Teacher s Fear Never Wanes After Assault

Transcription

1 Theory and Practice Edward M. Kantor, M.D. Department of Psychiatric Medicine University of Virginia Teacher s Fear Never Wanes After Assault New York(AP) Students had threatened Susan Hudson before, but when the attack came, she did not expect it: A magazine rolled around some heavy object and secured with a rubber band was slammed full force into her neck. It knocked her down, but the middle-aged remedial reading teacher got up and taught her remaining classes that day in February Then she went home. She never returned again to her Brooklyn high school classroom. She says she hasn t gone back due to her neck injury but also, she says, she s afraid. I am petrified when I see more than two teenagers together... Ms. Hudson, a ten-year teaching veteran who needs only to complete her dissertation to earn a doctoral degree, slides slowly, involuntarily into tears as she describes her injuries and her feelings about the assault. I know I m not handling this very well--i cry easily when I m reminded about this. It s been two years and I m getting worse. I m really bitter.

2 Crisis What is it? Webster defines crisis as a turning point Sheehy describes crisis as a passage The English word is derived from the Greek krinein, meaning to decide. Chinese term for crisis... Weiji Is composed of two characters: one signifies....the other Opportunity Danger

3 Generally Accepted Definition A temporary state of upset and disorganization, characterized by an inability to cope with a particular situation using customary methods of problem solving, and by the potential for a radically positive or negative outcome Slaikeu, 1984 Background The origin of modern crisis intervention dates back to Eric Lindeman (1942)& the Coconut Grove nightclub fire in Boston. 493 people died. His report on the survivors and relatives/friends became the basis for later theorizing on the grief process and mass disaster. They focused on short term intervention and therapy. *Of note, many of the short-term therapy theorists were emergency at this time, and possibly in response to this. Caplan (1964) first formulated significance of life crises in adult psychopathology. Looking at the hx of psychiatric pts. he noted that during life crises, some individuals dealt with problems in a maladjusted way, and seemed to emerge from the event less healthy than before.

4 Background cont... From these works, crisis centers and suicide hotlines popped up around the country, often using peer counselors to make immediate intervention available, further incorporating the concept of outreach. (the sixties). At the same time, CMMHCs were developing, mandating crisis and emergency services. Community Mental Health Models Preemptive intervention - Primary prevention Early intervention - Secondary Prevention Follow-up - Tertiary Prevention Crisis intervention has developed into the strategy of care --at the time of the severe disorganization, resulting from the crisis. It is viewed as the most opportune time for intervention ad defenses and usual coping strategies are not working, and new ones must emerge. Most Significant components of Crisis Intervention Crisis Theory: A general framework Overview Assumptions Systems Framework

5 Overview: Response to Crisis Perception Dysfunctional Response higher Event Decompensation and Regression Intervention? Resolution Recovery Vulnerability and Reduced Defenses (disorganization and disequalibrium) former lower Level of Function Lateral Changes in Function former Even with a return to former functioning there is often a shift of interest or change of course

6 Assumptions about Crisis Existence of a crisis is based on the individual Usual coping mechanisms are proving to be ineffective Crises can result from positive and negative events No one is immune to crisis in right circumstances Crisis is time limited by definition Early intervention can maximize return to function Eight Typical Phases of Emotional Reaction* High Anxiety *Epperson, 1977 Denial Anger Shame Guilt Remorse Grief Reconciliation Order May Vary

7 Types of Crises Situational Life Crises Typical Scenarios Situational Crisis of Modern Life Crisis Intervention in the Schools Developmental Life Crises Transition or Crisis Preoccupations through the Lifespan Social Readjustment Rating Scale* 100 Death of Spouse 73 Divorce 65 Separation 63 Jail term 63 Close family death 53 Personal injury/illness 50 Marriage 47 Fired from job 45 Marital reconciliation 45 Retirement * Holmes/Rahe 1967 TOP TEN Scale spans from 100, as most severe, to least severe at 10 or 11

8 Principles of Intervention First Order Intervention- Peer, Lay, Paraprofessional Psychological First Aid Intervention By Setting Second Order Intervention- Professional Multimodal Approaches Supportive, Cognitive, Components Assessment Treatment Intervention Summarized How Long? By Whom? Where? Goals? Procedure? 1st Order Intervention Psychological First Aid Minutes to Hours Front Line Caregivers Community Settings Re-Establish Immediate Coping Psychological First Aid 2nd Order Intervention Crisis Therapy Weeks to Months Psychotherapists and Counselors Office Settings Resolve Crisis Multimodal Crisis Therapy

9 Psychological First Aid-First Level Intervention Early Contact/Not forced debriefings Easy Availability and Access Often Generic or Group Oriented Attempt to Minimize Stigma Facilitates need to be heard and understood Supportive, Non-judgmental Provided by Peers, Lay Counselors, Police, Rescue Crisis Therapy More formal relationship Intervention as opposed to prevention Suggests more dysfunction Various modes target re-framing the incident and recognizing guilt, shame, anger, self doubt Professionals provide service Usually longer term than psychological first aid

10 Diagnostic Considerations Adjustment Disorder With Depressed Mood, with Anxiety, with mixed Anxiety and Depressed Mood, with Disturbance of Conduct, with Disturbance of Emotions and Conduct, Unspecified. Acute Stress Disorder Bereavement Brief Psychotic Disorder Conversion Disorder Dissociative Disorder Substance Abuse as 1 or 2 Factor Emerging Concerns Disaster Psychiatry Training Credentialing & Affiliation Referral All Hazards Response Chemical Biological Conventional Weapon Natural Disaster ICS (Incident Command Systems)

11 CRISIS - Take Away Points Subjective to the individual experiencing it Destabilizing, dysfunctional, taxed defenses Time limited Most amenable to early intervention Access and availability Goals: Adaptation, Integration, Empowerment and Decision-making