10.11770011000002250638ARTICLETHE COUNSELING PSYCHOLOGIST M.docx

10.1177/0011000002250638ARTICLETHE COUNSELING
PSYCHOLOGIST / March 2003Westefeld, Heckman-Stone /
CRISIS INTERVENTION
• PROFESSIONAL FORUM
The Integrated Problem-Solving
Model of Crisis Intervention:
Overview and Application
John S. Westefeld
The University of Iowa
Carolyn Heckman-Stone
Iowa State University
Crisis intervention is a role that fits exceedingly well with
counseling psychologists’
interests and skills. This article provides an overview of a new
crisis intervention model,
the Integrated Problem-Solving Model (IPSM), and
demonstrates its application to a
specific crisis, sexual assault. It is hoped that this article will
encourage counseling psy-
chologists to become more involved in crisis intervention itself
as well as in research and
training in this important area.
Recently, significant crisis events (e.g., sexual assaults, school
shootings,
terrorist attacks, and other violent crimes) have received major
media atten-

tion. This has led, among other things, to an increased interest
in this topic as
a subspecialty among human service providers (James &
Gilliland, 2001). In
addition, it appears that we live in an increasingly fast-paced
and technologi-
cal society in which individuals may be less connected with
family and other
positive influences than in the past (Pitcher & Poland, 1992).
Mental health
professionals need to be prepared to help society cope with such
crises, and
counseling psychologists are particularly well suited for this
type of interven-
tion. Coping with life transitions, a major focus of counseling
psychology
throughout its history, sometimes involves the successful
negotiation of cri-
ses (Brown & Lent, 2000). Counseling psychologists are
particularly skilled
in promoting self-enhancement among relatively healthy
individuals, which
is often the case in crisis situations. In addition, crisis
intervention matches
well with counseling psychologists’ skills at implementing
brief, problem-
solving, developmental, educational, and self-empowering
intervention
approaches.
Relatively few articles have been published in The Counseling
Psycholo-
gist concerning crisis intervention and the role of the
counseling psycholo-
221

Correspondence concerning this article should be addressed to
John S. Westefeld, Coun-
seling Psychology, 361 Lindquist Center, The University of
Iowa, Iowa City, IA 52242;
e-mail: [email protected]
THE COUNSELING PSYCHOLOGIST, Vol. 31 No. 2, March
2003 221-239
DOI: 10.1177/0011000002250638
© 2003 by the Division of Counseling Psychology.
gist. Indeed, we believe that the field of counseling psychology
has not his-
torically seen itself as working extensively in this area.
Interestingly, in
1979—more than 20 years ago—Baldwin published an excellent
manuscript
in The Counseling Psychologist, wherein he reviewed crisis
theory, discussed
types of crises, and described his own stage model of crisis
intervention.
Baldwin’s model consisted of the following major steps:
catharsis/assess-
ment, focusing/contracting, intervention/resolution, and
termination/inte-
gration. Since 1979, however, there has been little in this
journal explicitly
dealing with the topic of generic crisis intervention per se as a
major role of
counseling psychologists. A review of the articles written
concerning the last
major counseling psychology conference (the Georgia
conference)
(Weissberg et al., 1988) yields few indications that crisis

intervention per se
has been an explicit major area of concern for the field of
counseling psychol-
ogy. However, it should be noted that in our view, things are
changing. At the
Fourth National Conference for Counseling Psychology (the
Houston con-
ference), a large number of work/social action groups addressed
a wide spec-
trum of social issues, many of which relate to crisis
intervention. In addition,
it is important to note that The Counseling Psychologist
recently published a
major contribution on suicide (Westefeld et al., 2000), which is
obviously a
crisis-laden phenomenon. Because we believe that crisis
intervention is an
emerging and important area for counseling psychologists, we
present this
article in an effort to augment the current knowledge base in
this area. Rather
than review the numerous existing crisis intervention models
(e.g., Baldwin,
1979; James & Gilliland, 2001; Roberts, 1991), this article
presents the
authors’ Integrated Problem-Solving Model (IPSM) of crisis
intervention,
which is based on many of the principles of the specialty of
counseling psy-
chology as a profession. We then present an exemplar of how
this model may
be used in a specific type of crisis that counseling psychologists
may encoun-
ter: sexual assault.
For the purposes of this article, the term crisis is defined as a

relatively and
usually brief reaction of severe distress in response to a
typically unexpected
event or series of events that can lead to extreme and severe
disequilibrium,
growth, or both, depending on the effectiveness of the crisis
management
strategies employed. This definition draws on the work of James
and Gilliland
(2001), Pitcher and Poland (1992), Roberts (1991, 1995), and a
variety of
others. It emphasizes the unexpected and time-limited nature of
a crisis (e.g.,
sudden death of a child), the subjective perception of the
situation as over-
whelming to the resources available, and the experience of
disequilibrium or
disorganization among several areas of functioning (i.e.,
affective, cognitive,
behavioral). In addition, it emphasizes that the short- and long-
term conse-
quences of a crisis can involve deterioration, growth, or some
combination of
the two, depending on the nature of the crisis intervention
utilized. In fact, the
222 THE COUNSELING PSYCHOLOGIST / March 2003
ancient Greek term for crisis came from two root words
meaning “decision”
and “turning point,” and the Chinese ideograph for crisis
combines two sym-
bols representing “danger” and “opportunity” (Roberts, 1995).

BRIEF SUMMARY OF EXISTING
CRISIS INTERVENTION WORK
The mental health literature concerning crisis intervention work
is obvi-
ously very extensive and includes such diverse writings as
Erikson’s (1950)
stage model of normal developmental crises, recommendations
based on
World War II experiences with combat fatigue (Roberts, 1995),
and reactions
to bereavement after a major fire at the Coconut Grove
nightclub in Boston
(Lindemann, 1944). A flurry of crisis intervention work after
the deinsti-
tutionalization of many mentally ill individuals by the
Community Mental
Health Centers Act of 1963 led to an upsurge in research and
the increased
popularity of using paraprofessionals and crisis hotlines in the
1970s and
1980s. Currently, financial strains on the healthcare system are
leading to
greater accountability and briefer treatment approaches than
previously used
(Pitcher & Poland, 1992).
Numerous crisis intervention models have been developed
during the past
decade. To cite just two of many examples, Roberts’s (1991)
model and
James and Gilliland’s (2001) six-step model can be used by
professional
human service providers and laypersons alike. Roberts’s
excellent model is
based on facilitating positive change via a somewhat time-

limited and goal-
directed approach (Roberts, 1991, 1995). The highly regarded
model by
James and Gilliland (2001), as they stated, is based on
assessing, listening,
and acting, and “the entire six-step process is carried out under
an umbrella of
assessment” (p. 33). James and Gilliland also provided an
excellent discus-
sion concerning many other crisis intervention theories/models.
Extensive
data-based empirical research examining crisis intervention
models, how-
ever, appears to be lacking; as such, we propose the IPSM as a
model that
lends itself to such research because the IPSM is a graduated
approach, draws
on cognitive-behavioral approaches, and has a multicultural
perspective. We
hope that this model will be sufficiently user-friendly to
encourage research-
ers and clinicians alike to increase their participation in crisis
intervention
research and practice.
The authors’ model—the IPSM—involves 10 stages and is
designed to
provide step-by-step detail in responding to a crisis from
beginning to
postcrisis. As a point of contrast, Roberts’s (1991) model has
seven steps and
James and Gilliland’s (2001) model has six steps. The IPSM
also draws on
several of the models to which we earlier alluded. We believe
that the IPSM

Westefeld, Heckman-Stone / CRISIS INTERVENTION 223
does have several advantages over some previous models in that
it is very
detailed in terms of exploring and implementing options and
plans, places
emphasis on immediately and explicitly establishing and
maintaining rap-
port, and in particular is based on a framework that focuses on
cultural con-
text and empowerment. We feel that the notion of empowerment
is especially
critical to our model and is consistent with the philosophy of
counseling psy-
chology, that is, a focus on the existing assets that clients can
utilize to con-
tinue to grow and develop. Moreover, our model is distinct from
some others
in that we feel that evaluating outcome is an important part of
any therapeutic
intervention, and we explicitly identify this as a very critical
step in our
model. Finally, as counseling psychologists, we decided to
frame the inter-
vention explicitly in positive terms by including “set goals”
rather than to
“define the problem” as in some previous models. For these
reasons, we feel
that our model updates and advances the literature.
OVERVIEW OF THE IPSM
The IPSM is a wide-ranging integration of several different
perspectives,

including the crisis-intervention (e.g., Baldwin, 1979; James &
Gilliland,
2001; Pitcher & Poland, 1992; Roberts, 1991, 1995) and trauma-
theory
(Herman, 1997) literatures, the cognitive-behavioral problem-
solving
approach developed by D’Zurilla and colleagues (D’Zurilla,
1986; D’Zurilla &
Goldfried, 1971; D’Zurilla & Mashcka, 1988; D’Zurilla &
Nezu, 1982;
D’Zurilla & Sheedy, 1991), narrative and solution-focused
therapies
(Greene, Lee, Trask, & Rheinscheld, 2000; Semmler &
Williams, 2000), and
multicultural counseling (Sue & Sue, 1990). The perspectives
incorporated
into the IPSM framework are described as follows.
The IPSM is consistent with current trauma theory in that it
begins with a
focus on safety, stabilization, and self-care; moves to
processing the trau-
matic event; and finally, encourages integration of this material
into everyday
life (Herman, 1997). Some earlier approaches to trauma
treatment involved
primarily psychodynamic processing of the traumatic material
to the exclu-
sion of the other two stages. This may have left clients
somewhat defenseless
and incapacitated, albeit insightful and in touch with emotions,
yet unable to
function in the outside world. Therefore, we prefer a graduated
approach to
dealing with trauma: first enhancing coping skills and safety,
then processing

traumatic material, and finally, generalizing this foundation to
broader life
arenas (Herman, 1997). This more recent approach would also
seem to be
more consistent with multicultural perspectives in which diverse
clientele are
empowered to identify and utilize existing strengths and who
seem to appre-
ciate practical strategies for coping with everyday life (Sue &
Sue, 1990).
The IPSM differs from some previous crisis-intervention models
because it
also provides opportunities for processing traumatic material or
at least for
goals to be set along these lines for future reference. It is
interesting that
despite their relevance and similarities to one another, the
crisis-intervention
and trauma-theory literatures have not been well integrated yet.
The IPSM draws heavily from cognitive-behavioral approaches,
which
seem to be the most popular and have the most empirical
support for use in
crisis counseling (Dattilio & Freeman, 1994; Muran &
DiGuiseppe, 1994).
Cognitive-behavioral approaches are appropriate for crisis
intervention
because they are active, directive, structured, often time
limited, and psycho-
educational in nature (Dattilio & Freeman, 1994). Clients in

crisis can benefit
from this type of approach because crises are often time limited,
clients may
be in such a state of disorganization that they may need a firm
guiding hand,
and they may benefit from education because the experience
may be unlike
anything they have ever experienced before. Problem-solving
approaches in
particular may lend themselves to crisis situations in that they
are structured,
efficient, concrete, and directive, yet flexible (Spiegler &
Guevremont,
1993). Clients from underrepresented groups may especially
appreciate the
structured, directive, and present-focused qualities (Sue & Sue,
1990) of the
IPSM. As Sue and Sue (1990) pointed out, many minorities and
immigrants
may be more familiar and comfortable with medical as opposed
to psycho-
logical treatment and therefore expect immediate and concrete
solutions to
their problems provided by authoritative “experts.”
As counseling psychologists, we are also particularly influenced
by
solution-focused models (Greene et al., 2000) that emphasize
the existing
strengths and resources of clients in improving their own
situations. This
approach has clients identify what strategies have worked well
in the past and
encourages clients to increasingly employ the strategies in the
future; thus,
the approach focuses on solutions rather than problems.

Solution
-focused
models are well suited to crisis intervention situations because
clients are
encouraged to draw on all available resources and implement
concrete solu-
tions. Again, such characteristics also provide a good match for
diverse clien-
tele. Therefore, in the IPSM, we have clients frame the events
as much as pos-
sible in a positive light. For example, we designate a step to set
goals as
opposed to identify the problem as is done in some other crisis
intervention
models, and we use the term survivor as opposed to victim with
people who
have experienced sexual assault.
Similarly, we utilize aspects of narrative therapy (Semmler &
Williams,
2000) to help clients empower themselves and increase their
sense of control

by developing their own adaptive accounts of the traumatic
events and their
outcomes. This can be accomplished by helping clients
understand the mean-
ings that they have created of historical events and then by
assisting clients in
reconstructing a new “story” (Kelley, 1998). A common
narrative technique
is to help clients view the problem as external but the solution
as internal to
them. For example, women who have been sexually assaulted
often blame
themselves for the rape. A narrative approach can help
survivors appropri-
ately place blame on the perpetrators and can help women see
that the way
they can fight back is to progress in their recovery. By
emphasizing the strate-
gies that clients have used to cope with and survive a situation,
narrative clini-

cians might help clients “restory” the crisis event. Clients
would also likely
be encouraged to develop an audience—social support—with
roles to play in
their new, more adaptive life story. As we mentioned
previously, such posi-
tive and empowering approaches are appropriate for
multicultural clientele
and, in the case of narrative therapy, may even help such clients
progress
along the stages of cultural identity by moving from self-
deprecation to self-
appreciation (Helms, 1994).
To reiterate, it should be clear that the frameworks used to form
the foun-
dation of the IPSM are all consistent with the philosophy of
counseling psy-
chology in terms of empowering people to draw on their
inherent strengths,
resources, and coping skills. Other potential benefits of the
IPSM are that it is
a specific, clear, detailed, and step-by-step method that
comprehensively
integrates previous models using an empowerment framework.

We feel that
for these reasons the IPSM could be easily utilized by
counseling psycholo-
gist clinicians and researchers alike. However, the IPSM would
also be flexi-
ble enough to accommodate various types of crisis situations.
The following
is a description of the stages involved in the IPSM (see Table
1).
1. Establish and Maintain Rapport
As in all therapeutic encounters, rapport building is a crucial
first step in
effective intervention. This may be all the more true in crisis
situations due to
client distress, vulnerability, distrust, and fragility.
Relationship building
includes all of the standard tools that a counseling psychologist
would utilize
in other therapeutic situations, although the crisis situation
involves a com-
pressed time frame. These tools include basic attending and
listening skills,
empathy, reflection of affect, encouragement, support, and

instillation of
hope (Ivey & Ivey, 1999). Rapport building can foster a
thorough and accu-
rate assessment of client safety and form the background for
other subse-
quent stages. Special attention should be paid to contextual or
sociocultural
factors that may influence the way in which a client copes with
the crisis situ-
ation. For example, extra efforts may need to be taken in
building rapport
when intervening with a person of color who may feel a
“cultural mistrust”
(Sue & Sue, 1990) of traditional mental health and other social
support agen-
cies. Kiselica (1998) reminded us that we may also have to be
ready to use a
wide variety of strategies in helping clients from diverse
cultures. Clearly, a
key here is empathy throughout this stage and, in fact,

throughout the entire
model. In 1959, Rogers described empathy as the ability to
access another’s
view/feelings as if the helper were the helpee but without taking
on the
helpee’s emotional state. In crisis response, it seems to us that
this is espe-
cially crucial in that true empathy, as discussed by Rogers
(1959), provides an
opportunity for assistance while at the same time reducing the
chance of
burnout on the part of the helper.
2. Ensure Safety
Ensuring safety should be an early intervention and remain a
focus
throughout the entire crisis response period. Clients need to be
assessed as to
their level of safety in terms of overall physical environment
and physical
health, self-destructiveness, harm toward others, and/or harm by
others
toward them, depending on the nature of the crisis. If safety is
of concern, this

takes priority over other issues in terms of problem solving and
implementing
plans for resolution. Suicide, in particular, may be an initial
and/or continu-
ing safety concern. See Westefeld et al. (2000) for some
specific guidelines
related to suicide.
3. Assess Client and Begin Processing Trauma
In addition to safety issues, other areas for assessment include
circum-
stances of the crisis event, past and current coping abilities,
social support
and other practical resources, related developmental and
historical events, as
TABLE 1: Westefeld and Heckman-Stone Model
1. Establish and maintain rapport.
2. Ensure safety.
3. Assess client and begin processing trauma.
4. Set goals.

5. Generate options.
6. Evaluate options.
7. Select plan.
8. Implement plan.
9. Evaluate outcome.
10. Follow-up.
well as psychological distress and basic functioning.
Quantitative measures
can be used, although crisis situations typically limit time and
available
resources. Due to the frequently limited time frame of crisis
intervention,
processing of traumatic material and assessment of the client
often need to
occur simultaneously. However, if more time is needed for
cognitive and
emotional processing, this can be identified as a potential goal
to be explored
during the following stages.
4. Set Goals

Based on the assessment of the client, problems can be defined
and goals
set. As counseling psychologists, we feel it is important to
reframe negative
problems into positive goals, and this is a key aspect of our
model. Sample
solution-focused goals are improving self-care, developing
coping skills or
resources, processing and managing emotions and cognitions,
and improv-
ing relationships. These goals should allow clients to increase
their sense of
control over constructing the current narrative of the traumatic
experience,
for example, by externalizing the problem yet internalizing the
solution
(Greene et al., 2000). This also may be framed as growth
through dealing
with adversity.
5. Generate Options
This step involves the client and counseling psychologist
working

together in thinking creatively to generate a variety of potential
actions to
achieve the stated goals. The particular focus is on adaptive
techniques that
the client is already employing and those that would continue to
shape a
desirable narrative.
6. Evaluate Options
Here, the client and counseling psychologist discuss the
advantages and
disadvantages of each option depending on desirability,
feasibility, available
resources, and so forth.
7. Select Plan
Based on the evaluation of options, the client and counseling
psychologist
now collaboratively decide on a plan of action, which
frequently has multiple
components and steps. Developing a plan in a crisis situation
may involve a
more directive approach than in other clinical situations because

the client
may be quite disorganized and/or time is often a critical issue.
8. Implement Plan
During this step, the components of the action plan are carried
out. The
counseling psychologist should ensure that the client has
sufficient prepara-
tion and support for this step, which may require taking on the
role of advo-
cate, particularly if members of certain oppressed groups plan
to interact with
traditional social services agencies with which they may lack
experience or
have had negative experiences. However, the client should have
as much con-
trol over selection and implementation of the plan as possible.
9. Evaluate Outcome

During this stage, it is important to elicit and process feedback
from the
client about the plan, how it is working, how the client feels
about it, and so
forth, in case the plan needs modification. This step can help
the client to
identify how the client has grown (again, a key principle from
counseling
psychology), how the narrative has changed, and what has been
learned from
the crisis experience for future reference. If preintervention
measures have
been used, corresponding postintervention measures can be
administered.
10. Follow-Up
Follow-up can occur with the original counseling psychologist
or with a
referral source such as other therapists, physicians, community
organiza-
tions, religious and other support groups, traditional healers,
and so forth.
Regardless, the client should have future appointments
scheduled after the

initial crisis to help ensure that the client follows through with
the plan, that it
continues to be beneficial, and that new skills become
integrated into the cli-
ent’s everyday narrative. The entire crisis intervention process
may take only
one extended session or several sessions during days or weeks,
depending
on the nature of the crisis and the functioning level of the
client. Extended
follow-up is crucial and is another key aspect of our model.
APPLICATION OF THE IPSM TO SEXUAL ASSAULT
Because sexual assault is such an important societal issue and
an issue
with which many counseling psychologists may deal, we now
present an
overview of the phenomenon of sexual assault and the
application of the
IPSM to its intervention. We hope that applying our model to
one very impor-
tant example of a crisis will help to operationalize the model.
“Sexual assault
is the fastest growing, most frequently committed and most

underreported
violent crime” (Dunn & Gilchrist, 1993, p. 359) and “is a highly
traumatic
event from which many victims never completely recover”
(Resick &
Mechanic, 1995, p. 97). It can result in posttraumatic stress
disorder (PTSD),
depression, problems with self-esteem, anger and hostility,
somatic symp-
toms, and difficulties in relationships including sexual
dysfunction. Approxi-
mately a quarter of untreated sexual assault survivors report
normal function-
ing 1 year after the assault, but many report continuing
problems for 1 year or
more (Gilbert, 1994).
Sexual assault crisis intervention generally corresponds to the
three stages
of recovery from rape or “rape trauma syndrome,” first

described by Burgess
and Holmstrom in 1974. These stages are (a) acute
disorganization, (b) denial
and avoidance, and (c) help seeking and working through. Crisis
intervention
for sexual assault usually occurs during the acute
disorganization phase, but
crises can occur during the other phases as well. The goals of
rape crisis coun-
seling are to “reduce the victim’s emotional distress, enhance
her coping
strategies, and prevent the development of more serious
psychopathology”
(Calhoun & Atkeson, 1991, p. 39). The use of the IPSM
specifically with the
population of sexual assault survivors is now described.
1. Establish and maintain rapport. Due to the brief and urgent
nature of
rape crisis counseling, it must be more active, directive, and
supportive than
other modes (Calhoun & Atkeson, 1991). Crisis workers should
exhibit the
following characteristics as well as behaviors: warmth and
calmness,

patience, availability but not intrusiveness or control,
acceptance and under-
standing, empathy and concern, effective listening skills,
trustworthiness,
and encouragement of appropriate referrals and support seeking.
The mes-
sages the survivor should hear are “I’m sorry this happened to
you,” “You are
safe now,” and “This wasn’t your fault” (Kitchen, 1991, 35);
and “I know you
handled the situation right because you’re alive” (Dunn &
Gilchrist, 1993,
p. 364). These messages and statements may be particularly
important for
members of certain oppressed and stigmatized groups to receive
to alter their
preexisting and potentially self-depreciating narratives.
2. Ensure safety. Safety must be assessed/addressed in terms of
client self-
destructiveness or suicidality and potential situations in which
the victim
may come in contact with the perpetrator. Common coping
mechanisms
include self-mutilation, eating disorders, substance abuse, and

promiscuity
and other types of risk-taking behaviors. Ensuring safety is a
critical step in
which clients must be assessed and empowered to develop
effective safety
plans and/or contracts, which may be incorporated into
subsequent stages.
Resources should be identified for potential use by the survivor.
3. Assess client and begin processing trauma. Identifying the
stage of
recovery from rape trauma syndrome is important in guiding
treatment inter-
ventions (Daane, 1991; Petretic-Jackson & Jackson, 1990). The
crisis inter-
vention strategies presented here are structured with these
stages in mind.
The initial, acute phase of recovery from rape involves somatic,
emotional,
and cognitive disorganization and lasts for a few days to several
weeks or

months. Victims experience feelings of shock, helplessness,
fear,
hypervigilance, guilt, shame, intrusive recollections, and
exhaustion. The
behavioral response varies widely among victims and has been
characterized
as either expressed or controlled. The expressed response refers
to anxious,
angry, fearful, tense, and restless reactions, whereas controlled
tends to
involve masked emotions and a calm, composed, and subdued
appearance.
Of course, responses may vary along cultural and numerous
other dimen-
sions as well. Assessment may reveal that the client is in the
acute phase of
recovery and not yet prepared to participate in the more in-
depth processing
of the trauma that may occur in later stages of recovery.
However, potential
goals to be addressed in the following intervention stages may
be (a) to pro-
cess the trauma at the intensity level that the client can tolerate
at any given
time, and (b) to construct the trauma into a narrative that is

more adaptive and
empowering than the existing one. The narrative approach may
be especially
helpful for women with histories of prior traumatic experiences
in that it can
help them acknowledge and develop the courage and strength
that helped
them survive in the past (Draucker, 1998).
“Triage (rapid assessment and prioritizing of needs) is
necessary to deter-
mine what type of intervention is appropriate and whether some
approaches
are contraindicated” (Resick & Mechanic, 1995, p. 101). Risk of
decom-
pensation, suicide, self-harm, or lack of sufficient coping
resources must be
assessed and the client stabilized before intensive techniques
such as expo-
sure are utilized. Assessment of immediate presenting problem,
daily func-
tioning, the specific nature of the assault, reactions to the event
and coping
skills utilized, available social support, premorbid adjustment,
interpersonal

relationships, and previous traumatic experiences is necessary
to determine
the severity of the crisis and plan for treatment.
The effect of the assault on the individual and the length of
recovery
depend on many factors, including
age, race/ethnicity, family background, cultural and religious
mores, com-
munity attitudes, type of abuse experienced, length of time and
intensity of
victimization, attitudes about sex roles, attitudes of family and
support per-
sons following disclosure/discovery of the abuse, and effects of
policy or legal
proceedings following disclosure/discovery of the abuse.
(Williams &
Holmes, 1981, as cited in Gilliland & James, 1997, pp. 224-225)
Certain types of clients who may on occasion require alternative

crisis inter-
vention approaches are children, incest survivors, victims of
gang rape, racial
or ethnic minorities, men, people with disabilities, suicidal
clients, gay men,
lesbians, and so forth. For example, the mental health concerns
of some male
sexual assault survivors may be somewhat different from those
of some
female survivors in that the former may face a different type of
prejudice and
stigmatization and use different coping skills to deal with and
express emo-
tions such as anger, shame, and helplessness (Evans, 1990).
Likewise, Afri-
can Americans and other racial/ethnic minorities’ care may
sometimes be
affected by stereotypes about their sexuality and personalities,
and in some
cases minority women may be reluctant to “betray” members of
their com-
munities if the perpetrators also happen to be members of the
same minority
group (McNair & Neville, 1996). Similar discriminatory
attitudes and

assumptions may prevent gay and lesbian assault survivors from
obtaining
the unique care that they need (Orzek, 1989). A solution-
focused framework
could help the client identify current coping skills yet expand
these to become
a more flexible and comprehensive repertoire and therefore a
more adaptive
narrative.
4 and 5. Set goals and generate options. Sexual assault may
result in a
series of crises from the assault itself to reporting the attack,
appearing in
court, and resolving intimate relationships (Pruett & Brown,
1990). The
counseling psychologist
must help the victim deal with the following issues during the
acute phase: 1)
medical attention, 2) legal matters and police contacts, 3)
notification of family
or friends, 4) current practical concern, 5) clarification of
factual information,
6) emotional responses, and 7) psychiatric consultation. (Fox &

Scherl, 1972,
p. 38)
Again, these situations may be exacerbated because of cultural
issues such as
a lack of experience or previous unsatisfactory experiences with
various
agencies (Sue & Sue, 1990), and these factors must be taken
into account
when developing and implementing the action plan.
6 and 7. Evaluate options and select plan. Control is a major
issue of con-
cern for rape survivors. They have experienced an extreme loss
of control and
need “to be reassured that that loss of control is neither total
nor permanent”
(Gilliland & James, 1997, p. 239) while being given as many
choices as pos-
sible in their recovery, such as whom to tell and where to stay.
In this way, cli-
ents can restory their traumatic narrative into one in which they
have more
power and control and thus facilitate their long-term recovery.
The reasons

for seeking medical attention and what to expect during the
examination
should be presented (Muran & DiGuiseppe, 1994). The
counseling psychol-
ogist should help the survivor decide whether to discuss the
situation with an
attorney and the consequences of reporting or not reporting the
crime (Fox &
Scherl, 1972). The survivor should be made aware of the
importance of social
support to recovery, and potential difficulties with intimacy and
sexual func-
tioning should be discussed (Muran & DiGuiseppe, 1994).
Survivors should
be helped decide with whom they feel comfortable talking and
how to dis-
close the assault (Fox & Scherl, 1972). The survivor may
receive unsup-
portive responses from police, lawyers, physicians, or even
friends and rela-

tives, so the clinician may be in the unique position of
countering these
responses with supportive ones.
Specific cognitive-behavioral approaches such as exposure,
cognitive re-
structuring, and stress-inoculation seem to be popular and have
good empiri-
cal support for use in rape crisis counseling (Muran &
DiGuiseppe, 1994).
Advantages and disadvantages of these approaches should be
discussed with
clients so that they can provide informed consent for their use.
It is important
to remember that establishing a therapeutic alliance is just as
important in
cognitive-behavioral crisis intervention with rape survivors as
in any other
treatment modality. The counseling psychologist must
efficiently establish
rapport and communicate effectively. Both verbal and nonverbal
strategies
are required to convey sensitivity, understanding, validation,
and hope. The
counseling psychologist should discuss the goals and

frustrations of the
counseling process to reduce attrition. The goal of many
survivors, whether
explicit or implicit, is to be able to avoid dealing with rape-
related issues. The
achievability and appropriateness of this common goal will need
to be dis-
cussed by the psychologist.
8. Implement plan. Important components of cognitive-
behavioral inter-
ventions in cases of sexual assault crises include verbal and
imaginal expo-
sure to the traumatic event (Muran & DiGuiseppe, 1994).
Counseling psy-
chologists should actively address resistance to these
approaches caused by
shame or fear by using cognitive restructuring techniques. The
client’s sup-
port network may actively encourage the client to avoid
dwelling on the rape,
which—according to behavioral theory—may strengthen the
anxiety related
to the stimuli and the avoidance response. Therefore, the
counseling psychol-

ogist may be in the unique position of encouraging and
reinforcing the client
for the cathartic recounting of the entire trauma. The counseling
psychologist
should help the survivor focus on emotions and also address
maladaptive
cognitions (Calhoun & Atkeson, 1991). Rape myths, cultural
stereotypes,
and the victim’s own attitudes about sexual assault should be
explored. These
can be revised as part of a more healthy narrative of the
traumatic experience.
Because it may be difficult for the survivor to absorb all of this
information,
written summaries should be provided, and the client should be
encouraged
to share this information with one’s own support network
(Calhoun &
Atkeson, 1991).

Stress inoculation training (SIT) (Meichenbaum &
Deffenbacher, 1988)
has been adapted for use with rape survivors. SIT was originally
designed to
be used in 12 weekly sessions (Muran & DiGuiseppe, 1994), but
selective
elements were chosen for this Brief Behavioral Intervention
Procedure
(BBIP) that involves two 2-hour crisis intervention sessions
(Calhoun &
Atkeson, 1991). The first phase of BBIP involves imaginal
reexperiencing of
the rape and education about learning theory and rape-related
physiological,
behavioral, and cognitive responses (Muran & DiGuiseppe,
1994). This pro-
vides normalization for current reactions and anticipatory
guidance for
future ones. The second phase is coping-skills training to deal
with fear and
anxiety. These skills include controlled breathing, muscle
relaxation, covert
modeling, role playing, cognitive restructuring, thought
stopping, and guided
self-dialogue. Techniques should be individually selected based

on the
strengths and characteristics of the particular client so that her
new narrative
is appropriate and empowering to her. Petretic-Jackson and
Jackson (1990)
recommend that the clinician “set the stage for the development
of a survivor
mentality” (p. 138). This can be accomplished by sharing
experiences and
coping strategies used by other assault survivors. A group of
culturally simi-
lar survivor members might be ideal. In accordance with
solution-focused
approaches, counseling psychologists can help to highlight the
survival skills
the client has demonstrated thus far and help build on those
strategies.
Clients should also be encouraged to reduce their usual
responsibilities
and develop a plan to gradually work toward resuming normal
functioning
including some daily structure and regular social contact
(Calhoun &
Atkeson, 1991). The counseling psychologist can help the client

mobilize
social support by discussing its importance, hypothesizing about
possible
reactions of others, even notifying significant others and
educating them
about what to expect and how to cope. These measures can help
create a sup-
portive audience with roles scripted by the client for the new
narrative. The
counseling psychologist should help the client explore strategies
to increase
feelings of physical safety such as staying with friends,
installing locks or
security systems, or even changing residence.
9. Evaluate outcome. At the end of the first session and in
future sessions,
the client should be given the opportunity to express reactions
to the interven-
tions and the therapist, including what has been helpful, not
helpful, difficult,
and so forth. Most important, the client should be given the
opportunity to
consider what strengths have been demonstrated thus far and
those that will

continue to be drawn on in the face of future distress. This stage
offers a way
in which (a) survivors can be empowered to continue
developing their own
narrative, and (b) the counseling psychologist can improve
future clinical
work based on empirical support.
10. Follow-up. The client should have a specific plan for the
next 24 to 48
hours (Petretic-Jackson & Jackson, 1990), including mental
health and other
community referral information for future use (Fox & Scherl,
1972). Permis-
sion to contact the client by telephone within the next few days
for follow-up
is desirable, because client follow-up is often poor (Calhoun &
Atkeson,
1991). The counseling psychologist may need to be in contact
with the survi-

vor daily in the immediate aftermath of the crisis to listen to
and support the
survivor as well as assist with arrangements for medical care or
legal services
(Fox & Scherl, 1972). Assessment and treatment planning can
continue dur-
ing this time. Petretic-Jackson and Jackson (1990) recommend
follow-up at
24 hours, 48 to 72 hours, 1 week, 4 to 6 weeks, 3 months, 1
year, and when-
ever the survivor or the victim’s support system requests
assistance.
During the second or denial phase of recovery, help seeking
decreases.
This pseudoadjustment response is normal and should be
supported rather
than challenging defenses (Fox & Scherl, 1972). The counseling
psycholo-
gist may simply encourage keeping follow-up appointments,
although this
may be somewhat futile. The counseling psychologist can also
continue to
help support persons by educating them about rape and helping
them deal

with their own and the survivor’s reactions. Despite the lack of
external signs
at this stage, survivors often continue to struggle with feelings
of alienation,
depression, nightmares, sleeplessness, flashbacks, somatic
symptoms,
decreased self-esteem, feelings of being out of control, and
anxiety (Daane,
1991).
The third phase generally involves depression, help seeking,
working
through, and then integration (Fox & Scherl, 1972). Therapy can
help survi-
vors work through their feelings of guilt and anger toward
themselves and the
perpetrators. It is during this phase that survivors are more
likely to be open to
more intense, longer term modalities such as prolonged
exposure and
extended cognitive therapies, interpersonal therapy, or
psychodynamic
approaches. Personal growth and maturation often result from
such interven-
tions, with survivors developing a more independent, self-

reliant, and self-
accepting narrative (Moscarello, 1990).
Counseling psychologists and other mental health professionals
are at risk
of becoming overinvolved with survivors of trauma and
becoming burned out
due to the shock and rage over the horrible traumas that have
been perpetrated
(Gilliland & James, 1997). Working with survivors may disrupt
the thera-
pist’s own sense of security. Counseling psychologists must
utilize self-care
strategies such as consultation because “if the therapist believes
that the trau-
matic experience is too difficult to face, the client’s avoidance
will be rein-
forced” (Muran & DiGuiseppe, 1994, p. 174).
SUMMARY AND FUTURE DIRECTIONS

IN RESEARCH AND TRAINING
This article introduced the IPSM of crisis intervention and
applied it to a
specific type of crisis. We believe that the IPSM is a thorough
yet user-
friendly model that we hope other psychologists will help us
critique and
investigate. As the role of counseling psychologists adjusts to
new societal
demands, crisis intervention is clearly gaining importance. More
research
needs to be conducted in this area to determine the validity and
helpfulness of
current theories and practices. We realize that crisis
intervention research is
extremely challenging due to the nature of the client population,
the nature of
the interventions, the difficulty in maintaining experimental
control, and the
variability of methodologies across studies (Kolotkin &
Johnson, 1981).
However, we would like to see more outcome and comparison
studies of the
current intervention models, studies that use diverse client

groups, and stud-
ies that apply the models to specific types of crises. This
appears to us to be a
gap in literature, and we encourage counseling psychologists to
undertake
such studies. What we especially need to know is the long-term
helpfulness
of a variety of crisis intervention strategies because crises can
often yield
delayed long-term reactions. In addition, models may have
more—or less—
utility with different groups.
Research and training are, of course, linked. Commenting on
counseling
psychology training, Patton (2000) wrote, “Each program
should use teach-
ing and learning methods to help students acquire both the
declarative knowl-
edge base in scientific and counseling psychology and
procedural knowledge
of research and practice in complex learning situations” (p.
703). In our view,
these suggestions are clearly relevant to the area of crisis
intervention. It is

our contention that more training in crisis intervention needs to
be included in
our counseling psychology curricula. The problem, as always, is
when,
where, and how to do this. Clearly, our curricula are already
often operating at
capacity. However, it seems imperative that crisis intervention
skills be devel-
oped by our current trainees. These skills could be embedded in
a wide vari-
ety of courses such as prepracticum, practicum, assessment,
psycho-
diagnostics, therapy theory and practice, multicultural and
ethics courses,
and/or offered in one targeted course. We advocate a curriculum
that would
combine generic theoretical and empirical information on crisis
intervention
with practical training in how to respond to specific crises. For
a number of

years, the senior author has taught a crisis intervention seminar
that includes
general information as well as training in responding to suicide,
sexual
assault, domestic violence, disaster response, psychotic events,
and PTSD. In
addition, survivors of some of these crises have given
presentations directly
to the crisis intervention class. This is one example of a specific
training
mechanism that includes breadth and depth but certainly not the
only one.
Few programs include extensive, specific training in crisis
intervention
(Pitcher & Poland, 1992), and we believe this should change.
This would
allow the counseling psychologists of the future to respond
competently to
societal needs in this very critical area.
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Dattilio, F. M., & Freeman, A. (1994). Cognitive-behavioral
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D’Zurilla, T. J. (1986). Problem-solving therapy: A social
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Fox, S. S., & Scherl, D. J. (1972). Crisis intervention with
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Greene, G. J., Lee, M.-Y., Trask, R., & Rheinscheld, J. (2000).
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Pitcher, G. D., & Poland, S. (1992). Crisis intervention in the
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Pruett, H. L., & Brown, V. B. (1990). Crisis intervention and
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Spiegler, M. D., & Guevremont, D. C. (1993). Contemporary
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510.
Week 9: Psychotherapy with Children and Adolescents
Approximately 1 in 5 children and adolescents have a mental
health disorder, which may lead to issues at home, school, and
other areas of their lives (Prout & Fedewa, 2015). When
working with this population, it is important to recognize that
children and adolescents are not “mini adults” and should not be
treated as such. Psychotherapy with these clients is often more
complex than psychotherapy with the general adult population,
particularly in terms of communication. As a result, strong

therapeutic relationships are essential to success.
This week, as you explore psychotherapy with children and
adolescents, you assess clients presenting with disruptive
behaviors. You also examine therapies for treating these clients
and consider potential outcomes. Finally, you develop diagnoses
for clients receiving psychotherapy and consider legal and
ethical implications of counseling these clients.
Discussion: Counseling Adolescents
The adolescent population is often referred to as “young
adults,” but in some ways, this is a misrepresentation.
Adolescents are not children, but they are not yet adults either.
This transition from childhood to adulthood often poses many
unique challenges to working with adolescent clients,
particularly in terms of disruptive behavior. In your role, you
must overcome these behaviors to effectively counsel clients.
For this Discussion, as you examine the Disruptive
Behaviors media in this week’s Learning Resources, consider
how you might assess and treat adolescent clients presenting
with disruptive behavior.
Students will:
· Assess clients presenting with disruptive behavior
· Analyze therapeutic approaches for treating clients presenting
with disruptive behavior
· Evaluate outcomes for clients presenting with disruptive

behavior
To prepare:
· Review this week’s Learning Resources and reflect on the
insights they provide.
· View the media, Disruptive Behaviors. Select one of the four
case studies and assess the client.
· For guidance on assessing the client, refer to pages 137-142 of
the Wheeler text in this week’s Learning Resources.
Discussion
Post an explanation of your observations of the client in the
case study you selected, including behaviors that align to the
criteria in DSM-5.
Then, explain therapeutic approaches you might use with this
client, including psychotropic medications if appropriate.
Finally, explain expected outcomes for the client based on these
therapeutic approaches. Support your approach with evidence-
based literature.
Learning Resources
Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced
practice psychiatric nurse: A how-to guide for evidence-based

practice (2nd ed.). New York, NY: Springer Publishing
Company.
· Chapter 17, “Psychotherapy With Children” (pp. 597–624)
American Psychiatric Association. (2013). Diagnostic and
statistical manual of mental disorders (5th ed.). Washington,
DC: Author.
Note: You will access this text from the Walden Library
databases.
Bass, C., van Nevel, J., & Swart, J. (2014). A comparison
between dialectical behavior therapy, mode deactivation
therapy, cognitive behavioral therapy, and acceptance and
commitment therapy in the treatment of adolescents.
International Journal of Behavioral Consultation and Therapy,
9(2), 4–8. doi:10.1037/h0100991
Note: You will access this article from the Walden Library
databases.
Koocher, G. P. (2003). Ethical issues in psychotherapy with
adolescents. Journal of Clinical Psychology, 59(11), 1247–1256.
PMID:14566959
databases.

McLeod, B. D., Jensen-Doss, A., Tully, C. B., Southam-Gerow,
M. A., Weisz, J. R., & Kendall, P. C. (2016). The role of setting
versus treatment type in alliance within youth therapy. Journal
of Consulting and Clinical Psychology, 84(5), 453–464.
doi:10.1037/ccp0000081
databases.
Zilberstein, K. (2014). The use and limitations of attachment
theory in child psychotherapy. Psychotherapy, 51(1), 93–103.
doi:10.1037/a0030930
databases.
Laureate Education (Producer). (2013a). Disruptive behaviors -
Part 1 [Multimedia file]. Baltimore, MD: Author.
Laureate Education (Producer). (2013a). Disruptive behaviors -
Part 2 [Multimedia file]. Baltimore, MD: Author.
Walker, R. (n.d.). Making child therapy work [Video file]. Mill
Valley, CA: Psychotherapy.net.
Bruce, T., & Jongsma, A. (2010a). Evidence-based treatment
planning for disruptive child and adolescent behavior [Video

file]. Mill Valley, CA: Psychotherapy.net.
Note: You will access this media from the Walden Library
databases. The approximate length of this media piece is 63
minutes.
The Case Study on Disruptive Behavior
Disruptive Behaviors
Four disruptive behavior demonstrations are shown (choose
One). Critically analyze each of them. At the end of each clip,
you will be prompted to answer several questions based on what
you just observed (Never mind recording your answer to the
media. Just use the answer template and respond to the question
there).
There will be an opportunity to record your responses within the
media. It will be saved directly to the computer you are using. It
is important to view and respond to the questions in their
entirety, as your recorded responses will only be saved to this
computer. If you change computers, your recorded responses
will not be saved (Never mind recording your answer to the
media. Just use the answer template and respond to the question
there).
Go to this link below to view the video.
https://mym.cdn.laureate-
media.com/2dett4d/Walden/NURS/6640/09/mm/disruptive_beha

viors_01/index.html
Assignment
Post an explanation of your observations of the client in the
case study you selected, including behaviors that align to the
criteria in DSM-5.
Then, explain therapeutic approaches you might use with this
client, including psychotropic medications if appropriate.
Finally, explain expected outcomes for the client based on these
therapeutic approaches. Support your approach with evidence-
based literature.
1
Theory Into Practice: Four Social Work Case Studies
In this course, you select one of the following four case studies

and use it throughout
the entire course. By doing this, you will have the opportunity
to see how different
theories guide your view of a client and that client’s presenting
problem. Each time you
return to the same case, you use a different theory, and your
perspective of the problem
changes—which then changes how you ask assessment questions
and how you
intervene.
These case studies are based on the video- and web-based case
studies you encounter
in the MSW program.
Table of Contents
Tiffani Bradley
...............................................................................................
.................. 2

Paula Cortez
...............................................................................................
.................... 9
Jake Levey
...............................................................................................
..................... 10
Helen Petrakis
...............................................................................................
................ 13
2
Tiffani Bradley
Identifying Data: Tiffani Bradley is a 16-year-old Caucasian
female. She was raised in

a Christian family in Philadelphia, PA. She is of German
descent. Tiffani’s family
consists of her father, Robert, 38 years old; her mother,
Shondra, 33 years old, and
her sister, Diana, 13 years old. Tiffani currently resides in a
group home, Teens First,
a brand new, court-mandated teen counseling program for
adolescent victims of
sexual exploitation and human trafficking. Tiffani has been
provided room and board
in the residential treatment facility for the past 3 months.
Tiffani describes herself as
heterosexual.
Presenting Problem: Tiffani has a history of running away. She
has been arrested on
three occasions for prostitution in the last 2 years. Tiffani has
recently been court
ordered to reside in a group home with counseling. She has a
continued desire to be
reunited with her pimp, Donald. After 3 months at Teens First,
Tiffani said that she
had a strong desire to see her sister and her mother. She had not

seen either of
them in over 2 years and missed them very much. Tiffani is
confused about the path
to follow. She is not sure if she wants to return to her family
and sibling or go back to
Donald.
Family Dynamics: Tiffani indicates that her family worked well
together until 8 years
ago. She reports that around the age of 8, she remembered being
awakened by
music and laughter in the early hours of the morning. When she
went downstairs to
investigate, she saw her parents and her Uncle Nate passing a
pipe back and forth
between them. She remembered asking them what they were
doing and her mother
saying, “adult things” and putting her back in bed. Tiffani
remembers this happening
on several occasions. Tiffani also recalls significant changes in
the home's
appearance. The home, which was never fancy, was always neat
and tidy. During

this time, however, dust would gather around the house, dishes
would pile up in the
sink, dirt would remain on the floor, and clothes would go for
long periods of time
without being washed. Tiffani began cleaning her own clothes
and making meals for
herself and her sister. Often there was not enough food to feed
everyone, and Tiffani
and her sister would go to bed hungry. Tiffani believed she was
responsible for
helping her mom so that her mom did not get so overwhelmed.
She thought that if
she took care of the home and her sister, maybe that would help
mom return to the
person she was before.
Sometimes Tiffani and her sister would come downstairs in the
morning to find empty
beer cans and liquor bottles on the kitchen table along with a
crack pipe. Her parents
would be in the bedroom, and Tiffani and her sister would leave
the house and go to
school by themselves. The music and noise downstairs
continued for the next 6

years, which escalated to screams and shouting and sounds of
people fighting.
Tiffani remembers her mom one morning yelling at her dad to
“get up and go to
work.” Tiffani and Diana saw their dad come out of the
bedroom and slap their mom
so hard she was knocked down. Dad then went back into the
bedroom. Tiffani
3
remembers thinking that her mom was not doing what she was
supposed to do in the
house, which is what probably angered her dad.
Shondra and Robert have been separated for a little over a year
and have started
dating other people. Diana currently resides with her mother
and Anthony, 31 years
old, who is her mother’s new boyfriend.

Educational History: Tiffani attends school at the group home,
taking general
education classes for her general education development (GED)
credential. Diana
attends Town Middle School and is in the 8th grade.
Employment History: Tiffani reports that her father was
employed as a welding
apprentice and was waiting for the opportunity to join the
union. Eight years ago, he
was laid off due to financial constraints at the company. He
would pick up odd jobs
for the next 8 years but never had steady work after that. Her
mother works as a
home health aide. Her work is part-time, and she has been
unable to secure full-time
work.
Social History: Over the past 2 years, Tiffani has had limited
contact with her family
members and has not been attending school. Tiffani did contact

her sister Diana a
few times over the 2-year period and stated that she missed her
very much. Tiffani
views Donald as her “husband” (although they were never
married) and her only
friend. Previously, Donald sold Tiffani to a pimp, “John T.”
Tiffani reports that she was
very upset Donald did this and that she wants to be reunited
with him, missing him
very much. Tiffani indicates that she knows she can be a better
“wife” to him. She
has tried to make contact with him by sending messages through
other people, as
John T. did not allow her access to a phone. It appears that over
the last 2 years,
Tiffani has had neither outside support nor interactions with
anyone beyond Donald,
John T., and some other young women who were prostituting.
Mental Health History: On many occasions Tiffani recalls that
when her mother was
not around, Uncle Nate would ask her to sit on his lap. Her
father would sometimes

ask her to show them the dance that she had learned at school.
When she danced,
her father and Nate would laugh and offer her pocket change.
Sometimes, their
friend Jimmy joined them. One night, Tiffani was awakened by
her uncle Nate and his
friend Jimmy. Her parents were apparently out, and they were
the only adults in the
home. They asked her if she wanted to come downstairs and
show them the new
dances she learned at school. Once downstairs Nate and Jimmy
put some music on
and started to dance. They asked Tiffani to start dancing with
them, which she did.
While they were dancing, Jimmy spilled some beer on her. Nate
said she had to go to
the bathroom to clean up. Nate, Jimmy, and Tiffani all went to
the bathroom. Nate
asked Tiffani to take her clothes off and get in the bath. Tiffani
hesitated to do this,
but Nate insisted it was OK since he and Jimmy were family.
Tiffani eventually
relented and began to wash up. Nate would tell her that she
missed a spot and would
scrub the area with his hands. Incidents like this continued to

occur with increasing
levels of molestation each time.
4
The last time it happened, when Tiffani was 14, she
pretended to be willing to dance
for them, but when she got downstairs, she ran out the front
door of the house. Tiffani
vividly remembers the fear she felt the nights Nate and Jimmy
touched her, and she
was convinced they would have raped her if she stayed in the
house.
About halfway down the block, a car stopped. The man
introduced himself as Donald,
and he indicated that he would take care of her and keep her
safe when these things
happened. He then offered to be her boyfriend and took Tiffani

to his apartment.
Donald insisted Tiffani drink beer. When Tiffani was drunk,
Donald began kissing her,
and they had sex. Tiffani was also afraid that if she did not have
sex, Donald would
not let her stay— she had nowhere else to go. For the next 3
days, Donald brought
her food and beer and had sex with her several more times.
Donald told Tiffani that
she was not allowed to do anything without his permission. This
included watching
TV, going to the bathroom, taking a shower, and eating and
drinking. A few weeks
later, Donald bought Tiffani a dress, explaining to her that she
was going to “find a
date” and get men to pay her to have sex. When Tiffani said she
did not want to do
that, Donald hit her several times. Donald explained that if she
didn’t do it, he would
get her sister Diana and make her do it instead. Out of fear for
her sister, Tiffani
relented and did what Donald told her to do. She thought at this
point her only
purpose in life was to be a sex object, listen, and obey—and
then she would be able

to keep the relationships and love she so desired.
Legal History: Tiffani has been arrested three times for
prostitution. Right before the
most recent charge, a new state policy was enacted to protect
youth 16 years and
younger from prosecution and jail time for prostitution. The
Safe Harbor for Exploited
Children Act allows the state to define Tiffani as a sexually
exploited youth, and
therefore the state will not imprison her for prostitution. She
was mandated to
services at the Teens First agency, unlike her prior arrests when
she had been sent
to detention.
Alcohol and Drug Use History: Tiffani’s parents were social
drinkers until about 8
years ago. At that time Uncle Nate introduced them to crack
cocaine. Tiffani reports
using alcohol when Donald wanted her to since she wanted to

please him, and she
thought this was the way she would be a good “wife.” She
denies any other drug use.
Medical History: During intake, it was noted that Tiffani had
multiple bruises and burn
marks on her legs and arms. She reported that Donald had
slapped her when he felt
she did not behave and that John T. burned her with cigarettes.
She had realized that
she did some things that would make them mad, and she tried
her hardest to keep
them pleased even though she did not want to be with John T.
Tiffani has been
treated for several sexually transmitted infections (STIs) at
local clinics and is
currently on an antibiotic for a kidney infection. Although she
was given condoms by
Donald and John T. for her “dates,” there were several “Johns”
who refused to use
them.

5
Strengths: Tiffani is resilient in learning how to survive the
negative relationships she
has been involved with. She has as sense of protection for her
sister and will sacrifice
herself to keep her sister safe.
Robert Bradley: father, 38 years old
Shondra Bradley: mother, 33 years old
Nate Bradley: uncle, 36 years old
Tiffani Bradley: daughter, 16 years old
Diana Bradley: daughter, 13 years old
Donald: Tiffani’s self-described husband and her former pimp
Anthony: Shondra’s live-in partner, 31 years old
John T.: Tiffani’s most recent pimp

6
Paula Cortez
Identifying Data: Paula Cortez is a 43-year-old Catholic
Hispanic female residing in New
York City, NY. Paula was born in Colombia. When she was 17
years old, Paula left
Colombia and moved to New York where she met David, who
later became her
husband. Paula and David have one son, Miguel, 20 years old.
They divorced after 5
years of marriage. Paula has a five-year-old daughter, Maria,
from a different
relationship.
Presenting Problem: Paula has multiple medical issues, and
there is concern about
whether she will be able to continue to care for her youngest
child, Maria. Paula has
been overwhelmed, especially since she again stopped taking
her medication. Paula is

also concerned about the wellness of Maria.
Family Dynamics: Paula comes from a moderately well-to-do
family. Paula reports
suffering physical and emotional abuse at the hands of both her
parents, eventually
fleeing to New York to get away from the abuse. Paula comes
from an authoritarian
family where her role was to be “seen and not heard.” Paula
states that she did not feel
valued by any of her family members and reports never
receiving the attention she
needed. As a teenager, she realized she felt “not good enough”
in her family system,
which led to her leaving for New York and looking for
“someone to love me.” Her
parents still reside in Colombia with Paula’s two siblings.
Paula met David when she sought to purchase drugs. They
married when Paula was 18
years old. The couple divorced after 5 years of marriage. Paula
raised Miguel, mostly by

herself, until he was 8 years old, at which time she was forced
to relinquish custody due
to her medical condition. Paula maintains a relationship with
her son, Miguel, and her
ex-husband, David. Miguel takes part in caring for his half-
sister, Maria.
Paula does believe her job as a mother is to take care of Maria
but is finding that more
and more challenging with her physical illnesses.
Employment History: Paula worked for a clothing designer, but
she realized that her true
passion was painting. She has a collection of more than 100
drawings and paintings,
many of which track the course of her personal and emotional
journey. Paula held a full-
time job for a number of years before her health prevented her
from working. She is
now unemployed and receives Supplemental Security Disability
Insurance (SSD) and
Medicaid. Miguel does his best to help his mom but only works

part time at a local
supermarket delivering groceries.
Paula currently uses federal and state services. Paula
successfully applied for WIC, the
federal Supplemental Nutrition Program for Women, Infants,
and Children. Given
Paula’s low income, health, and Medicaid status, Paula is able
to receive in-home
childcare assistance through New York’s public assistance
program.
7
Social History: Paula is bilingual, fluent in both Spanish and
English. Although Paula
identifies as Catholic, she does not consider religion to be a big
part of her life. Paula
lives with her daughter in an apartment in Queens, NY. Paula is

socially isolated as she
has limited contact with her family in Colombia and lacks a
peer network of any kind in
her neighborhood.
Five (5) years ago Paula met a man (Jesus) at a flower shop.
They spoke several times.
He would visit her at her apartment to have sex. Since they had
an active sex life, Paula
thought he was a “stand-up guy” and really liked him. She
believed he would take care
of her. Soon everything changed. Paula began to suspect that he
was using drugs,
because he had started to become controlling and demanding.
He showed up at her
apartment at all times of the night demanding to be let in. He
called her relentlessly, and
when she did not pick up the phone, he left her mean and
threatening messages. Paula
was fearful for her safety and thought her past behavior with
drugs and sex brought on
bad relationships with men and that she did not deserve better.
After a couple of
months, Paula realized she was pregnant. Jesus stated he did not

want anything to do
with the “kid” and stopped coming over, but he continued to
contact and threaten Paula
by phone. Paula has no contact with Jesus at this point in time
due to a restraining
order.
Mental Health History: Paula was diagnosed with bipolar
disorder. She experiences
periods of mania lasting for a couple of weeks then goes into a
depressive state for
months when not properly medicated. Paula has a tendency
toward paranoia. Paula
has a history of not complying with her psychiatric medication
treatment because she
does not like the way it makes her feel. She often discontinues
it without telling her
psychiatrist. Paula has had multiple psychiatric hospitalizations
but has remained out of
the hospital for the past 5 years. Paula accepts her bipolar
diagnosis but demonstrates
limited insight into the relationship between her symptoms and
her medication.

Paula reports that when she was pregnant, she was fearful for
her safety due to the
baby’s father’s anger about the pregnancy. Jesus’ relentless
phone calls and voicemails
rattled Paula. She believed she had nowhere to turn. At that
time, she became scared,
slept poorly, and her paranoia increased significantly. After
completing a suicide
assessment 5 years ago, it was noted that Paula was
decompensating quickly and was
at risk of harming herself and/or her baby. Paula was
involuntarily admitted to the
psychiatric unit of the hospital. Paula remained on the unit for 2
weeks.
Educational History: Paula completed high school in Colombia.
Paula had hoped to
attend the Fashion Institute of Technology (FIT) in New York
City, but getting divorced,
then raising Miguel on her own interfered with her plans.
Miguel attends college full time

in New York City.
Medical History: Paula was diagnosed as HIV positive 15 years
ago. Paula acquired
AIDS three years later when she was diagnosed with a severe
brain infection and a T-
cell count of less than 200. Paula’s brain infection left her
completely paralyzed on the
right side. She lost function in her right arm and hand as well as
the ability to walk. After
8
a long stay in an acute care hospital in New York City, Paula
was transferred to a skilled
nursing facility (SNF) where she thought she would die. After
being in the skilled nursing
facility for more than a year, Paula regained the ability to walk,
although she does so
with a severe limp. She also regained some function in her right
arm. Her right hand

(her dominant hand) remains semi-paralyzed and limp. Over the
course of several
years, Paula taught herself to paint with her left hand and was
able to return to her
beloved art.
Paula began treatment for her HIV/AIDS with highly active
antiretroviral therapy
(HAART). Since she ran away from the family home, married
and divorced a drug user,
then was in an abusive relationship, Paula thought she deserved
what she got in life.
She responded well to HAART and her HIV/AIDS was well
controlled. In addition to her
HIV/AIDS disease, Paula is diagnosed with Hepatitis C (Hep
C). While this condition
was controlled, it has reached a point where Paula’s doctor is
recommending she begin
a new treatment. Paula also has significant circulatory
problems, which cause her
severe pain in her lower extremities. She uses prescribed
narcotic pain medication to
control her symptoms. Paula’s circulatory problems have also
led to chronic ulcers on

her feet that will not heal. Treatment for her foot ulcers
demands frequent visits to a
wound care clinic. Paula’s pain paired with the foot ulcers make
it difficult for her to
ambulate and leave her home. Paula has a tendency not to
comply with her medical
treatment. She often disregards instructions from her doctors
and resorts to holistic
treatments like treating her ulcers with chamomile tea. When
she stops her treatment,
she deteriorates quickly.
Maria was born HIV negative and received the appropriate
HAART treatment after birth.
She spent a week in the neonatal intensive care unit as she had
to detox from the
effects of the pain medication Paula took throughout her
pregnancy.
Legal History: Previously, Paula used the AIDS Law Project, a
not-for-profit organization
that helps individuals with HIV address legal issues, such as

those related to the child’s
father . At that time, Paula filed a police report in response to
Jesus' escalating threats
and successfully got a restraining order. Once the order was
served, the phone calls
and visits stopped, and Paula regained a temporary sense of
control over her life.
Paula completed the appropriate permanency planning
paperwork with the assistance
of the organization The Family Center. She named Miguel as
her daughter’s guardian
should something happen to her.
Alcohol and Drug Use History: Paula became an intravenous
drug user (IVDU), using
cocaine and heroin, at age 17. David was one of Paula’s “drug
buddies” and suppliers.
Paula continued to use drugs in the United States for several
years; however, she
stopped when she got pregnant with Miguel. David continued to
use drugs, which led to

the failure of their marriage.
Strengths: Paula has shown her resilience over the years. She
has artistic skills and has
found a way to utilize them. Paula has the foresight to seek
social services to help her
9
and her children survive. Paula has no legal involvement. She
has the ability to bounce
back from her many physical and health challenges to continue
to care for her child and
maintain her household.
David Cortez: father, 46 years old
Paula Cortez: mother, 43 years old
Miguel Cortez: son, 20 years old
Jesus (unknown): Maria’s father, 44 years old
Maria Cortez: daughter, 5 years old

10
Jake Levy
Identifying Data: Jake Levy is a 31-year-old, married, Jewish
Caucasian male. Jake’s
wife, Sheri, is 28 years old. They have two sons, Myles (10) and
Levi (8). The family
resides in a two-bedroom condominium in a middle-class
neighborhood in Rockville,
MD. They have been married for 10 years.
Presenting Problem: Jake, an Iraq War veteran, came to the
Veterans Affairs Health
Care Center (VA) for services because his wife has threatened
to leave him if he

does not get help. She is particularly concerned about his
drinking and lack of
involvement in their sons’ lives. She told him his drinking has
gotten out of control
and is making him mean and distant. Jake reports that he and his
wife have been
fighting a lot and that he drinks to take the edge off and to help
him sleep. Jake
expresses fear of losing his job and his family if he does not get
help. Jake identifies
as the primary provider for his family and believes that this is
his responsibility as a
husband and father. Jake realizes he may be putting that in
jeopardy because of his
drinking. He says he has never seen Sheri so angry before, and
he saw she was at
her limit with him and his behaviors.
Family Dynamics: Jake was born in Alabama to a Caucasian,
Eurocentric family
system. He reports his time growing up to have been within a
“normal” family system.
However, he states that he was never emotionally close to either

parent and viewed
himself as fairly independent from a young age. His dad had
previously been in the
military and was raised with the understanding that his duty is
to support his country.
His family displayed traditional roles, with his dad supporting
the family after he was
discharged from military service. Jake was raised to believe that
real men do not
show weakness and must be the head of the household.
Jake’s parents are deceased, and he has a sister who lives
outside London. He and
his sister are not very close but do talk twice a year. Sheri is an
only child, and
although her mother lives in the area, she offers little support.
Her mother never
approved of Sheri marrying Jake and thinks Sheri needs to deal
with their problems
on her own. Jake reports that he has not been engaged with his
sons at all since his
return from Iraq, and he keeps to himself when he is at home.

Employment History: Jake is employed as a human resources
assistant for the
military. Jake works in an office with civilians and military
personnel and mostly gets
along with people in the office. Jake is having difficulty getting
up in the morning to go
to work, which increases the stress between Sheri and himself.
Shari is a special
education teacher in a local elementary school. Jake thinks it is
his responsibility to
provide for his family and is having stress over what is
happening to him at home and
work. He thinks he is failing as a provider.
Social History: Jake and Sheri identify as Jewish and attend a
local synagogue on
major holidays. Jake tends to keep to himself and says he
sometimes feels
pressured to be more communicative and social. Jake believes
he is socially inept

11
and not able to develop friendships. The couple has some
friends, since Shari gets
involved with the parents in their sons’ school. However,
because of Jake’s recent
behaviors, they have become socially isolated. He is very
worried that Sheri will leave
him due to the isolation.
Mental Health History: Jake reports that since his return to
civilian life 10 months ago,
he has difficulty sleeping, frequent heart palpitations, and
moodiness. Jake had seen
Dr. Zoe, a psychiatrist at the VA, who diagnosed him with post-
traumatic stress
disorder (PTSD). Dr. Zoe prescribed Paxil to help reduce his
symptoms of anxiety
and depression and suggested that he also begin counseling.
Jake says that he does
not really understand what PTSD is but thought it meant that a
person who had it was

“going crazy,” which at times he thought was happening to him.
He expresses
concern that he will never feel “normal” again and says that
when he drinks alcohol,
his symptoms and the intensity of his emotions ease. Jake
describes that he
sometimes thinks he is back in Iraq, which makes him feel
uneasy and watchful. He
hates the experience and tries to numb it. He has difficulty
sleeping and is irritable, so
he isolates himself and soothes this with drinking. He talks
about always feeling
“ready to go.” He says he is exhausted from being always alert
and looking for
potential problems around him. Every sound seems to startle
him. He shares that he
often thinks about what happened “over there” but tries to push
it out of his mind.
Nighttime is the worst, as he has terrible recurring nightmares
of one particular event.
He says he wakes up shaking and sweating most nights. He adds
that drinking is the
one thing that seems to give him a little relief.

Educational History: Sheri has a bachelor’s degree in special
education from a local
college. Jake has a high school diploma but wanted to attend
college upon his return
from the military.
Military History: Jake is an Iraqi War veteran. He enlisted in
the Marines at 21 years
old when he and Shari got married due to Sheri being pregnant.
The family was
stationed in several states prior to Jake being deployed to Iraq.
Jake left the service
10 months ago. Sheri and Jake had used military housing since
his marriage, making
it easier to support the family. On military bases, there was a lot
of social support and
both Jake and Sheri took full advantage of the social systems
available to them
during that time.
Medical History: Jake is physically fit, but an injury he

sustained in combat sometimes
limits his ability to use his left hand. Jake reports sometimes
feeling inadequate
because of the reduction in the use of his hand and tries to push
through because he
worries how the injury will impact his responsibilities as a
provider, husband, and
father. Jake considers himself resilient enough to overcome this
disadvantage and
“be able to do the things I need to do.” Sheri is in good physical
condition and has
recently found out that she is pregnant with their third child.
Legal History: Jake and Sheri deny having criminal histories.
12
Alcohol and Drug Use History: As teenagers, Jake and Sheri
used marijuana and
drank. Both deny current use of marijuana but report they still

drink. Sheri drinks
socially and has one or two drinks over the weekend. Jake
reports that he has four to
five drinks in the evenings during the week and eight to ten
drinks on Saturdays and
Sundays. Jake spends his evenings on the couch drinking beer
and watching TV or
playing video games. Shari reports that Jake drinks more than
he realizes, doubling
what Jake has reported.
Strengths: Jake is cognizant of his limitations and has worked
on overcoming his
physical challenges. Jake is resilient. Jake did not have any
disciplinary actions taken
against him in the military. He is dedicated to his wife and
family.
Jake Levy: father, 31 years old
Sheri Levy: mother, 28 years old
Myles Levy: son, 10 years old
Levi Levy: son, 8 years old

13
Helen Petrakis
Identifying Data: Helen Petrakis is a 52-year-old, Caucasian
female of Greek descent
living in a four-bedroom house in Tarpon Springs, FL. Her
family consists of her
husband, John (60), son, Alec (27), daughter, Dmitra (23), and
daughter Althima (18).
John and Helen have been married for 30 years. They married in
the Greek Orthodox
Church and attend services weekly.
Presenting Problem: Helen reports feeling overwhelmed and
“blue.” She was referred
by a close friend who thought Helen would benefit from having
a person who would

listen. Although she is uncomfortable talking about her life with
a stranger, Helen
says that she decided to come for therapy because she worries
about burdening
friends with her troubles. John has been expressing his
displeasure with meals at
home, as Helen has been cooking less often and brings home
takeout. Helen thinks
she is inadequate as a wife. She states that she feels defeated;
she describes an
incident in which her son, Alec, expressed disappointment in
her because she could
not provide him with clean laundry. Helen reports feeling
overwhelmed by her
responsibilities and believes she can’t handle being a wife,
mother, and caretaker
any longer.
Family Dynamics: Helen describes her marriage as typical of a
traditional Greek
family. John, the breadwinner in the family, is successful in the
souvenir shop in
town. Helen voices a great deal of pride in her children. Dmitra

is described as smart,
beautiful, and hardworking. Althima is described as adorable
and reliable. Helen
shops, cooks, and cleans for the family, and John sees to yard
care and maintaining
the family’s cars. Helen believes the children are too busy to be
expected to help
around the house, knowing that is her role as wife and mother.
John and Helen
choose not to take money from their children for any room or
board. The Petrakis
family holds strong family bonds within a large and supportive
Greek community.
Helen is the primary caretaker for Magda (John’s 81-year-old
widowed mother), who
lives in an apartment 30 minutes away. Until recently, Magda
was self-sufficient,
coming for weekly family dinners and driving herself shopping
and to church. Six
months ago, she fell and broke her hip and was also recently
diagnosed with early
signs of dementia. Helen and John hired a reliable and trusted
woman temporarily to

check in on Magda a couple of days each week. Helen would go
and see Magda on
the other days, sometimes twice in one day, depending on
Magda’s needs. Helen
would go food shopping for Magda, clean her home, pay her
bills, and keep track of
Magda’s medications. Since Helen thought she was unable to
continue caretaking for
both Magda and her husband and kids, she wanted the helper to
come in more often,
but John said they could not afford it. The money they now pay
to the helper is
coming out of the couple’s vacation savings. Caring for Magda
makes Helen think
she is failing as a wife and mother because she no longer has
time to spend with her
husband and children.
14
Helen spoke to her husband, John (the family decision maker),

and they agreed to
have Alec (their son) move in with Magda (his grandmother) to
help relieve Helen’s
burden and stress. John decided to pay Alec the money typically
given to Magda’s
helper. This has not decreased the burden on Helen since she
had to be at the
apartment at least once daily to intervene with emergencies that
Alec is unable to
manage independently. Helen’s anxiety has increased since she
noted some of
Magda’s medications were missing, the cash box was empty,
Magda’s checkbook
had missing checks, and jewelry from Greece, which had been
in the family for
generations, was also gone.
Helen comes from a close-knit Greek Orthodox family where
women are responsible
for maintaining the family system and making life easier for
their husbands and
children. She was raised in the community where she currently
resides. Both her
parents were born in Greece and came to the United States after

their marriage to
start a family and give them a better life. Helen has a younger
brother and a younger
sister. She was responsible for raising her siblings since both
her parents worked in a
fishery they owned. Helen feared her parents’ disappointment if
she did not help
raise her siblings. Helen was very attached to her parents and
still mourns their loss.
She idolized her mother and empathized with the struggles her
mother endured
raising her own family. Helen reports having that same fear of
disappointment with
her husband and children.
Employment History: Helen has worked part time at a hospital
in the billing
department since graduating from high school. John Petrakis
owns a Greek souvenir
shop in town and earns the larger portion of the family income.
Alec is currently
unemployed, which Helen attributes to the poor economy.
Dmitra works as a sales

consultant for a major department store in the mall. Althima is
an honors student at a
local college and earns spending money as a hostess in a family
friend’s restaurant.
During town events, Dmitra and Althima help in the souvenir
shop when they can.
Social History: The Petrakis family live in a community
centered on the activities of the
Greek Orthodox Church. Helen has used her faith to help her
through the more
difficult challenges of not believing she is performing her “job”
as a wife and mother.
Helen reports that her children are religious but do not regularly
go to church
because they are very busy. Helen has stopped going shopping
and out to eat with
friends because she can no longer find the time since she
became a caretaker for
Magda.
Mental Health History: Helen consistently appears well

groomed. She speaks clearly
and in moderate tones and seems to have linear thought
progression—her memory
seems intact. She claims no history of drug or alcohol abuse,
and she does not
identify a history of trauma. More recently, Helen is
overwhelmed by thinking she is
inadequate. She stopped socializing and finds no activity
enjoyable. In some
situations in her life, she is feeling powerless.
15
Educational History: Helen and John both have high school
diplomas. Helen is proud
of her children knowing she was the one responsible in helping
them with their
homework. Alec graduated high school and chose not to attend
college. Dmitra
attempted college but decided that was not the direction she

wanted. Althima is an
honors student at a local college.
Medical History: Helen has chronic back pain from an old
injury, which she manages
with acetaminophen as needed. Helen reports having periods of
tightness in her
chest and a feeling that her heart was racing along with trouble
breathing and
thinking that she might pass out. One time, John brought her to
the emergency room.
The hospital ran tests but found no conclusive organic reason to
explain Helen’s
symptoms. She continues to experience shortness of breath,
usually in the morning
when she is getting ready to begin her day. She says she has
trouble staying asleep,
waking two to four times each night, and she feels tired during
the day. Working is
hard because she is more forgetful than she has ever been.
Helen says that she
feels like her body is one big tired knot.

Legal History: The only member of the Petrakis family that has
legal involvement is
Alec. He was arrested about 2 years ago for possession of
marijuana. He was
required to attend an inpatient rehabilitation program (which he
completed) and was
sentenced to 2 years’ probation. Helen was devastated,
believing John would be
disappointed in her for not raising Alec properly.
Alcohol and Drug Use History: Helen has no history of drug use
and only drinks at
community celebrations. Alec has struggled with drugs and
alcohol since he was a
teen. Helen wants to believe Alec is maintaining his sobriety
and gives him the
benefit of the doubt. Alec is currently on 2 years’ probation for
possession and has
recently completed an inpatient rehabilitation program. Helen
feels responsible for his
addiction and wonders what she did wrong as a mother.

Strengths: Helen has a high school diploma and has been
successful at raising her
family. She has developed a social support system, not only in
the community but
also within her faith at the Greek Orthodox Church. Helen is
committed to her family
system and their success. Helen does have the ability to
multitask, taking care of her
immediate family as well as fulfilling her obligation to her
mother-in-law. Even under
the current stressful circumstances, Helen is assuming and
carrying out her
responsibilities.
John Petrakis: father, 60 years old
Helen Petrakis: mother, 52 years old
Alec Petrakis: son, 27 years old
Dmitra Petrakis: daughter, 23 years old
Althima Petrakis: daughter, 18 years old
Magda Petrakis: John’s mother, 81 years old

Final Case Assignment: Application of the Problem-Solving
Model and Theoretical Orientation to a Case Study
The problem-solving model was first laid out by Helen Perlman.
Her seminal 1957 book, Social Casework: A Problem-Solving
Process, described the problem-solving model and the 4Ps.
Since then, other scholars and practitioners have expanded the
problem-solving model and problem-solving therapy. At the
heart of problem-solving model and problem-solving therapy is
helping clients identify the problem and the goal, generating
options, evaluating the options, and then implementing the plan.
Because models are blueprints and are not necessarily theories,
it is common to use a model and then identify a theory to drive
the conceptualization of the client’s problem, assessment, and
interventions. Take, for example, the article by Westefeld and
Heckman-Stone (2003). Note how the authors use a problem-
solving model as the blueprint in identifying the steps when
working with clients who have experienced sexual assault. On
top of the problem-solving model, the authors employed crisis
theory, as this theory applies to the trauma of going through
sexual assault.
In this Final Case Assignment, using the same case study of

Tiffani Bradley (attached), you will use the problem-solving
model AND a theory from the host of different theoretical
orientations you have used for the case study.
You will prepare a PowerPoint presentation consisting of 11 to
12 slides.
To prepare:
· Review and focus on the case study of Tiffani Bradley
(attached).
· Review the problem-solving model, focusing on the five steps
of the problem-solving model formulated by D’Zurilla
(attached).
· In addition, review this article listed in the Learning
Resources: Westefeld, J. S., & Heckman-Stone, C. (2003). The
integrated problem-solving model of crisis intervention:
Overview and application. The Counseling Psychologist, 31(2),
221–239. https://doi-
org.ezp.waldenulibrary.org/10.1177/0011000002250638
(attached)
Do a PowerPoint presentation that addresses the following:
· Identify the theoretical orientation you have selected to use.
· Describe how you would assess the problem orientation of the
client in the case study of Tiffani Bradley(attached) (i.e., how
the client perceives the problem). Remember to keep

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