The Crisis Intervention
Approach
By: Kharel B. Patentis
The Crisis Intervention Approach
Is an approach that is being used with individuals, families, groups and
communities that are in a state of disequilibrium because of a crisis they have
experienced. Social workers are now doing a great deal of crisis-related work in
their practice. The term “CISD” or Crisis Incident Stress Debriefing which is a form
of crisis intervention has bedame popular in the country and many social workers
are being trained in it because it has been found to be very helpful particularly for
victims of natural disasters.
What is Crisis?
A crisis is an “upset in a steady state” an emotional reaction on the part of the
individual, family, or group to a threatening life event. In a state of crisis, there is a
temporary disturbance in one's equilibrium resulting in the immobilization of
problem-solving abilities and other aspects of daily functioning.
The following are the main elements of a crisis:
1. Stressful event or precipitating stress,
A. A hazardous circumstance or experience (
an accident, the sudden death of a loved
one, a natural disaster)
B. A developmental/ maturational stress (
puberty, entering school, becoming a
parent, going through menopause, retiring)
C. A transitional, situational stress ( getting
leaving or losing a job, relocating,
separating form a husband)
2. Perception of stress, it os a threat to
important life goals, security, or a affectional
needs.
3. Response phase characterized by an acute
period of disequilibrium manifested in rising
tension; marked discomfort and disturbance in
thinking, feeling and day-to-day behaviour;
dusruption of familiar routines; over-burdenes
coping capacities; feelings of helplessness and
inability to manage within the predictable future;
feelings of considerable pressure and anxiety.
4. Resolution phase
The problems caused by the stressful event are resolved adaptively or
maladaptively depending on the nature and perception of the stressful event, the
coping and response patterns of those affected, and the availability of support and
problem solving resources.
Crisis Intervention
Crisis intervention is a process for actively influencing the psychosocial
functioniong of individuals, families and groups during a period of acute
disequilibrium. The aim is to help these systems, through differential assessment
and intervention techniques, to move toward adaptive and away from maladaptive
resolution.
Characteristics of Crisis Intervention
Crisis intervention involves crisis-oriented, time-limited work. It should be readily
available and properly timed in order to be effective. This means making help
accessible within 24 to 72hours of the request or “cry for help.” Since prompt
intervention is necessary, there should be no intake procedures and no waiting
lists and no transfer of workers.
The Assessment Planning-Intervention
Or ( Study-Diagnosis-Treatment) sequence is not always followed because the
urgency of the person's undertaken.
Participation in the helping process is usually voluntary and client system is
supposed to have a reasonable commitment to it. Since most crisis states are
limited to four to six weeks, a minimum of six sessions of crisis, intervention work
with individuals is seen an adequate.
Two major goals of crisis intervention:
1. To cushion the immediate impact of the
disruptive stressful event
2. And to help those directly affected as well as
significant others in the social environment
mobilize and use their psychosocial capabilities,
interpersonal skills, and social resources for
coping adaptively with the effects of stress.
PHASES IN CRISIS INTERVENTION
A. Assessment
This involves an evaluation of the five components of a
client’s situation to determine whether a crisis exists and what
its current status is.
B. Implementation
The “middle phase” is about setting up and working out
specific tasks(primarily by the client, but also by the worker
and significant others) designed to solve specific problem in
the current life situation, to modify previous inadequate.
Golan presents two of tasks involved in Crisis
Intervention which maybe carried out concurrently:
1. Marital-arrangement tasks
Which are concerned with the provision of concrete
assistance and services(recall resource provision as a generic
interventive role of social workers);and
2. Psychosocial tasks
Which are concerned with dealing with client’s feelings,
doubts, ambivalences, anxieties, and despair, which arise while
trying to carry out what both worker and client agree needs to be
done.
The following treatment techniques are used in the Crisis
Intervention approach:
●
●
Sustaining techniques with reassurance and
encouragement predominant to lower anxiety, guilt,and
tension, and to provide emotional support.
Direct influence procedures like giving advice(particularly
when the client is feeling overwhelmed and need help in
choosing a course of action);advocating a particular
course of action; and warning clients of the consequences
of maladaptive resolution of the situation.
●
●
Direct intervention in extreme situations such as
threats of or attempts at suicide or where the
client is deteriorating rapidly.
Reflective discussion techniques as the client
becomes more integrated, e.g., of her current and
recent past situation and patterns of interaction.
C. Termination
●
As the end of the time-limited helping relationship
nears worker and client review their progress,
focusing on the key themes and basic issues.
Target Population
Crisis intervention with groups would have the
following as targets of assistance:
1. Individual in crisis(e.g. victims of rape and domestic
violence)
2. Those in collective crisis(e.g. victims of natural
disasters);and
3. Those associated with persons in crisis(e.g.
professionals and volunteers helping people in
crisis).
ADVANTAGE OF GROUP CRISIS INTERVENTION
1.
2.
3.
4.
5.
The crisis group allows the ventilation of feelings and
emotions in the presence of others in the same situation;
Group support helps to assuage pain and offers hope;
Group sharing helps to mobilize personal strengths and
resources;
Group participation makes for mutual assistance in
considering alternative ways of coping with the crisis; and
Group members help each other in identifying community
resources that may be needed for problem solving.
SPECIAL FEATURES OF CRISIS INTERVENTION
GROUPS
Membership may be open or closed,depending on the
situation and need.
2. There is no rule about group size,but membership ranging
from four to twelve is considered more manageable
3. Groups are time-limited,usually up to six sessions per
person(our sources however,admit that there is no “magic” in
this six weeks patter,and that there are many variations in
practice,from marathon weekend groups to weekly sessions
over six to twelve weeks,depending on expediency and worker
style).
1.
SPECIAL FEATURES OF CRISIS INTERVENTION
GROUPS
4.
5.
6.
Group process is usually accelerated in a crisis group
because of the sense of urgency inherent in crisis and
the constraint of time limits.
The worker assumes a very active directive role in order
to hold on to the goal of the crisis group which has to be
achieved within a tight time structure.
Individual assessment of group members is necessary
because individuals differ in terms of vulnerability to crisis
and crisis-coping ability.
THE 4-STEP
APPROACH IN
GROUP CRISIS
INTERVENTION
Step 1. The Search for
the Participating Event and
Its Meaning to the Client
1. When did the discomfort begin, or when
did the client start feeling worse?
2. What recent change represents a threat
to instinctual needs, or threatened or actual
loss of a significant role relationship? How
does the client interpret this event
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3. What reminders have there been of a
previous situation that was upsetting?
4. Why is the client coming for help now?
5. What non-verbal cues as to affect the
impact of current distress does the client
exhibit in discussion of recent and past
events?
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Step 2. The Search for
Coping Means Utilized by the
Client
1. What has the client tried to do to cope with the
stress produced by the participating event?
2. What means of coping did the client use in the
past to cope with similar situations?
3. Why is there a lack of “fit” between the
particular dilemma(problem-to-be-solved) and the
coping means the client has employed?
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Step 3. The Search for
Alternative Ways of Coping
that Might Better Fit the
Current Situation
1. What different approaches to modifying the
problem might be feasible to try out?
2. What outside resources might be needed and
tapped for helping to resolve the
problem/dilemma?
3. What new plan for action can be tested out
now?
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Step 4. Review and
Support of Client’s Efforts to
Cope in New Ways;
Evaluation of Results
1. What worked, what did not work,in client’s
experimentation with new approaches to solving
the problem?
2. What additional efforts might pay off?
3. When does the client begin to show signs of
relief, improved ego functioning, and readiness to
carry on alone?
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CRISIS INCIDENT
STRESS
DEBRIEFING
Reporter: ANGEL D. MANGURAY
Crisis Incident Stress Debriefing
The “CISD” is a form of crisis intervention that has
been found helpful to many Filipinos in collective
crisis caused by natural disasters like
earthquakes and floods.
-is a preventive stress management strategy
designed to assist affected people in handling
normal severe stress.
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The affected people are victims, who may
classified as:
1.
2.
3.
Direct victims: those hurt or injured, or who
escaped harm;
Indirect victims: family, friends and others
identifying with the direct victims.
Hidden victims: the crisis workers, helpers or
rescuers who are “silent sufferers “ though not
directly affected by crisis.
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CISD is tool to achieve the following
purposes:
1. Assist victims to deal positively with the
1
emotional effects of a severe stressproducing event.
2. Provide education about current and
anticipated stress responses
3. Provide information and support for
coping and stress management.
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How is CISD done?
A. Administrative Preparation
1.Timing. It is preferred that CISD be held immediately
after the critical incident for three to four hours.
2. Physical arrangements. The group should be small
enough- ideally, not more than 10 participants- so that
everyone has a chance to speak and be listened to.
There should be uninterrupted use of room/space during
the CISD sessions and also privacy and reasonable
noise levels to allow intent listening.
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Continuation…
3. Facts of the critical incident. The facts of the
incident and the roles of the participants should be
ascertained.
4. The debriefing group. The composition of the
debriefing group should be discussed. As much as
possible, individuals, with the same experience should
be grouped together.
5. Announcements of debriefing. Assistance should be
offered in preparing debriefing announcements.
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B. The “CISD” Process
Phase I. Start-Up
1.
Introduction of the participants.
The worker/facilitator welcomes the participants introduces
herself (and the co-facilitator, if any) and the members of the
group (self- introductions can also be done. The need for
participation is emphasized, i.e., for each one to express
thoughts, feelings and reactions to the critical incident, and to
listen to each other . She points out the importance of
confidentiality.
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2. Conduct of a 5-minutes experimental exercise.
The following instructions are given to the group:
a. Close your eyes, breathe in , breathe out ( slowly, RELAX)
b. Recall a crisis experience in your personal life or work (if the
group has just gone through a collective experience, the group is
instructed to recall the recent crisis that happened. )
c. Think of scenes from that experience and notice that feelings
that return in relation to the experience (5 minutes of silence is
allowed, then group members are instructed to open their eyes
but to remember the event and the feelings associated with it. )
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Phase II. Sharing the Crisis/Stressful
Experience
1. The worker/facilitator asks each participant:
a. What happened to you ?
b. How did you feel then ?
c. How do you feel now ?
2. The worker/facilitator identifies a participant who is ready to
share or who seems to be in need to talk and share with the
group. If there are no volunteers, the worker can give an
example by briefly sharing her own experience similar to the
shared critical incident.
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The worker/facilitator mentions that each participant
is given 10 to 15 minutes to share (the time limit
depends on the group size. )
▪︎ Identify for appropriate referral participants who
show signs of serious stress reactions or who
experienced something in the past which has not
been resolved.
▪︎ Elicit feelings instead of facts surrounding the
experience;
▪︎ Encourage everybody to share
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continuation….
▪︎ Take note of stress reactions while the
participants are sharing ( i. e., physical,
emotional, cognitive, behavioral and spiritual
aspects) to prepare for the discussion of their
Stress Responses and Reactions.
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4. After sharing, the worker/facilitator
compliments the group members for their
openness and willingness to share their
thoughts, feelings and reactions. It would be
helpful to do the following at this point:
▪︎ Point out the commonality of the participants,
responses, and that their feelings and reactions
are normal reactions of normal people exposed to
an abnormal situation ml.
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▪︎ Comment how the sharing has recreated the
critical incident in the room, with the group reexperiencing the tension of the past.
▪︎ Conduct breathing exercises, e.g.,
a. The Noisy Sigh, a quick and easy method of
discharging tension (The worker illustrates the
deep breath, breathing in, then exhaling with a
sound while relaxing the shoulders; she invites the
group to do likewise, then comments on the
release of tension that is achieved.
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b. Optional Breathing Exercise
(The worker instructs the participants to close their
eyes and breathe naturally without any extra effort
but just to heighten their awareness of the flow of air
in and out of their nostrils; this is maintained for a
few minutes. )
The worker declares a short break ( refreshments
may be served. )
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Phase III. Understanding Symptoms /Stress
Responses
1. The worker/facilitator leads the participants in
an interactive discussion of their stress
responses during and after the critical incident,
at home, at school, or at work and further elicits
other stress responses through questioning.
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2. The worker guides the group in categorizing
the responses shared through the following
questions:
a. Do you see similarities and differences in these
responses ?
b. Is it possible to group some of the responses
together ?
C. What responses do you think are related to our
body, feelings, behaviors, etc. ?
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Based on their responses, the worker points
out that there are four types of stress
responses which show that an individual’s
body, feelings, thoughts, and actions can be
affected by a crital incident, and that these can
interfere with or impair one’s functioning (a fifth
category , spiritual stress responses has been
reported to have emerged from CISD sessions
in the country. )
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What are the Stress Responses ?
a. Physical Stress Response: responses that
relate to bodily functions (e.g., loss of energy,
palpitations, headaches, muscle aches,
dizziness, etc.)
b. Emotional Stress Response : responses
that relate to feelings affected by the incident
(e.q., fear, anger, shock, panic, depression,
worry, sense of helplessness)
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c. Cognitive Stress Response : responses that
indicate how the stress affects the way the participants
think (e.g., concentration problems, absent- mindedness,
confusion, difficulty in making decisions, thoughts of
death. )
d. Behavioral Stress Response : responses that
show the effects of the stress on the behavior of
participants (e.g., running, screaming, shaking, being
hysterical, withdrawal, sleep difficultly, crying,
irritability.)
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e. Spiritual Strength Response:
Responses that relate to, the spiritual
dimension (e.g., feelings and attitudes
about and toward God or a Supreme
Being .)
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Phase IV. Understanding Grief and Loss
1. The worker/facilitator elicits the participants’
concept of loss (It should be stressed that loss
does not mean only death of an important
person in one’s status, reputation, separation
from loved ones, and impaired physical,
social or psychological functioning. )
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2. The worker explains that when we lose
something/someone important, we go
through a grieving process as a five-part
reaction which consists of denial,
bargaining, anger and frustration,
depression/sadness,
acceptance/resignation.
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3. The worker helps the group to deepen their understanding
of crisis (the worker shares the “basics” that she knows about
crisis; she emphasizes that if a crisis is well managed, growth
to a stage of competence higher than the pre – crisis period
may occur; however; if damage has occurred , return to pre –
crisis functioning may not immediately follow; making
contingency plans will prevent, control or limit possible
damage and shorten the trial and error period leading to a
quicker resolution)
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Phase V. Coping with Stress
1. The worker/facilitator asks the participants
what they did or are doing to cope with the
stressful situation (she takes note of their
coping responses, their similarities and
differences; she helps the participants to
identify the most and least effective coping
behaviors; she asks them to explain why.)
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2. The worker emphasizes that their coming to
the group session is a form of coping by using
communication among them.
3. The worker points out that stress can be
managed without the use of pills , cigarettes,
alcohol or other drugs. She shares the following
basic stress management strategies: (a)
exercise; (b) proper nutrition, (c) rest and
relaxation time; (d) Spiritual/praying.
Phase VI . Planning for a Contingency
The worker/facilitator asks the group about their
plans after the incident. They may have personal
plans for the family, work, school, community, the
group, etc. They may now want to be prepared in
case another earthquake/flood/fire occurs by
securing money/documents/ jewelry, etc. or by
having disaster exercises; they may want to replicate
the CISD with other groups; if death occurred, the
group may want to plan for memorial events.
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Phase VII. Summarizing and Evaluating
1. The worker/facilitator asks the participants to review their CISD
experience. She lets them comment if anything has been missed
in the discussion; if the session was helpful and if so, in what way
and how they felt after the session.
2. The worker summarizes discussion on ways in which
participants can help themselves ( she emphasizes the need to
accept the current situation, to develop short term goals, and to
promote self-care )
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Team Presentation
Thank
You !
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