This paper will focus on the clinical aspects of crisis management. It will present a perspective of a clinician in practice working on the case of a patient-reported as being suicidal. The paper will highlight the differences in working with patients who are experiencing a crisis and the ones who are not. Furthermore, it will provide the steps to be taken when treating such people including assessments and possible interventions made based on them, a safety plan for the patient and his/her family, and the ethical implications for the client’s family resulting from the crisis. Finally, the paper will describe some practices and national standards for the MFT discipline that apply to working with clients in crisis and offer my reflection on my thoughts and feelings while dealing with this patient.
Working with patients in crisis and their families is a special case for any clinician occupied in a practice setting. It requires quick but planned actions so that there is a possibility to change a patient’s mind and save his/her life. First of all, the process of treating such patients should start with assessing their current state. Among the assessments that I might want to include, the primary ones would be analyzing the patient’s environment including family members, relations with co-workers and friends detecting whether he/she is isolated or always surrounded by people, whether the client takes some medications and has addictions such as to alcohol or drugs, and whether he/she has already tried to commit suicide. Finding out the general information, I would want to assess the current state of my patient trying to discover the cause of the crisis whether it was something that happened some time ago or recent trauma, estimate his/her psychoemotional condition, i.e. what is the level of self-hatred, and discover whether the patient has a plan for committing suicide (Roberts & Ottens, 2005). The primary objective is to define whether the client experiences extreme self-hatred, isolation, hopelessness, suffers from the thoughts of being a burden to his/her friends and family and that is why pushes them away. What I realized working on the case is that there are differences between the patients who are in crisis and the ones who are not, and the primary is their desire to cooperate with me and their openness to my recommendations and treatment.
The second step of my plan is to establish rapport with the patient. What is important at this stage of crisis intervention is to make my client believe that I accept him/her and his/her problems and want to solve them. I will try to focus on my patient’s currents matters of concern and try to make him/her share the feelings and thoughts with me so that it is easier to understand the situation, develop a safety plan, and find the ways to implement it. Speaking of a safety plan, it will comprise of several elements, including making the patient’s environment safe by removing the means of possible harm, persuading the client to not make attempts to commit suicide for a negotiated period, developing a system of practices that will calm him/her down in the case of aggravation of the emotional crisis such as taking a walk or a cold shower, etc. (Stanley & Brown, 2012). What is vital in designing a safety plan and implementing it is making sure that the client will not be isolated and his/her family will always stay close to him/her so that there is no single chance that the plan will fail and that they always have a copy of it with them wherever they are (Sher & LaBode, 2011). This plan together with seeing the patient more often and guaranteeing him/her and his/her family members that they can contact me whenever they need to are the most frequently used interventions in the case of crisis treatment. The most radical interventions may include prescribing medication or hospitalization.
Some practices have proved to be effective in treating patients in crisis. For example, there is an approach known as dialectal behavior therapy consisting of several elements such as training skills necessary to overcome the periods of crisis aggravation, individual and collective therapy, telephone coaching, etc. (Linehan et al., 2015). Another popular practice is transference-focused therapy that is based on the relationships between the patient and therapist and individual treatment aimed at reducing the impact of negative emotions on a patient. One more approach is a mentalization-based treatment that centers on developing alternative perspectives to the experience of a client and seeing the mind behind every action he/she takes (Bliss & McCardle, 2014).
Working with patients in crisis and their families is an issue of heavy ethical burden. On one hand, every person has the right to decide what to do with his/her life and how to end it, and, from an ethical standpoint, no one has the right to intervene in his/her plans. On the other hand, I, as a clinician, cannot accept this point of view because I feel the duty to help every single patient I can. It is aggravated by my upbringing because my family believed in the sanctity of human life and soul, and I was taught that suicide is the worst sin. Even though I am a person of science and people often think that we are not religious, I do believe in the existence of the soul and the necessity to save it, so, in this particular case, I will do anything I can to help the patient overcome the crisis he/she experiences.
References
Bliss, S., & McCardle, M. (2014). An exploration of common elements in dialectical behavior therapy, mentalization-based treatment and transference focused psychotherapy in the treatment of borderline personality disorder. Clinical Social Work Journal, 42(1), 61-69.
Linehan, M. M., Korslund, K. E., Harned, M. S., Gallop, R. J., Lungu, A., Neacsiu, A. D.,… Angela M. Murray-Gregory. (2015). Dialectal behavior therapy for high suicide risk in individuals with borderline personality disorder. JAMA Psychiatry, 72(5), 475-482.
Roberts, A. R., & Ottens, A. J. (2005). The seven-stage crisis intervention model: A road map to goal attainment, problem solving, and crisis resolution. Brief Treatment and Crisis Intervention, 5(4), 329-339.
Sher, L., & LaBode, V. (2011). Teaching health care professionals about suicide safety planning. Psychiatria Danubina, 23(4), 396-397.
Stanley, B., & Brown, J. K. (2012). Safety planning intervention: A brief intervention to mitigate suicide risk. Cognitive and Behavioral Practice, 19(2), 256-264.