Chapter 3 - Crisis Intervention: A Unique Helping Process

Must balance a number of skills…

1. they must embody a number of unique characteristics.

2. they should employ the fundamental skills of helping while demonstrating the ability to discern the specific skills necessary at the time of the crisis and how these may be different than those typically employed in a counseling dynamic.

3. crisis interventionists must understand the theoretical underpinnings of crisis work

Characteristics of Crisis Counselors

1. Life experience

2. Poise

3. Creativity and Flexibility

4. Intellectual Quickness

5. Energy, Resilience, and Optimism

6. Multicultural Competence

7. Balance of Optimism and Realism

8. Courage

9. Identifying Client Strengths

Identifying Client Strengths

In order to help clients overcome the negative impacts of a crisis. It is important that the helper be adept at identifying the strengths a client possesses and encourage the client tap into those strengths during the helping process.

Courage

Working in a crisis situation can often be frightening. Showing courage in the face of fear can often serve as a modeling technique for clients.

Balance of Optimism and Realism

ln order to be effective, the crisis interventionist must believe in the ability of the client to grow and overcome the effects of the crisis. At the same time, a crisis is a real event, full of danger and difficulty.

Multicultural Competence

it is necessary for crisis workers to understand how culture influences reactions to crises and how the helper can be culturally competent in providing interventions.

Energy, Resilience, Optimism

Working with people during a crisis event, such as a disaster, requires the ability to find untapped personal energy and optimism in the face of difficulty.

Intellectual Quickness

Time is critical during a crisis. The helper should be able to think quickly and adapt to the constantly changing context of a crisis. This intellectual quickness is also related to the ability to be creative and flexible.

Life Experience

A host of life experiences tend to allow the crisis worker to be more empathetic with the client in crisis, in addition to developing a sense of maturity that is important in this work.

Poise

Crises often cause disequilibrium. While this experience is subjective by definition, often, a crisis can impact people who experience it. Being able to remain calm under pressure is important.

Creativity and Flexibility

In the midst of an emergency or a disaster, knowledge learned in textbooks or skills learned through experience often must be adapted or abandoned altogether. The ability to be creative and adaptable can be extremely helpful during a crisis.

Focus of Crisis Work

Resolve immediate concerns & develop short-term coping skills

Focus of Long-Term Therapy

Resolve life goals through the development of measurable objectives

Goal of Long Term Therapy

Provide long-term strategies for resolution of life stressors

Client Intent of Long Term Therapy

Change behaviors, cognitions, affect

Strategies of Long Term Therapy

Individual or group therapy

Nature and Time of Long Term Therapy

Long-term, non-directive

Interventionist of Long Term Therapy

One helper who works individually with client or in small groups

Approaches of Long Term Therapy

Development of therapeutic alliance based on theory

Goal of Crisis Work

Reduce immediate stress & incapacitation. Return to environment with coping skills

Client Intent of Crisis Work

Return to normal

Strategies of Crisis Work

Psychoeducation and symptom management

Nature and Time of Crisis Work

Short-term, directive

Interventionist of Crisis Work

Often multiple helpers who interact with the client at different times/places

Approaches of Crisis Work

Employs multiple forms of intervention based on context and circumstances

Primary Prevention of Crisis

• the goal of the intervention is to be intentional and proactive in attempting to prevent a crisis situation from occurring.

• Primary prevention occurs prior to a crisis event, and is intended to educate or prepare individuals in order to avoid the negative experience. 

Secondary Prevention of Crisis

aimed at engaging with individuals who may be at risk for developing crisis-related symptoms after a precipitating event so as to mitigate the impact of the event and prevent negative outcomes.

Tertiary Prevention of Crisis

a method of intervention that occurs after individuals find themselves in Crisis but is intended to mitigate the effects and return people to a state of relative equilibrium as quickly as possible.

Question, Persuade, Refer

The idea behind this evidenced-based training program is to educate and prepare anyone to intervene with a suicidal person. The program helps to educate laypeople on the signs of suicidal ideation, as well as provide intervention strategies for helping people and referring them to mental health resources.

Behavioral Intervention Teams or Threat Assessment Teams

BITs and TATs are comprised of faculty, counselors, student service professionals, Deans of Students, and others. These teams collect data on concerning student behavior to identify students who may be at risk to themselves or others. 

SAFE-R

1. stabilization of situation

2. acknowledgement of crisis

3. facilitation of understanding

4. encouragement of adaptive coping

5. referral or restoration of independent functioning

stabilization of situation

the helper attempts to mitigate emotional escalation, remove the individual from stressors, and meet basic needs. 

acknowledgement of crisis

interventions are aimed at encouraging catharsis and reducing emotional arousal.

facilitation of understanding

works with client to conceptualize their reactions as a normal response to an abnormal situation

encouragement of adaptive coping

teaching the client basic crisis management skills in an effort to improve short-term coping strategies.

referral or restoration of independent functioning

stage includes assessment of the client’s functioning as adequate or requiring referral to longer-term care.

Acute Traumatic Stress Management

• Assess for Danger/Safety for Self and Others

• Consider the Mechanism of Injury

• Evaluate the Level of Responsiveness

• Address Medical Needs

• Observe and Identify

• Connect with the Individual

• Ground the Individual

• Provide Support

• Normalize the Response

• Prepare for the Future

Prepare for the future

Review the event, bring the person to the present, describe possible future events, and provide referrals, aS necessary.

Normalize the Response

Normalize, validate, and educate. Remind the individual that the response is a normal response to an abnormal situation

Provide Support

Display empathy and active listening. Demonstrate an understanding of the client's affective responses that are the subtext of the content of the story.

Ground the Individual

Discuss the facts, and allow the client to tell his or her story. Discuss psychological and behavioral responses.

Connect the Individual

Begin the process of building rapport. Be sure to state your title and position and attempt to remove the individual from the stressor(s).

Observe and Identify

Who has been exposed to the crisis situation, and who is displaying evidence of subjective distress or maladaptive functioning?

Address Medical Needs

For those trained to assess medical condition or referral, if not trained.

Evaluate the Level of Responsiveness

!s the individual alert? Are there substance use/abuse issues to be considered?

Consider the Mechanism of Injury

How did the crisis event impact the individual physically and subjectively?

Assess for Danger/Safety for Self and Others

Are there important factors that may put the individual at risk, or is there a risk to others?

Assessment, Crisis Intervention, and Trauma Treatment

1. Intake and Assessment

2. Readily Establish Rapport

3. Identify Major Problems

4. Deal with Feelings and emotions

5. generate and explore alternatives

6. implement an action plan

7. follow up

Intake and Assessment

The helper conducts a thorough biosocial assessment and evaluates for lethality/suicidality and other imminent dangers. 

readily establish rapport

Through genuineness, respect, and acceptance, the helper works to establish rapport with the client as quickly as possible.

Identify Major Problems/Crisis Participants

the interventionist attempts to identify the major problems that have initiated the crisis (i.e., the precipitating event), which also allows the clinician to prioritize the client’s concerns and learn more about effective and ineffective coping strategies.

Deal with Feelings and Emotions

• the helper allows the client to vent, to express feelings, and to feel that his or her feelings have been heard and understood.

• includes challenging the client to consider alternative cognitions regarding the crisis, loosening the client’s maladaptive thinking, and allowing for cognitive reframing.

Generate and Explore Alternatives

• Clients often do not see alternatives, otherwise they would have employed them and avoided the crisis altogether.

• once the client is able to address and cope with the difficult emotions associated with the crisis, the helper can begin to work with the client to explore more effective skills and methods of coping with the precipitating event(s).

Implement Action Plan

• Implementation of an action plan is both a cognitive and a behavioral process.

• On the behavioral level, the client is challenged to take action to try new coping skills.

• the client is also challenged to reflect on cognitive responses to the crisis event,

Follow-Up

The helper plans a follow-up contact with the client in order to assess physical, cognitive, and behavioral functioning, as well as to assess for new stressors and coping strategies.

James and Gilliland’s Six-Step Model

Listening

• Step 1: Defining the Problem: At this step, the helper works with the client to define and understand the problem through the use of core listening skills such as empathy, genuineness, and acceptance.

• Step 2: Ensuring Client Safety: The second step involves making sure the client is physically and psychologically safe. While employed as the second step it is a process that should occur at all stages of intervention

• Step 3: Providing Support: Here, the helper communicates a sense of caring and valuing of the client.

Acting Strategies

• Step 4; Examining Alternatives: At this step, the helper works with the client to examine and assess different options for coping with the crisis.

• Step 5: Making Plans: This step includes developing positive, achievable strategies for moving beyond the crisis. Establishing a sense of agency is important in recovering from the crisis.

• Step 6: Obtaining Commitment: The client should demonstrate an understanding and commitment to the plan developed in Step Five. If the plan is developed collaboratively, commitment should be easier to obtain. It is also important to follow up with the client to ensure the plan is working, and the client is functioning better as a result.

PFA 12 Strategies

1. Make connection

2. Help People be safe

3. be kind, calm and compassionate

4. meet basic needs

5. listen

6. give realistic reassurance

7. encourage good coping

8. help people connect

9. give accurate and timely info

10. make referral to a disaster mental health

11. end the convo

12. take care of yourself

make a connection

helper makes an introduction and focuses on the individual in need

help people be safe

It is critical to ensure the individual is physically and psychologically safe.

End the Convo

When ending the conversation, it is important to ask if there are any unmet needs that can be addressed, and provide contact information for referrals and resources.

Make a referral to a Disaster Mental Health worker

When the individual providing PFA is not trained in a mental health field, making a referral to those who are is sometimes necessary.

Give accurate and timely info

Not only is it important to communicate with those in crisis to provide a sense of control, but it is also helpful to put an end to rumors and misinformation.

Help People Connect

Connecting people with communication options (e.g., phones, texts, email, etc.) can help mitigate stress reactions. Communicating with loved ones is critical during a crisis.

Encourage Good Coping

The helper works with the client to identify adaptive, healthy coping skills.

Give realistic reassurance

Reminding people that their reactions are normal given the circumstances is helpful. Letting people know that their stress reactions will likely go away with time can be reassuring, as well. It is also important not to minimize the client’s reaction

Listen

Employing active listening skills helps the individual feel connected,

grounded, and heard.

Be kind, calm, and compassionate

The helper expresses patience and respect and maintains a composed demeanor.

Meet people’s basic needs

Ensuring people’s most critical needs are met is important to ensuring a sense of safety. Connecting people with family and friends is also important in this step.

American Red Cross

• The mission of Disaster Mental Health is “to respond to the psychosocial needs of people affected by disaster, including Red Cross disaster workers, across the continuum of disaster preparedness, response and recovery”

• trained to provide an array of services to individuals during crises, from PFA to psychological triage and short-term crisis intervention 

NOVA Crisis Response

originally founded to assist victims of violent crime but has since evolved to provide an array of services, including crisis intervention services at a systemic level through the National Crisis Response Project

FEMA

• founded in 1979 in response to concerns that the federal government was ill-equipped to respond to crises and disasters due to inter-agency conflicts, bureaucracy, and inefficiency

• provides services related to disaster and crisis preparation and prevention, as well as training and mitigation following a disaster.

Transcrisis

• After the event that precipitated the crisis has subsided, individuals may appear to return to a normal state of functioning. People exposed to traumatic or difficult events may believe that the crisis has subsided and that they have returned to normal.

• However, the notion of transcrisis suggests that individuals may not be functioning as well as it appears.

• Transcrisis occurs after the precipitating event has concluded, but the individual has not yet resolved the emotional and cognitive difficulty presented by the crisis 

Transcrisis Points

are benchmarks that represent successful navigation of the crisis and lead to the client’s emotional growth.