Crisis Application Assignment 1

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Chapter One Basic Training

Crisis Intervention Theory and Application

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.

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.

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

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.

Crisis response grows from all-volunteer efforts to bureaucratic institutions as the need for organization grows

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).

Influence of the Media

The media has a significant influence on public consciousness.

Matthew Brady’s Civil War photographs brought war images into the public discourse.

Real-time news coverage of crisis events impacts our perceptions of an small, interconnected world in both positive and negative ways.

POSITIVE: public recognition about crisis intervention

NEGATIVE: people may rush in to help haphazardly

The Case Against Too Much “Helping”

The reality is that in most instances, victims of disaster are resilient and 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.

There is an assumption that experiencing a disaster will invariably lead to psychopathology.

“Trauma tourism”-when people travel to disaster scenes to provide unrequested assistance or to gawk at survivors.

Definitions of Crisis (1 of 2)

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.

Behavioral emergency-when a crisis escalates to immediate danger for injury or death to someone involved in the crisis.

Parasuicide-when a person in crisis accidentally or intentionally places themselves in a position to be killed.

Definitions of Crisis (2 of 2)

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.

Primary Prevention-stopping a problem before it starts.

Secondary Intervention-minimizing the harmful effects that have already occurred.

Characteristics of Crisis (1 of 2)

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 (2 of 2)

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

Crisis interventionists try to tap into people’s natural ability to get on their feet and move through a crisis.

Perception

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

Complicated symptomology

Crisis is complex and defies linear causality.

Transcrisis

The events immediately following the crisis have a large impact on the duration.

A crisis event may seem to be resolved, but may actually be submerged into the survivor’s unconsciousness.

A transcrisis state occurs when unresolved issues from a previous traumatic event resurface because of a current stressor.

Transcrisis is not synonymous with PTSD.

PTSD is an a DSM-5 defined anxiety disorder resulting from a crisis

Transcrisis is the re-emergence of crisis symptoms from some unresolved prior crisis event.

Transcrisis Points

Can be seen as therapeutically progressive and are frequently characterized by approach-avoidant behavior toward change.

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.

Theories of Crisis Intervention

No single theory is 100% comprehensive.

Three major theories

Basic Crisis Theory (Lindemann, Caplan)

Expanded Crisis Theory (theoretically integrative)

Applied Crisis Theory (Brammer)

Basic Crisis Theory (1 of 2)

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

Basic Crisis Theory (2 of 2)

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 attempts to remediate ongoing emotional issues

Basis Crisis Theory assists individuals in crisis and addresses their affective, behavioral, and cognitive distortions resulting from the traumatic event.

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 and relationships among people and between people and events.

Ecosystems

Extension of systems theory to include an environmental context

Theories that Influence Expanded Crisis Theory

Adaptational Theory

Crisis 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 human functioning as a self-organizing system.

Developmental Theory

Potential for crisis arises from developmental tasks that are not accomplished.

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

Four Domains of Applied Crisis Theory

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)

Crisis Intervention Models

Basic models of crisis intervention

Equilibrium model

Cognitive model

Psychosocial transition model

Models based on Ecosystemic Theory

Developmental-ecological model

Contextual-ecological model

Models based on field-based practice

Psychological first aid

ACT model

Game Plan model

Basic 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.

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.)

Field-based Models (1 of 2)

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 (2 of 2)

ACT Model

Assessment of presenting problem.

Connecting clients to support systems.

Traumatic reactions and posttraumatic stress disorders.

Game Plan Model

Developed for police-based crisis intervention

Based on coaching first responders in the use of defusing and de-escalation techniques

Integrated Crisis Theory

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

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