Crisis Theory and
Intervention
SOW6425 Assessment and
Planning
Professor Nan Van Den Bergh
THE NATURE OF CRISIS
• A crisis is the perception of an experienced event as an
intolerable difficulty
• A crisis is an “upset in a steady state….” ( from a previous
equilibrium)
• A person experiencing a crisis may be lacking:
• knowledge about how to manage the situation (cope)
• ability to focus and utilize her or his strengths
• A crisis often results when we face a serious stressors:
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Biological ( illness, disability, loss of prior physical functioning)
Psychological (a sense of loss of esteem, self worth) important
relationship ending)
Social (ending of valued relationship/s)
Economic (economic insecurity, poverty, layoff, etc )
STAGES OF A CRISIS
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There is a sharp and sudden increase in the person’s level
of tension.
The person tries to cope, but fails, experiencing stress
• tension increases and contributes to the sense of being
overwhelmed.
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The crisis resolves (normatively within 4 to 6 weeks):
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negatively (with an unhealthy coping solution)
positively (with successful management leading to enhanced
sense of personal competence)
With prior level of functioning intact
A PERSON’S RESPONSE TO A CRISIS
• The growth pattern - the client recovers from the event
and then develops new skills and strengths.
• The equilibrium pattern - the client returns to the precrisis level of functioning
• The frozen crisis pattern - the client does not improve.
New coping strategies may be harmful such as:
• Withdrawal
• Self destructive behaviors
• Violence
TYPES OF CRISES
• Developmental crises occur in the normal flow of life as
significant changes in life status:
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college graduation
marriage/committed partnership
birth of children
midlife career change
retirement from work
• Situational crises refer to extraordinary events that a
person has no way of forecasting or controlling
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physical injuries
sexual assault
loss of a job
the death of a loved one
Types of Crises (cont.)
• Existential crises are characterized by inner conflicts related
to:
• searching for a sense of meaning and purpose in life
• Experiencing remorse over past life choices,
• questioning of one’s basic values or spiritual beliefs
STRESS, COPING, AND ADAPTATION
• Stress is the emotional, cognitive, physiological and behavioral result
of an event in which environmental or internal demands exceed a
person's coping capacity.
• Psychological stress can be experienced as:
• Harm: effects of a damaging event that has already occurred
(victimization)
• Threat: potential for harm in the future (layoff, bankcruptcy)
• Challenge: appraisal of opportunity, not harm (downsizing)
• Coping is a person’s efforts to master the demands of stress. It
includes:
• thoughts, feelings, and actions that constitute those efforts.
• Adaptation involves adjustments the person makes in biological
responses, perceptions, or lifestyle.
BIOLOGICAL COPING - THE GENERAL
ADAPTATION SYNDROME
• Alarm - the body becomes aware of a threat
• Resistance - the body attempts to maintain or restore homeostasis.
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Endorphins and specialized cells of the immune system fight off stress
and infection
• Exhaustion - the body terminates coping efforts because of its inability
to physically sustain the state of disequilibrium.
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Cumulative wear and tear of stress episodes can gradually depletes the
immune system.
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Outcomes
include some physical and emotional disorders.
PSYCHOLOGICAL COPING
• Problem-focused coping to change the stressful
situation (cognitive problem solving strategies)
• This method is appropriate when we view the situation as
changeable or controllable via taking action.
• In emotion-focused coping (distancing, avoidance,
and reappraisal of the threat)
• The external situation does not change, but our behavior or
attitudes change with respect to it.
• Psychologically, the primary coping method
employed is denial and repression (emotional
numbing)
Relational Coping
• Relational coping takes into account actions that
maximize the survival or others
• Research has shown that within stressful
situations, rather that ”fight or flight” women may
be more likely to “gather the brood”
– Oxytocin is produced
SOCIAL SUPPORT
• Social support : interpersonal interactions and relationships that
provide people with assistance or positive feelings of attachment
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Family
Friends
Neighbors
• Material support: food, clothing shelter, transportation, other tangible
items or services
• Instrumental support: services provided by casual contacts, such as
grocers, hairstylists
• Support clusters - distinct categories of people such as the nuclear
family, extended family, friends, neighbors, school peers, work peers,
church associates, recreational groups
HOW SOCIAL SUPPORT AIDS COPING
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Nurtures and promotes an ordered worldview
Promotes hope
Promotes timely withdrawal and initiative
Provides guidance
Provides communication channels with the social world
Affirms personal identity
Provides material help
Modulates distress through reassurance and affirmation
Ensures adequate rest
Mobilizes other personal supports
Clinical Aspects of Crisis Assessment
• Rapid establishment of a constructive relationship:
• acceptance,
• empathy
• verbal reassurance
• Eliciting and encouraging the client’s expression of
feelings:
• reduces anxiety,
• promotes return to focusing,
• assists re-establishing a sense of calm
• Assessment is rapid but thorough enough to result in a
well-crafted plan.
Aspects of Assessment (cont.)
• Assessment includes:
• Investigating precipitating factors of the crisis
• Determining the meaning of the precipitating event
to the client
• Clarifying the client’s capacities for adaptive
functioning
• Determining the client’s potential and actual
support systems
ASSESSMENT QUESTIONS
• What factors can the client identify relative to the onset of
the crisis?
• What is the current quality of the client’s affective,
cognitive, and behavioral functioning?
• Which areas appear to be the most adversely affected?
• Is the client self-destructive?
• Does the client require immediate medical or psychiatric
attention?
• How does the client’s current level of functioning compare
with pre-crisis functioning?
ASSESSMENT QUESTIONS (Cont.)
• Has there been significant trauma, illness, pathology,
or substance abuse in the client’s past?
• What are the client’s strengths? Areas of life stability?
• What are the client’s realistic alternatives for
managing the distress?
• What are the client’s formal, informal, and potential
support systems?
• Are there financial, social, or personal impediments to
the client’s progress?
Crisis Interventions
• Two unique features of crisis interventions:
– Social worker's short term and intensive involvement with
client ( and others if needed)
– Worker’s active use of the environment in establishing
linkages plus concrete and social support
• Crisis interventions are adapted from other practice
theories: ego psychology, cognitive, behavioral,
solution-focused, narrative, structural family therapy
• Intervention is present-focused
• Clinical case management will almost always be
provided
Three Major Clinical Case Management
Tasks in Crisis Intervention
• Forge relationship and make positive connection
– Nature of the relationship will depend upon characteristics of the
client:
– Highly interactive
– Formal and distant
• Facilitate client moving from dependence to
greater self-sufficiency
• Alter the client's physical environment to
facilitate improved adjustment to crisis
Skills Needed for Clinical Case
Management in Crisis Intervention
• Recognize a client’s fluctuating competence
• Develop a realistic view of the client's strengths and
limitations
• Continue to reinforce client's strengths so the s/he can acknowledge and
utilize them
• Adjust levels of support to maximize a client’s capacity for
self-efficacy
– Facilitate client moving from dependency to greater self-sufficiency
• Determine the biological and psychological reaction to the
crisis
• Skills Needed for Clinical Case Management
in Crisis Intervention (cont.)
• Help the client’s significant others cope with the crisis
situation
• Appreciate the effects of social factors on a client’s sense of
competence
• Appreciate a client's conscious and unconscious motives for
behavior
• Maintain relationship boundaries during often-intensive work
• Provide agency, but not, personal phone number
• Clarify need to maintain appointments, not just “drop in”
• Provide information on how to access “emergency services”
INTERVENTIONS FROM EGO PSYCHOLOGY
• Ego-sustaining techniques help clients become mobilized to resolve their
crises and to understand their motivations and actions more clearly
• Sustainment
• Exploration-description-ventilation
• Person-situation reflection
• Education
• Direct influence
• Structuring (Partializing)
Interventions From Ego Psychology (cont.)
• Restoration of cognitive functioning techniques:
– Worker utilizes reflective statements regarding nature of
crisis and its meaning to client
– Normalizes the client’s experiences based on the nature of
the crisis and its meaning to the client
– Affirms the client’s capacity to “make lemonade out of
lemons”
INTERVENTIONS FROM BEHAVIOR THEORY (cont.)
• Life skills training
• Independent living
• Navigating systems
• Stress management training
• Breathing
• Progressive muscle relaxation
• Coping skills training
• Proactive communication
• Self-assertion
• Systematic desensitization
Intervention Strategies From Cognitive Theory
• Cognitive restructuring:
• the ABC review (event/thought/feeling)
• the point-counterpoint techniques (costs and benefits of
current beliefs)
• Cognitive coping via education and skills training:
• self-instruction: internal cognitive framework for instructing
themselves on how to cope with problem situations
• communication skills training: attention to clients’ social,
assertiveness and negotiation skills
Crisis Intervention Strategies From
Cognitive Therapy (con.t)
• Problem solving: structured five step method for clients who
don’t have to eliminate cognitive distortions
– Define the problem
– Brainstorm solutions
– Evaluating the alternatives
– Choosing and implementing an alternative
» Role play this for “trial run….”
– Evaluate the implemented option
TOPICS FOR DISCUSSION
• Share examples of crises that you or people you know have
experienced.
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What was the nature of the crisis?
How did the person (or group) respond, and what factors seemed to influence
the response?
• Psychological stresses can be categorized as involving harm,
threats or challenges.
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Identify examples of each of these stress perceptions as they are seen in
clinical practice.
How does the way in which the situations are perceived influence
clients’ reactions?
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Are client perceptions generally realistic in this regard?
• In this chapter crisis intervention strategies are described from the
perspective of six clinical practice theories.
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Consider the types of client presentations that would be suited to each of these
intervention perspectives.
ROLE PLAYS
Organize role-plays for each scenario in two parts. First, the social worker and
client are meeting for the first time. Second, the social worker and client have
met twice already and are now engaging in their final conversation (the client
may be terminating or referred to another provider for ongoing assistance)
A 52-year-old working mother with a spouse and two children (aged 25 and 20)
learns that she has pancreatic cancer and will probably not live through another
year.
A family of four (father, 46; mother, 45, and two daughters, 16 and 11) has lost
its home due to hurricane damage. They must break up temporarily to occupy
other living quarters (the homes of a friend and a relative, and a shelter).
An adolescent learns that his single father is going to prison. He will be living
with an aunt in another city whom he knows but is not close to.
After each role-play discuss the actions of the social worker, their rationales,
and their apparent effectiveness.