RESPONDING TO ISSUES REQUIRING PROFESSIONAL INTERVENTION

Most helpers eventually encounter situations which represent a relatively long-term problem such as do- mestic violence, depression, or a crisis situation

such as a potential suicide, unplanned pregnancy, or sudden job loss. Under no circumstances does this series prepare you to work with helpees around issues linked to psychological and/or sociological problems. However, such circumstances require your immediate attention.

You need to be aware of these issues, recognize when these conditions may exist, and refer the helpee for professional counseling as soon as possible. Con- sultation with professional helpers such as counselors, social workers, and psychologists is very important under these circumstances. Until the referral has been made, ask for advice in dealing with crisis situations. As a helper, your most valuable tools in crisis situations are:

• Common sense

• Attending skills

• Attention to what your intuition tells you about the situation

• Knowledge of and access to community resources

As soon as you can do so without alienating the helpee, refer him/her to a professional helper. (Review Unit IX on referral for help in knowing who to contact and how to build a referral network.)

The issues which require specialized, professional intervention include but are not limited to the following:

1. Suicidal behavior or threatened suicide 2. Depression

3. Alcohol and drug abuse

4. Domestic violence, including spouse and child abuse

5. Rape

6. Unplanned pregnancy when it is upsetting to one or both parents, and/or the parents are teenagers

7. Unemployment when accompanied by feelings of depression, confusion, and/or low self esteem

8. Eating disorders, i.e., bulimia and anorexia nervosa

Each of these problems can be identified by their own signs and symptoms which are too numerous to de- lineate here. However, Attachment A lists signs of the most common of these issues: alcohol abuse, de- pression, and suicide. It is to the benefit of all helpers to have at least a peripheral understanding of each of these issues. The references listed at the end of this unit are good resources to begin with to familiarize yourself with these issues. A good overview is Crisis Counseling by Eugene Kennedy.

There are general things you can do in any crisis situation:

Listen: Allow and encourage the person to com- municate what he/she feels. Show that you are concerned.

Assess the level of crisis: Ask yourself questions such as, is this person dangerous to himself/herself or others? Ask the person with whom else he/she has discussed the problem or whom else knows about the problem. How quickly must a decision be made in this situation?

Consult with professional helpers: The helpee may not be ready to approach his/her situation with someone else. Develop your own support network of experts you can call on when you are in a situation too complex for your training and experience. Learn about the resources available in your community. Foster these contacts before you need them so you know who to call and how to reach those persons in an emergency.

The most immediately threatening of these issues is the potential suicide. When a helpee indicates the potential for suicide, follow the suggestions below:

1. Listen. Demonstrate concern. 2. Explore the helpee's feelings.

3. If the helpee has not directly stated he/she is considering suicide, ask "Are you thinking about killing yourself?" or "Are you thinking of ending your life?"

4. Begin talking about the value of counseling and how it can help. Do not try to handle the situation alone.

5. Tell the helpee you would like to help him/ her get counseling. Seek his/her consent to do so. Stay with the helpee as you seek

further assistance. If you are making an appointment to go to someone's office, ac- company the helpee to that appointment. You may want to ask the helpee if he/she would like you to wait for him/her or contact someone else to be there for him/her after the appointment. If your contact with the helpee is via telephone, you will need to break contact with him/her to seek further assistance. In this case, obtain a verbal agreement from the helpee that he/she will not hurt himself/herself before you talk again. Arrange a set time when you will be back in touch.

6. Avoid the tendency to think you must solve this person's problems to keep him/her alive. Your concern, involvement, and ability to encourage and solicit professional intervention are much more important than solutions.

The problems mentioned in this unit are very prevalent in this society. You are likely to hear about them as people come to recognize that you are a person who cares and who they can trust. Respect this privileged position in people's lives and recognize your responsibility. Stay involved to the extent possible and practical, but recognize your limits as well. The issues mentioned in this unit are most appropriately handled through referral.