• To introduce students to crisis theory and different forms of crisis intervention, and prevention.
• To help students understand the application of the human relations counseling model to crisis interventions prevention.

Helpers are increasingly engaged in crisis intervention and disaster relief.  Lesson 12 presents an overview of basic crisis theory.  It discusses the application of helping relationship skills and appropriate strategies of the human relations counseling model to this particular type of helping.  Crisis intervention is differentiated from trauma and disaster intervention in that the latter is more likely to require coordinated team efforts to deliver services to larger groups of sufferers.

 Lesson 12 begins by defining crisis and the six generally accepted classes of emotional crises:  dispositional; anticipated life transitions; traumatic stress; maturation/developmental; psychopathological; and psychiatric emergencies.  Crisis intervention and disaster relief are short-term and focused.  Attention is directed toward reduction of tension and adaptive problem solving.  The chapter relates the stages and steps of the human relations counseling model to the stages and steps of crisis intervention.  With its active focus on finding solutions, brief therapy is described as a viable form of crisis intervention.  Different formats of crisis intervention, such as hot lines, drop-in centers, crisis centers, outreach counseling, disaster relief, and crisis prevention, are described.  Available support networks are considered critical components of crisis intervention.  This review of crisis theory/intervention indicates that short-term interventions can be effective.

 It is a state that exists when a person is thrown completely off balance emotionally by an unexpected and potentially harmful event or a difficult developmental transition.  Unlike stress that can be ongoing, a crisis is limited.  Results of a crisis can be described as disequilibrium, disorientation, and disruption, and common feeling responses are apathy, depression, guilt, and loss of self-esteem; the usual problem solving techniques no longer work, causing upset and fright.  People react differently to similar situations; for one a situation is a crisis, for another it is not.  So a crisis worker deals with a person’s perception of the situation, not the situation itself.

 Crises are either situational (result of internal stresses, external stresses, or both) or developmental (passing through stages of life).  Six classes of emotional crises:  

• Dispositional crises: Lack of information such as not knowing which job to take, what type of medical referral to seek for a particular symptom, etc.
• Anticipated life transitions: developmental crises that are fairly common in our society such as midlife career changes, getting married, divorce, onset of terminal illness.
• Traumatic stress:  externally imposed stress situations – rape, assault, sudden death of loved one, loss of job or status, etc. 
• Maturational developmental crises: Life stages that reflect issues of dependency, value conflicts sexual identity, capacity for emotional intimacy, response to authority, or our level of self-discipline. 
• Psychopathological crises: Precipitated by preexisting psychopathology, which impairs or complicates the way one deals with a situation.
• Psychiatric emergencies: severely impaired where one becomes incompetent or dangerous to oneself, to others, or to both. 

 Cries fall into two main categories (helps determine crisis intervention means): developmental – have to do with growth and passing through life stages; or situational – result of internal stresses, external stresses, or both.  

 Complete Exercise 9.2 on crises classification

 Depending on level of crisis, different interveners.  There is need for professional psychiatric help for psychiatric emergencies, and professional psychological help for psychopathology. Anyone can help with dispositional crises, and many can help with life transitions, traumatic stress, and developmental crises.  Police, friends, family, pastors, physicians are usually alerted in crises.  They usually call counselors/human service workers who help with problem solving, and work through feelings associated with crisis.

Pioneered by Eric Lindermann who studied reactions of bereaved families of victims who died in the Coconut Grove nightclub fire in Boston (1944).  Discovered that crisis involves loss (with feelings such as tightness in the throat, shortened breath, exhaustion, lack of strength, digestive problems, insomnia, guilt, disturbed relationships) and requires a period of grieving (about six weeks). 

 Caplan and Lindermann believed that in crisis, people choose adaptive or maladaptive ways; their problem solving ways will affect their later adjustment and coping.  They believed that people can be taught to identify, understand and master the psychological tasks of grieving. 

 Caplan identifies four phases of crisis reaction:

• Person uses usual kinds of problem solving to restore equilibrium
• Increase in tension as usual problem solving strategies fail
• Increased tension requiring additional helping strategies and novel problem-solving strategies
• Problem not resolved in previous phases may result in major personality disorganization and emotional breakdown.

 Lindemann and Caplan indicate that a person in crisis can be receptive to major change in a brief period of time and can be influenced and helped by others; also, needs a much support as possible form whoever is available – helper, family, friends, etc.  Adaptive crisis resolution can result in enduring, positive change.

 Unresolved bereavement from earlier losses (person, relationship, security, capacity, a dream) that may be traumatic (physical, sexual, or emotional abuse) or not, affects later day-to-day functioning; it also affects one’s reactions to later crises.  Thus, for best choice of intervention strategies, it is important to have a good history of crisis victim. 

 Crisis theory is heavily influenced by major theories discussed in earlier lessons: suicide research, which focuses on relation of current crisis to previous experiences such as birth trauma, birth order, damilial and interpersonal relationships, shows psychodynamic influence; focus on here and now, positive growth potential, shows phenomenological and existential influence; supportive relationships with significant other, empathic helper, allowance of expression of intense feelings show influence of phenomenological influence; cognitive appraisal, and correction of faulty thinking in crisis intervention indicates cognitive theory; reinforcement and problem solving shows cognitive-behavio0ral influence; focus on significant relationships shows ecological/systems influence; and focus on race, culture, class and sexual orientation shows multicultural theoretical orientation.  

 Major difference between helping strategies and crisis intervention strategies: crisis intervention strategies focus on on immediate, time-linited reactions to a specific source of stress. 

Goal: provide as much support and assistance as possible to individuals and their families thus enabling the regaining of psychological equilibrium ASAP.  Six major components of crisis intervention: 

• Focus is on specific and time-limited treatment goals (attention on tension reduction and problem solving).
• Clarification and accurate assessment of the stress source and the meaning of the stress to helpee – entails active, directive cognitive restructuring. 
• Assist helpee develop adaptive problem-solving mechanism os as to teturn to former level of functioning
• Reality-oriented, and focus on clarifying cognitive perceptions, confronting denial and distortions, and providing emotional support (not false assurance).
• For support uses existing helpee relationships as much as possible
• May serve as a prelude to further treatment. 

 BASIC ID model of Lazarus is a good comprehensive assessment for crisis intervention – elicit information on the seven levels from which appropriate strategies can be developed.  

 Complete Exercise 9.4

 Stages and Steps of Crisis Intervention

 Stage 1 – Relationship

 Step 1: Initiation/entry

• Assess cognitive, affective, and behavioral reactions to crisis and impact of same
• Explore significant relationship systems
• Create ongoing opportunities for helpee to express and ventilate intense feelings

 Step 2: Clarification of problem/crisis

• Assess major environmental variables (social physical, economic, emotional
• Determine helpee’s perceptions of strengths/weaknesses
• Determine precipitating events of crisis
• Determine reason helpee is seeking help
• Determine kinds of problem solving and coping strategies helpee has attempted
• Assess phase and classification of crisis (dangerous to self or others, etc).

 Step 3: Structure/contract

·        Inform helpee what help you can give/not give to help overcome the crisis

 Step 4:  Intensive exploration of crisis and reactions

 Step 5: Goals and Objectives, time limits

·        Reiterate problem focus

·        Reaffirm time limits

·        Determine how other people and resources to be used

·        Clarify who is responsible for each part

 Stage 2: Strategies

 Step 1: Mutual acceptance of defined goals and objectives

Step2: Use of strategies

• Cognitive restructuring
• Referral
• Supportive, empathic, responsive listening
• Assertiveness training
• Behavioral contract
• Ventilation of feelings
• Decision making
• Systematic desensitization
• Gestalt experiments

 Step 4:  Evaluation of strategies

 Step 5:  Termination when crisis is resolved

• Formulate realistic plan
• Verify that helpee is detached from intense emotional reaction
• Confirm accurate cognitive appraisal of crisis and appropriate management of affect by helpee
• Helpee willing to accept help from others as appropriate
• Helpee understands how present crisis can help in coping with future events

 Step 6:  Determine whether crisis resolution endured

 Solution-focused therapy limited to ten or fewer sessions. Four step helping model of Watzlawick, Weakland, and Fisch (1974) appropriate to crisis intervention:

• Describe crisis in concrete behavioral terms
• Investigate previous attempts at problem resolution
• Obtain a clear definition of the change to be achieved
• Formulate and implement a plan to produce the change. 

 Three main forms:

• Hotlines, drop-in centers, and crisis clinics (deal with suicide, drug, runaway, rape, alcoholic, abortion crises, etc., by helpers with special training)
• Outreach counseling (based on visiting nursing concept, helpers go and provide immediate support and comfort to crisis victims –see victim in context/own environment and hence more expensive)
• Disaster relief (teams work with victims of major catastrophes

 Many educational programs in colleges and communities to hep people avoid certain kinds of crises – developmental crises, rape-prevention, sex-education, drug-education, etc. 

 The ability to: remain calm in an emergency; use common sense; project self-confidence; responsive listening communication skills; communicate comfort, support, and respect to helpee; differentiate empathy (important for faster recovery in most crises) from sympathy (use in bereavement only), and confrontation (confront remorseful alcoholic with the consequences of physical abuse toward his wife); be able to work quickly; and know community resources thoroughly.   

 In the beginning steps of crisis intervention, the helper poses questions about event in order to elicit information and determine best intervention strategies.   At the same time, communicate comfort, support and respect for victim and take direct action where necessary (prevent danger to self or others).   Dependency on helper is accepted until ready for referral or victim can take over for self. 

 Reactions to crises involving loss (divorce, death) have stages as outlined by Kubler-Ross (1969):  initial shock and denial (can’t happen to me – helper provides empathetic support), anger (helper can get the brunt of it), acceptance (coping strengths emerge).

1. A crisis is when a person is thrown completely off balance emotionally by an unexpected and potentially harmful event or a difficult developmental transition.  T/F
2. Sudden loss of a job or status is an example of a dispositional crisis.  T/F
3. Crises result in disequilibrium, disorientation, and disruption.  T/F
4.  Lindemann and Caplan were opposed to community mental health clinics as sources of crisis intervention.  T/F
5. As described by Caplan, phase four of a crisis reaction may result in major personality disorganization and an emotional breakdown.  T/F
6. Cognitive theory is not helpful for crisis intervention work.  T/F
7. Crisis intervention is strictly short term and should never lead to further treatment.  T/F
8. Outreach counseling is usually inexpensive.  T/F
9. College and community educational programs can be helpful in the prevention of certain kinds of crises.  T/F
10. The ability to remain calm in an emergency is an important skill of the crisis intervention helper.  T/F

• Review newspaper and news magazine articles (that can be accessed from the Internet) about a recent local or international crisis or disaster.
• Ask students to find web sites that are helpful in understanding crisis prevention and intervention, as well as disaster relief programs.  Consider:

International Federation of Red Cross and Red Crescent Societies:        www.ifrc.org

American Foundation for Suicide Prevention  www.afsp.org/index-1.htm

American Association of Suicidality       www.suicidology.org

United Nations High commissioner for Refugees            www.unhcr.ch/