Crisis Intervention in Counselling, Part 2
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.
In a previous article we introduced the concept of crisis intervention and looked at two approaches: Faberow & Gordon Model of Crisis Intervention and Critical Incident Stress Debriefing. In this article we explore Robert’s Seven Stage Crisis Intervention Model and overview the role of counsellors in facilitating family and community adaptation.
Robert’s Seven Stage Crisis Intervention Model
In conceptualising the process of crisis interventions, Robert’s Seven Stages Crisis Intervention Model provides practitioners with a useful framework to apply. This model identifies 7 critical stages that are essential in the process of crisis intervention. These stages are listed and explained in more detail below:
- Plan and Conduct Crisis and Biopsychosocial Assessment (Including lethality Measures)
- Establish Rapport and Rapidly Establish the Relationship
- Identify Dimensions of presenting problems
- Explore feelings and emotions (Including active listening and validation)
- Generate and Explore Alternatives (Untapped resources and coping skills)
- Develop and formulate an action plan
- Follow up plan and agreement
Stage 1 – Psychosocial and Lethality Assessment: At this stage the practitioner must conduct a swift but thorough biopsychosocial assessment covering environmental supports and stressors, medical needs and medications, current use of drugs and alcohol and available internal and external coping methods and resources (Roberts & Ottens, 2005). Also included at this stage is a mental state assessment and suicide risk assessment.
Stage 2 – Establishing rapport: Rapport is facilitated by the presence of the therapist’s respect and acceptance of the client as well as their genuineness in authentically engaging with the client in an empathetically congruent and real way. This is also the stage in which the qualities of the therapist are naturally showcased through the authenticity of their presence in the relationship thus instil trust and confidence in the client’s attitude towards the therapist and the therapeutic process.
Stage 3 – Identifying presenting problems: At this stage the therapist aims to clarify what occurred specifically in the client’s life that has them requiring help at the present time. It is at this stage, clarity is obtained over the crisis with a specific focus on what it is about the crisis that has it presenting as a problem from the client. Issues around the problem are prioritised and both the client and the therapist decide on which problems to work on first. The therapist must ensure they gain an understanding of those issues that make the problem a crisis for the client.
Stage 4 – Exploring feelings and emotions: In this stage the therapist invites the client to share their crisis experience. The aim of sharing is to:
- Explain their current crisis situation and what it is about the situation that makes it difficult to cope with,
- Allow opportunity for the client to express their feelings evoked by the crisis,
- To vent any frustrations, angst, disappointments or any other feelings they may have but may find difficult to express in a constructive way,
- To be heard and validated.
Very cautiously the therapist is to work on giving challenging responses. Challenging responses can include, for example, giving information, reframing, and interpretations. When appropriately applied, challenging responses help to realign the client’s maladaptive beliefs by encouraging them to consider the validity of other, more constructive options (Roberts & Ottens, 2005).
Stage 5 – Generating and exploring alternatives: This stage is considered to be the most challenging because clients in crisis may not be readily open to alternatives. As a consequence, the timing of this stage is important. Generally, it is only after the crisis has been properly identified and explained with emotions expressed, listen to and validated the client will be in a better place to consider alternative ways of perceiving and dealing with the crisis.
If stage 4 has been successfully achieved, both the therapist and the client can begin to put options in place that will enable the client to return back to “normality” or more accurately return to a productive and fulfilling life post-crisis. Although alternatives are collaboratively generated between the client and the therapist, they are really only effective if they are “owned” by the client (Roberts & Ottens, 2005).
One way to bring out alternatives is through establishing how the client may have coped in similar crises or different crises that were similar in their impact. This process helps to identify effective coping mechanisms that may have been used in the past to be employed in the present crisis state. Sources of resilience in the client and their environment should also be identified (Walsh, 2007).
Stage 6 – Implementing an action: This is a stage where those alternative paths of approach to the crisis agreed on in stage 5 become integrated into the treatment plan. The concrete plans executed at this stage are crucial for restoring the client’s equilibrium and psychological balance. The client is also encouraged to work through the meaning of the crisis event. Working through the meaning of the event helps the client gain mastery over it by encouraging a shift in focus from what happened to, what they can do about it.
The therapist should continue to draw attention to the clients’ strengths, for example raising their attention to attributes of courage, strength and perseverance when they are truly demonstrated (Roberts & Ottens, 2005; Walsh, 2007). The therapist can also encourage the client to ask and answer for themselves common questions. For example:
- Why did the crisis happen?
- What does it mean?
- What are the alternatives that could have been put in place to prevent the event?
- Who was involved?
- What responses to the crisis potentially exacerbated it(cognitively and behaviourally)?
(Roberts & Ottens, 2005)
Stage 7 – Follow Up: Therapists working with crisis should plan to follow up with the client following the treatment to ascertain progress and evaluate the post crisis state of the client. Follow up can also include the scheduling of “booster” sessions about a month following the termination of the crisis intervention. In follow up, any positives as well as possible challenges around the treatment and its outcomes should be discussed. Post crisis follow up of the client could include:
- Physical condition of the client (e.g., sleeping patterns, nutrition and hygiene)
- Cognitive mastering of the precipitating event (i.e. does the client have a better understanding of what happened, how it happened and potentially why it happened?)
- An assessment of overall functioning including social, spiritual and professional.
- Satisfaction and progress with ongoing treatment
- Assessment on how the client is managing current stressors if present
- Investigate need for referral.
Facilitating Family and Community Adaptation
To foster recovery from major traumatic events, professionals can facilitate healing and resilience by encouraging individuals, families and communities to actively engage in the following processes:
- Shared acknowledgement of the reality of the traumatic event: Clarification of facts, circumstances and ambiguities.
- Shared experience of loss and survivorship: Active participation in memorial rituals, tributes; Shared meaning and emotional expression; Spirituality of connectedness and potential meaning.
- Reorganisation of family and community: Restabilisation to foster continuity and change; Realignment of relationships, relocation of roles and functions; Rebuilding of lives and homes.
Key families and social processes during traumatic loss:
Belief Systems
Risks for Maladaptation
- Shattered assumptions, ambiguous or senseless loss.
- Sense of failure/ fault, blame, shame or guilt.
- Hopelessness and despair.
- Powerless, helpless and overwhelmed.
- Spiritual distress, sense of injustice, punishment sins, cultural/spiritual disconnection.
Key processes for resilience
- Make meaning of traumatic loss experience by normalising and contextualising distress.
- Positive outlook: instilling a sense of hope and encouragement.
- Affirm strengths.
- Acceptance of what can’t be changed.
- Transcendence and spirituality through faith rituals (e.g. prayers).
Communication Problems
Risks for Maladaptation
- Ambiguous information about traumatic experience.
- Secrecy, distortion or denial of the event.
- Blocked emotional sharing.
- Blocked problem solving and decision making.
- No future focus or planning.
Key processes for resilience
- Clear, consistent information.
- Messages clarifying traumatic experience and related ambiguity.
- Open emotional expression with empathetic response.
- Promote collaborative decision making and problem solving by encouraging resourcefulness.
- Encourage proactive planning and preparedness.
Adapted from: (Walsh, 2007)
References:
- Roberts, A.R. & Ottens, A.J. (2005). The seven stage crisis intervention model: A road map to goal attainment, problem solving and crisis resolution. Brief Treatment and Crisis Intervention, 5, 329-339.
- Walsh, F. (2007). Traumatic loss and major disasters: Strengthening family and community resilience, Family Process, 46, 207-227.
Source: www.mentalhealthacademy.com.au
