CRISIS INTERVENTION
Introduction
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Situational crises are usually sudden, unexpected, often life-threatening time-limited events
that may overwhelm an individual’s capacity to respond adaptively.
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Extreme stressful stressors may result in personal crises, traumatic stress, and even
Posttraumatic Stress Disorder (PTSD).
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A crisis occurs when a stressful life event overwhelms an individual’s ability to cope
effectively in the face of a perceived challenge or threat.
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During critical situations/incidents people’s psychological homeostasis are said to have been
disrupted; their usual coping mechanisms have failed to re-establish homeostasis; and, the
distress produced by the crisis has yielded some evidence of functional impairment.
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Traumatic crises may occur in the face of actual or threatened death, serious injury, or some
other threat to the victim’s physical integrity. Individuals may also be victimized by
witnessing these events occurring to others. Crises may also emerge as the result of a
contradiction to some deeply held belief.
Frequently, victims of these traumatic events experience disruptions in reasonable mastery of
the environment, in caring attachments to others, and in sustaining a purposeful meaning in
life
Victims may also experience the common symptoms of hyper-vigilance, sleep disturbance,
intrusive recollections of the event, and a tendency to withdraw from full participation in
daily activities
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Hyper-vigilance is a condition associated with PTSD and it refers to the experience of being
constantly tense. The person experiencing hyper-vigilance is motivated to maintain an
increased awareness of his surrounding environment, sometimes even frequently scanning
the environment to identify potential sources of threat. Hyper-vigilance is also often
accompanied by changes in behavior, such as always choosing to sit near the exit.
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The impact of traumatic events may be profound and may last until death if these events are
left untreated.
Crisis Intervention
Crisis intervention is defined as the provision of emergency psychological care to victims so as
to assist those victim’s in returning to an adaptive level of functioning and to prevent or mitigate
the potential negative impact of psychological trauma.
The goals of crisis intervention are:
1) Stabilization, i.e., stopping the rising of distress;
2) mitigation of acute signs and symptoms of distress; and,
3) Restoration of adaptive independent functioning, if possible
Basic principles of crisis intervention
Immediacy of interventions. Crises are emotionally hazardous situations that place
victims at high risk for maladaptive coping. Crisis intervention may be thought of as
urgent and acute psychological intervention to prevent victims from adopting negative
coping strategies of developing psychological disorders.
- Stabilize. One important immediate goal is the stabilization of the victims or the victim
community actively mobilizing resources and support networks to restore some
semblance of order and routine. Such a mobilization provides the needed tools for
victims to begin to function independently.
- Facilitating understanding. Another important step in restoring victims to pre-crisis level
of functioning is to facilitate their understanding of what has occurred. This is
accomplished by gathering the facts about what has occurred, listening to the victims
recount events, encouraging the expression of difficult emotions, and helping them
understand the impact of the critical event.
- Promoting problem-solving skills. Actively assisting victims to use available resources to
regain control is an important strategy. Assisting the victim in solving problems within
the context of what the victim feels is possible enhances independent functioning.
- Encourage self-reliance. Related to active problem-solving is the emphasis on restoring
self-reliance in victims as an additional means to restore independent functioning and to
address the aftermath of traumatic events. Victims should be assisted in assessing the
problems at hand, in developing practical strategies to address those problems, and in
fielding those strategies to restore a more normal equilibrium.
Components of crisis intervention
There are three components involved in crisis intervention:
(a) The unmanageable situation (crisis)
Disastrous situation e.g. an individual or group of people is/are unable to deal with
effectively (crisis).
(b) The individual or group experiencing crisis
A stressful event alone does not constitute a crisis; rather, crisis is determined by the
individual's perception of the event and response to it. A crisis results from a person's
negative perception of a situation.
If the individual sees the event as significant and threatening, has exhausted all his/her
usual coping strategies without effect, and is unaware of or unable to pursue other
alternatives, then the event may push the individual toward psychological disequilibrium
(a state of crisis).
Psychological disequilibrium may be characterized by feelings of anxiety, helplessness,
fear, inadequacy, confusion, agitation, and disorganization.
The person(s) should receive timely and skillful support to help him/her/them cope with
his/her/their situation before physical, psychological or emotional deterioration occurs.
(c) The persons who provide support (counselors, health workers, social workers, etc.).
Psychologists, counselors, social workers, mental health personnel, and therapists trained
to provide services to individuals in crisis.
Can assist person(s) in crisis by providing direct intervention, by identifying alternative
coping skills, or by consulting with others.
The primary goals of the helpers are to (1) identify, assess, and intervene; (2) to return the
individual to his/her prior level of functioning as quickly as possible; (3) to lessen any
negative impact on future mental health, and (4) to help the person acquire new skills and
coping mechanisms leading to positive behavioral change.
Crisis intervention process
An effective intervention plan requires identification and assessment of the nature and magnitude
of the crisis event/situation, and its impact on the individual or group of people, before the actual
intervention starts.
Identification
Identification focuses on:
1) the event's significance in the person's environment, and
2) the person's current functioning.
The counselor needs to establish the nature of the crisis situation. Is it a developmental crisis or a
situational one? Developmental crises are those that result from predictable changes due to
normal human growth or development, e.g. the onset of adolescence, while situational crises are
either predictable, arising from certain events, such as divorce, or are unpredictable, such as an
accidental death or natural disaster e.g. the Bududa landslides. Both types involve a change in
circumstances, usually accompanied by a loss, which can lead to a crisis reaction in an
individual.
Crisis counselors and other service providers (helpers) should promptly identify a person in crisis
by the symptoms exhibited by the victims. These symptoms could be physical such as changes in
overall health, energy, or activity level, as well as in eating or sleeping patterns. Emotional signs
may include increased tension or fatigue, and changes in temperament, such as angry outbursts
or depression. Behavioral signs such as the inability to concentrate, being preoccupied with
certain ideas, or social withdrawal may also indicate a person in crisis.
Assessment
After identifying a crisis situation and the person in crisis, workers assess the crisis's impact on
the individual(s). Information upon which to base the assessment is obtained through
observations and interviews, during which the worker strives to convey an atmosphere of
acceptance, support, and calm confidence about the future. Communication with the person
experiencing a crisis is very important. This involves establishing eye, and sometimes, physical
contact.
Questions addressed to the individual may include his/her perception of the problem, the
frequency and sequence of events, his/her feelings, and a history of attempts to deal with the
problem. Forced choice or open-ended questions may be used to assess the individual's ability to
communicate, as he/she may experience difficulty in expressing him/herself, in making
decisions, or in solving problems.
Assessment may include what the individual is saying as well as his/her nonverbal
communication, i.e., facial expression, posture, body and eye movements, and mannerisms. An
essential part of this assessment is an evaluation of the person's current safety as well as any risk
to his/her own or someone else's life. Additionally, factors such as alcohol and drug use, current
stress level, and emotional affect, such as hopelessness and helplessness, should be identified.
Intervention
After identification and assessment of the crisis and the person involved, the intervention occurs.
Points to consider while intervening:
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First, while supporting and empathizing with the individual in crisis, listen and allow the
individual full and open expression of feelings and emotions.
Secondly, the counselor or worker needs to have a good understanding of and respect for
the cultural values of the individual(s) in crisis for rapid, effective, and sensitive
treatment of emergency situations. The information clarifying the incident and
highlighting the social and cultural factors relevant to the crisis is obtained from the
victim
Thirdly, counselor or worker develops an awareness of the significance of the crisis from
the individual's point of view.
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Fourthly, mutual brainstorming of alternatives and discussion of available resources are
jointly carried out by the individual in crisis and the worker. At this point, the worker
may need to be more directive, by focusing on the current situation, proposing ideas and
strategies for action, as well as suggesting other resources for support, instead of just
listening and reflecting.
Fifth, the individual in crisis and the counselor/worker choose specific, time-limited goals
which take into account the person's relatives and other people important to him, social
network, culture, and lifestyle. Complete planning, including recognition of all the steps
involved, as well as consideration of any barriers to success, should be completed before
the solution is attempted. Some brief education, modeling, role playing or rehearsal of
potential situations may be done in this step to empower the individual further.
Sixth, the counselor/worker and individual implement their plan and, if possible, evaluate
its effectiveness. They then adjust the plan as necessary.
Seventh, the worker provides for follow-up or refers the individual in crisis to a resource
that can provide ongoing support. The worker then terminates the established crisis
relationship.
Assignment questions
1. By applying one theoretical perspective and utilizing relevant examples discuss the view
that crises are a response rather than an environmental stimulus. How can a psychologist
mitigate the impact of death as stressor in the home on a grieving individual?
2. Justify the use of one counseling approach for family members whose home has been
destroyed by fire. How can you account for the differences in their reaction to the
incident and loss?