Crisis Counselling Case Studies

Case Study 9.1 What Is Sexual Assault? Cindy’s Story –
You have been working as a counselor at a university counseling center. Cindy—an 18-year-old college student—has come to see you because she is failing most of her classes. She recently took her midterm exams and did not pass any of them. In addition, she did not even take two of the exams. She graduated at the top of her high school class, even receiving an academic scholarship covering the majority of her tuition. She reports that she is in jeopardy of losing her scholarship. She is also concerned because her grades will be sent home to her parents in the next few weeks. They have always expected her to excel in school, and she feels they will be very disappointed with her, possibly even insisting she return home to her small rural town, which she was trying to escape.
At your first meeting with Cindy, she also reports that she is having trouble going to her classes because she is sleeping through most of them. She reports wanting to sleep all the time, having a depressed mood, and avoiding her friends, who have convinced her to attend counseling. Cindy’s appearance is disheveled, and she is wearing what seem to be dirty clothes.
During the first two sessions, Cindy cries frequently and rarely shares information. Finally, she reveals to you that a couple of weeks ago she went on a date with Dennis, a guy from her sociology class, whom she has been interested in dating since the beginning of the semester. Although Cindy reports that she is not a big drinker, she had a few glasses of wine at dinner. They were having a great time, talking and laughing. She accompanied Dennis back to his dorm room, where they laid on his bed and began kissing. Dennis offered her another drink, after which she became dizzy and thinks she passed out. She is uncertain if she agreed to sex with Dennis, but is convinced her willingness to go to his dorm room indicated to him that she wanted to have sex. She was shocked when she woke up in the hallway outside her dorm room, missing her underwear and feeling sore in her private area. Later that day, she received several text messages from Dennis, who wanted to see her again. When she responded that she was not interested, his next few texts became increasingly hostile. When she asked him to stop and not contact her again, he sent her a video of their sexual encounter. He told her that if she didn’t have sex with him again, he would upload the video on social media sites. She is considering meeting him but is terrified he will harm her.
Discussion Questions
Does this case meet the legal definition of sexual assault? If yes, what type?
What are the issues with consent in this case?
In this situation, how would you proceed with Cindy?
What are the legal and ethical guidelines that will drive your work with Cindy?
With a peer, role-play implementation of the task model for crisis assessment and intervention featured in Chapter 1

Level I: Four Essential Crisis Assessment Tasks
Assessment Task 1: Address Safety, Stabilization, and Risk
Assessment Task 2: Follow a Holistic Bio-Psycho-Social-Spiritual Approach
Assessment Task 3: Clarify the Problem(s)
Assessment Task 4: Explore Coping Skills, Resources, and Supports
Level II: Four Essential Crisis Intervention Tasks
Intervention Task 1: Normalize and Educate
Intervention Task 2: Explore Options
Intervention Task 3: Develop a Plan and Obtain a Commitment
Intervention Task 4: Prepare Documentation, Follow Up, and Provide Referrals

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Case Study 10.1 Crisis Intake with a Child Sexual Abuse Client: Eliminating Blame – ABOUT ONE PAGE FOR THE QUESTIONS THAT FOLLOW
Eight-year-old Marcus has been seeing Justin, his clinical mental health counselor, for the past 3 months. Marcus was referred to Justin by the boy’s mother, who expressed concern that her son began wetting his bed about 10 months ago, responding to the slightest criticism with emotions incongruent with the situation at hand, and refusing to play with other children at home or school. While routinely discussing his week at the start of the session, Marcus discloses to Justin that his stepfather “hurt my penis again.” Although Justin is stunned, he remains outwardly calm and focuses on simply reflecting Marcus’s words as a prompt for the child to continue.
Marcus: Yeah. All that happened last week. And then . . . my stepdad hurt my penis again.
Justin: Your stepfather sometimes hurts your penis. And he did it again last week . . .
Marcus: Yeah . . . (Long silence ensues.)
Justin: (Says nothing, but inclines his head downward as if to scoop up Marcus’s eyes, which are fixed on the floor.)
Marcus: It really hurts when he does it. But I’m not allowed to talk about it or else he’ll hurt me worse. And he said he’d tell mama what I’ve done to him if I tell anyone.
Justin: He has told you that, if you tell, bad things will happen to you— that your mama will blame you for it all.
Marcus: (Suddenly raising fear-filled eyes to meet Justin’s; he is nodding emphatically.) She will, too. I get blamed for everything bad that happens even when it’s not my fault.
Justin: You’re afraid that your mama won’t understand—that she’ll get mad at you. (Pause.) Here’s the thing, Marcus. You and I know that it’s not your fault. It’s your stepdad’s fault because he is the adult who is supposed to take good care of you—not hurt you. It’s never okay for people to do what he’s been doing to you.
Marcus: Yeah, but he makes me do stuff. Stuff that makes me feel sick. It’s really bad what he makes me do—and I have to do it. I have to do whatever he says. (He drops his eyes to the floor.)
Justin: You’re really scared of your stepdad. You do whatever he tells you so he won’t hurt you worse. That tells me that you sure mustered up a lot of courage when you decided to tell me this today—and that was the right thing to do. (Short silence.) Although I’m really sad that your stepdad has been hurting you, I also feel really glad that you told me because that tells me that you trust me to do the right things to keep you safe.
Marcus: (Nodding, but with some uncertainty in his eyes.) Does that mean you’re going to tell mama? (His expression conveys a look of both anxiety and hopefulness.)
Justin: (Nodding.) Your mama needs to know this has been happening to you because it is her job to keep you safe. There are also some other people who need to know,
too—people whose job it is to protect kids when adults do things like hurt little boys’ penises and do stuff that’s wrong. Sometimes it takes a few important people knowing this stuff for it to stop and stay stopped.
Marcus: (Lets out a soft but high-pitched whine and starts to shake and cry.)
Justin: (Leaning forward.) I know it seems pretty scary right now to think about your mom finding out that this has been going on. I also know that, together, we can figure out the best way for her to learn this news today. I’ll be right here with you, Marcus.
Marcus: (Continues to cry quietly as Justin waits; after a minute or so, he nods and lifts his head.)
Justin: I wonder if it would help to stand up and take a deep breath so we can think clearly about how best to do this . . .
Justin and Marcus stand up and do some breathing exercises that Justin often does with his minor clients to help them calm and center themselves. Justin explains that kids have told him things like this in the past and asks Marcus if he’d like to know what typically happens after they do. Marcus indicates he would like to know. Justin explains that he has a friend named Joan in Child Protective Services (and/or law enforcement office) that he tells these things to, that she takes kids’ stories like this very seriously, and that she sometimes helps moms understand that it’s never the kid’s fault.
Justin explains that both Marcus’s mom and Justin’s friend Joan need to hear his story and asks how he would like for them to find out (who should tell the story, who should find out first). Marcus decides that he wants Justin to tell his mom for him, but that he wants to be in the room while he does. He says he doesn’t care who talks to Joan or when she is told. Because Justin is not sure about how Marcus’s mother will react, Justin decides to tell Marcus that he thinks it is a good idea to tell Joan first because she might be able to come over either now or sometime soon and help. Justin calls the designated law enforcement officer with whom he has a relationship of trust while Marcus is in the room, telling her that there is a little boy with him right now who has told him something that worries him and that she needs to hear. The officer is available and agrees to come to Justin’s office.
Justin explains that he needs to speak to Marcus’s mother now. Justin reinforces that Marcus has done the right thing by telling him and that his job as Marcus’s counselor is to make sure that Marcus’s mother understands it is not her son’s fault. Justin goes to the lobby to meet the mother. Together, Justin and Marcus tell the mother that Marcus’s stepdad has been “hurting his penis.” When her look of shock turns to anger and she demands to know details, Justin intervenes to help the mother understand that Marcus is very afraid that she will be mad at him and that part of why he hasn’t told this in the past is that he is afraid of being blamed for this—that the stepdad has told Marcus that all this is the boy’s fault. Justin tells the mother that, in accordance with a state mandate, he has called the local law enforcement authorities and that they will be on their way soon to come to the office to help Marcus and his mother get through the next few days.
It should be noted that Justin took pains to do several things correctly. First, when the boy was disclosing the abuse to him, he merely reflected the boy’s own words, careful not to sabotage a potential prosecution by requiring the boy to tell his story in detail. In this case, the counselor gathered only enough information as was absolutely necessary to substantiate his own reasonable suspicions that the boy might have been sexually abused and then made the mandated report to the proper agency. He did not ask questions or pump the child for details about when, where, how often, etc., the abuse had occurred. Rather, with the amount of information that Marcus had already volunteered (that his stepfather had “hurt his penis again” and the most recent time was within the past week), when combined with information that he already had (e.g., the identity of the stepfather and the knowledge that the stepfather resided in the same home as Marcus and a younger sibling), he focused on the feelings the boy was having, validated those feelings, reinforced the boy’s decision to disclose the abuse, supported him by letting him know that it was not his fault, and reassured him that he would help him through the process of telling and reporting.
Second, Justin did not use the word abuse. Knowing that this is a term that boys can sometimes find emasculating and disempowering, Justin chose only to use the boy’s own words in very concrete (rather than euphemistic) terms such as “he hurt your penis.”
Third, Justin remained calm and matter of fact, while communicating empathy with his tone and body language. The message this manner conveyed to the child was that adults can handle these things calmly without the response of blame or anger, which can be scary for children; that they care; and that they should be told in order to keep children safe.
Finally, Justin gave Marcus as many choices as he could. Some of those choices were who to tell first, who should do the telling, and where the telling should happen. This facilitated the child’s sense of empowerment, restored to the child’s confidence in his choices and, by proxy, reinforced his sense of self-worth.
In the weeks immediately following, Justin maintained consistent contact with Marcus’s mom, the assigned CPS caseworker, law enforcement, and the local children’s advocacy center. Although Justin agreed to see Marcus twice a week, the boy was very reluctant to talk about his abuse. Justin therefore decided that play therapy might be the best course of treatment. They undertook about 20 sessions of child-centered play therapy before Marcus’s original presenting symptoms, and his later anxiety, depression, and anger dissipated.
What information do you need to collect for CPS?
How can you determine the safety of other family members?
Case Study 11.2 Responding to a Hostage Situation – – ONLY 3 SENTENCE ANSWERS FOR 11.2, 11.3, 11.4 – ABOUT ONE PAGE FOR 11.2, 11.3 11.4
Once a recent 14-hour hostage standoff finally ended, a mother and young child were killed by the hostage taker (the estranged father), one LEO was killed in the gun fire exchange, and two other LEOs sustained non–life-threatening gunshot injuries. One officer, who was shot in the back, is expected to be paralyzed. EMS professionals were on the scene since the beginning of the police intervention, anticipating transport of any injured persons to the hospital. As part of the CISM team connected with the police department, describe your action plan for intervening in this situation.
Discussion Questions
What groups would you assess as being a priority and how would you proceed?
If the timeframe for the standoff lasted longer than expected, how would the intervention change and how would you implement PFA, CISM, or MANERS during the standoff?
What unique stressors would the injured officers or family members of the officers experience that may need to be addressed? What resources would you think are important to have available for them?
What intervention would you integrate if, during a debriefing, a first responder terminated prior to you getting a comprehensive assessment?
Think About It 11.3
Think about what it must be like to be a first responder to the scene of a crisis or disaster. Before reading the information that follows on stressors experienced by first responders, list the types of common calls experienced by first responders and the types of trauma to which they are exposed.

Activity 11.4
Think about your personal perceptions of first responders. Are there stereotypes you have developed or continue to believe about this population? How has recent media attention affected your perception of first responders? If assigned to work with first responders, how might any of your perceptions interfere with your interventions? If you have no perceptions that would impact your work, how could perceptions affect other crisis counselors? What would you need to keep in mind when working with first responders due to their unique stressors and situations?
***************************11.2, 11.3, 11.4 – ONLY 3 SENTENCE ANSWERS**************
Case Study 12.2 Dealing with a Residential Fire – ONE PAGE FOR THE QUESTIONS THAT FOLLOW
The Zhang family—Kane, the 32-year-old father; Miya, the 28-year-old mother; Asa, the 7-year-old daughter; and Kenji, the 3-month-old son—lives on the sixth floor of a 9-story apartment building in a major metropolitan area. Last week there was an electrical fire in their neighbor’s apartment. As a result, their entire floor caught fire, as did parts of the floors above and below them. The majority of the building experienced significant smoke damage. The Zhang family was awakened at 2:30 a.m. by fire alarms and the smell of smoke. They barely escaped the fire; Kane and Asa both got second-degree burns and Miya got third-degree burns on 10% of her body. All four family members also experienced significant smoke inhalation.
After the fire was extinguished, the tenants were taken to the hospital and treated. The building was declared to be unsafe, and the Zhang family and the rest of the tenants were told that they could not move back into the building.
As a crisis counselor, you are meeting with the entire Zhang family for the first time 3 weeks after the fire. They are living with family nearly 40 miles away from their previous home and did not recover any of their belongings from the fire.
Shortly after the fire, Kane started to drink heavily (a minimum of 8 beers a day and a maximum of a fifth of bourbon a day). You are meeting them in a group room in a local mental health clinic.
Discussion Questions
As a crisis counselor, what would be your priority with the Zhang family?
What might be some of their thoughts, feelings, and behaviors?
Consider the appropriateness of individual, group, or family counseling for this family. How might each be conducted if found to be appropriate?
How might you facilitate growth in this family?
What might be some developmental concerns for each of the family members?
What might be some multicultural considerations for the family?
What physical concerns might you have for each of the family members?
Consider the reaction and consequence of Kane’s recent drinking.
With a peer, role-play implementation of the task model of crisis assessment and intervention presented in Table 1.1.

Table 1.1 The Task Model of Crisis Assessment and Intervention (Jackson-Cherry, 2018)
Level I: Four Essential Crisis Assessment Tasks
Assessment Task 1: Address Safety, Stabilization, and Risk
Assessment Task 2: Follow a Holistic Bio-Psycho-Social-Spiritual Approach
Assessment Task 3: Clarify the Problem(s)
Assessment Task 4: Explore Coping Skills, Resources, and Supports
Level II: Four Essential Crisis Intervention Tasks
Intervention Task 1: Normalize and Educate
Intervention Task 2: Explore Options
Intervention Task 3: Develop a Plan and Obtain a Commitment
Intervention Task 4: Prepare Documentation, Follow Up, and Provide Referrals

Case Study 12.3 A Commercial Hostage Situation – ONE PAGE FOR THE QUESTIONS
In a small convenience store located in an Appalachian town, two men wearing masks, attempt to rob the store. Both men have guns. Besides the two gunmen, the people in the store are the owner, who is behind the checkout counter, and six customers, located in different aisles in the store. The gunmen ask for money from the cash register, but the owner denies their request. While the gunmen and the owner are arguing, one of the customers calls the police from his cell phone, and within 4 minutes, a police car pulls up in front of the store. One of the gunmen locks the store’s front door, and the robbery has quickly turned into a hostage situation. The hostage situation lasts for 7 hours. Given the information presented earlier, imagine what goes on during those 7 hours.
Discussion Questions
Discuss how the hostage takers and the hostages think, feel, and act during the different stages of the situation.
What would be some follow-up resources for the hostages?
What might be some multicultural considerations for the hostages?
What would be some key counseling skills to use with the hostages?

Case Study 14.1 A Counselor’s Countertransference Experience – ONE PAGE FOR THE QUESTIONS
Rachel is a licensed professional counselor (LPC) in private practice. She went through a messy divorce 3 years ago and feels she has healed from that experience. Today she has a new couple coming in to see her. They are seeking counseling and state that they want to try to save their marriage. During the intake session, Rachel is struck by how similar the husband is to her former husband. His angry tone of voice and some of the emotionally charged statements he makes to his wife remind Rachel of difficult encounters in her own marriage. Rachel feels herself wanting to protect the wife. She thoroughly dislikes the husband.
Discussion Questions
Should Rachel continue to see the couple? Explain.
If Rachel decides to continue, what can she do to ensure best practice?
If Rachel decides not to continue, what should she do regarding her own self-care?

Case Study 14.2 Vicarious Resiliency after a House Fire – ONE PAGE FOR THE QUESTIONS
Two years ago, Jennifer and her husband, Ryan, lost their house in a fire. They were able to escape with their two children and the family dog without harm, but the family lost everything in the fire. Jennifer worked through this crisis with Ann, her counselor until 6 months ago, when she moved into a new home in another city. She has come back in to see Ann for a follow-up appointment.
Ann: It’s so good to see you, Jennifer. I appreciated you e-mailing me the pictures of your lovely new house. It’s been a long journey.
Jennifer: Yes, I appreciate you being there for me through this. So much of what we worked on has helped me cope. I see things differently now.
Ann: How so?
Jennifer: Well . . . life, life is what really matters. I mean, at first I was in shock and I couldn’t believe it. I questioned God, I had so many mixed emotions.
Ann: Yes, I remember how difficult it was for you to accept and cope with this tragedy at first. But I also remember your courage in seeing things through, not only in the nuts and bolts details of insurance and moving, but also in your resolve to face feelings and place this event into your life story as a challenge met and an opportunity to learn and grow.
Jennifer: I guess that’s what I want to focus on today with you. I’m different because of the fire. Of course, I wish it hadn’t happened, but I believe I’m a better person because of it and I wouldn’t want to trade that growth and knowledge about what I can accomplish and also about what really matters.
Ann: The fire helped you discover the resiliency you had within you all along.
Jennifer: Yes, I appreciate my husband and children more. I know that life, relationships, and loved ones are what really matter. I don’t care about material things anymore. I no longer mourn the possessions I lost in the fire because I know the emotions connected to them were because of the people they reminded me of. A fire can never take away my memories of my grandmother and mother. The memories are real. The antiques were things that can be replaced, but I haven’t lost my memories. I feel very free and joyful. I appreciate every day and every person in my life.
Ann: You’re living life with more awareness of love and relationships. How wonderful to fully realize the depth and importance of the people in your life.
Jennifer: I think back to how I was before the fire, I was so distracted and busy and I often took my family for granted. Now I’m thankful every day for life and the people I love.
Discussion Questions
What has Jennifer learned through her crisis event?
What might the counselor learn from Jennifer’s story?
How do stories like Jennifer’s foster vicarious resiliency?

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