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  1. 1. Examining Alternatives<br />Step 4<br />
  2. 2. Examining alternative options within a crisis situation is a step in crisis intervention frequently overlooked by both survivors and sexual assault counselors. <br />Survivors are often unable to think clearly about their options, and counselors, in their effort to be nonjudgmental, empathetic, and nondirective, are reluctant to introduce suggestions into the conversation. <br />In an interesting study of the effectiveness of crisis workers, survivors indicated that direct exploration of options was more helpful than nonjudgmental support.<br />
  3. 3. Two categories:<br />Social Resources<br />include people who might be helpful in vthe survivor’s recovery.<br />Personal Resources<br />include personal qualities, skills, and other assets as well as environmental resources that can be used to help the survivor through the current crisis.<br />
  4. 4. Different Psychotherapies<br />Cognitive-behavior therapy<br />Stress Inoculation Training (SIT)<br />Brief Cognitive Behavioral Therapy<br />Exposure Therapy<br />Cognitive Processing Therapy (CPT)<br />Supportive counseling<br />Eye movement desensitization and reprocessing (EMDR)<br />Hypnosis.<br />Family and couples counseling<br />Support groups<br />Twelve-step programs<br />
  5. 5. Making Plans<br />Step 5<br />
  6. 6. It is worth repeating that making a plan must be done in collaboration with the survivor.<br />The goal of crisis intervention is reempowerment and reconnection. If a plan is constructed without a survivor’s sense of ownership, then she has been robbed (again) of her power and independence.<br /> The guiding principle of all exchanges with a survivor should be the installation of control and the opportunity for reconnection.<br />
  7. 7. After brainstorming possible social and personal resources and evaluating their practical and realistic merit for helping the survivor, a plan is developed that requires specific actions. <br />This plan would include identifying people, groups, or referral resources that the survivor will contact for immediate support. <br />Theplan would also include a list of specific personal coping resources that the survivor can use now. If specific coping skills are lacking, the plan may include additional contact with a sexual assault counselor or a mental health professional.<br />
  8. 8. Questions that may help with the process are:<br />Is the alternative specific enough?<br />Is the alternative believable and conceivable?<br />Does the alternative help the person to grow?<br />Is the alternative something that can be controlled?<br />Is the alternative consistent with the person’s culture and values?<br />What is the first action that has to be done to put the plan into action?<br />When will the first action be taken?<br />
  9. 9. Obtaining a Commitment<br />Step 6<br />
  10. 10. This final step, obtaining a commitment, is often brief and simple.<br />The plan should be simple (no more than two or three action steps), specific, and time-limited. <br />If possible, the plan should include a follow-up contact with the crisis worker or center.<br />
  11. 11. Encouraging Follow-up<br />1. Explain reasons for offering further contacts. For example, it may be helpful to tell the survivor that the three main factors that appear to prolong post-trauma difficulties are avoidance, negative thoughts or self-statements, and difficulty coping with anxiety.<br />The purpose of your follow-up contacts will be to address these three factors.<br />
  12. 12. 2. With a person who seems unsure about further contacts, it is helpful to explore and discuss obstacles to further contacts.<br />Example: <br />I can’t explain what I’m feeling.<br /> No one else can help me; I need to help myself.<br />
  13. 13. 3. It may be important to make clear the possibility that the survivor’s anxiety or other reactions (for example, intrusive thoughts, insomnia) may worsen in anticipation of follow-up contacts and that she may feel like avoiding them but that it is important not to avoid.<br />
  14. 14. 4. Make concrete arrangements (date and time) for a follow-up contact; if possible, when scheduling another contact, give a written appointment reminder to the person.<br />
  15. 15. 5. If she is not sure whether she wants further contact, ask for permission to call her in the next day or two to find out how she is doing.<br />This will provide her with another contact and with another chance to arrange follow-up support<br />
  16. 16. 6. When a person misses a scheduled follow-up contact, a phone call to offer to reschedule can reduce likelihood of dropout.<br />
  17. 17. Types of crisis<br />1. Maturational crisis – also called developmental crisis. These are predictable events in a person’s life which includes getting married, having a baby and leaving home for the first time.<br />Situational crises – unexpected or sudden events that imperils ones integrity. Included in this type of crisis are: loss of a job, death of a loved one or relative and physical and emotional illness of a family member or an individual.<br />Adventitious crisis – also called social crisis. Included in this category are: natural disasters like floods, earthquakes or hurricanes, war, terrorist attacks, riots and violent crimes such as rape and murder.<br />
  18. 18. References:<br /><br /><br />