency and emotional intensity of the crisis situation (Sterba & Davis, 1999).

Maintaining flexibility. As described previously, client crises are not singular events but, instead, tend to occur as sequences of interconnected events, each having unique an- tecedents, outcomes, and intervention needs. Throughout a client crisis, counselors must stay alert to constantly changing conditions and, within acceptable limits as defined in the crisis intervention protocol, they must be ready to adjust their re- sponse strategy according to the assessed changes (Cavanagh & Levitov, 2002). Accurate understanding of crisis etiology will assist them in determining the type of adjustment needed. Their level of accuracy in “reading and flexing” to the constant and sometimes subtle changes in a client’s behaviors and needs during a crisis can determine whether the crisis continues, begins to move toward resolution, or escalates even further (Foster & McAdams, 1999).

In-Crisis Awareness

Knowledge alone about what to do in a client crisis is insuf- ficient to prepare a counselor for effectively handling an actual event. Required actions may be overlooked or avoided unless, along with knowledge of what needs to be done, the counselor is also aware of and able to overcome potential barriers to handling the event. The influences of professional territo- riality, intellectual–emotional fusion, performance anxiety, and tunnel vision can each prove to be detrimental to safety and success during client crisis intervention by preventing a counselor from applying his or her full range of relevant knowledge, skills, and clinical judgment.

Professional territoriality. Territoriality comes into play when a counselor resists or refuses to use appropriate and available external crisis support services because of distrust in the capabilities of those services or the knowledge that, by doing so, he or she may have to relinquish or share primary authority for the client’s subsequent care (Lamb et al., 2002). Counselors who summon police or hospitalization services should, in fact, be prepared for the subsequent involvement and authority of other professionals in their clients’ care. Le- gal and mental health policies often mandate the subsequent involvement of professionals such as lawyers, probation offi- cers, social workers, psychiatrists, and hospital administrators in postcrisis client services (Monahan, Swartz, & Bonnie,

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2003). Rather than resisting the use of such services when necessary for safe and effective crisis intervention, counselors should become familiar with the type and degree of involve- ment that can be expected and learn to work collaboratively with the individuals who provide the needed services. When collaborative relations with community support services have been established in advance, the “intrusion” of other professionals into a client’s care will usually be outweighed by the benefits afforded by the professionals’ assistance in a challenging situation.

Intellectual–emotional fusion. Intellectual–emotional fusion refers to a condition in which the distinction between emotions and intellectual thought processes become blurred during periods of high stress, resulting in emotion-laden, irrational, and ineffective decision making (Bowen, 1978). Decisions made in a state of fusion tend to be guided more by the immediate feelings of the decision maker than by the actual needs of the situation. Professional survivors of client crises suggest that emotionally driven impairment in objective decision-making and problem-solving abilities (i.e., fusion) is to be expected in highly stressful client crises situations (Hillman, 2002). Fusion-impaired crisis response decisions are as likely to be based on a counselor’s own fear, anger, frustration, and exhaustion as on careful clinical and contextual assessment of the presenting situation (McAdams & Foster, 2002). For this reason, it is essential in every client crisis that counselors receive supervision and support from other individuals who are less intimately involved and, thus, less subject to the anticipated but detrimental effects of intellectual–emotional fusion.

Performance anxiety. Performance anxiety stems from counselors’ perceptions that others will view their need for assistance in a crisis as a personal weakness or performance deficit (Corey et al., 1998). Performance anxiety impairs crisis intervention effectiveness if counselors fail to summon appropriate consultation or assistance because they believe that, in their professional role, they should be able to handle the crisis themselves. Performance anxiety also comes into play when counselors who view the client crisis as their own failure attempt to rectify the failure (and their self-esteem) by resolving the crisis single-handedly. Both novice and ex- perienced counselors are vulnerable to performance anxiety, with experienced counselors feeling pressured to “live up” to their position and credentials, and novices feeling pressured to demonstrate their worthiness for credentialing and indepen- dent practice (Kleespies, Penk, & Forsyth, 1993; McAdams & Foster, 2000). Frank discussion between counselors and supervisors about performance expectations and concerns has been shown repeatedly to be the most effective means of addressing performance anxiety in a variety of settings (Powell, 2004).

Tunnel vision. To be effective in crisis intervention, coun- selors must be able to attend to the apparent, immediate needs of the client in crisis while simultaneously monitoring and being prepared to respond to the dynamic contextual variables

at play that might move the crisis toward either resolution or escalation (Cavanagh & Levitov, 2002). Working against them, however, is the propensity to apply tunnel vision to the task when panoramic vision is needed. Research suggests that when under stress, an individual’s scope of alternative strategies for problem solving tends to narrow, and the individual is more prone to fall back on those strategies that are familiar and read- ily available (Horsman, 2000). Under the duress of a serious client crisis situation, counselors are more likely to overlook or misread subtly changing conditions in the crisis situation and to mismatch their response strategies with contextual demands. It is essential that all counselors be aware of the constraining influence of stress on their work and that they plan in advance for consultation and support to be available in the event of client crises wherein they can expect to be under considerable stress and their clinical abilities compromised.

Postcrisis Recovery

Successful “recovery” from the experience of a serious mental health crisis is said to occur when crisis survivors become able to manage the debilitating effects of the crisis sufficiently to re- sume precrisis levels of functioning. Recovery is further marked by applying what has been learned from the experience toward personal growth and preventing crises in the future (Hendricks, McKean, & Hendricks, 2003; Kanel, 2003). The extent to which clients are able to recover from a crisis during counseling has been shown to influence their potential for continued clinical progress and the likelihood that they will or will not become involved in a similar crisis in the future (McAdams & Foster, 1999; Sterba & Davis, 1999). Recovery appears to occur in a four-phase process beginning with immediate physical, psycho- logical, and emotional damage-control or triage, followed by movement through progressive steps toward coping with losses incurred; reinvesting in the counseling process; and, finally, promoting change by integrating what has been learned from the experience into future thought and action.

Triage. The triage phase of postcrisis recovery begins im- mediately after crisis conditions have ended and is marked by the client’s willingness to reflect on the event and the counselor’s return to counseling processes that were suspended during the crisis itself. Triage involves the guidance and support of crisis survivors in defining and accepting a formal endpoint to the crisis, committing to movement beyond the crisis, and determining what action will be necessary to proceed, a process that Treishman et al. (1971) referred to as “packaging” a crisis. For effective packaging to be achieved, counselors must be prepared to assist clients in examining and identifying the defining elements of the crisis (e.g., antecedents, actions, outcomes) so that the hurtful and irresponsible behavior they exhibited during that singular event can be isolated from other positive aspects of their life and their sense of worth as a person. Toward prevention of a return to previous crisis conditions, counselors must also assist clients in examining the “triggers” of their crisis behavior and identifying appropriate alternatives to such behavior for responding to those or similar triggers in future situations. Exhaustion, anxiety, and

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self-doubt (over failing to predict and avoid the crisis) are feel- ings that are common to all survivors following a serious mental health crisis (Jordan & McMenamy, 2004; Pehrsson & Boylan, 2004). For effective triage, counselors must be prepared to set aside and/or seek support for such feelings of their own in order to be fully present to assist their clients in packaging the crisis during its immediate aftermath, the time when awareness of and sensitivity to specific events are greatest.

Addressing loss. Real and perceived losses are intrinsic to all client crises (Hoff, 2001). Aside from the more obvious risks of physical injury or death, clients risk losses of self- respect, self-efficacy, trust and respect from others, various degrees of personal freedom, and the evaporation of hopes and dreams (Mitchell, 1999). Counselors, likewise, risk physical injury, damage to professional confidence and credibility, loss of postcrisis clinical authority for a client’s treatment, and loss of clients altogether in cases of suicide and institutionalization. Acknowledging the real and perceived losses after a crisis is necessary for the effective management of grief that invariably accompanies loss and that, left unmanaged, can be debilitat- ing for crisis survivors (Worden, 2002). Following effective triage, the focus of counseling can (and should) be expanded to include assessment of the longer term impact of the crisis, particularly as it relates to the survivor’s likelihood of achiev- ing precrisis counseling goals. Specifically, counselors should be prepared to amend precrisis counseling agendas to assist clients in distinguishing real from perceived losses, recouping real losses where possible, and coping with real losses that cannot be recovered.

Facilitating reinvestment. The optimal outcome of postcrisis triage and grief work is survivor readiness for reinvestment in the counseling relationship and process. Reinvestment is indi- cated when the surviving counselor and client are able to criti- cally examine the crisis together, with the goal of strengthening the future counseling relationship and expectations (Kanel, 2003). At this phase of the postcrisis recovery process, counsel- ing interventions include assisting clients with (a) identifying what was learned from the event, (b) examining changes in the helping relationship and process indicated by the new learning, and (c) planning for the appropriate incorporation of changes indicated. These interventions are aimed at shifting the recovery process from a remedial focus toward a developmental one in which there is a potential for client benefit beyond a mere re- turn to precrisis conditions. At the reinvestment phase of crisis recovery, active counselor support and guidance are pivotal factors in determining whether or not client survivors, who have overcome their fears and mustered the strength to reinvest in their counseling relationship, will be able to do so effectively (McAdams & Foster, 2002; Spencer & Munch, 2003).

Promoting change. Serious mental health crises have result- ed in positive, long-term changes for survivors who were able apply what they learned from the experience toward personal growth and future crisis prevention. For clients in counseling, the developmental benefits of successful crisis recovery have included a heightened awareness of their problems, a renewed

belief in their ability to face and overcome their problems, and a revitalization of their trust in the counselor and com- mitment to the counseling process (McAdams & Foster, 2002; Tedeschi, Park, & Calhoun, 1998). During the final phase of crisis recovery, the counselor’s task is to assist and support the client in operationalizing goals for positive change that were established during reinvestment. Success at the task depends on the client’s incorporation of durable changes in attitude and behavior that are antagonistic to a return of crisis conditions in the future and realistic for long-term implementation and maintenance (Joseph, Alex-Linley, & Harris, 2005). From the counselor, active engagement with the client is needed to explore, evaluate, rehearse, and revise personal and interper- sonal lifestyle modifications that will lead to second order change and reduced propensity for future crises.

Postcrisis Awareness

The benefits of assistance in postcrisis recovery are subject to compromise unless counselors recognize and work to avoid pitfalls common to each step in the recovery process. They include the counselor’s (a) temptation to abbreviate the recov- ery process, (b) inattention to client denial of crisis impact, (c) fear of intrusion into the client’s personal recovery process, and (d) self-neglect.

Abbreviation of recovery. In an effort to move beyond a client crisis and restore forward motion in counseling as quickly as possible, counselors may be tempted to return to precrisis activity as soon as crisis behaviors have subsided and the client has expressed a desire to move on; that is, they may attempt to abbreviate the postcrisis recovery process to include triage alone. The temptation to equate full recovery from a crisis with relief of its symptoms can be particularly great if counselors fail to appreciate the sequential trajectory of the recovery process. Crisis-linked responses that were packaged away during triage can return if more functional alternative responses are not subsequently developed during grief work and reinvestment (Wiger & Harowski, 2003). Reinvestment may likewise fade and fail to progress to integration if the guidance and support necessary to transform new perspectives into new actions is withheld or prematurely withdrawn. Effec- tive assistance in survivor recovery from a client crisis requires understanding of the full range of postcrisis recovery phases and commitment to support of the survivor through all phases. Counselors and, subsequently, their clients must be aware that recovery from a client crisis is an ongoing process rather than a finite event and that successful recovery is indicated when the harmful effects of a crisis are managed, not eliminated, for survivors (Cavanagh & Levitov, 2002).

Inattention to denial. A second common pitfall in post- crisis recovery occurs when counselors fail to sufficiently anticipate and address survivor denial, underestimation, or minimization of the impact of the crisis experience. Without assistance from their counselor, some clients may simply not be able to recognize the presence or significance of the

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damage done by a crisis to their self-esteem, personal and professional relationships, and future goals. Other clients who realize the significance of their losses may deny or attempt to minimize them in an effort to avoid the grief as- sociated with facing personal failure and lost aspirations; still others may fear stigmatization and retribution as a result of acknowledging their losses “publicly” (Tedeschi et al., 1998). For these reasons, counselors should anticipate their clients’ underrepresentation of the impact that a serious crisis has had upon them. In all cases of postcrisis assistance, they must be proactive in facilitating careful exploration and resolution of potential losses, even when clients suggest that such activity is unnecessary. Losses concealed or suppressed by survivors at the time of a serious crisis have the potential to be intrusive and even debilitating for years after the event (Kleespies & Dettmer, 2000; McAdams & Foster, 2002).

Fear of intrusion. A third pitfall in crisis recovery occurs when counselors hesitate to be proactive and assertive in facili- tating recovery for fear of intruding on their clients’ personal recovery efforts. This response is particularly likely when a sad or self-deprecating survivor has expressed an adamant desire to be left alone (Goldstein & Noonan, 1999). Fears of intrusion frequently stem from a counselor’s faulty supposi- tion that once crisis survivors are reinvested in the recovery process, they will reach out for assistance as they need it. As shown in the preceding section, survivors may not recognize that they need assistance, and even when they do, they may not, for viable reasons, know what kind of assistance they need or be willing to seek out that assistance voluntarily. The importance (if not the necessity) of counseling and super- visory assistance in crisis recovery has been demonstrated repeatedly (Richard & Gilliland, 2001; Spencer & Munch, 2003). With this in mind, counselors must overcome fears of intrusion, presume a survivor’s need for their assistance, and be prepared to extend it respectfully, but assertively.

Self-neglect. A final pitfall in crisis recovery assistance occurs when counselors fail to acknowledge that they too are “survivors” of the crisis experience, with needs for assistance and support in the recovery process that can parallel those of their surviving client(s). Guilt, self-doubt, and anxiety about fitness for future practice are feelings that are common to coun- selors who have failed to predict and avoid the serious crisis of a client in their care (Foster & McAdams, 1999; Hillman, 2002). Such feelings have been shown to persist and to sometimes intensify to debilitating levels unless they are packaged at the time of the event. Personal losses and corresponding grief have likewise resulted in intrusive thoughts and avoidant behaviors for years after a crisis if they are not acknowledged and function- ally integrated into the counselor’s personal and professional self-image and view of the work (McAdams & Foster, 2002; Richards, 2000). Full reinvestment and unencumbered reentry into professional practice have proven difficult until counselors can distinguish failures in a crisis situation from other successful aspects of their relationship with clients and their overall sense of competence as professionals. There is a common tendency

for counselors to avoid or underutilize the two sources of as- sistance reported to be most beneficial in their recovery from a client crisis—direct supervision and personal counseling (Kanel, 2003; McAdams & Foster, 2000, 2002), viewing the need for them an indication of their own inadequacy. In fact, the immediate threats to personal and professional stature posed by seeking help in the wake of a crisis appear to be far outweighed by the risks of long-term counselor impairment resulting from insufficient crisis recovery.

Applications and Conclusion There is no “standard” form of client crisis; thus, there can- not be a fully standardized form of counselor response. The PAR framework is not meant to be a substitute for a carefully planned, collaborative, and well-rehearsed crisis response protocol that is unique to the needs of an individual counseling setting. Rather, it is meant to serve as a guide for ensuring that counselors and crisis response procedures in any counseling setting are comprehensive and well-informed with regard to the nature, needs, and potential effects of crisis situations.

PAR has clear utility in counselor preparation. It can be adapted for application in a complete, preservice or in-service training venue or integrated into an ongoing counselor education curriculum. The specific considerations of counselor action and awareness across each of the preevent, in-event, and postevent crisis phases provide logical points for the division of crisis response instruction into manageable units. With counselor education curricula already taxed to meet increasingly rigorous core standards for counselor licensure and certification, versatility in PAR application is anticipated and acceptable provided that applications address all six phases of the framework and provide opportunities for practice of skills where indicated.

The PAR framework can be infused throughout individual and group supervision. It can benefit counseling supervisors by clarify- ing their role in and vital importance to supervisee success in each of the preparation, intervention, and recovery phases of client crisis response. In all mental health disciplines, clinical supervision has been shown to be central to the translation of theoretical knowledge into effective clinical practice (Bernard & Goodyear, 2004). Active involvement of the clinical supervisor is essential to completion of all considerations in the PAR framework. In crisis preparation, the accuracy of a counselor’s awareness of personal and professional preparedness for client crisis response may depend upon observa- tion and objective feedback from a clinical supervisor who has experienced the events of PAR as well as studied them. During a crisis, supervisor availability and support will be critical to effective and ethical counselor decision making as unforeseen aspects of the crisis unfold. In the aftermath of a crisis, a supervisor’s com- mitment to active, long-term support will play a central role in the effectiveness of a counselor’s recovery. Supervision is clearly a critical, if not definitive, element of effective counselor response to client crises. Working knowledge of the PAR framework can ensure that the supervision provided is consistent with counselor need throughout a crisis sequence.

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Finally, the PAR framework can be of practical benefit to counselors in practice and the clients they serve. No training program in crisis response can effectively prepare counselors for the multitude of different crises that may await them in practice. Similarly, no national or state standards for counselor certification can (or should be expected to) adequately define specific counselor responses to client crises in every context. The PAR framework bridges the gap between regulatory re- quirements for counselor proficiency in crisis response and planful definitions of the kind of preparation they need to fully satisfy those requirements. It reduces counselors’ risk of being surprised, ineffective, or harmed in a client crisis by informing them comprehensively of the considerations necessary for effective response in all crisis situations, considerations that they can then apply to the development of context-specific crisis response perspectives and protocols. Above all, PAR emphasizes the critical importance of professional collabora- tion and personal support to the success of counselors who face the serious crises of a client in their care.

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Test to Earn CE Credit Note: Correctly completing 3 of 3 test questions earns 1 continuing education contact hour.

Preparation, Action, Recovery: A Conceptual Framework for Counselor Preparation and Response in Client Crises (JCD, Volume 86, Number 4, Fall 2008)

Instructions Online: Complete the test online at www.counseling.org/Resources/OnlineLearning.aspx. You will be able to pay online and download your

CE certificate immediately. Mail: Complete the test and form above and mail (with check or money order made payable to American Counseling Association) to: ACA Accounting

Department/JCD, American Counseling Association, 5999 Stevenson Ave., Alexandria, VA 22304. Allow 2–4 weeks for processing. For further assistance, please contact Debbie Beales at [email protected], or by phone at 800-347-6647, x306

Examination Questions 1. What percentage of mental health counselors can expect to ex-

perience the suicide of a client at some point in their career?

 a. 10%  b. 25%  c. 33%  d. 50%

2. According to the authors, the absence of a consistent and comprehensive conceptual framework for dealing with serious client crises in professional counseling could result in which of the following risks:

 a. The counselor not being adequately prepared to perform a core aspect of service to clients.

 b. Unnecessary malpractice litigation.  c. Potential detriment to the personal and professional

development of the responding counselor.  d. All of the above.

3. Which of the following should not be advanced as a character- istic of Preparation, Action, and Recovery (PAR) framework?

 a. It can be infused throughout individual and group counseling supervision.

 b. It can be adapted for application in a counselor preservice and in-service training venue or integrated into the counselor education curriculum.

 c. It can be substituted for a crisis response protocol that is unique to the needs of the individual counseling session.

 d. It bridges the gap between regulatory requirements for counselor proficiency in crisis response and planful definitions of the kind of preparation they need to fully satisfy those requirements.

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Walker, H. M., Colvin, G., & Ramsey, E. (1995). Antisocial behav- ior in school: Strategies and best practices. Pacific Grove, CA: Prentice Hall.

Wiger, D. E., & Harowski, K. J. (2003). Essentials of crisis counsel- ing and intervention. Hoboken, NJ: Wiley.

Worden, J. W. (2002). Grief counseling and grief therapy: A handbook for the mental health professional. New York: Springer.

Z a j o n c , R . B. ( 1 9 6 5 ) . S o c i a l f a c i li t a t i o n . S c i e n ce, 1 4 9 , 269–274.