Assessment and Diagnosis
Main Discussion Post
A person in crisis is feeling momentarily out of control, unable to utilize personal resources or those of others around them in an effort to stay in a safe psychological place (James & Gilliland, 2017). It is a crisis worker’s responsibility to help the person re-gain control of their psychological balance (James & Gilliland, 2017). Assessments are critical when working with someone who is experiencing crisis trauma. Assessments help counselors to determine the severity of the crisis, the client’s current emotional, behavioral, and cognitive states of mind, the alternatives, coping skills, and support systems available to the client, the client’s level of harm to self or others, and the progress of the counselor with de-escalating the situation while helping the client to calm down (James & Gilliland, 2017).
Selected TAF Scale
The triage assessment form scale that I have chosen is the behavioral severity scale. When filling out the triage assessment form, the behavioral scale was a 6/7. Based on Amy’s case study, she instantly becomes distant, stutters, and begins to sweat when having to talk to men in class (Laureate Education, 2018). Although she wants to have a relationship with a man, she cannot seem to overcome her anxiety concerning her sexual assault in high school (Laureate Education, 2018). She even recognizes the fact that she will have trouble making her medical rounds as a nurse if she does not overcome her anxiety with her interactions with men (Laureate Education, 2018). Once the crisis exceeds the client’s ability to meaningfully cope in a purposeful manner, the client is considered immobilized, stuck in the approach, avoidance, or behavior no matter how proactive they appear to be (James & Gilliland, 2017). Amy’s behaviors are unstable but not immediately destructive however there is concern for her safety with her cutting herself as a stress reliever. She is struggling with accomplishing daily tasks such as walking throughout campus and being approached by men (Laureate Education, 2018). She recognizes that her anxiety with being around others, especially men, has to subside for her to accomplish her personal goals. Amy also recognizes that her behavior can be controlled with effort which is why she is seeking professional assistance. She needs to know how she can better handle her anxiety, reconnect with her spiritual beliefs, and effectively interact with men without panicking or thinking the worse. With crisis intervention, the best way to get the client mobile is to promote positive actions that the client can do at once (James & Gilliland, 2017). Once the client becomes more involved with doing something concrete, control is restored, and the climate for forward moving is established (James & Gilliland, 2017).
Crisis is time limited and should be assessed from the client’s subjective viewpoint and the crisis worker’s objective viewpoint (James & Gilliland, 2017). Performing an assessment on the client is imperative to know how to approach the crisis that the client is experiencing. The ultimate end goal is to help the client to get back in a position of control and stability. The length of time that the client has been in crisis will help determine how much time the counselor has in which to safely defuse the situation (James & Gilliland, 2017).
James, R. K., & Gilliland, B. E. (2017). Crisis intervention strategies (8th ed.). Boston, MA: Cengage Learning.
Laureate Education (Producer). (2018). Document: Case Study: Amy [PDF].
Classmate K. Brew
In Amy’s case, as you read on the more and more you realize how big of a crisis she is in. As we read in Chapter 7 of James and Gilliland (2017), Amy clearly exhibits symptoms to meet criteria for a PTSD diagnosis.
In scoring her Triage Assessment form, I felt some scales were easier than others. I noted in the observations section that she reported flashbacks and loss of reality contact and also noted her self-injurious behavior. I think these two issues were clearly identified in the case study.
In scoring the severity scales, I rated Amy moderate impairment on the first two sections (Feelings are primarily negative and are exaggerated or increasingly diminished and efforts to control emotions are not always successful). I rated her this way due to her report of having “bad thoughts and panic and worry”. I also rated her about her emotions not always in control because she does have some coping strategies (although they may not be the healthiest) they have somewhat worked for her. I rated her emotions of the crisis are generalized to other people and situations. I rated her this way due to the nature of her crisis and her stating that her crisis began when a male colleague asked her out on a date. This could very well be a trigger for her repressed trauma and her believing that any other man that she enters a relationship with will sexually assault her again. The last affective question was difficult for me to rate. I went and rated that Amy’s responses to questions/requests are emotional but composed. In reading the narrative of the case study, it does not seem that she has any outbursts until the end, but you can see how that response is linear and warranted. It seems Amy is frustrated that this trauma has prevented her from obtaining what she really wants and that is a healthy, appropriate relationship with a man.
In scoring her behavior, I noted that her behaviors are maladaptive but not immediately destructive. I did this as evidenced by the visual cutting on her arms and the statement, “I cut sometimes to help release my feelings.” This is obviously maladaptive behavior, but since there is not a desire to end her life I would not identify it as a crisis situation. I noted that her ability to perform tasks needed for daily functioning is seriously impaired; this was due to her having to go out to her car and feeling that she cannot be around men in completing her medical rounds. I noted that her behaviors are a minimal threat to self or others. Lastly, I noted that her behavior is becoming unstable and offensive. This one was difficult for me. I think this was the one that fit Amy best due to having to run out to her car to avoid negative stimuli. Behaviors that concern me are the increase in drinking and cutting these two behaviors can definitely lead to being unstable.