1 approaching crisis intervention

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  • 1. ©2013, Brooks/Cole Cengage Learning
  • 2. Brief History of Crisis Intervention National Save-a-Live League (1906)  The first known crisis phone line. Cocoanut Grove nightclub fire (1942)  Dr. Erich Lindemann’s clinical assessment of the survivors. Community Mental Health Centers Act of 1963  Large state-run asylums were replaced by community mental health centers. ©2013, Brooks/Cole Cengage Learning
  • 3. The Importance of Volunteerism Tasks completed by volunteer workers may range from menial administrative chores to frontline crisis intervention with clients.  The greatest number of frontline volunteers are used to staff 24-hour suicide hotlines in major cities.  More than 75% of all crisis centers in the United States report that volunteer workers outnumber professional staff by more than 6 to 1. ©2013, Brooks/Cole Cengage Learning
  • 4. Crisis Intervention as a Grassroots Movement Crisis intervention typically remains unrecognized by the public until victims/victim advocates exert enough legal, political, or economic pressure to cause change. As crisis agencies become crisis organizations, they gain power, prestige, and notoriety.  Offer opportunities for research, clinical training sites, and employment for recent graduates. Three major grassroots movements helped shape crisis intervention into an emerging specialty.  Alcoholics Anonymous (AA)  Vietnam veterans  Women’s movement during the 1970s ©2013, Brooks/Cole Cengage Learning
  • 5. Transition from a Grassroots Movement to a Specialty Area Large influx of crisis organizations from the 1970s-1990s. Recognition that immediate intervention is essential in alleviating stress related to trauma. Professional recognition within the helping fields.  Division 56: Trauma Psychology, American Psychology Association (2006)  Accreditation standards set by the Council for Accreditation of Counseling & Educationally Related Programs (2009) and National Association of School Psychologists (2010). The media has a significant influence on public consciousness of crisis after a large-scale disaster. ©2013, Brooks/Cole Cengage Learning
  • 6. The Case Against Too Much “Helping” “Trauma tourism”-burgeoning industry in post-intervention psychological trauma replete with trade shows, trade publications, talk shows, and charitable giving. There is an assumption that experiencing a disaster will invariably lead to psychopathology. The reality is that in most instances, victims of disaster do not panic.  Victims of disaster create an “altruistic or therapeutic community”-characterized by the disappearance of community conflicts, heightened internal solidarity, charity, sharing, communal public works, and a positive attitude. ©2013, Brooks/Cole Cengage Learning
  • 7. Definitions of Crisis There are varied definitions for both an individual and a system in crisis. For the purpose of this text, definitions have been selected.  Individual crisis-crisis is the perception or experiencing of an event or situation as an intolerable difficulty that exceeds the person’s current resources and coping mechanisms.  Systemic crisis-when a traumatic event occurs such that people, institutions, communities, and ecologies are overwhelmed and response systems are unable to effectively contain and control the event in regard to both physical and psychological reactions to it.  “Metastasizing crisis”-occurs when a small, isolated incident is not contained and begins to spread. ©2013, Brooks/Cole Cengage Learning
  • 8. Characteristics of Crisis Presence of both danger and opportunity  A crisis is dangerous because the related stress may result in pathological behavior such as injury to self or others.  A crisis can be an opportunity because it may be the catalyst for the individual to seek help. Crisis can provide the seeds of growth and change  Many times a person will not seek help until they can admit that they do not have control of the problem. No panaceas or quick fixes  It is common that the failure of a quick fix to a problem may actually lead to a crisis situation. ©2013, Brooks/Cole Cengage Learning
  • 9. Characteristics of Crisis Cont. The Necessity of Choice  Choosing is proactive and deciding not to choose is actually a choice that typically has negative results. Universality and Idiosyncrasy  Crises are universal because no one is immune to them.  Crises are idiosyncratic because individuals may react differently to the same situation. Resiliency Perception  It is the perception, not the event, that causes distress. Complicated symptomology  Crisis is complex and defies linear causality. ©2013, Brooks/Cole Cengage Learning
  • 10. Transcrisis States Historically, crises have typically been seen as lasting between 6-8 weeks in duration. Current view is that the events immediately following the crisis have a large impact on the duration. A transcrisis state occurs when unresolved issues from a previous traumatic event resurface because of a current stressor. Transcrisis states are not synonymous with PTSD.  The key difference is that the transcrisis state is residual and recurrent and always present to some degree. ©2013, Brooks/Cole Cengage Learning
  • 11. Transcrisis Points Occur within the therapeutic intervention and are seen as necessary for progression. Are marked by the client gaining awareness of the various aspects of the crisis. May occur frequently and are not regular, predictable, or have a linear progression. When transcrisis points occur, the therapists shifts from traditional therapeutic techniques to crisis intervention.  The individual will experience similar affect, behavior, and cognition as the original crisis event. ©2013, Brooks/Cole Cengage Learning
  • 12. Theories of Crisis Intervention No single theory is 100% comprehensive. Three major theories  Basic Crisis Theory  Expanded Crisis Theory  Applied Crisis Theory ©2013, Brooks/Cole Cengage Learning
  • 13. Basic Crisis Theory Based on a psychoanalytic approach to crisis. Behavioral responses related to grief are normal, temporary, and can be relieved with short-term intervention techniques. Normal grief behaviors include:  Preoccupation with the lost one  Identification with the lost one  Feelings of guilt and hostility  Disorganization of daily routine  Somatic complaints ©2013, Brooks/Cole Cengage Learning
  • 14. Basic Crisis Theory Cont. Crisis occurs when something impedes one’s life goals.  Equilibrium/disequilibrium paradigm  Disturbed equilibrium  Brief therapy or grief work  Client’s working through the problem or grief  Restoration of equilibrium Basic Crisis Theory vs. Brief Therapy  Brief Therapy tends to resolve ongoing emotional issues whereas Basis Crisis Theory assists individuals in crisis and addresses their affective, behavioral, and cognitive distortions resulting from the traumatic event. ©2013, Brooks/Cole Cengage Learning
  • 15. Expanded Crisis Theory Explores social, environmental, and situational factors of a crisis. Is influenced by several theories  Psychoanalytic Theory  Early childhood experiences determines why a traumatic event becomes a crisis.  General Systems Theory  Examines the interdependence among people who experience a crisis.  Ecosystems  Extension of systems theory to include an environmental context ©2013, Brooks/Cole Cengage Learning
  • 16. Theories that Influence Expanded Crisis Theory Cont.  Adaptational Theory  Crisis response is sustained through maladaptive behaviors.  Interpersonal Theory  A state of crisis can not be sustained if a person has an intact sense of self-worth and has a healthy support system.  Chaos Theory  Theory of evolution applied to crisis intervention.  Developmental Theory  Potential for crisis arises from developmental tasks that are not accomplished. ©2013, Brooks/Cole Cengage Learning
  • 17. Applied Crisis Theory Encompasses four domains:  Normal developmental crises  Consequence of events in typical human development that produce an abnormal response  Birth of a child, graduation from college, or career change  Situational crises  Occurs when an uncommon event, that the individual or system has no way to predict or control, causes extreme stress.  Terrorist attacks, automobile accidents, or sudden illness ©2013, Brooks/Cole Cengage Learning
  • 18. Four Domains of Applied Crisis Theory Cont. Existential crises  A result of intrapersonal conflicts related to one’s sense of purpose, responsibility, independence, freedom, or commitment. Ecosystemic crises  When a natural or human-caused disaster overtakes a person or system through no fault of their own.  Natural phenomena (hurricanes, tornadoes, forest fires)  Biologically derived (disease, epidemic)  Politically based (war)  Severe economic depression (Great Depression) ©2013, Brooks/Cole Cengage Learning
  • 19. Crisis Intervention Models Traditional models of crisis intervention  Equilibrium model  Cognitive model  Psychosocial transition model Modern models based on Ecosystemic Theory  Developmental-ecological model  Contextual-ecological model Modern models based on field-practice  Psychological first aid  ACT model Eclectic model of crisis intervention ©2013, Brooks/Cole Cengage Learning
  • 20. Traditional Models Equilibrium Model  Crises are seen as a state of psychological disequilibrium.  Main focus is on stabilizing the individual.  Most appropriately used for early intervention. Cognitive Model  Crisis is a result of distorted thinking related to an event, not the event itself.  The goal is to help people change their perception of the crisis event.  Most appropriately used after the individual has been stabilized. Psychosocial Transition Model  Assumes that people are products of their genes and their environment.  The goal is for the person to gain coping mechanisms and establish a support system.  Most appropriately used after a client is stabilized. ©2013, Brooks/Cole Cengage Learning
  • 21. Ecosystemic Models Developmental-Ecological Model  Crisis worker should assess the individual’s developmental stage, their environment, and the relationship between the two. Contextual-Ecological Model  Contextual elements are layered by physical proximity and the emotional meaning attributed to the event.  Reciprocal impact occurs between the individual and the system.  Primary vs. secondary relationships  Degree of change triggered by the event  Time directly influences the impact of a crisis.  The amount of time that has passed  Special occasions (anniversaries, holidays, etc.) ©2013, Brooks/Cole Cengage Learning
  • 22. Eclectic Model Intentionally and systematically integrates valid concepts and strategies from all available approaches. Operates from a task orientation and has three major tasks.  Identify valid elements in all systems and integrate them.  Consider all pertinent theories, methods, and standards for evaluating and manipulating clinical data.  Do not identify with one specific theory. Fuses two pervasive themes  All people and all crisis are unique and distinctive  Two people may experience the same traumatic event but react to it differently  All people and all crises are similar  There are global elements to specific crisis types ©2013, Brooks/Cole Cengage Learning
  • 23. Field-based Models Psychological First Aid Model  Seeks to address the immediate crisis needs.  Non-intrusive because not everyone exposed to a traumatic event will experience a crisis.  Psychological First Aid: Field Operations Guide (The National Center for PTSD) consists of 8 core actions  Psychological Contact and Engagement  Safety and Comfort  Stabilization (if necessary)  Information Gathering: Current Needs and Concerns  Practical Assistance  Connection with Social Supports  Information on Coping  Linkage with Collaborative Services ©2013, Brooks/Cole Cengage Learning
  • 24. Field-based Models Cont. ACT Model  Assessment of presenting problem.  Connecting clients to support systems.  Traumatic reactions and posttraumatic stress disorders. ©2013, Brooks/Cole Cengage Learning
  • 25. Characteristics of Effective Crisis Workers Effective Crisis intervention is a hybrid of science and art. Crisis workers need a mastery of technical skill, theoretical knowledge, and certain characteristics to develop this hybrid.  Diverse life experiences  Poise  Creativity  Flexibility  Energy  Resiliency  Quick mental reflexes  Assertiveness  Tenacity ©2013, Brooks/Cole Cengage Learning