Crisis Intervention

A Practical Guide

Alan A. Cavaiola, Joseph E. Colford

• Publisher: SAGE Publications, Inc
• Year: 2017
• ISBN:
  9781506322407
• Edition: 1
• Topic: Social Sciences
• Subtopic: Global Development Studies
• Index: Social Sciences

Crisis Intervention takes into account various environments and populations across the lifespan to provide students with practical guidelines for managing crises. Drawing on over 25 years of relevant experience, authors Alan A. Cavaiola and Joseph E. Colford cover several different types of crises frequently encountered by professionals in medical, school, work, and community settings. Models for effectively managing these crises are presented along with the authors’ own step-by-step approach, the Listen–Assess–Plan–Commit (LAPC) model, giving students the freedom to select a model that best fits their personal style or a given crisis. Future mental health professionals will gain the knowledge, skills, and confidence to help their clients manage the crises they will encounter in their day-to-day lives.

Chapter 1 Understanding Crisis

Boston Marathon Bombing: April 15, 2013: Two bombs went off near the finish line of the Boston Marathon, killing three spectators and wounding more than 260 other people, many of them with catastrophic injuries. Coverage of the disaster saturated all forms of media for weeks, bringing into everyone’s living room images of destruction. The search for the two terrorist brothers also shut down the entire city of Boston.

Superstorm Sandy: October-November, 2012: Hurricane Sandy, dubbed a superstorm because of its ferocity, was the deadliest and most destructive hurricane of the 2012 Atlantic hurricane season as well as the second costliest in U.S. history. It resulted in the deaths of 233 people in eight different countries before it hit the east coast of the United States. The states of New Jersey and New York were particularly hard hit. Flooding and high winds resulted in property damage, loss of power, and relocation of families to temporary shelters throughout the area. School buildings also were destroyed, keeping children and families in a recurring nightmare as relief efforts faltered.

9–11 and the Twin Towers; President Vows Exact Punishment for “Evil:” (New York Times September 12, 2001, New York City): Hijackers rammed jetliners into each of New York’s World Trade Center towers yesterday, toppling both in a hellish storm of ash, smoke, glass and leaping victims; third plane crashes into Pentagon in Virginia and a fourth plunges to the ground near Pittsburgh; military is put on highest alert; National Guard units called at Washington and New York, two aircraft carriers are called to New York harbor.

Tales of crisis and of people in the throes of crisis appear in all forms of media on any given day, in any city or town in the United States. Whether the article is about a terrorist attack, a domestic violence incident, a kidnapping, a school shooting, a rape, an earthquake, or any other natural disaster, it can resonate across communities and whole nations. Suddenly, unexpectedly, and without forewarning, individuals are left to their own devices in the immediate aftermath of such events. Most individuals do find some means of coping after a crisis, relying on assistance from their own social support networks consisting of extended family members, friends, or trusted individuals like clergy or other members of the community. However, there are those who feel overwhelmed and immobilized, or who find that they are unable to cope, even with the assistance of well-meaning friends or family members. Some also find that the ways they might have used to cope in the past are not working for them in dealing with the present crisis.

Often when one hears the term, “crisis intervention,” one may immediately think of those services which would ordinarily be provided by mental health professionals in a mental health clinic, a private practitioner’s office, or a hospital emergency room. While psychiatrists, psychologists, psychiatric social workers, and professional counselors often do provide these services, one must also consider the array of other individuals who are either at the scene of the crisis event or who arrive shortly after. Police officers, teachers, school counselors, college counselors, firefighters, rescue workers, community volunteers, first aid squads, nurses, physicians, clergy, funeral directors, attorneys, employee assistance counselors, human resource managers, neighbors, friends, roommates, family, and other relatives may find themselves performing crisis intervention services, sometimes without realizing it.

It might appear that there are more crisis situations and traumatic events that take place in today’s society, but this perception is due, in part, to the media coverage of such events. What is clearly different today is that there are many more types of crisis delivery services than there were forty or fifty years ago: hotlines; mobile emergency teams trained in crisis intervention; school intervention personnel, such as school psychologists and student assistance counselors; workplace intervention specialists, such as employee assistance counselors; and emergency room services, which include crisis services for both psychiatric emergencies and substance abuse.

This chapter provides an overview of crisis intervention, definitions of and types of crises, and diagnostic considerations that are part of the crisis experience. Multicultural issues related to crisis considerations also is discussed. Finally, the chapter includes a brief historical overview of the field of crisis intervention and some examples of the assessment and intervention models that have evolved.

Defining Crisis

As suggested by Graf (personal communication, August 19, 2002), a broad definition of crisis is a predictable or unpredictable life event which is perceived by an individual as stressful to the extent that normal coping mechanisms are insufficient. Gerald Caplan, one of the early pioneers in the crisis intervention field, was the first to articulate what he referred to as crisis theory. In order to understand his crisis theory, it is helpful to look at how he defined crisis. For Caplan (1964), a crisis is a temporary state of upset and disorganization, characterized chiefly by an individual’s inability to cope with a particular situation using customary methods of problem solving, and by the potential for a radically positive or negative outcome. There are many assumptions made by Caplan which are implicit in his definition.

First, a crisis begins with a precipitating event. These precipitants can be specific predictable life events, such as getting married, graduating from school, moving to a new town, a planned pregnancy, and retirement; or they can be unpredictable, such as natural disasters, accidents, an untimely death of a loved one, or other traumatic events, such as being a victim of rape. The second assumption made is that a crisis state, by its very definition is “time-limited.” Caplan claimed that the immediate impact of a crisis usually lasts from six to eight weeks, depending on the nature and intensity of the crisis. This is not to say that there are not long-lasting effects to many of the crises that are experienced. The third assumption is that crises create a state of disequilibrium and disorganization for the individual. Therefore, individuals who tend to be organized and operate with a certain degree of predictability, now are faced with days filled with chaos as the crisis event sometimes controls or dominates their every waking moment.

Another assumption of Caplan’s is that once the crisis event takes place, there is a cognitive interpretation or appraisal of the event, which accounts for the notion that not everyone reacts to a crisis in the same way. For example, being fired from a job may seem like the end of the world to one person, while for another, it can be a chance to take a few months off, do some traveling, and relax between jobs. The Greek philosopher, Epictetus, once said, “It’s not the events of life that make men mad, but rather the view we take of them.” It’s the “view we take of them” that suggests this cognitive interpretation of crisis events.

Finally, crisis events will cause a breakdown in one’s ability to cope. The goal of crisis intervention, therefore, is to help clients mobilize their own coping resources in an effort to restore balance or equilibrium. In developing his crisis theory, Caplan was interested not only in identifying the crisis itself, but also in assessing the individual’s ego functioning in the aftermath of the crisis situation as they attempt to cope with it. According to Caplan, adequate ego functioning was the basis of one’s mental health.

Danger vs. Opportunity

According to Slaikeu (1990), the word crisis itself is very rich in psychological meaning. In Chinese, the word for crisis is made up of two symbols, “danger” and “opportunity” (Wilhelm, 1967). The word, therefore, connotes not only a time of danger, which may be physical (as with assault, natural disaster, medical illness) or psychological (losing one’s job or going through a divorce), but also the opportunity for personal growth that results from having experienced a crisis and having come to the realization of one’s inner strength. This would be the case with rape victims who come to the realization that they have survived and can use their strength to help other rape victims, or the person who experiences a job layoff and obtains training to get a better or more satisfying job. Of course, while a person is going through a crisis, the notion of “opportunity” probably doesn’t make much sense. It sometimes isn’t until months or years after the crisis has passed that one realizes the personal growth and self-efficacy that has been achieved. Perhaps the old English proverb sums this up best, “A smooth sea never made a skilled mariner.”

The English derivative of the word crisis is taken from the Greek word, krinein that means “to decide” (Lidell & Scott, 1968), emphasizing that a crisis is a time for decision making, a turning point or moment of reckoning. In some instances, these decisions will help to improve one’s life. Slaikeu (1990, p. 15) notes the potential for a “radically positive or negative outcome” in the aftermath of a crisis. In a fundamental way, the direction that the outcome takes depends on the decisions made by the affected individuals as part of the crisis resolution process. Often the decision reached because of a crisis enables that individual to thrive. In other instances, however, these decisions may lead to a life that is negatively impacted and/or diminished in some way. To acknowledge this potential for positive or negative outcomes and the role of the individual’s decisions in determining the outcome is not as simple as implying that all the person in crisis needs to do is to “think positively.” To suggest this would be to deny the unique complexity of crisis events and the often-insurmountable difficulties that they pose to affected individuals.

Types of Crises

Based on these definitions, one could argue that just about any stressor could bring about a crisis situation. In order to further delineate this term, it is helpful to conceptualize crises as being grouped into three areas: normal developmental crises, traumatic event crises, and existential crises (Brammer, 1985). A fourth area, psychiatric crises, also can be included, since there are many instances where a psychiatric condition can serve as the catalyst to the crisis state (e.g., a person who suffers from bipolar disorder may begin to experience a manic episode which results in a gambling spree). Conversely, a crisis can exacerbate an already existing psychiatric condition (e.g., stops taking her medication after being evicted from the boarding home where she had been living).

Developmental Crises

What is unique to developmental crises is that the precipitating event of the crisis or the stimulus event is embedded in normal maturational processes (Slaikeu, 1990). Throughout the lifespan, human beings are constantly changing; yet the normal growth process is characterized by continuity, as one passes from one stage to the next, through a series of life transitions.

Erikson (1963) was one of the first developmental theorists to point out that development continues through the lifespan. What was also unique to his approach was his assertion that at each stage of development, there is a major task or conflict to be resolved by the individual in order to move onto the next stage. The table below summarizes Erikson’s developmental stages, outlining both the transitional theme and the developmental tasks associated with each stage. It also identifies conflicts or events that could potentially precipitate a developmental crisis for an individual at each identifiable stage. What Erikson referred to as a potential crisis imbedded in each of his eight stages might also be considered a “challenge” instead; that is, a test of the individual to master the needs of each stage before moving onto the next one. The Latin derivation of the word “impediment” comes from the word “impedimenta,” meaning “heavy baggage,” and it is just this excess baggage that individuals drag with them to the next developmental stage. It is as if their unfinished business at one stage will impede their ability to master the challenges of subsequent ones.

Erikson (1963) considered a major task of adolescence to be identity formation. He believed that by the end of the teen years, healthy individuals must develop some sense of identity, including who and what kind of persons they are in relationships, what their strengths and weaknesses are, and what they see as future life goals and/or directions. The teenager who is unable to “find” their identity may wander aimlessly from job-to-job, or from college-to-college feeling depressed and lonely. “Stuck” in a developmental crisis that Erikson refers to as “role confusion;” these individuals may be unable to proceed with the later developmental tasks of young adulthood, including establishing intimate, committed relationships, and achieving occupational stability.

Table 1.1

Male midlife crisis is another example of a developmental crisis (Mayer, 1978; Levinson, 1978). This crisis may occur as men begin to experience various emotions of anxiety or sadness or fear of death as they contemplate and take stock of the accomplishments in their lives. These emotions may be exacerbated as they take on the developmental tasks of adjusting to aging and preparing to retire. Women may experience a similar type of midlife crises with the onset of menopause or as grown children leave home, resulting in “the empty nest syndrome.” Certainly, not every man or woman experiences a crisis as they navigate these life transitions, but for some individuals the normal developmental passages do indeed precipitate crisis responses.

It should be emphasized that when individuals are experiencing what may be a developmental crisis, it is not always certain that they will seek professional help, nor will they identify their problem as “developmental” in nature. Instead, they may experience frustration, anxiety, loneliness, depression or may express other complaints. It should also be noted that developmental crises can sometimes occur simultaneously, as would be the case with a 50-year-old man or woman who is going through a divorce and having to make decisions regarding the care of his or her elderly parents.

Traumatic Event Crises

Traumatic event crises are what most people imagine a crisis to be, and each of the events reported at the beginning of this chapter were, in fact, traumatic event crises. The most distinguishing characteristic of traumatic event crises is that there is a clear external precipitating event. The traumatic event is usually an uncommon or extraordinary incident, which one cannot predict, nor control. Unlike the developmental crises described above, traumatic...