| Course | PAC 120 Multicultural Advocacy |
|---|---|
| Module | Module 7 |
| Paper type | Crisis intervention case |
| Length | About 1,113 words, 7 pages |
| Format | APA 7 student paper |
| School | Aspen University |
| Program | Psychology and Addiction Studies |
| Updated | October 2026 |
Free sample paper for PAC 120 Module 7
When Grief Arrives as an Ataque: A Seven-Stage Crisis Intervention With a Puerto Rican Client in the Waiting Room
Student Name
Psychology and Addiction Studies Program, Aspen University
PAC 120: Multicultural Advocacy
Instructor Name
Month Day, Year
When Grief Arrives as an Ataque: A Seven-Stage Crisis Intervention With a Puerto Rican Client in the Waiting Room
Carmen is forty-seven, born in Ponce, Puerto Rico, and has lived in Milwaukee since her twenties. For three months she has been coming to Northside, this course's fictional clinic, for help with her drinking. On a Tuesday afternoon she arrived for her appointment, answered a call from her sister in the waiting room and learned that her younger brother, Javier, had been found dead of an overdose that morning. Within seconds she was on the floor, screaming, shaking and striking the tiles with her fists, and saying in Spanish that she could not breathe and that her chest was on fire. A receptionist reached for the phone to call 911 for a psychiatric emergency. This paper describes the crisis intervention that followed and how culture shaped it. Carmen and Northside are composites for teaching, and the sources cited are real.
The Seven-Stage Model
Roberts and Ottens (2005) described a seven-stage model of crisis intervention. The first stage is a thorough assessment, including lethality and imminent danger. The second is making psychological contact and rapidly establishing a relationship. The third is identifying the major problems, including what precipitated the crisis. The fourth is encouraging the person to explore and express feelings. The fifth is generating and exploring alternatives and coping strategies. The sixth is developing an action plan. The seventh is establishing follow-up. The authors emphasized that the stages often overlap and that the model is meant to restore the person's ability to cope, not to resolve every problem.
What an Ataque de Nervios Is
Guarnaccia et al. (2003) studied how Puerto Ricans understand nervios, a broad term for a state of distress and vulnerability, and ataque de nervios, an acute episode. People they interviewed described ataques as including uncontrollable shouting and crying, trembling, heat rising in the chest, a sense of losing control and sometimes aggressive behavior or fainting. Ataques were most often triggered by family events: a death, especially an unexpected one, conflict or news of harm to a family member. The authors found that ataques were a recognized and, in context, understandable response to overwhelming loss, though people who experienced them were also more likely to meet criteria for some psychiatric disorders. An ataque, in other words, is neither a sign of psychosis nor a guarantee that nothing else is wrong.
Hinton and Lewis-Fernández (2010) described idioms of distress, culturally shaped ways of experiencing and expressing suffering, and argued that they are clinically useful. Asking about a client's idioms can reveal trauma-related disorders and other conditions, help clinicians understand what symptoms mean to the client and strengthen rapport, because the client feels understood in her own terms.
The Intervention, Stage by Stage
| Stage | What happened | How culture shaped it |
|---|---|---|
| 1. Assess danger | Counselor knelt beside Carmen, checked she was not injured and, once she could talk, asked directly about thoughts of harming herself | Questions asked in Spanish by a bilingual colleague; ataque recognized, but suicide risk still assessed |
| 2. Establish contact | Counselor spoke slowly, said her name, said "Estoy aquí," and moved her to a quiet room with her permission | Physical presence and touch on the arm accepted; she had named the counselor her confianza, her trusted person |
| 3. Identify the problem | Javier's death; she had not spoken with him in a month after an argument | Family conflict before a death is a known trigger of ataques and of guilt |
| 4. Explore feelings | She cried, spoke of Javier as a boy and said she should have called him | Grief expressed loudly and physically was allowed, not hushed |
| 5. Generate alternatives | Who could be with her tonight; how to get to her mother's home | Family, not solitude, as the first resource |
| 6. Action plan | Her niece would drive her to her mother's; she agreed not to drink tonight and to call the program in the morning | Plan centered on family and on the vigil and funeral to come |
| 7. Follow-up | Counselor called the next morning and scheduled a session after the funeral | Funeral and novena honored in scheduling |
Safety and Relapse
Two risks needed explicit attention. The first was suicide. Sudden bereavement, guilt over an unresolved argument and an alcohol use disorder together raise risk. The bilingual colleague asked Carmen directly whether she had thoughts of dying or of hurting herself. She said she wished she could be with Javier but that she would never leave her mother and her daughter. The counselor treated the wish to be with Javier as passive ideation to be monitored, documented it and reviewed it again the next morning and after the funeral. The second risk was relapse. Carmen said the first thing she wanted was a drink. The action plan addressed that directly: no alcohol at her mother's house, her niece aware of her recovery and a call to the program the next morning. Carmen also agreed to let her counselor speak with her sister about the risk, since her sister would be with her through the week.
What Went Well and What Did Not
The receptionist's call was stopped by a senior counselor who recognized an ataque. Had police or an ambulance arrived, Carmen would likely have been restrained or taken to an emergency department in a moment of grief, an experience many Latino families describe as humiliating and frightening. But the program's protocol did not mention cultural expressions of distress, and the outcome depended on one staff member's knowledge.
The lethality assessment also depended on a colleague who spoke Spanish. Carmen's English is fluent, but in crisis she spoke only Spanish. Asking about suicide through her niece, who arrived later, would have been inappropriate.
Lessons for Northside's Crisis Protocol
Three changes follow. First, the protocol should include a brief section on cultural expressions of acute distress, including ataque de nervios, with guidance to assess before calling emergency services unless there is immediate danger. Second, every shift should have access to a bilingual staff member or a professional phone interpreter for crisis assessment, and family members should not interpret questions about suicide. Third, follow-up should be scheduled around family rituals such as funerals and novenas, which are part of how many clients grieve and recover.
Conclusion
Carmen's grief arrived as an ataque de nervios, a recognized Puerto Rican response to sudden loss. Roberts and Ottens's seven stages structured the response, Guarnaccia and colleagues explain what an ataque is and is not and Hinton and Lewis-Fernández show why understanding a client's idiom of distress improves both assessment and rapport. The intervention worked because the model was followed and filled with Carmen's own family, faith and language.
References
Guarnaccia, P. J., Lewis-Fernández, R., & Marano, M. R. (2003). Toward a Puerto Rican popular nosology: Nervios and ataque de nervios. Culture, Medicine and Psychiatry, 27(3), 339-366. https://doi.org/10.1023/A:1025303315932
Hinton, D. E., & Lewis-Fernández, R. (2010). Idioms of distress among trauma survivors: Subtypes and clinical utility. Culture, Medicine, and Psychiatry, 34(2), 209-218. https://doi.org/10.1007/s11013-010-9175-x
Roberts, A. R., & Ottens, A. J. (2005). The seven-stage crisis intervention model: A road map to goal attainment, problem solving, and crisis resolution. Brief Treatment and Crisis Intervention, 5(4), 329-339. https://doi.org/10.1093/brief-treatment/mhi030
PAC 120 Module 7 instructions, in plain terms
Crisis intervention arrives late in PAC 120, and a seventh-module assignment usually hands you a case and wants a structured model applied to it while showing how culture shaped both the crisis and the response. Your Aspen course's Module 7 page sets the actual task; the case here is invented. Explain the crisis model you use, stage by stage. Describe the crisis concretely. Show how culture shaped the way distress was expressed and how staff first read it. Address safety and lethality explicitly. Present the follow-up, since crises do not end when the client calms. Draw lessons for the program and cite every source in APA 7, avoiding exoticizing language about the client's culture. Say who interpreted and why.
How this PAC 120 Module 7 example is built
Carmen arrives for her Tuesday appointment, takes a call from her sister and collapses, screaming, shaking and striking the floor. A staff member reaches for the phone to call 911 for a psychiatric emergency. Roberts and Ottens's Brief Treatment and Crisis Intervention article supplies the seven stages. Guarnaccia, Lewis-Fernández and Marano's Culture, Medicine and Psychiatry study explains ataque de nervios as a recognized response to family loss. Hinton and Lewis-Fernández's article in the same journal explains how asking about idioms aids assessment. A seven-row table pairs each stage with what happened and the cultural adaptation. Safety, relapse risk, follow-up after the funeral and three lessons for the program's written protocol close the paper.
PAC 120 Module 7 rubric: what earns full marks
Crisis case papers earn credit for applying a model accurately, for addressing safety explicitly and for showing cultural understanding without stereotyping. This example works through all seven of Roberts and Ottens's stages in order and shows how culture shaped each, from the lethality assessment conducted in Spanish to the follow-up with her family. It explains ataque de nervios through research rather than impression, and it notes that the ataque does not rule out other risks, which is the clinical point instructors look for. The lessons for the program's protocol show that a single crisis can change practice for the clients who come after Carmen. The receptionist's near call is treated as a system gap, not a personal failure.
Common PAC 120 Module 7 mistakes, and how to avoid them
Crisis papers often skip the lethality assessment or treat it as a formality. Assess danger to self and others explicitly, even when the presentation seems explained by culture. Another weakness is treating a cultural idiom of distress as harmless or, the opposite error, as proof of psychosis; research supports neither. Work through each stage of your model rather than summarizing it. Include follow-up. Avoid exoticizing language; describe the client's experience in her own terms. Address relapse risk, since a crisis can trigger use. Draw lessons for the program as well as the individual. When you lack the client's language, say how you obtained interpretation and why family members should not interpret clinical questions.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official Aspen University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.
More PAC 120 and Psychology and Addiction Studies sample papers
- PAC 120 Module 1: Culture, Identity and Addiction
- PAC 120 Module 2: Cultural Self-Awareness for Counselors
- PAC 120 Module 3: Attending, Observing and Questioning
- PAC 120 Module 4: Reflecting Feelings and Meaning
- PAC 120 Module 5: Empathic Self-Disclosure and Confrontation
- PAC 120 Module 6: Advocacy for Clients and Communities
- PAC 120 Module 8: Assessing Suicide Potential
- PAC 310 Module 5: Boundaries and Dual Relationships
- PAC 102 Module 2: Risk and Protective Factors
- PAC 415 Module 3: Beneficence and Client Goals
- PAC 201 Module 4: Perception and Cognition in the First Years
PAC 120 Module 7 questions, answered
What does PAC 120 Module 7 usually ask for?
Aspen's PAC 120 covers crisis intervention in this module, so a crisis case applying a structured model with attention to culture and safety is typical. Look at the Module 7 prompt.
What is ataque de nervios?
A Puerto Rican and broader Latino category of acute distress, often with shouting, crying, trembling and a sense of losing control, typically triggered by family loss or conflict, as Guarnaccia and colleagues describe.
What are Roberts's seven stages of crisis intervention?
Assess danger, establish rapport, identify the major problems, explore feelings, generate alternatives, make an action plan and arrange follow-up.
Where can I find a free PAC 120 Module 7 sample paper?
This page holds the full paper: a seven-stage crisis intervention with a client in an ataque de nervios, with a stage table and protocol lessons.
Why ask clients about idioms of distress?
Hinton and Lewis-Fernández explain that idioms can reveal trauma-related and other disorders, help counselors understand symptoms and build rapport.