Crisis Intervention in Counselling, Part 1
Crisis intervention is the most widely applied form of brief treatment used by mental health practitioners. All crisis intervention and trauma treatment specialists are in agreement that before intervening, a full assessment of the individual and the situation must take place.
Early intervention may prevent acute traumatic stress reactions from becoming chronic stress disorders. Crisis intervention attempts to help individuals take advantage of opportunities to develop from within the context of the crisis encountered and minimise risks of getting stuck in the memory of the crisis whereby the incident dominates the person’s life well after it has ended.
Crisis therapists support the process of assisting clients to fully comprehend the situation, apply effective decision-making, and to move on in the present day of life and relationships. Crisis interventions generally aim to encourage the person in crisis to observe the problem from a more remote and objective vantage point, to consider other points of view, and to understand the range of options available in understanding and in coping with the crisis. A primary goal of crisis intervention is to support development by assisting the process of decision-making, without which growth is obstructed.
Ideally, crisis intervention is a brief intervention with prompt but precise diagnosis and rapid commencement of brief, focused and structured therapy. Those skilled and efficient in crisis intervention will complete their diagnosis in the first encounter and swiftly begin other therapeutic tasks. Through such an approach, it is believed that when a crisis is focused on specifically and resolved, the person may be able to go on independently, without further assistance.
Other pathologies, which may be found, are not focused on or dealt with until the completion of the crisis intervention. From this context, crisis intervention is regarded as a structured therapy that is focused on the central issues surrounding the crisis that is to be completed within a limited time (France, 1990).
It is time limited because the mere passage of time beyond 6 weeks is seen to determine more chronic psychopathology. Thus it is generally viewed that such therapy must attain successful termination within this period, otherwise other forms of treatment modalities should be employed or appropriate referral made. Therapists or clinics that offer crisis intervention are more likely to be sympathetic to and prepared for this kind of focused, brief work.
Crisis intervention does not attempt to provide the client with solutions, but rather, it assists the process of independent decision-making. Empowerment of the client is an essential constituent of crisis intervention even in children (van-Oruum & Mordock, 1983). Identifying and utilizing the client’s own resources and relating to him/her as the agent of change in their own life, is crucial (France, 1990).
The primary goals of crisis interventions are listed below:
- Stabilising symptoms of distress
- Mitigating symptoms of distress
- Restoring functional capabilities
- Assisting in decision making
Faberow & Gordon Model of Crisis Intervention
The timing of when to implement crisis intervention is based upon the psychological readiness of the individual rather than on a specific time. A useful model for understanding crisis intervention is by Faberow and Gordon (1981). This model proposes a four phase response to disaster that offers an explanation of how individuals progress through such crises. These four phases are listed below.
Heroic Phase: This phase occurs immediately upon the onset of a disaster and may even begin in anticipation of the event itself. It consists of efforts to protect life and property.
Honeymoon phase: This phase is characterised by optimism and gratefulness. Appreciation and realisation of survival brings a sigh of relief to individuals.
Disillusionment phase: This phase may begin as early as 3 to 4 weeks post-disaster and is characterised by a realisation that something disastrous has really taken place. It is during this phase that feelings of anger and frustration and blaming and questioning become eminent. The question “why did this have to happen to me” is often posed. It is at this phase mourning begins.
The growth and development of the individual and the community is arrested in the context of mourning, thus stagnation becomes evident. This phase may last for weeks, months or even years. Crisis intervention is considered crucial at this stage to facilitate the transition from disillusionment to the final phase of reconstruction.
Reconstruction Phase: This is a phase where restoration occurs and normal functioning is achieved and the growth of the individual and the community continues.
Critical Incident Stress Debriefing
Debriefing is a psychological treatment intended to reduce the psychological morbidity that arises after exposure to trauma (Hodgkinson & Stewart, cited in Rose, 1999). Its origins can be traced to efforts aimed at maintaining group morale and reducing psychiatric distress amongst soldiers immediately after combat. It became prominent in the 1980s. More recently a more comprehensive approach to pre and post incident care termed Critical Incident Stress Management has been developed (Mitchell, 1997; Huckshorn, 2003).
In Critical Incident Stress Management, Critical Incident Stress Debriefing (CISD) is described as the fourth component in a seven phase, structured group discussion, usually provided 1 to 10 days post crisis, and is designed to mitigate acute symptoms, assess the need for follow-up and, if possible, provide a sense of post-crisis psychological closure.
Debriefing has been routinely offered in a number of settings on an international scale, including for victims of mass disasters, or individuals involved in traumatic incidents in the workplace such as police officers. It is founded on the belief that promptly talking through traumatic experiences will aid people in recovering from potential psychological damage.
It is usually offered on a voluntary basis, but there are groups, for whom it is compulsory following trauma, including bank employees in both the UK and Australia and some UK police forces (Rose, Bisson, Churchil & Wessly, 2009). The assumption is that debriefing can prevent the onset of PTSD and that such a policy of compulsory debriefing may reduce the threat of litigation by employees over subsequent development of PTSD after a critically traumatic incident (Butterfield, Borgen, Maglio & Amundson, 2009; Carlier, Voerman & Gersons, 2000; Roberts & Everly, 2006).
A typical debriefing process takes place in a session 2 to 3 days after the trauma. Although initially designed to be used in groups, debriefing has also been used on individuals, couples and families (Carlier, Voerman & Gersons, 2000; Rose, Bisson, Churchill & Wessly, 2009). According to Mitchel (1997), debriefing occurs in seven stages:
- Introducing clients to the process
- Relaying facts about the incident
- Relaying thoughts and impressions about the incident
- Relaying emotional reactions to the incident
- Normalisation of facts, impressions and reactions to the incident
- Planning for the future
- Disengagement
In the next article… we will explore Robert’s Seven Stage Crisis Intervention Model and look at how counsellors can facilitate family and community adaptation and communicate effectively during crisis.
References:
- Butterfield, L.D., Borgen, W.A., Maglio, A.T., & Amundson, N.E. (2009). Using enhanced critical incident technique in counselling psychology research. Canadian Journal of Counselling, 43, 265-282.
- Carlier, I.V.E., Voerman, A.E. & Gersons, B.P.R. (2000). The influence of occupational debriefing on post traumatic stress symptomatology in traumatised police officers. The Journal of Medical Psychology, 73, 87-98.
- France, K., (1990). Crisis Intervention: A Handbook of Immediate Person-to- Person Help. (2nd Ed.). Springfield, Ill.: Charles Thomas Pub.
Mitchell , J.T., Everly, G.S. (1997). The scientific evidence for critical incident stress management. Journal of Emergency Medical Service, 22, 86–93. - Roberts, A. R. & Everly, G.S. (2006). A meta analysis of 36 crisis intervention studies. Brief Treatment and Crisis Intervention, 6, 10-21.
- Rose, S.C., Bisson, J., Churchill, R. & Wessly, S. (2009). Psychological debriefing for preventing post traumatic stress disorder. The Cochrane Collaboration: Wiley Publishers.
- Van-Oruum, W. & Mordock, JB. (1983). Crisis Counselling with children and Adolescents: A Guide for Non Professionals Counsellors. New York: Continuum.
Source: www.mentalhealthacademy.com.au
