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Crisis, Trauma, and
Disaster
4 Kay 4 Ever
—L.L.B.
—S.V.F.
Crisis, Trauma, and
Disaster
A Clinician’s Guide
SAGE Publications, Inc. All rights reserved. Except as permitted by U.S. copyright
2455 Teller Road law, no part of this work may be reproduced or distributed in
Thousand Oaks, California 91320 any form or by any means, or stored in a database or retrieval
E-mail: order@sagepub.com
system, without permission in writing from the publisher.
SAGE Publications Ltd.
All third party trademarks referenced or depicted herein
1 Oliver’s Yard
55 City Road
are included solely for the purpose of illustration and are
London, EC1Y 1SP the property of their respective owners. Reference to these
United Kingdom trademarks in no way indicates any relationship with, or
endorsement by, the trademark owner.
SAGE Publications India Pvt. Ltd.
B 1/I 1 Mohan Cooperative Industrial Area Printed in the United States of America
Mathura Road, New Delhi 110 044
India ISBN: 978-1-4833-6903-7
Foreword xv
by Allen J. Ottens
Preface xvii
Acknowledgments xix
References 269
Index 307
• Foreword •
While I was putting these words to paper, the announcement came over the local
news that the automobile assembly plant near where I live would soon eliminate
an entire shift of workers. I morosely considered the consequences for the soon-
to-be unemployed workers, the crises facing the financially strapped families, and
the rippling impact on the larger community. Add one more to the expanding
list of crises and disaster sweeping through society: devastating natural calamities
(fires, floods) fueled by climate change, an epidemic of narcotic addictions (and
fatal overdoses), and growing animosity directed toward racial, ethnic, and reli-
gious minorities, just to name three.
If there is any silver lining in that dire picture, it might be that “crisis may
be viewed in various ways, but most definitions emphasize that it can be a turn-
ing point in a person’s life” (Yeager & Roberts, 2015, p. 13). But helping dis-
tressed individuals and families to plot courses to arrive at those turning points
(e.g., retraining, relocating, rethinking, rededicating, renewing) requires a cadre
of helping professionals (psychologists, counselors, social workers, psychiatric
nurses) who have the training and skills to intervene effectively. Crisis, Trauma,
and Disaster by Linda Lutisha Black and Stephen V. Flynn can now be added to
the arsenal of training materials to equip these professionals. Moreover, one of
the features that makes Crisis, Trauma, and Disaster an important addition is its
sweeping coverage of knowledge, skills, and techniques designed to mitigate the
impact of crisis and trauma that are applicable for students-in-training as well as
seasoned clinicians.
The authors impart a full spectrum of perspectives from various theoretical
approaches, sharing knowledge and insights from generations of leaders in the
crisis intervention field. Coverage extends from understanding in what ways dele-
terious events affect physiological functioning to how crises are experienced across
the lifespan. The authors address intervention skills needed to implement change
across affective, behavioral, and cognitive dimensions with individual clients, as
well as the skill of advocacy, whereby the clinician works toward environmental
changes on behalf of a particular client or class of clients. Techniques receiving
focus include steps for applying psychological first aid as well as selecting and
administering the Mental Status Exam (MSE) and a variety of triage assessment
instruments.
Besides the expected heavy emphases on knowledge, skills, and techniques,
the authors should be commended for taking a firm stance on the importance of
xv
xvi Crisis, Trauma, and Disaster
References
Ottens, A., Pender, D., & Nyhof, D. (2009). Essential personhood: A review of the counselor
characteristics needed for effective crisis intervention work. International Journal of Emer-
gency Mental Health, 11(1), 43–52.
Yeager, K. R., & Roberts, A. R. (2009). Bridging the past and present to the future of crisis
intervention and crisis management. In K. R. Yeager & A. R. Roberts (Eds.), Crisis interven-
tion handbook: Assessment, treatment, and research (4th ed.), (pp. 3–35). New York: Oxford
University Press.
• Preface •
xvii
xviii Crisis, Trauma, and Disaster
Textbook Features
The text opens with an introduction to crisis, trauma, and disaster counseling
and describes how they relate to clinician self-awareness, reflective practice,
professional development, and the spectrum of these events. Chapter 2 presents
the historical and theoretical foundations of crisis counseling. Chapter 3
showcases the knowledge, skills awareness, techniques, and resources necessary
for crisis counseling. The format of a foundations chapter preceding the skills
chapter continues for trauma (Chapters 4 and 5) and disaster (Chapters 6 and 7).
Chapter 8 focuses on clinician wellness and the prevention of burnout, and
Chapter 9 reviews emerging trends. Unique features of this text include the
focus on the clinician’s level of professional development, developmentally
graduated case studies, and the Counselor’s Toolkit. Each chapter provides
Extended Learning Exercises and Helpful Resources.
Pedagogical Aids
Crisis, Trauma, and Disaster: A Clinician’s Guide is presented in a logical sequential
manner, grounded in professional development that aids readability and supports
student readiness. Structurally, each chapter begins with an overview and
objectives section and ends with a summary section. Educators can direct student’s
attention to the chapter learning exercises, case studies and encourage further
student learning with the suggested web links and readings. Lastly, throughout
the textbook we provide clear, detailed, and contextually relevant examples of a
variety of crisis, trauma, and disaster experiences and interventions. Incorporating
these examples into student learning can greatly enhance and contextualize the
student’s understanding of the material.
• Acknowledgments •
T his textbook and our process have benefited tremendously many individuals
and their contributions. We begin by thanking our SAGE Acquisitions Editor,
Abbie Rickard, for her coordination, encouragement, and support throughout the
project. We also thank the entire SAGE staff for their encouragement of the field
of crisis, trauma, and disaster counseling.
The author(s) and SAGE would like to thank the following for their feedback
during development:
Reviewer Affiliation
xix
xx Crisis, Trauma, and Disaster
xxi
Sara Miller McCune founded SAGE Publishing in 1965 to support
the dissemination of usable knowledge and educate a global
community. SAGE publishes more than 1000 journals and over
800 new books each year, spanning a wide range of subject areas.
Our growing selection of library products includes archives, data,
case studies and video. SAGE remains majority owned by our
founder and after her lifetime will become owned by a charitable
trust that secures the company’s continued independence.
1
2 Crisis, Trauma, and Disaster
than half of those identified as eligible for professional treatment did not seek it. Therefore,
it is quite likely that fewer than half of individuals affected by a CTD will seek professional
treatment; others will opt for help from natural or lay helpers; and a substantial number
will seek not treatment due to personal and or cultural reasons, proximity to care, stigma,
or confidence in counseling. Given the extent and gravity of these events, it is important
to remember that although 70% to 80% of the U.S. population will experience at least one
traumatic event in their lifetime and 7% to 9% will develop PTSD, most will never seek
counseling or therapeutic services. This book focuses on the theoretical foundations and
skills related to crisis, trauma, and disaster counseling within the context of counselor’s
professional development. We hope you find it a useful resource throughout your career.
Learning Objectives
After reading this chapter and participating in the reflective exercises provided, you
will be able to
1. Differentiate helping professionals from natural helpers
2. Distinguish important issues related to the development and training of helping
professionals
3. Understand key aspects to reflective practice and self-awareness
4. Compare key techniques at each stage of your development
5. Understand and discuss the spectrum of crisis, trauma, and disaster
Educating Clinicians
Your advanced education focuses on theories, skills, and assessments and occurs in
classrooms, counseling laboratories, and field placements over your professional
lifespan. But this is only one form of education. You may also have had training
at the baccalaureate and associate levels, which may or may not have involved
applied or supervised practice or resulted in a certification or credential. Gener-
ally, CTD Clinicians seek post-degree professional development, certifications, and
self-study specific to CTD counseling like Red Cross certification, nonviolent crisis
intervention training, Eye Movement Desensitization and Reprocessing [EMDR],
and trauma informed care. Although formal education is critical, so too is your
personhood, personal awareness, and ways of being. In the sections that follow,
we describe the perspective—clinician as instrument; context—accreditation stan-
dards and educational programs; and processes—self-awareness, reflective prac-
tice, supervision, and professional development that provide the foundation of
your CTD education.
4 Crisis, Trauma, and Disaster
Educational Programs
Students in graduate counseling, psychology, or social work programs typically
complete a minimum of two years of study and supervised practice. Likely, you
have completed courses on counseling theories; core counseling skills for individ-
ual, groups, and families; assessment and treatment planning; case management;
cultural competence; advocacy; and supervised practice. Within the last decade,
accrediting bodies (CACREP, APA, CSWE) and university faculty have determined
clinicians need additional and specialized education related to crisis, trauma-
informed counseling, and client advocacy within an ethical and social justice
framework. Thus, many graduate programs have at least one academic course
dedicated to CTD counseling as well as expectations that clinicians will work with
clients experiencing crisis, trauma, or disaster during their field placements.
Advanced CTD education provides you specialized knowledge and skills focused
on individual, family, or community treatment and services. Students use concep-
tual and procedural knowledge (deJong & Ferguson-Hessler, 1996) to address a
variety of client needs, to promote stability, to improve coping, and to aid the cli-
ent’s return to adaptive functioning. Adaptive functioning is described as the nec-
essary cognitive and social skills, comprehension, and communication required
to navigate environmental demands. In sum, clinicians are educated to support
the health, recovery, and well-being of those experiencing acute or chronic crisis,
trauma, or disaster. Advanced education is the hallmark of a professionally trained
clinician and includes the ability to engage in a reflective practice and continuous
personal and professional development. Three elements—advanced education,
reflective practice, and continued personal and professional development—form
the pillars of your professional practice. These pillars are highlighted throughout
professional codes of ethics, standards of practice, and distinguish clinicians from
other helpers.
Tack så mycket för ditt kärkomna bref, som jag fick i början af
denna månad och förlåt att jag icke har förut skrifvit ej heller genast
svarat ditt sista bref, du tror väl och har skäl också, att tro jag är
rysligt vårdslös ock likgiltig i min skrifning, orsaken har varit, (jag
måst öppet tillstå) att jag har haft mycket treflig här och till det
andra så har jag haft rysligt mycket att göra, man har tre gånger
mera att göra då man är tillsammans med Operan, alla dagar måst
man gå på Opera repititioner som man måst sjunga med i körerna
och dessutom Dramatiska. —
Många nya roller har jag fått som jag måst instudera förty Fru
Aspegren skall i vår resa till Paris för att utveckla sig i sin konst,
och jag får då börja och spela de flesta af hennes roller om jag bara
kan — I söndags gafs Luci för Sjunde och sista gången och Emmy
Strömmer hyllades rysligt af Publiken efter Vansinnighets sen
ropades hon tre gånger fram och fick emottaga en stor Lager krans
och Blom bukett. —
Sista Söndags en vecka var här en stor Maskerad bal, och der
var de flesta af Finska Teaters medlemmar maskerade. Vi
föreställde di Olympiska Gudar och Gudinnor dit hörde icke allenast
våra egna utan äfven fremmande, vi klädde oss på Teatern och
derifrån gick vi sedan alla till Socitetshuset när vi trädde in i
Salongen så gick först Jupiter med sin gemål Juno sedan Mars och
Minerva, sedan Venus och Apollo ock Neptun och Ceres, Jag var
Flora Blomstergudinnan, öfver höljd af blommor och en
blomsterkcrg i handen mitt par var Mercurius Herr Anderson m m,
der var rysligt trångt för den var besökt af 1,200 personer mycket
trefligt var der Doctor Bergbom var äfven der. måndags var jag hos
Bangens, Stafva lystes första gången i Söndags med Maschinisten
Lindholm hon sickar hjertliga helsningar till dig
Var snäll och skrif åt mig efter 2'3 veckor och addressera det
sedan till Björneborg förty du kan intte skrifva föryt när jag ej vet
säkert när vi res —»[7]
Jo vuoden 1875 arvosteluista voi nähdä, että Ida Aalberg oli yksi
niistä tuhansista näyttelijöistä, jotka ensi menestyksestään, tai
oikeammin: osakseen tulleesta suosiosta, saavat kiittää nuoruuttaan.
Nuoruuttaan ja nuorekasta suloaan hän näytti yleisölle, kyky ja taide
olivat vielä tulevaisuuden huomassa. Hän oli vielä melkein lapsi, ellei
iältään, niin ainakin ulkonaiselta olemukseltaan. Kaarola Avellanin,
joka kesällä 1876 Kuopiossa liittyi Suomalaiseen teatteriin, oli
vaikeata uskoa, että Ida Aalberg olisi silloin ollut jo kahdeksantoista
vuoden ikäinen. Hän oli pitkä ja laiha tyttö, hänellä oli suuret siniset
silmät, seurassa hän ei puhunut paljoa, ja yleensä häntä pidettiin
sangen yksinkertaisena, melkeinpä tyhmänä. Kerrotaan Kaarlo
Bergbomin kuulleen moitteita siitä, että hän salli moisen pikku
hanhen olla teatterissa. Vuosi 1876 ei tuonut mitään sanottavaa
muutosta. Suomalainen teatteri vaelteli sangen paljon ja Ida
Aalbergista kerrottiin perin vähän. »Pietarin Lehti» sai »Puolan
juutalaisen» johdosta todeta, että »neiti Ahlberg on sievä tyttö», ja
viipurilainen »Ilmarinen» näki hänet »hyviä toiveita» antavaksi
kertoen lisäksi: »Neiti Ahlbergin kieli on erittäin ihanan sointuista ja
viehättävää.» Vuoden lopulla hämeenlinnalainen lehti sanoi hänen jo
liikkuvan ja toimivan näyttämöllä »ihan moitteettomasti».