Crisis Management Lecture Crisis: event that a patients defence mechanisms cannot cope with: Developmental (life-transition events)

) Existential (inner conflicts and anxieties related to purpose/responsibility/independence/freedom/commitment) o Realisation that one will never make a significant impact (hopeless) Environmental (natural or man-made disasters) people usually deal with these better than mental health teams suggest Medical (new diagnosis) Psychiatric (actual syndromes that affect coping) Situational (loss of job, MVA, rape etc.) Response to crisis (resilience versus developing PTSD) 1. Factors to do with person 2. Events or process occurring Crisis happens to everyone, what follows depends on the personal/environmental factors: Physiological grief Acute stress reaction PTSD Adjustment disorder Personal factors Biological o Genetic make-up o Age, gender o Intellectual disability o ABI o Illicit substances Congenital Environmental Psychosocial o Socioeconomic o Home environment o Peer group, relationships o Employments o Pre-morbid functioning o Developmental stages

Defence Mechanisms: Patterns of thoughts, feelings, behaviours that are involuntary Arise in perception to danger Good defence mechanisms reflect developmental stages 1. Psychotic Defences a. Delusional projection: to put your problems onto to some thing or someone else (delusional) b. Denial of external reality c. Distortion: turning the problem into something else, reshaping external reality to meet internal needs (eg. my twins were taken away rather than dying) 2. Immature defences a. Schizoid fantasy (withdrawn, hermit-style: withdraw into fantasy world) b. Hypochondriasis (somatisation. If its difficult to explain a psychological problem so it is turned into a physical expression of your emotions). c. Passive-aggression (aggression towards others) d. Acting out (Impulse of action, often to draw a desired response from others) e. Idealisation

3. Neurotic defences a. Repression (taking the complete opposite belief because the truth causes anxiety, homophobia in closet homosexuals) b. Displacement c. Reaction formation d. Dissociation e. Regression (becoming more child-like) 4. Mature defences a. Altruism (thinking about others) b. Humour (could be worse etc.) c. Suppression (down-size the problem, deal with the problem in your own comfort zone in your own time; perhaps putting the problem off to deal with other problems) d. Anticipation (look ahead and see when a problem may arise, anticipating the problem ahead of time) e. Sublimation (taking out your aggression on another past-time, eg. sport) Coping Skills: adaptive or maladaptive Stages 1. Mounting tension 2. Plateau of disorganisation 3. Mobilisation of external/internal resources 4. Adaption or maladaptation Crisis counselling 1. Facilitating the expression of emotion 2. Facilitating communication 3. Facilitating the patients understanding of their problems and responses 4. Showing concern and empathy 5. Bolstering self-esteem 6. Problem-solving a. Define problem realistically (what/why/who/where of the factors involved) b. Define goals -> generate solution 7. Use of medication: lower the level of arousal / treat distress / sleep disturbance Angry Patient: Not normally a personality trait (per se), more a manifestation of experiences: o Pain o Drug intoxication / withdrawal o Previous experiences with health o Displacement of internal anger professionals externally o Fear of rejection Countertransference: feelings healthcare professionals have towards patients Run late, fail to treat with respect, fail to provide information, take short-cuts