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1 approaching crisis intervention
- 2. Brief History of
Crisis Intervention
National Save-a-Live League (1906)
The first known crisis phone line.
Cocoanut Grove nightclub fire (1942)
Dr. Erich Lindemann’s clinical assessment of the
survivors.
Community Mental Health Centers Act of 1963
Large state-run asylums were replaced by community
mental health centers.
©2013, Brooks/Cole Cengage Learning
- 3. The Importance of Volunteerism
Tasks completed by volunteer workers may
range from menial administrative chores to
frontline crisis intervention with clients.
The greatest number of frontline volunteers are used to
staff 24-hour suicide hotlines in major cities.
More than 75% of all crisis centers in the United States
report that volunteer workers outnumber professional
staff by more than 6 to 1.
©2013, Brooks/Cole Cengage Learning
- 4. Crisis Intervention as a
Grassroots Movement
Crisis intervention typically remains unrecognized by the
public until victims/victim advocates exert enough legal,
political, or economic pressure to cause change.
As crisis agencies become crisis organizations, they gain
power, prestige, and notoriety.
Offer opportunities for research, clinical training sites, and
employment for recent graduates.
Three major grassroots movements helped shape crisis
intervention into an emerging specialty.
Alcoholics Anonymous (AA)
Vietnam veterans
Women’s movement during the 1970s
©2013, Brooks/Cole Cengage Learning
- 5. Transition from a Grassroots
Movement to a Specialty Area
Large influx of crisis organizations from the 1970s-1990s.
Recognition that immediate intervention is essential in
alleviating stress related to trauma.
Professional recognition within the helping fields.
Division 56: Trauma Psychology, American Psychology
Association (2006)
Accreditation standards set by the Council for Accreditation of
Counseling & Educationally Related Programs (2009) and
National Association of School Psychologists (2010).
The media has a significant influence on public
consciousness of crisis after a large-scale disaster.
©2013, Brooks/Cole Cengage Learning
- 6. The Case Against Too
Much “Helping”
“Trauma tourism”-burgeoning industry in post-intervention
psychological trauma replete with trade shows, trade
publications, talk shows, and charitable giving.
There is an assumption that experiencing a disaster will
invariably lead to psychopathology.
The reality is that in most instances, victims of disaster do not
panic.
Victims of disaster create an “altruistic or therapeutic
community”-characterized by the disappearance of community
conflicts, heightened internal solidarity, charity, sharing,
communal public works, and a positive attitude.
©2013, Brooks/Cole Cengage Learning
- 7. Definitions of Crisis
There are varied definitions for both an individual and a
system in crisis.
For the purpose of this text, definitions have been selected.
Individual crisis-crisis is the perception or experiencing of an
event or situation as an intolerable difficulty that exceeds the
person’s current resources and coping mechanisms.
Systemic crisis-when a traumatic event occurs such that
people, institutions, communities, and ecologies are
overwhelmed and response systems are unable to effectively
contain and control the event in regard to both physical and
psychological reactions to it.
“Metastasizing crisis”-occurs when a small, isolated incident
is not contained and begins to spread.
©2013, Brooks/Cole Cengage Learning
- 8. Characteristics of Crisis
Presence of both danger and opportunity
A crisis is dangerous because the related stress may result
in pathological behavior such as injury to self or others.
A crisis can be an opportunity because it may be the
catalyst for the individual to seek help.
Crisis can provide the seeds of growth and change
Many times a person will not seek help until they can admit
that they do not have control of the problem.
No panaceas or quick fixes
It is common that the failure of a quick fix to a problem may
actually lead to a crisis situation.
©2013, Brooks/Cole Cengage Learning
- 9. Characteristics of Crisis Cont.
The Necessity of Choice
Choosing is proactive and deciding not to choose is actually a
choice that typically has negative results.
Universality and Idiosyncrasy
Crises are universal because no one is immune to them.
Crises are idiosyncratic because individuals may react differently
to the same situation.
Resiliency
Perception
It is the perception, not the event, that causes distress.
Complicated symptomology
Crisis is complex and defies linear causality.
©2013, Brooks/Cole Cengage Learning
- 10. Transcrisis States
Historically, crises have typically been seen as
lasting between 6-8 weeks in duration.
Current view is that the events immediately following
the crisis have a large impact on the duration.
A transcrisis state occurs when unresolved issues
from a previous traumatic event resurface because
of a current stressor.
Transcrisis states are not synonymous with PTSD.
The key difference is that the transcrisis state is residual and
recurrent and always present to some degree.
©2013, Brooks/Cole Cengage Learning
- 11. Transcrisis Points
Occur within the therapeutic intervention and are seen as
necessary for progression.
Are marked by the client gaining awareness of the
various aspects of the crisis.
May occur frequently and are not regular, predictable, or
have a linear progression.
When transcrisis points occur, the therapists shifts from
traditional therapeutic techniques to crisis intervention.
The individual will experience similar affect, behavior, and
cognition as the original crisis event.
©2013, Brooks/Cole Cengage Learning
- 12. Theories of Crisis Intervention
No single theory is 100% comprehensive.
Three major theories
Basic Crisis Theory
Expanded Crisis Theory
Applied Crisis Theory
©2013, Brooks/Cole Cengage Learning
- 13. Basic Crisis Theory
Based on a psychoanalytic approach to crisis.
Behavioral responses related to grief are normal,
temporary, and can be relieved with short-term
intervention techniques.
Normal grief behaviors include:
Preoccupation with the lost one
Identification with the lost one
Feelings of guilt and hostility
Disorganization of daily routine
Somatic complaints
©2013, Brooks/Cole Cengage Learning
- 14. Basic Crisis Theory Cont.
Crisis occurs when something impedes one’s life
goals.
Equilibrium/disequilibrium paradigm
Disturbed equilibrium
Brief therapy or grief work
Client’s working through the problem or grief
Restoration of equilibrium
Basic Crisis Theory vs. Brief Therapy
Brief Therapy tends to resolve ongoing emotional issues
whereas Basis Crisis Theory assists individuals in crisis
and addresses their affective, behavioral, and cognitive
distortions resulting from the traumatic event.
©2013, Brooks/Cole Cengage Learning
- 15. Expanded Crisis Theory
Explores social, environmental, and situational
factors of a crisis.
Is influenced by several theories
Psychoanalytic Theory
Early childhood experiences determines why a traumatic
event becomes a crisis.
General Systems Theory
Examines the interdependence among people who
experience a crisis.
Ecosystems
Extension of systems theory to include an environmental
context
©2013, Brooks/Cole Cengage Learning
- 16. Theories that Influence Expanded
Crisis Theory Cont.
Adaptational Theory
Crisis response is sustained through maladaptive behaviors.
Interpersonal Theory
A state of crisis can not be sustained if a person has an
intact sense of self-worth and has a healthy support system.
Chaos Theory
Theory of evolution applied to crisis intervention.
Developmental Theory
Potential for crisis arises from developmental tasks that are
not accomplished.
©2013, Brooks/Cole Cengage Learning
- 17. Applied Crisis Theory
Encompasses four domains:
Normal developmental crises
Consequence of events in typical human development
that produce an abnormal response
Birth of a child, graduation from college, or career
change
Situational crises
Occurs when an uncommon event, that the individual or
system has no way to predict or control, causes extreme
stress.
Terrorist attacks, automobile accidents, or sudden
illness
©2013, Brooks/Cole Cengage Learning
- 18. Four Domains of Applied
Crisis Theory Cont.
Existential crises
A result of intrapersonal conflicts related to one’s sense of
purpose, responsibility, independence, freedom, or
commitment.
Ecosystemic crises
When a natural or human-caused disaster overtakes a
person or system through no fault of their own.
Natural phenomena (hurricanes, tornadoes, forest fires)
Biologically derived (disease, epidemic)
Politically based (war)
Severe economic depression (Great Depression)
©2013, Brooks/Cole Cengage Learning
- 19. Crisis Intervention Models
Traditional models of crisis intervention
Equilibrium model
Cognitive model
Psychosocial transition model
Modern models based on Ecosystemic Theory
Developmental-ecological model
Contextual-ecological model
Modern models based on field-practice
Psychological first aid
ACT model
Eclectic model of crisis intervention
©2013, Brooks/Cole Cengage Learning
- 20. Traditional Models
Equilibrium Model
Crises are seen as a state of psychological disequilibrium.
Main focus is on stabilizing the individual.
Most appropriately used for early intervention.
Cognitive Model
Crisis is a result of distorted thinking related to an event, not the
event itself.
The goal is to help people change their perception of the crisis
event.
Most appropriately used after the individual has been stabilized.
Psychosocial Transition Model
Assumes that people are products of their genes and their
environment.
The goal is for the person to gain coping mechanisms and
establish a support system.
Most appropriately used after a client is stabilized.
©2013, Brooks/Cole Cengage Learning
- 21. Ecosystemic Models
Developmental-Ecological Model
Crisis worker should assess the individual’s developmental
stage, their environment, and the relationship between the two.
Contextual-Ecological Model
Contextual elements are layered by physical proximity and the
emotional meaning attributed to the event.
Reciprocal impact occurs between the individual and the
system.
Primary vs. secondary relationships
Degree of change triggered by the event
Time directly influences the impact of a crisis.
The amount of time that has passed
Special occasions (anniversaries, holidays, etc.)
©2013, Brooks/Cole Cengage Learning
- 22. Eclectic Model
Intentionally and systematically integrates valid concepts
and strategies from all available approaches.
Operates from a task orientation and has three major
tasks.
Identify valid elements in all systems and integrate them.
Consider all pertinent theories, methods, and standards for
evaluating and manipulating clinical data.
Do not identify with one specific theory.
Fuses two pervasive themes
All people and all crisis are unique and distinctive
Two people may experience the same traumatic event but react
to it differently
All people and all crises are similar
There are global elements to specific crisis types
©2013, Brooks/Cole Cengage Learning
- 23. Field-based Models
Psychological First Aid Model
Seeks to address the immediate crisis needs.
Non-intrusive because not everyone exposed to a traumatic
event will experience a crisis.
Psychological First Aid: Field Operations Guide (The
National Center for PTSD) consists of 8 core actions
Psychological Contact and Engagement
Safety and Comfort
Stabilization (if necessary)
Information Gathering: Current Needs and Concerns
Practical Assistance
Connection with Social Supports
Information on Coping
Linkage with Collaborative Services
©2013, Brooks/Cole Cengage Learning
- 24. Field-based Models Cont.
ACT Model
Assessment of presenting problem.
Connecting clients to support systems.
Traumatic reactions and posttraumatic stress disorders.
©2013, Brooks/Cole Cengage Learning
- 25. Characteristics of Effective
Crisis Workers
Effective Crisis intervention is a hybrid of science and art.
Crisis workers need a mastery of technical skill,
theoretical knowledge, and certain characteristics to
develop this hybrid.
Diverse life experiences
Poise
Creativity
Flexibility
Energy
Resiliency
Quick mental reflexes
Assertiveness
Tenacity
©2013, Brooks/Cole Cengage Learning