Counseling Services

Crisis Intervention

FACULTY AND STAFF CRISIS INTERVENTION GUIDELINES


Both psychological crises and psychological emergencies warrant an immediate call to the Student Health Center for crisis intervention. A psychological crisis situation occurs when the student feels unable to cope with the circumstances of his/her life. The more helpless the individual feels, the greater the crisis. Typically, a person may be temporarily overwhelmed and unable to carry on, but is not in immediate physical danger. Crisis intervention helps a person cope with the immediate situation and make a plan to address any ongoing problems. A psychological crisis may be triggered by a traumatic event such as an accident, a loss of a family member or loved one, or some kind of assault, or it may be related to exhaustion and severe stress. A psychological emergency exists when the crisis is so severe that the person is potentially in danger and may need to be hospitalized. A psychological emergency occurs when a person is:

  • Suicidal
  • Aggressive towards others
  • Gravely impaired: confused, agitated, disoriented, having hallucinations or delusions


Gardner-Webb University provides crisis intervention as needed and as available. You may contact the GWU Counseling Center or a member of the Crisis Management Team (see appendix).

PROCEDURE

The procedure for crisis intervention is as follows:

1) Contact the GWU Counseling Center for an assessment or assistance. If the GWU Counseling Center is closed or the student is acting aggressively or threatening to harm someone, call University Police. If you cannot call, enlist the help of another student – don’t try to handle a crisis alone. Tell the health center staff person who you are and that there is a crisis.

2) Until help arrives:

a) Listen. Avoid any physical contact and allow the student to talk.

b) Assist. Provide a quiet atmosphere; minimize environmental stimulation. Give the student some space. Ask the student what or who might be helpful.

c) Recognize. Know your limitations.

The Gardner-Webb Counseling Center staff will make an assessment and contact the student’s family or significant other, if it is necessary to protect the health and safety of the student or other persons. If hospitalization appears warranted, staff will either assist the student and his/her family in getting an assessment for admission or contact Woodridge Psychological Associates in Rutherfordton, NC at 828-287-7806 or law enforcement if an evaluation for involuntary hospitalization is needed.

The Depressed Student

College students are at significant risk for depression. Student life is demanding and many students work. Younger students are at a developmental stage marked by uncertainty, change and strong emotions, and older students are likely to be juggling an exhausting load of school, work, and family obligations. The lifetime prevalence (how many people will meet diagnostic criteria during a specified period in their life) for major depressive disorder in 15-24 year olds is 20.6 percent for females and 10.5 percent for males. Major depression differs from feeling sad or struggling with life events. It significantly impairs a person’s functioning while reducing their hope for change and motivation to seek help. In major depression, a person’s appraisal of him or herself, the future and the world at large become markedly and irrationally negative and distorted.

Due to the opportunities that faculty and staff have to observe and interact with students, they are often the first to recognize that a student is in distress, even when the student continues to function in class. Depressed behavior includes:

  • Tearfulness/general emotionality
  • Markedly diminished performance
  • Dependency (a student who makes excessive requests for your time)
  • Infrequent class attendance
  • Lack of energy/motivation, indecisiveness
  • Increased anxiety/test anxiety/performance anxiety
  • Irritability
  • Deterioration in personal hygiene
  • Significant weight loss or gain
  • Alcohol or drug use
  • Agitation, hostility, or angry outbursts


Students experiencing depression often respond well to a small amount of attention for a short period of time. Early intervention increases the chances of the student’s return to health.

Do:

  • Let the student know you’re aware he/she is feeling down and you would like to help.
  • Reach out more than halfway and encourage the student to discuss how he/she is feeling.
  • Offer options to further investigate and manage the symptoms of the depression. Remind the student that feeling hopeless and helpless are symptoms of depression, not the objective reality – people do get better with treatment.
  • Gently and directly ask the student if he/she has had/is having thoughts or impulses to harm or kill him/herself – both impulses for self-harm (e.g., cutting) and suicide can be present in students who don’t “look that bad.”


Don’t:

  • Minimize the student’s feelings, e.g., “Don’t worry.” “Everything will be better tomorrow.”
  • Bombard the student with “fix it” solutions or advice.
  • Chastise the student for poor or incomplete work.
  • Be afraid to ask whether the student is suicidal – you can’t cause a suicide just by asking.



The Suicidal Student

Suicide is the second leading cause of death among college students. It is important to view all suicidal comments as serious and make appropriate referrals. Suicidal people are irrational about how bad things are, now and in the future. High-risk indicators include:

  1. Feelings of hopelessness, helplessness, and futility
  2. A severe loss or threat of loss (death, break up of a relationship, flunking out)
  3. Talk of ending things (quitting school, work)
  4. A detailed suicide plan with specified means (high risk of lethality)
  5. A history of a previous attempt
  6. Tearfulness, agitation, insomnia
  7. Giving away important possessions, taking care of business, saying “thank you for all you’ve done for me”
  8. History of alcohol or drug abuse
  9. Feelings of alienation and isolation


Do:

  • Take the student seriously – 80 percent of suicides give warning of their intent.
  • Be direct – ask if the student is suicidal, if he/she has a plan and if he/she has the means to carry out that plan. Exploring this with the student actually decreases the impulse to use it. Access to a gun is highly lethal, refer the student ASAP or call 911 if he/she has a weapon.
  • Be available to listen but refer the student to the Gardner-Webb University Counseling Center at 704-406-4563 for additional help. The student does not need to agree to this. It’s safer to offend than to overlook.


Don’t:

  • Assure the student that you are his/her best friend; agree that you are a stranger, but even strangers can be concerned.
  • Be overly warm and nurturing.
  • Flatter or participate in their games; you don’t know their rules.
  • Be ambiguous, cute, or humorous
  • Challenge or agree with any mistaken or illogical beliefs.
  • Assume their family knows about their suicidal thoughts and feelings.



The Anxious Student

Anxiety is a normal response to a perceived danger or threat to one’s well-being. For some students the cause of their anxiety will be clear but for others it is difficult to pinpoint the source of stress. Regardless of the cause, the resulting symptoms are similar and include: rapid heart palpitations; chest pain or discomfort; dizziness; sweating; trembling or shaking; and cold, clammy hands. The student may also complain of difficulty concentrating, always being “on the edge,” having difficulty making decisions or being too fearful to take action. In rarer cases, a student may experience a panic attack in which the physical symptoms occur spontaneously and intensely in such a way that the student may fear he/she is dying.

The following guidelines remain appropriate in most cases.

Do:

  • Let them discuss their feelings and thoughts. Often this alone relieves a great deal of pressure. Normalize where appropriate.
  • Provide reassurance. Nobody ever died of a panic attack. However, reassurance alone, without further action, is not helpful.
  • Remain calm.
  • Be clear and directive. “Let’s sit down and do some slow breathing.”
  • Provide a safe and quiet environment until the symptoms subside.
  • Remind them that their anxiety will subside, sooner or later.


Don’t:

  • Trivialize the perceived threat to which the student is reacting.
  • Take responsibility for their emotional state.
  • Overwhelm them with information or ideas to “fix” their condition. Anxious people can’t take in very much. Make sure they write down appointments and phone numbers.



The Student Experiencing Delusions or Confusion

A person having delusions is literally out of touch with reality for biological reasons. This can be seen in college students who are having a “first break” episode of a thought disorder or, occasionally, in students who have abused stimulant drugs for an extended period. College-aged students are in the middle of the period (late teens to mid-thirties) when most people with thought disorders first demonstrate the symptoms of their illness.

Some of the features of being out of touch with reality are disorganized speech, disorganized behavior, odd or eccentric behavior, inappropriate or no expression of emotion, expression of erroneous beliefs that usually involve a misinterpretation of reality, expression of bizarre thoughts that could involve visual or auditory hallucinations, withdrawal from social interactions, an inability to connect with people and an inability to track and process thoughts that are based in reality. Less severe symptoms may come across as a kind of “oddness”, with the student responding with non-sequiturs and showing extended delays before responding to questions or in conversations. While this student may elicit alarm or fear from others, they are generally not dangerous and are likely to be more frightened and overwhelmed by you than you are by them. Occasionally, a person experiencing a paranoid delusion may act violently, but this occurs in the minority of cases. If you cannot make sense of their conversation, they are in trouble.

When you encounter a student who demonstrates delusions or confusion:

Do:

  • Call the GWU Counseling Center to consult first, if the situation is not an immediate crisis.
  • Respond with warmth and kindness, but with firm limits.
  • Remove extra stimulation from the environment (turn off the radio and step outside of a noisy classroom).
  • Acknowledge your concerns and state that you can see they need help. “I don’t really understand what you’re trying to tell me, but I see that you’re upset.”
  • Acknowledge their feelings or fears without supporting the misperceptions, e.g., “I understand you think someone is following you, but I don’t see anyone and I believe you’re safe.”
  • Acknowledge your difficulty in understanding them and ask for clarification or restatement. “Sorry, I’m not understanding you, what I asked was…”
  • Focus on the “here and now.” Tell the student the plan for getting him/her to a safe environment, and repeat the plan emphasizing the safe environment. “Ok, let’s get you over to the Gardner-Webb University Counseling Center to talk with the folks there, it’s a safe place. They’ll help you figure out what to do to be safe.”
  • Speak to their healthy side, which they have. It’s OK to laugh and joke when appropriate – but not about any of their beliefs or fears.
  • Be aware that the student may show no emotions or intense emotions.
  • Be aware that the student may be extremely fearful to the extent of paranoia.
  • Be aware that the student may not understand you or understand only parts of what is being said.
  • Be aware that, on occasion, a student in this state may pose a danger to self or others.


Don’t:

  • Argue or try to convince them of the irrationality of their thinking, as their brain may be literally incapable of accepting the information.
  • Play along, e.g., “Oh yeah, I hear the voices (or see the devil).”
  • Encourage further discussion of the delusional processes.
  • Demand, command, or order.
  • Expect that the student will understand you.
  • Assume the student will be able to take care of him/herself when out of touch with reality.
  • Allow friends to take care of the student without getting a professional opinion.
  • Assume the family knows about the student’s condition.



The Verbally Aggressive Student

Students usually become verbally abusive when in frustrating situations that they see as being beyond their control; anger and frustration become displaced from those situations onto the nearest target. Explosive outbursts or ongoing belligerent, hostile behavior become this student’s way of gaining power and control in an otherwise out-of-control experience. It is important to remember that the student is generally not angry with you personally, but is angry at his/her world and you are the object of pent-up frustrations.

This behavior is often associated with the use of alcohol and other drugs, as intoxication is used to relieve tension, but ends up lowering their inhibitions about expressing their anger.

Do:

  • Acknowledge their anger and frustration, e.g., “I hear how angry you are.”
  • Rephrase what they are saying and identify their emotion (e.g., “I can see how upset you are because you feel your rights are being violated and nobody will listen.”)
  • Reduce stimulation; invite the person to a quieter place if this is comfortable and safe for you.
  • Allow them to ventilate, get the feelings out, and tell you what is upsetting them. However, if the person is escalating and becoming agitated, take care of your own safety first. (“You are getting worked up, please control yourself or I will have to call the University Police.”)
  • Be directive and firm about the behaviors you will accept (e.g., “Please step back; you’re too close.” “I cannot listen to you when you yell at me.” “If you want my help, you’ll have to speak politely and I will do the same.”)
  • Help the person problem solve and deal with the real issues when they become calmer.
  • Keep a safe distance from the student. There should be a minimum of three feet between you and the student.


Don’t:

  • Get into an argument or shouting match.
  • Become hostile or punitive yourself (e.g., “You can’t talk to me that way!”)
  • Press for explanations for their behavior.
  • Ignore the situation.
  • Touch the student.



The Violent Student

Violence, because of emotional distress, is rare and typically occurs when the student’s level of frustration has been so intense or of such an enduring nature as to erode all of the student’s emotional controls. The adage, “An ounce of prevention is worth a pound of cure,” best applies here. Potentially violent people almost always exhibit warning signs prior to acting out - no one “just snaps.” While no one clue indicates absolute dangerousness, any can be cause for concern and warrant a response. There are four broad categories of behaviors that might indicate a developing problem:

  1. Verbal clues: direct and indirect threats; talking about violent plans, fantasies or past behavior; expressing a wish to kill or die, harassing or abusive language.
  2. Physical clues: weapons possession, drawings or writing with violent themes; frequent listening to music with violent themes, agitated or threatening behavior, bullying, destruction of property, deteriorating appearance, isolating, inappropriate displays of anger/aggression, rebelling against college rules.
  3. Obsessive thinking: preoccupation with resentments or grudges against someone, romantic obsessions, perceived injustice, weapons, past violent events.
  4. Bizarre thoughts: persecutory delusions, paranoia, grandiose delusions involving power, control or destruction, deteriorating thought processes.


Alcohol and other drugs can reduce inhibitions against violence. If it appears the student is intoxicated and agitated, your primary goal then is to keep yourself and any others safe. Call for help.

Do:

  • First determine if you feel safe with the student. If not, remove yourself and call 911 or Campus Police.
  • For non-crisis situations, consult with the GWU Counseling Center.
  • Attempt to prevent total frustration and helplessness by quickly and calmly acknowledging the intensity of the situation (e.g., “I can see you’re really upset and are ready to lash out.”)
  • Explain simply, clearly and directly what behaviors are acceptable (e.g., “Sit down and lower your voice.”)
  • Use brief and specific directives and questions. (“What do you need?”)
  • Get necessary help (send a student for Counseling Center Staff, University Police, other staff, dean, etc.).
  • Stay safe: have easy access to a door (student should not be between you and the door); keep furniture between you and the student.
  • Debrief the situation with a colleague.


Don’t:

  • Assume the student can take in a normal amount of information – keep it simple. Try for five to ten words in a statement, max.
  • Ignore warning signs that the person is escalating (e.g., raised voice, flushed face, clenched fists, threats.)
  • Threaten, tease or corner the student.
  • Make promises you can’t keep.
  • Touch the student.
  • Be alone with the student.
  • Overlook bizarre or irrational statements.



The Demanding, Passive, or Manipulative Student

Typically even giving these students a tremendous amount of time and energy is not enough. They often seek to control your time and unconsciously believe the amount of time received is a reflection of their worth. You may find yourself increasingly drained and feeling responsible for this student beyond your normal involvement. It is important that this student be connected with many sources of support on-campus and in the community.

Demanding students can be difficult to interact with because they can be intrusive and persistent. Demanding traits can be associated with anxiety, agitated depression, and/or personality disorders. Some characteristics of demanding students are a sense of entitlement; an inability to empathize; a need to control; difficulty dealing with ambiguity; a strong drive for perfection; difficulty respecting structure, limits, and rules; persistence after hearing “no”; dependency on others to take care of them and a fear of dealing with the realities of life.
When dealing with a demanding student:

Do:

  • Insist that they make their own decisions. You specify what you can do, then they decide.
  • Set firm and clear limits on your time and involvement. End the conversation when it exceeds those limits, even if the student is not satisfied. It’s not helpful to the student to stay engaged, despite their distress. You may feel like you’re being harsh, but you’re not.
  • Offer referrals to other resources on and off campus.
  • Set and enforce limits to prevent the disruption of a class, lab or study group via acting out or monopolizing the discussion.
  • Set limits on where and when you talk with them, e.g., no home numbers (unless everybody gets it), no being cornered while you are having lunch.
  • If excessive student demands become disruptive, consult the Student Conduct Code, located in the GWU Student Handbook, which cites the standards of student conduct.
  • Remember that your ability to be able to teach or serve other students and the other students’ needs for an environment conducive to learning also must be met.


Don’t:

  • Avoid the student as an alternative to setting and enforcing limits.
  • Argue with the student.
  • Accommodate inappropriate requests or get trapped into giving advice, special conditions, changing your schedule, etc.
  • Feel obligated to take care of him/her or feel guilty about not doing more.
  • Allow the student to intimidate you.
  • Ignore the problem and the impact that it has on you and the other students.



The Student Under the Influence

Alcohol is the most widely used psychoactive drug. It is common to find alcohol abusers in college populations also abusing other drugs, both prescription and illicit. Patterns of use are affected by fads and peer pressure. Currently, alcohol is the preferred drug on college campuses.

The effects of alcohol on the user are well known to most of us. Student alcohol abuse is most often identified, by faculty, when irresponsible, unpredictable behavior affects the learning situation (i.e., drunk and disorderly in class), or when a combination of the health and social impairments associated with alcohol/drug abuse sabotages student performance. Because of the denial that exists in most substance abusers, it is important to express your concern about the student not in terms of suspicions about alcohol and other drugs but in terms of specific changes in behavior or performance. If you are uncertain about how to approach a difficult situation, please call the GWU Counseling Center to consult.

Do:

  • Confront the student with their behavior that is of concern.
  • Address the substance abuse issue if the student is open and willing.
  • Offer support and concern for the student’s overall well-being.
  • Maintain contact with the student after a referral is made.
  • Consider informing your class at the beginning of the semester that students who appear to be intoxicated will be asked to leave. “This probably won’t ever come up, but if anyone even appears to be intoxicated in class…”


Don’t:

  • Convey judgment or criticism about the student’s substance abuse.
  • Make allowances for the student’s irresponsible behavior.
  • Ignore signs of intoxication in the classroom. The Prohibited Code of Behavior in the Student Handbook clearly outlines the student’s responsibilities.


The Suspicious Student

Typically, these students complain about something other than their psychological difficulties. They are tense, anxious, mistrustful, loners, and have few friends. They tend to interpret minor oversights as significant personal rejection and often overact to insignificant occurrences. They see themselves as the focal point of everyone’s behavior and everything that happens has special meaning to them. They are overly concerned with fairness and being treated equally. Feelings of worthlessness and inadequacy underlie most of their behavior. They seem capable and bright.

Do:

  • Express compassion without intimate friendship. Remember that suspicious students have trouble with closeness and warmth.
  • Be firm, steady, punctual, and consistent.
  • Be clear about the expected standards of behavior. These include requirements for academic performance, (e.g., due dates, grading, expectations for classroom participation).


Don’t:

  • Assure the student that you are his/her friend; agree that you are a stranger, but even strangers can be concerned.
  • Be overly warm and nurturing.
  • Flatter or participate in their games; you don’t know their rules.
  • Be cute or humorous.
  • Challenge or agree with any mistaken or illogical beliefs.
  • Be ambiguous.



The Sexually Harassed Student

Sexual harassment involves unwelcome sexual advances, requests for sexual favors and other verbal or physical conduct; it is usually found in the context of a relationship of unequal power, rank or status. It does not matter that the person’s intention was not to harass; it is the effect it has that counts. If the conduct interferes with a student’s academic performance or creates an intimidating, hostile or offensive learning environment, it is considered sexual harassment.

Sexual harassment usually is not an isolated one-time only case but a repeated pattern of behavior that may include:

  • Comments about one’s body or clothing
  • Questions about one’s sexual behavior
  • Demeaning references to one’s gender
  • Sexually-oriented jokes
  • Conversations filled with innuendoes and double meanings
  • Displaying of sexually suggestive pictures or objects
  • Repeated non-reciprocated demands for dates or sex


The Gardner-Webb University Student Handbook covers sexual harassment of students.

Common reactions by students who have been harassed is to doubt their perceptions, wondering if it was a joke, did it really happen or if, in some way, they have brought it on themselves. A student may begin to participate less in the classroom, drop or avoid classes, or even change majors.

Do:

  • Separate your personal biases from your professional role.
  • Listen carefully to the student, validate his/her experience.
  • Encourage the student to approach the person, directly or in writing. “I am uncomfortable when you_____, please stop.”
  • Encourage the student to keep a log or find a witness.
  • Help student seek informal advice through a department chair, supervisor, or advisor.
  • If unresolved, refer to one of the College Sexual Harassment Intake Facilitators.
  • Refer the student to the Student Health Center for support and assistance.


Don’t:

  • Fail to act. Taking no action invalidates the student’s already shaky perception and puts the college in a vulnerable position, should this behavior continue.
  • Overreact. Listen, support, and guide the student to appropriate channels.



* This information copied and used by permission from Ventura College Student Health and Psychological Services (805-654-6346).