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Ch. 1 Approaching Crisis Intervention

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Michael Taub

on 20 May 2014

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Transcript of Ch. 1 Approaching Crisis Intervention

©2013, Brooks/Cole Cengage Learning
Chapter One
Basic Training:
Crisis Intervention
Theory and Application

©2013, Brooks/Cole Cengage Learning
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
Field-based Models
©2013, Brooks/Cole Cengage Learning
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.)
Ecosystemic Models
©2013, Brooks/Cole Cengage Learning
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
Not being locked into any theoretical approach in a dogmatic fashion
Crisis Intervention Models
©2013, Brooks/Cole Cengage Learning
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
Applied Crisis Theory
©2013, Brooks/Cole Cengage Learning
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.

Extension of systems theory to include an environmental context
Expanded Crisis Theory
©2013, Brooks/Cole Cengage Learning
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
No single theory is 100% comprehensive.

Three major theories
Basic Crisis Theory
Expanded Crisis Theory
Applied Crisis Theory
Theories of Crisis Intervention
©2013, Brooks/Cole Cengage Learning
Historically, crises have typically been seen as time-limited; 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.
Transcrisis States
©2013, Brooks/Cole Cengage Learning
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.
Characteristics of Crisis
©2013, Brooks/Cole Cengage Learning
“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.
The Case Against Too
Much “Helping”
©2013, Brooks/Cole Cengage Learning
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
Crisis Intervention as a
Grassroots Movement
©2013, Brooks/Cole Cengage Learning
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
Quick mental reflexes
Characteristics of Effective
Crisis Workers

©2013, Brooks/Cole Cengage Learning
ACT Model
Assessment of presenting problem.
Connecting clients to support systems.
Traumatic reactions and posttraumatic stress disorders.
©2013, Brooks/Cole Cengage Learning
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
Eclectic Model
©2013, Brooks/Cole Cengage Learning
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.
Traditional Models
©2013, Brooks/Cole Cengage Learning
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
Adaptational Theory
Crisis response is sustained through maladaptive behaviors.

Interpersonal Theory
A state of crisis can not be sustained when people believe in their ability to overcome the crisis.

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
Based on a psychoanalytic approach to crisis.

Behavioral responses related to grief are normal, temporary, and can be relieved with short-term intervention techniques. This negates the perception that clients in crisis should be treated as abnormal or pathological.

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
Basic Crisis Theory
©2013, Brooks/Cole Cengage Learning
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--they are unpredictable.

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.
Transcrisis Points
©2013, Brooks/Cole Cengage Learning
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.

Successful crisis work may be described as tapping into the client's reservoir of resiliency

It is the perception, not the event, that causes distress.

Complicated symptomology
Crisis is complex and defies linear causality.
©2013, Brooks/Cole Cengage Learning
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.
Definitions of Crisis
©2013, Brooks/Cole Cengage Learning
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.
Transition from a Grassroots Movement to a Specialty Area
©2013, Brooks/Cole Cengage Learning
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.

That means that volunteers provide a majority of crisis services
The Importance of Volunteerism
©2013, Brooks/Cole Cengage Learning
National Save-a-Life 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.
Brief History of
Crisis Intervention
Full transcript