Introduction
Various crises can occur in individuals’ lives, and they respond differently to these situations. The concept of crisis can be defined as an obstacle perceived by a person during a specific period of time as insurmountable because attempts to resolve the problem were unsuccessful (Kanel, 2019). It consists of four major stages: the occurrence of the precipitating event, perception of the event as stressful, emotional distress, and functional impairment due to the lack of healthy coping mechanisms (Kanel, 2019). One of the ways to revert this scenario is to change the viewpoint about the crisis, which will gradually lead to a decrease in emotional distress and an increase in functioning (Kanel, 2019). The crisis can be perceived as a danger, but at the same time, the situation can be altered to become an opportunity. However, the latter is only possible if a person receives adequate emotional support. This paper aims to present a case of a 20-year-old female client presenting with an acute crisis related to her roommate’s suicide. This situational crisis resulted in tremendous emotional distress that should be managed by improving the client’s emotional well-being through cognitive-behavioral therapy.
The Client’s Profile
The client is a 20-year-old female college student, Olivia, who was referred to therapy after she found her roommate, Sophia, dead. An autopsy showed no signs of violence, and the girl hanged herself on the chandelier. Olivia and Sophia had very similar cultural backgrounds since both were African Americans and Christians; thus, they spent much time together studying, going to the cinema, visiting the church on Sundays, and sometimes shopping. The client is not married or in a relationship, and the only emotional support she received was from Sophia. Olivia’s parents separated when she was 15, and both were focused on their personal lives instead of their daughter. Her major is in African Development Studies at Harvard University.
The inciting event for her current state of emotional distress occurred on Sunday, November 13, 2022. Olivia returned to her dormitory room late in the afternoon from her short trip to Cleveland to meet her high-school friend. They did not see each other for almost two years; hence, Olivia decided to switch off her phone not to be interrupted. On her way back to Boston, she received multiple notifications of missed calls from Sophia. The girl tried to call and text her roommate, but Sophia’s phone was off. It did not surprise her since her roommate used to turn off all distracting devices when she was studying. Olivia first saw Sophia’s body hanging on the chandelier when she entered the room, which shocked her severely, and the girl started screaming and calling for help. She could not sleep, eat, or attend classes during the past four days; hence, her academic advisor requested assistance from the school psychologist.
Types of Crises: Developmental and Situational
Two types of crises are known, and they are situational and developmental. The latter is a normal adjustment response to transitions from one life phase to another (Kanel, 2019). Examples of developmental crises include acquiring new roles in a family and adjusting to a new environment. On the other hand, the former occurs as a result of an unusual or unexpected event that cannot be controlled or prevented (Kanel, 2019). A situational crisis may stem from the death of a loved one, rape, crime, divorce, community disaster, or severe illness (Kanel, 2019). In the case of Olivia, the crisis was situational because she could not predict or expect Sophia, who was always cheerful, ever decide to commit suicide. In fact, Sophia, a pre-med student, always had the top performance in all her courses and was in good relationships with her family. Furthermore, she did not leave any notes; hence, it was unclear what triggered her to take her own life. Olivia admitted to the psychologist’s office feeling guilty and distressed because she was unavailable when Sophia called.
Symptoms and Problems
Olivia’s case is the crisis of loss, described in chapter six, and she is in emotional distress because she cannot accept the fact that her friend committed suicide. The main problem is that she was the one who found Sophia dead in their shared room. Thus, Olivia’s symptoms include loss of sleep, poor appetite, and inability to concentrate, especially when in the room. Five stages of death can be applied to loss: denial, anger, bargaining, depression, and acceptance (Kanel, 2019). As the interview revealed, Olivia seems to be in the fourth stage of depression because she realized that Sophia is dead and now feels guilty because she could not prevent it. In this situation, the goal of therapy should be to guide the client through the mourning process and attain the stage of acceptance, which should help diminish stress and restore normal functioning. The goals of mourning are accepting the reality of loss, experiencing emotional pain, adapting to a new reality without the deceased, and redirecting energy to another activity or person (Kanel, 2019). Overall, Olivia’s case is complex, but achieving recovery is not an impossible task.
Ethical Issue
There are five ethical standards and guiding principles for mental health workers. They are autonomy or freedom of choice, non-maleficence or not causing harm, beneficence or benefiting the client, justice or equal treatment, and fidelity or guarding trust (Kanel, 2019). In the case of Olivia, it seems that her autonomy was violated because the girl did not want to go to therapy. However, she had to attend these sessions because there was much pressure from her advisor, other faculty members, and classmates. Undoubtedly, the girl was in a state of acute crisis, and her circle was genuinely concerned about her. At the same time, her freedom of choice appears to be violated. Still, in this situation, the benefits outweighed this violation because not only Olivia’s mental health but also her physical well-being was in danger.
Legal Issue
Law obliges healthcare professionals to protect patient privacy and avoid personal data leaks. Health Insurance Portability and Accountability Act (HIPAA), which was established in 1996, requires the protection of health information, including data related to mental well-being (Kanel, 2019). Healthcare workers who do not abide by the HIPAA law are punished in case of violations. Interestingly, in Olivia’s case, patient privacy does not seem to be violated since all conversations with the psychologist and therapist remained confidential. At the same time, many students and professors knew about the incident; hence, it was impossible to avoid altogether the fact that many people were aware of the problems the girl had.
Intervention
The client presented in a state of acute situational crisis due to the unexpected loss of a friend. Since Olivia was not on campus, she was not able to talk to Sophia, her roommate, who committed suicide in their shared room while she was away; thus, she felt guilty and depressed. Therefore, proper intervention is required to help the girl overcome the crisis and emotional stress and restore normal functioning. The goal of psychological intervention is to assist people in understanding a particular life situation that resulted in a crisis and diminish its negative effect on a client’s mental health (Yao & Zhang, 2021). Furthermore, the aim of counseling is to facilitate an individual’s internal resources to resolve the conflict that led to a psychological crisis (Shportun et al., 2022). Improving intervention programs in colleges and universities where students are under increased academic and social pressure is essential.
Specific Problems Causing the Crisis
The specific problems causing this crisis are the fact that the client’s friend hanged herself in the dormitory room they shared. Furthermore, Olivia was unavailable when Sophia called and possibly needed her emotional support. Thus, the client is depressed because she feels accountable for her roommate’s death. Since Sophia never mentioned she had problems and did not appear stressed during the last week, her suicide shocked her family and friends.
Client’s Perception of a Crisis
The difficulty but at the same time advantage of psychological crisis is that any event’s perception is the primary cause of the problem; therefore, it can be changed. Olivia thinks it is her fault that Sophia took her life because it appeared from her call log that the deceased only tried to contact her roommate several hours before committing suicide. Therefore, it is crucial to convince Olivia that she is not responsible for her friend’s death. Although Sophia’s family appeared sad at the funerals, they were not severely depressed. Furthermore, both of her parents’ speeches mentioned that it was their daughter’s own decision to take her own life, and they hoped God would forgive her for this sin. The client should understand that other factors likely forced Sophia to kill herself, and Olivia was certainly not one of them.
Diversity Issues Impacting the Client
The client is a young African American female student at Harvard University, which creates an additional burden on her current crisis. Olivia is faced with the trauma of loss, and at the same time, she must meet the requirements of her courses to complete this semester and academic year. It does not seem that the client has concerns about diversity because the girl cannot recall the instances when she was discriminated against by her race.
Stabilization of Psychological Functioning
The ultimate goal, in this case, should be to restore Olivia’s psychological well-being and normal functioning. First, it is essential to identify the client’s protective factors, including supportive relationships, self-regulation skills, problem-solving, optimism, self-efficacy, and having meaning and purpose in life (Masten, 2019). Additionally, using specific rituals pertinent to the client’s culture that will help eliminate the feeling of guilt can be useful (Masten, 2019). The primary therapy for this girl is cognitive-behavioral counseling, which includes controlled research, Socratic dialogue, the method of falling arrows, and role games (Shportun et al., 2022). At the same time, additional techniques like existential and gestalt therapy can be used. Specifically, the existentialist approach helps people find meaning in life to change their focus from the inciting event and realize that a person is part of something bigger (Shportun et al., 2022). Gestalt therapy can help the client develop a more positive perception of herself and the situation related to her friend’s suicide. Overall, cognitive-behavioral therapy should be utilized in combination with other techniques to attain a favorable outcome for Olivia.
Resources for Further Care
The two other methods that can be implemented for Olivia are mindfulness-based therapy and meditative practices. Both approaches will help to restore normal functioning by increasing the client’s awareness of her current state, rethinking the causes of the crisis, and reducing her levels of depression and anxiety. Indeed, it was shown that yoga and meditation resulted in a drop in depressive symptoms, aggressiveness, and nervousness and an increase in the ability to relax (Shportun et al., 2022). Furthermore, research showed that these practices led to the growth of self-esteem and stress management skills (Shportun et al., 2022). Moreover, the client is known to be Christian, and spirituality is another protective factor in this case. Therefore, Olivia should be recommended to continue attending church and possibly to do social service.
Conclusion
In crisis intervention, it is essential to have a multidisciplinary approach, especially in the case of a crisis of loss and death. Apart from undergoing cognitive-behavioral counseling as well as gestalt and existential therapy, the client should be recommended to practice self-care to avoid burnout. Specifically, Olivia may consider mindfulness, meditation, yoga classes, visiting the church, and doing social work. Additionally, it is essential for the client to be followed up regularly by her therapist to monitor the progress and ensure that recovery is attained.
References
Kanel, K. (2019). A guide to crisis intervention. Cengage Learning.
Masten, A. S. (2019). Resilience from a developmental systems perspective. World Psychiatry, 18(1), 101-102.
Shportun, O. M., Demchenko, I., Sımko, R., Hudyma, O., Levchuk, N., & Samara, O. (2022). Psychological counseling of clients in crises. BRAIN, 13(2), 104-118.
Yao, F., & Zhang, A. (2021). Integration of education management and mental health in psychological crisis intervention in colleges and universities. ASP Transactions on Psychology and Education, 1(1), 31–38.