Crisis Intervention Ethics Casebook

Rick A. Myer,Julia L. Whisenhunt,Richard K. James

• Publisher: American Counseling Association
• Year: 2021
• ISBN:
  9781119814399
• Edition: 1
• Topic: Education
• Subtopic: Professional Development

The fast-paced, unpredictable, and high-risk nature of crisis intervention creates critical ethical dilemmas that can result in personal harm and professional liability if not handled appropriately. Applying a traditional model of ethical decision-making is often impractical when time is limite and decisions must be made quickly. This counseling tool kit offers a new operational approach for integrating ethical decision-making in crisis intervention. Following detailed discussions of crisis intervention within the framework of realtional-cultural theory, a triage assessment system, and an original ethical decision-making protocol, nine diverse case studies in hospital, telebehavioral health, school, clinical, and public settings are presented. Students and practitioners will build a repertoire of ethical decision-making skills to de-escalae crisis incidents and provide an appropriate level of support to individuals experiencing crisis.

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CHAPTER 1
Crisis Roots and Building Blocks

This chapter provides a brief overview of the basic theory and tools of crisis intervention. Suffice it to say that this chapter is not a condensed course in crisis intervention, but we believe providing some basis information on crisis intervention will help you as you work through the cases. If you have not taken or do not have a crisis course available, see the reference list for crisis works that provide an in-depth understanding of how crisis intervention is carried out.

You Say You Want to Work in Crisis Intervention

The business of trauma and crisis intervention has become a growth industry. To pass muster, programs accredited under the Council for Accreditation of Counseling and Related Educational Programs (2016) are required to provide instruction on crisis intervention. It is interesting to note that neither social work nor psychological accreditation programs mention crisis intervention.

One of the major positive outcomes of increased consciousness and understanding of disaster mental health has been the emergence of national crisis response teams (CRTs) that can be mobilized and deployed hours after a major disaster. CRTs were formed through the efforts of the National Organization for Victim Assistance (NOVA). Originally developed to help victims of crime, this nonprofit agency established the National Crisis Response Project and set up CRTs, which include representatives from all of the primary mental health professions. Once a disaster occurs, community leaders can ask for assistance, and after consultation with NOVA, a trained CRT will be sent to the community (Young, 1991).

There are a lot of local emergency management agencies in the country, but not many of them have administrators with mental health backgrounds. If you are in the mental health business, you might be seen as a valuable staff member and be able to find a job there. If you are in criminal justice, it doesn’t take a week of viewing the national news to see the scrutiny and anger that boils over after police department shootings, particularly when racial/ethnic minorities are the victims. The need for police officers with verbal de-escalation skills is one of the faster tracks to promotion in contemporary departments.

If you are employed by a Federal Emergency Management Agency (FEMA) state or local affiliate, you may have a chance to attend the Emergency Management Institute in Emmitsburg, Maryland. There you can learn everything you ever wanted to know about emergency management, including rounding up domestic and wild animals (Emergency Management Institute, 2019). Programs from a bachelor’s degree to a PhD in the crisis counseling/emergency management field are available. Search online for “crisis intervention degrees” or “crisis management degrees,” and you will find a range of programs from certification in emergency management areas to associate’s, bachelor’s, and master’s degrees as well as doctorates. There is a crisis intervention program out there to fit almost everyone.

Crisis Defined

There are about as many definitions of “crisis” as there are ways to have one (Belkin, 1984; Caplan, 1961; Carkhuff & Berenson, 1977; France, 2014; Hoff et al., 2009), and this debate is ongoing. That debate should tell you that this is still a growing and changing field. In this book, we use a modified definition of crisis that one of the authors (James) has been using for a long time: “A crisis for an individual is the perception or experiencing of an event or situation as an intolerable difficulty that exceeds the person’s current resources and coping mechanisms, and means of support are either missing or unequal to the task of helping alleviate the crisis” (James & Gilliland, 2017, p. 9). This definition has three key components. First, the crisis is intolerable, or as Albert Ellis (1984) described it, “I have a case of I can’t stand it itis. And it can’t be put up with any longer” (p. viii). Second, whatever positive attitudes, willingness to work, faith in good works, and resiliency were available to an individual before the crisis are now gone, and the person’s affective, behavioral, and cognitive resources well has run dry. Third and most important, support systems are gone, and a shoulder to lean on or cry on is difficult to find. Either physically or psychologically, or both, individuals are now alone with the crisis.

Transcrisis

Most crises were generally thought to be of limited duration, lasting 6 to 8 weeks and then slowly dissipating (Caplan, 1961; Janosik, 1984). That perspective has changed with the advent and formalization of posttraumatic stress disorder (PTSD) as a bona fide clinical mental health problem (American Psychiatric Association, 1980). However, it should be clearly understood that individuals do not have to be diagnosed with PTSD to be in transcrisis, even though transcrisis states are a hallmark of PTSD.

For many people, a crisis may subside for a while and become quiescent, much like arthritis, then flare up at transcrisis points and become intolerably painful and disabling; this disequilibrium can last a lifetime (van der Kolk & McFarlane, 1996). Until the original crisis is dealt with, the transcrisis state may continue (James, 2008). Individuals suffering from domestic or interpersonal violence and those with substance use problems are common examples of people in transcrisis who experience numerous transcrisis points. These individuals are most often participants in long-term therapeutic interventions, and when these transcrisis points erupt, their treatment might better be called “crisis therapy.” These are the tough, intractable cases that can lead to counselor burnout.

Systemic Crisis

To suppose that a crisis affects only an individual in isolation is an incorrect assumption. Rarely does a crisis affect just one person. Whether it is a diagnosis of childhood leukemia, the sexual assault of a college student, an unemployed construction worker who dies by suicide, a person with an addiction who is involved in a fatal car crash, a new case of HIV, a family wiped out in a house fire, a community destroyed in a tornado, or a whole coastline devastated by a hurricane, we are all affected. John Donne’s (1624) classic poem ends, “For whom the bell tolls, it tolls for thee.” Because of the advent of social media and instantaneous worldwide news, it is difficult for any of us to escape the tsunami waves that spread from the epicenter of a crisis, be it large or small.

From that standpoint, crisis can also be defined systemically (Hermann, 1963; Roberts, 2005; Zdziarski et al., 2007). For us, a systemic crisis may be defined as a crisis event that overwhelms communities and institutions such that communications systems break down, basic infrastructures are destroyed, and emergency responders are unable to effectively contain and control the event with regard to both physical and psychological reactions to it. When this happens, the crisis has become systemic (James & Gilliland, 2017, pp. 10–11).

Metastasizing Crisis

Although you may go through American Red Cross disaster training and be called to the scene of a large-scale ecological disaster, it is far more likely that you will be involved in what we call a metastasizing crisis (James & Gilliland, 2017, p. 11). A metastasizing crisis may start out very small, such as a series of escalating phone texts between two teenage girls fighting over a boyfriend. As their messages spread over social media, sides are chosen, and opposing gang members may become involved to the point that a gang war erupts and drive-by shootings occur. When a crisis metastasizes, a crisis team composed of numerous individuals with different areas of expertise that include mental health, law enforcement, media, and government social services is required to contain it and keep it from turning into a wide-scale systemic crisis (Myer et al., 2011, pp. 55–57). Given the multiple descriptions of crisis, let’s look at how this business of crisis intervention got started, and where it is going.

A Brief History of Crisis Intervention

A crisis probably occurred when a Cro-Magnon was about to become a cave lion’s dinner and, in desperation, picked up a sharp limb and solved the crisis by stabbing the lion, and in the process invented a thing called a “spear.” But it is within the last century that the words “crisis” and “intervention” have been formalized. Crisis intervention is a formal therapeutic procedure to help people out, and it is probably the first therapeutic approach to use technology. In 1906, a crisis phone line was established by the National Save-a-Life League for suicide prevention (Bloom, 1984).

Here Comes Alcoholics Anonymous

Although not identified as crisis intervention, Alcoholics Anonymous (AA) meetings in the 1930s had a firm foundation in crisis intervention techniques. AA is oriented to the here and now and does not look past the next few hours in dealing with the presenting problem of wanting to drink. It is reality oriented and honest in its face-to-face group meetings. AA’s 12-step program resembles a crisis plan in that it is faith based, solution focused, and directly addresses the dynamics of addiction (AA, 1939). AA’s operational approach to staying sober through continuous group meetings and sponsorship by fellow members is a gold standard for a person in transcrisis, along with its book of daily readings that can keep yearning to drink in abeyance. Finally, the support system it establishes is a core feature of all crisis intervention strategies because the support system for many people in crisis is either gone or unequal to the task of helping them.

Crisis Becomes a Construct

Bill Wilson’s group in Akron, Ohio, started to expand at a rapid rate in the late 1930s, but litt...