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Crisis Intervention

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CJ 440

1.      Crisis Intervention:-                 A crisis occurs when a stressful life incident overwhelms an individual’s capability to deal with efficiently in the face of a seeming challenge or threat and crisis intervention is the provision of emergency psychological care to victims as to assist those victims in returning to an adaptive level of functioning and to prevent or mitigate the potential negative impact of psychological trauma. (Everly, Flannery & Mitchell, 2000)

Steps in the Six Step model of Crisis Intervention:- In 1910 John Dewey proposed five classical steps of problem solving:

1.         A difficulty is felt

2.         The difficulty is located and defined

3.         Possible solutions are suggested

4.         Consequences are considered

5.         A solution is accepted

Earlier different psychologists proposed different episodes of problem solving and with minor modifications this approach to the steps in problem solving has persisted over the years till Guilford in 1967 made a general problem solving process. (Donna, 1998)

1.                  Defining the problem: – A crisis therapist should use his logic and background knowledge to sort out the problem and accordingly plan the intervention. These professionals should be familiar with the model for problem solving in the crisis approach. It involves assessing the individual and the problem, planning of therapeutic intervention, intervention, and resolution of the crisis and anticipatory planning. (Morley, Messick, and Aguilera, 1967)

2.                  Ensuring client Safety: – The therapist who is intervening crisis should make sure the safety of the patient. Anything that can happen will happen, when you least expect it and at the worst possible time. The recipe for failure in a crisis is failing to plan for situations that can result in poor patient care, injuries, and lawsuits. He should stabilize the victim and it is important to know what has happened within the immediate situation. How the individual has coped in past situations may affect his present behavior. Observations are made to determine his level of anxiety, expressive movements, emotional tone, verbal responses, and attitudinal changes and hence look after the patient. (Pamela Waters)

3.                  Providing Support: – A supportive, anxiety reducing relationship is established between the patient and crisis intervener. He should listen and helps the patient gain perspective both on internal and external environments and to work collaboratively for possible solutions.

4.                  Examing Alternatives: – Therapist should always observe for all possible alternatives which can make the patient feel good.

5.                  Making Plans: – After identifying the precipitating event and the factors that are influencing the individual’s state of disequilibrium, the therapist plans the method of intervention. This is basically a search process in which data are collected. It requires the use of cognitive abilities and recollection of past events for information relative to the present situation. An anticipatory planning is required to evaluate that weather the planned action will produce the expected results. Appraisal must be objective and impartial to be valid. Will the individual return to his usual level or higher level of equilibrium in his functioning.

6.                  Intervention: – In this step, intervention is initiated. Action is taken with the expectation that, if the planned action is taken, the expected result will occur. The therapist modifies assumptions, considers options and selects the most appropriate solution gaining insights and learning. The intervention is of a short-term nature and usually terminates once the acute crisis is over and adaptive means lead to a reestablishment of equilibrium. The short-term nature puts maximal responsibility for self direction, supports self-esteem and minimizes the risks of dependency.

2.       Differences between the principles of Long-term therapy and Crisis intervention:-

Crisis intervention is a form of psychological “first aid”. As medical first aid is to surgery, crisis intervention is to long- term therapy. Crisis intervention is supportive not curative. Long term therapy context is reparation, reconstruction and growth whereas crisis intervention context is prevention, acute mitigation and restoration to adaptive function. Former is a conscious and unconscious source of pathology whereas latter is a conscious process and environmental stressor. Former purpose is personal growth and development of individual and crisis intervention purpose is emotional first aid to reduce distress and assist the person in crisis to return to a state of adaptive functioning. Long term therapy mainly focuses on the present and past of the person whereas latter focuses then and now. Former is provided by expert mental health professionals and crisis intervention is provided by a trained, outgoing person who cares for people and has a desire to help those in a state of crisis. In first one the provider’s role is guiding, collaborative and cunsultive whereas active and directive in second one. Formers timing is within weeks to months or years after the development of a problem that interferes with normal life pursuits delayed, distant from stressor and latter’s timing is during a critical incident and in the immediate aftermath of an exposure to the event immediate, close temporal relationship to stressor generally within hours to four weeks. In first one the duration of treatment is 8-12 sessions for short term, months to years of weekly sessions for as long as needed for long term whereas 3 to 5 contacts some of which are only minutes in length, usually 8 contacts maximum required in crisis intervention. The goal of long term therapy is symptom reduction, reduction of impairment, correction of pathological states, personal growth, personal reconstruction and crisis intervention are stabilization, reduce impairment, return to function or move to next of care. (Jeffrey T)

3.       Phases of recovery for Post-Traumatic Stress Disorder: – A psychological disorder affecting individuals who have experienced or witnessed profoundly traumatic events, such as torture, murder, rape, or wartime combat, characterized by recurrent flashbacks of the traumatic event, nightmares, irritability, anxiety, fatigue, forgetfulness, and social withdrawal. It is a shell shock, battle fatigue, accident neurosis, and post rape syndrome and is often been misunderstood or misdiagnosed, event though the disorder has very specific symptoms that form a definite psychological syndrome.(Donna, 1998)  It is a normal response by normal people to an abnormal situation. It is a deep emotional wound. (Glenn R) A definitive treatment does not yet exist for PTSD nor is there a known cure. However, a number of therapies such as cognitive-behavior therapy, group therapy, and exposure therapy are showing promise. Here we discuss the five stages of recovery for PTSD:-

1.         Emergency or outcry stage: – In this stage the victim’s responses are very intense and run at high levels where they feel that they are facing a life-threatening situation. These victims show physical signs such as rapid breathing, rapid pulse, and elevated blood pressure. Feelings of fear and helplessness overtake their bodies. The victim feels truly relieved but very confused, when the situation ended.

2.         Emotional numbing and denial phase: – In this phase the survivor protects themselves by denying these emotions and trying to forget them.  They avoid emotion to eliminate anxiety and stress they are feeling.  Many victims cannot remove themselves from this state and may remain in it throughout their lives without professional assistance.

3.         Intrusive-repetitive phase: – The survivors now have nightmares, can have volatile mood swings and intrusive images, and display higher startle responses.  They may go into an antisocial stage to be used as an internal defense mechanism as to not have to relive the trauma.

4.         Reflective-transition phase: – In this phase the survivor has a larger picture of the events and moves forward with a positive and constructive outcome and do not look back on the negative.   This could be called the healing process as they are able to deal with the issues constructively and confront the trauma head on.

5.         Integration phase: – This is the final phase in which survivor has succeeded in overcoming the trauma and past experiences.  They can now move forward by placing the trauma securely in the past and can regain peace within themselves. (Christina R, 2007)

4.        In this case I want the information about her family background. How was her relation with her husband? Identify her major problems? How this impact of hazardous event disturbed the homeostatic balance of the lady. How Precipitants and sequence of events eliciting the crisis incident? How the lady has coped in past situations may affect his present behavior. Her level of anxiety, expressive movements, emotional tone, verbal responses and attitudinal changes? What is her immediate problem? How she is seeing her future? Now with whom she is living, who is her best friend, who does she trust, is there a family member to whom she particularly feels close? What she usually does when she has a problem she cannot solve? What are her coping skills? How does she usually reduce tension, anxiety or depression. What does she feel would reduce her symptoms of stress? Is she planning to kill herself? Is she merely thinking about it or does she have a method selected? Is it a lethal method like a loaded gun?

After gathering all these information I will go for intervening. With the recognition of the stage of crisis I will make my action plan. I will implement the six stage model of crisis intervention. I will create trust via confidentiality and honesty and listen to her in an attentive manner provide her the opportunity to communicate by talking less. I will assess the degree of distress, plan a therapeutic intervention. Doing all this I will also ensure the safety of lady and utilize my communication skills essential for crisis intervention, stabilize her thoughts and give her emotional support, make a relationship which keeps her away from distress and anxiety, listen for feelings, hearing what is said and not said, focusing on what she is feeling. Utilize my listening and boundary skills and respond with customary repertoire of problem solving mechanisms, mobilizes new emergency methods, maintaining good eye contact, posture and appropriate social distance if in a face-to-face situation. Though knowing what she does when having a problem she cannot solve, I will ask her to do so; like if she is distress and in that feel she plays piano or something she get relieved, I will ask her to do so while keeping watch on her. Ask her if she has plans for suicide or homicide and take action accordingly.

5.        The application of active listening skill helps to create an emphatic relationship between patient and the therapist. It is an effort over a relatively short period of time to stabilize emotions and restore the patient’s ability to think more rationally. Patient tends to listen to and follow the advice of therapist who has influence over them. Therapist generally achieves peaceful resolutions only after they demonstrate their desire to be nonjudgmental, no threatening, and understanding of the patient’s feelings. By projecting that understanding, therapist show empathy and lead the patient to perceive them, not as the enemy, but as concerned individuals who want to help.

Reference:

1.         Understanding the nature of crisis – Reeta kohli, 1991

2.         Hand book of Crisis Counseling, Intervention and Prevention in the schools – By Jonathan sandoval, Lawrence Erlbaum Associates, Mahwah, NJ,2002

3.         Crisis Intervention & CISM – By Jeffrey T. Mitchell, CTS

4.         Post traumatic stress Disorder sourcebook: A guide to Healing, Recovery and Growth – By Glenn R. Schiraldi, Mc Graw- Hill Professional

5.         Crisis Intervention: Theory and Methodology – Donna

 

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