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HN499 Bachelor’s Capstone for Human
Services
Unit 5: Crisis InterventionDeborah Smith
Prepared by Cathy Moore
Crisis Intervention… “emotional first aid” (Rosenbluh, 1981)
Emotional equivalent of physical first aid Must be applied skillfully and timely [within 2 to
3 weeks after event leading to crisis] Act immediately to stop the emotional bleeding;
attempt to Relieve anxiety Prevent further disorientation Ensure that suffers do not harm themselves
or cause harm to others Is to emergency room medicine what a
medical practice is to psychotherapy practice
Crisis defined… “an obstacle that is, for a time,
insurmountable by the use of customary methods of problem solving. A period of disorganization ensues, a period of upset, during which many abortive attempts at a solution are made … an upset in the steady state of the individual.” -- Gerald Caplan, 1961 [father of modern crisis intervention theory]
A Crisis can occur when any event leads a person to look for an immediate solution to an acute situation.
If a solution to the event is found, no matter how reasonable or not, there is not a crisis.
If a solution is not found, a Crisis state ensues.
Stress-Producing Situations may lead to
Crisis: Changes in family
dynamics or structure – separation, divorce, blended family, gaining new family member
Economic changes Community changes Significant life events Natural disasters Entry to school/college Being arrested Physical illness
Change in job/career Acute episodes of
mental disorder Sexual difficulties Auto accident – with
or without injury Death of loved one Major illness of family
member Actual or impending
loss of something significant in one’s life
A Crisis Leads to Decrease or Change in Functioning *[Different people indicate crisis in
different ways]; i.e. cry, explode, verbalize, withdrawal, depression
Emotional/psychological Feel sad, angry, miserable
Cognitive Thinking is confused, ‘fuzzy’
Behavior Risk-taking, non-ordinary
EMOTIONAL Signs & Symptoms of Psychological Reactions to
Crisis Shock Denial Insecurity Fatigue uncertainty Fear Helplessness Depression Panic Despair
Frustration Inadequacy Anger Feeling out of control Numbness Grief Outrage Irritability Survivor guilt
COGNITIVE Signs & Symptoms of Psychological Reactions to Crisis
Confusion Poor attention span Poor concentration Flashbacks
Loss of trust Difficulties in decision
making Nightmares
BEHAVIORAL Signs & Symptoms of Psychological Reactions to
Crisis
Withdrawal Angry outbursts Change in appetite Increased fatigue Excessive use of sick
leave Alcohol or drug abuse Frequent visits to
physician for nonspecific complaints
Spending sprees
Anger remarks to God Loss of desire to attend
religious services Crying Preoccupation with
crisis to exclusion of other areas of life
Diminished job/college performance
Hysterical reactions
Formula for Understandingthe Process of Crisis Formation:
A Triology Definition
• Precipitating Event Occurs • Perception of Event Leads to Subjective
Distress leads to Impairment in Functioning• Coping Skills Fail to Improve Functioning
Crisis and stress are NOT the same thing.
Cognitive Key is the most Crucial part of understanding
Crisis: Perception
Cognitive Key: ‘the meaning a person gives to the event’
Role of Crisis worker is to ‘unlock’ or ‘reframe’ person’s perception of event = increase functioning
The most difficult part of a crisis to diagnose The most easily and quickly altered by counselor Goal of CI is to help restore functioning level,
never to change the precipitating event.
Crisis as Danger and Opportunity
Opportunity:1. With help / Counseling / Intervention, the
individual survives the crisis with increased coping skills, emotional growth, and resources which prepare him for future stressors.
Danger:2. Without Help, the individual may return to a
lowered level of functioning by use of the ego defense mechanisms or remain nonfunctional via suicide, homicide, or psychosis.
With same event, some are thrown into crisis and others
are not…Why?
Material Resources: money, shelter, transportation, food, clothing
Personal Resources: ego strength, personality traits, physical well-being, intelligence and education
Social Resources: friends, family, school mates, co-workers, church, clubs
TYPES OF CRISES Developmental: normal, expected,
transitional phases as people move from one stage of life to another. People often unable to cope with evolving needs of family members
Situational: uncommon, extraordinary events. No way of forecasting or controlling them, emergency quality
THE ABC MODEL OF CRISIS INTERVENTION
A: Developing strong rapport Basic attending skills CI worker perceived by client as empathic, present,
nonjudgmental, genuine B: Identifying the nature of the crisis and altering perceptions
Most important phase of CI model Using skills in Phase A, identify precipitating event,
perspective, subjective distress, current and previous functioning
Provide new ways for client to think about, perceive, process the situation
C: Offering coping skills Encourage & listen to client’s ideas for coping before
offering CI worker’s ideas Plan for Follow-up of some type
A: DEVELOPING AND MAINTAINING RAPPORT
Foundation of CI – Rapport, trust, open “People don’t care what you know, until
they know how much you care.” Purpose: ‘to develop rapport’ - invites
client to talk, bring calm to situation, allow client talk about facts & express feelings, allows counselor to hear, empathize, respect.
Gain clear understanding of internal experience of crisis as client sees it.
Open-ended Questioning Most effective way to invite client to talk Allow for exploration of what the client just
said Begin with “how” and “what” Attach the question with something the
client just said Don’t ask “why” questions: tends to create
defensiveness Avoid “have you” questions, they are
usually forms of hidden advice
Closed-ended Questions Questions such as “do you”, “does it”, and
“are you” lead to answers such as “yes” and “no” which go nowhere. Change them into what and how questions.
Be specific and direct. Avoid “would you mind”, “could you tell me
more”. Direct the client about what to explore
A: SUMMARIZATION Purpose: help client pull together his/her
thoughts This helps move the interview along and
into other areas, such as the C section. Useful when the counselor is not sure
where to lead the client. Includes emotions, facts, cognitions
disclosed throughout the entire session
Note…. Developing rapport is ongoing Must develop rapport at the
beginning – establish trust But also must continue to foster
rapport throughout to maintain trust and encourage a more successful interaction.
B: IDENTIFYING THE PROBLEM
Counselors need to identify the nature of the crisis: precipitating events cognitions about these events emotional distress how the client is functioning
socially, academically, occupationally, and behaviorally since the crisis.
Identifying Precipitating Event
Important to learn what is going on with client “What brings you here today” “What prompted you to call for an appt?
Learn how client has been trying to cope since event happened: difficulty has brought them here
Identify client’s perception about event –what it means to him/her now
Review formula for understanding Crisis Formation
ETHICAL ISSUES Counselor must assess directly or
indirectly for the following: suicide child abuse elder and disabled adult abuse danger to others medical or organic illness, substance
abuse Examples p. 84-85
Therapeutic Interaction Statements
Validation & Support Educational Empowering Reframing
Therapeutic Interaction Statements: Validation &
Support these make clients feel that their
point of view and subjective experiencing is valid and that the counselor empathizes with their plight.
Counselor lets clients know that their feelings are normal and difficult.
Say things that friends/family probably wouldn’t say
Validation & Support Statements
NOT “It’s okay.” or “Don’t worry.” or “Forget about it.”
“I know that you feel like everything is falling apart right now, but many people have gone through the same situation and have survived. You have every reason to believe you can survive too.”
Therapeutic Interaction Statements: Educational
counselor offers factual information based on counselor knowledge about various aspects of the client’s crisis.
This helps normalize the experience or corrects false ideas the client might hold.
Educational Statements
Based on facts and research (things you could learn from annotated bibliography types of resources)
“30% of women live in abusive situations.”
63% of rape victims are raped by someone they know – a partner or an acquaintance.”
Therapeutic Interaction Statements: Empowering
these comments help the client feel more powerful and in control.
Counselor points out choices available and how client can overcome feelings of helplessness.
Empowering Statements “You did not have a choice in being
raped, but you do have a choice of what you do now. You have the choice to call the police, go to court, tell a friend, or not do any of these things. You alone control that decision. Let’s talk about your feelings and thoughts on each of those choices.”
Therapeutic Interaction Statements: Reframing
helps the client view the situation from a slightly different point of view using the client’s frame of reference.
Sometimes a positive perspective is changed into a negative one, sometimes a negative perspective is changed into a positive one.
Probably one of the strongest healing skills available
Reframing Statements First understand the client’s frame
of reference (can’t “reframe” if you don’t know the “frame”) – ask open ended questions.
"The art of reframing is to maintain the conflict in all its richness but to help people look at it in a more open-minded and hopeful way."
Initial frame Reframe I am in a tunnel and I can’t see a way out.
Every tunnel has an entrance and exit.
I am too anxious to study. You need to be anxious enough to concentrate.
I know I will never be confident. Being confident starts with having insights about our limits.
When he/she looks at me like that he/she hates me.
People cover up their hurt by putting a scowl on their faces.
He hits me because I do stupid things and deserve it.
People who hit are insecure and trying to control other people through violence. No one deserves that.
I am never going to get over this pain. You can choose to let go of hurtful feelings.
Examples of Reframing Statements
C: COPING Have client explore their own attempts at coping
and think of what they would like to do now. Counselor then offers alternative coping ideas
such as referrals to support groups, 12 step groups, long term, family, or marital therapy, shelters or other agencies, physicians & lawyers
Sometimes counselors might recommend that clients journal, or read books, view films or participate in assertive training or stress management courses.
Discussion… Why is it so important to provide
crisis intervention before moving on to more in-depth intervention?
What unique challenges might professionals face when working with people in crisis that they might not face when working with other clients?