The Basics of Crisis Intervention

Roger Daniel

WHAT IS A CRISIS?

  • An emotionally significant event or radical change of status in a person’s life.
  • Turning point in the course of life.
  • An upset in a person’s baseline level of functioning.
  • A disruption of normal balance.
  • Temporary loss of coping ability.

From the perspective of a turning point, a crisis will almost always present two alternatives, as illustrated below:

 

CRISIS

                                           Growth                                                                         Pain

                                           Enrichment                                                                 Bitterness

                                           Improvement                                                              Dissolution

 

The ultimate goal of crisis intervention is to lead those in crisis toward a positive outcome, with the understanding that such an outcome may not be immediate or consistent. Appropriate intervention at the time of occurrence can be worth more than hours of professional counseling later. That is, it can reduce the need for longer term psychological intervention.

FOUR COMMON ELEMENTS IN A CRISIS

  • A hazardous event, circumstances, or situation. Starts a chain reaction of events culminating in crisis.
  • A vulnerable state. In most crises there is a sense of vulnerability … a sense of helplessness to manage circumstances or events that are beyond human control.
  • Precipitating factor. The proverbial “straw that breaks the camel’s back.” A decisive moment that ushers in a full-blown crisis.
  • State of active crisis. Symptoms of stress: physical, cognitive, behavioral, and emotional changes. Attitude of panic or defeat. Focus on relief. Lowered efficiency: the greater the crisis the less effective people will be.

FIVE STAGES OF A CRISIS (Phoenix Phenomenon, Jason Aronson)

  • Impact
  • Chaos
  • Adaptation
  • Equilibrium
  • Transformation

PHASES OF A CRISIS (Living With Stress, Lloyd Ahlem)

Impact Phase

Usually brief (from hours to a few days)

Reduced cognitive function (disorientation, inability to concentrate, impaired memory)

Searching for lost object (looking at photographs, reminiscing, etc.)

Guilt (in some instances, not all)

Withdrawal-Confusion Phase

The Elijah response (he withdrew into the desert). Key factor: emotional turmoil; a sense of …

Denial – “this can’t be happening”

Self-pity – “why is this happening to me?”

Bewilderment – “I’ve never felt this way before”

Danger – “I’m scared”

Confusion – “I can’t think clearly”

Impasse – “I’m stuck; nothing helps”

Desperation – “I need to do something, but what?”

Apathy – “Nothing helps, what’s the use of trying”

Helplessness – “I can’t deal with this; please help.”

Urgency – “I need help right now!”

Discomfort – “I am so miserable and unhappy”

Assessment Phase

B – behavior

A – affective (emotions, feelings)

S – symptoms (physical, behavioral)

I – interpersonal (relationships)

C – cognitive (thinking)

Adjustment Phase

Usually the longest phase

Completing detachment (moving away from denial toward acceptance)

Looking for the new

Gaining hope

Reconstruction Phase

Expressions of hope (change in attitude and speech)

New strength, perspectives, values, and way to approach life

BALANCING FACTORS

  • Adequate perception – the way a problem is viewed
  • Adequate network – relational support from
  • Coping mechanisms – rationalizing, denial, new knowledge, prayer, worship, scripture, etc.
  • Limited duration – “weeping may endure the night but joy comes in the morning”

GOALS OF CRISIS INTERVENTION

  • Listen – the person will tell you where they are on the journey
  • Be calm – you are the anchor in the storm
  • Be compassionate – loving concern is better than clever words
  • Assess – evaluate the situation; triage the needs
  • Normalize – no, they’re not crazy
  • Reassure – dispense hope
  • Support – establish a circle of relational support
  • Plan – they’re not thinking clearly and will need your help to organize
  • Educate – help them understand why they feel as they do
  • Monitor – don’t assume their progress
  • Problem solving – what can be done to provide relief?

14 CATEGORIES OF REPRESENTATIVE NEEDS

  • A strong person to protect and control – “please take over for me”
  • Someone who will help them maintain contact with reality – “help me know I am real”
  • Those who feel empty and needing love – “care for me”
  • Someone to provide security – “always be there”
  • The need to confess – “take away my guilt”
  • The need to talk things out – “let me get this off my chest”
  • The need for advice – “tell me what to do”
  • The need to sort out conflicting ideas – “help me put this into perspective”
  • A desire for self-understanding and insight into their problem – “what’s really going  on?”
  • Medical attention – “I need a doctor”
  • Practical help – “I need specific assistance”
  • The need to intercede – “do it for me”
  • Those who want information – “where can I get what I need?”
  • Unmotivated or psychotic persons who are there against their will – “I want nothing”

THOSE WHO COPE POORLY

  • Emotional weakness – emotionally weak prior to the crisis; those who are already hurting.
  • Poor physical condition – a physical ailment that contributes to the problem and reduces their resources to cope.
  • Denial of reality – the excessive attempt to avoid the pain.
  • The need to confess – “take away my guilt”
  • “Magic of the mouth” – the tendency to eat, drink, smoke, and talk excessively.
  • Unrealistic approach to time – the tendency to crowd the time dimensions of a problem, or extend it into the future.
  • Excessive guilt – self-blame.
  • Excessive dependence or independence – either turn away offers of help or become clinging vines.
  • Theology – those who believe in the sovereignty and caring nature of God have a better basis to deal with crisis.