Transcript Document

THEORIES OF CRISIS,
CRISIS INTERVENTION
DEFINITIONS OF CRISIS
• Caplan (1960) defines crisis: brief episode of
psychological unbalance which occurs when
the subject is faced with a problem that cannot
be solved or avoided.
• Triggers of a crisis:
- traumatic events
- life changes entailed by the life cycle
CRISIS
 Stressful event or perceived threat + lack of
efficient coping skills, resulting in emotional
unbalance
 Limited in time: 1-6 weeks
 During the crisis, the subject asks for help
 During the crisis, the subject is more compliant
to external intervention
 The evolution in crisis depends on the timing of
the intervention
COPING AND CRISIS
• Stages of coping in crisis:
Stage I. Immediate response: astonishment,
denial
Stage II. Emotional reactions: anxiety, anger,
guilt, regression, depression
Stage III. Resolution: acceptance, planning the
future
Model of crisis (G. Caplan, 1961)
THREAT
EMOTIONAL BALANCE
Automatic resolution of
the problem-situation
STAGE 1
INCREASE OF PSYCHOLOGICAL
TENSION
(brief, unnoticed)
Problem-solving
strategies
STAGE 2
FURTHER INCREASE OF
PSYCHOLOGICAL TENSION
(acknowledged)
New problem-solving
strategies
STAGE 3
PSYCHOLOGICAL DISTRESS
(anxiety, discomfort)
STAGE 4
SEVERE PSYCHOLOGICAL
TENSION, DISORGANISATION,
SYMPTOMS, UNBALANCE, CRISIS
TYPES OF CRISIS
1. MATURATIONAL CRISIS
– Periods in life which entail changes in social
roles, biological and social pressures;
– Adolescence, marriage, birth of a child,
retirement;
– Adolescence: maturational crisis –
originality, hormonal and psychological
unbalance
TYPES OF CRISIS
2. SITUATIONAL CRISIS
– A specific external event disrupts the
internal psychological balance of the
individual;
– Holmes & Rahe Scale:
Death of spouse, divorce
Illness, accidents
Pregnancy, childbirth
Sexual dysfunction …
SITUATIONAL CRISIS
1. The experience of loss (of a loved one, of selfesteem, of normal functioning, of status, of
job…)
2. Issues concerning change (transition in
Romania, marriage, birth of a child, moving,
change of job…)
3. Interpersonal issues (family conflicts)
4. Environmental factors (polution, work
environment…)
TYPES OF CRISIS
3. CATASTROFIC CRISIS (SOCIAL)
– accidental, unusual, unexpected: fire,
earthquake, flood, kidnapping, nuclear
accidents…
– They do not occur in any subject’s life
– Severe stress, requiring maximal coping
strategies and abilities
CATASTROFIC CRISIS - STAGES
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Impact
Heroic stage
“Honeymoon” stage
Disillusionment stage
Reconstruction, reorganisation
CATASTROFIC CRISIS - STAGES
Impact: shock, extreme fear; poor/ distorted
assessment of reality, and self-destructive behaviour
Heroic stage: Cooperative spirit between friends,
neighbours, and emergency teams; constructive
activity at this time may help overcome anxiety and
depression but excessive activity can lead to "burnout"
Honeymoon: 1 week-several months after the disaster;
the need to help others is sustained; psychological
problems may be overlooked
Disillusionment: 2 months to 1 year; disappointment,
resentment, frustration, anger; victims often begin to
show hostility toward others
Reconstruction: Individuals admit that they must come
to grips with their own problems; they begin to behave
in a constructive manner
THE CONSEQUENCE OF
UNRESOLVED
CRISIS→SUICIDE!!!!
SPECIFIC GOALS OF CRISIS
INTERVENTION (Korchin)
a) Releasing the psychological tension and
distress (anxiety, despair, confusion, agitation)
b) Restoring the level of functioning and activity
that the subject had prior to the crisis
c) Reassuring the subject that the coping
resources (internal, external) and support are
available
TECNIQUES OF CRISIS
INTERVENTION
1. Abreaction – remembering the highly
emotionally charged events decreases the
tension: "ventilation of emotions";
2. Clarifying – encouraging the subject to
rationalize the relationship between previous
life events and current situation;
3. Suggestion – persuasive discourse in order to
improve personal and overall situation;
4. Manipulation – employing patient’s emotions
and desires in the therapeutic process;
TECHNIQUES OF CRISIS
INTERVENTION
5. Positive reinvestment - positive answers to
patient’s successful adaptive behaviors;
6. Supporting effective defense mechanisms that
maintain integrity of the ego;
7. Encouraging the increase of self-esteem –
regaining the purpose of living, reassuring the
subject of his/her value and meaning;
8. Exploring solutions – finding specific alternative
solutions and problem-solving through
teamwork;
PROBLEM-SOLVING SEQUENCE
IN CRISIS INTERVENTION
 Step-by-step sequence:
a) Assessment of severity of crisis
b) Planning the actions according to available
resources
c) Intervention
d) Reassessment of the situation and planning of
future actions
 If the specific goal has not been attained after
these 4 steps, the crisis team has to start over
and retrace the 4 actions.
a) ASSESSMENT
 The first action in crisis intervention:
assessment of the subject and of triggers
 The therapist gathers specific information
concerning the triggering event
 The current risk for suicide and violence are
assessed
 If the assessment indicates that
hospitalization is not required, the therapist
may proceed with the intervention
b) INTERVENTION PLANNING
 The decisive factor in planning: the time passed from
the outbreak of crisis (commonly: the event occurs
1-2 weeks prior to the subject’s “cry for help”)
 The impact of the event on subject’s life
 The impact on people close to the subject
 Coping styles previously (but not currently)
employed by the subject in difficult situations
 Time required for intervention
 Size and structure of the intervention team
 First specific actions
 Estimated time until the first signs of improvement
c) INTERVENTION
1. First contact with the person in crisis
2. Employing a set of specific questions in order
to find out specific information about the case
3. Involving the family, facilitating communication
4. Accurate assessment of the situation, drawing
up a “therapeutic contract” between all parties
involved
5. Inventory of the problems and establishing
priorities
FIRST CONTACT
 Establishing a “normal” environment
 The subject, other people present and their
relationship with the subject are identified
 The triggering event is debated
 The therapist informs all parties involved that
they will all be required to take part in the
resolution of crisis
SPECIFIC QUESTIONS
 About the triggering event of the crisis
 About symptoms generated by the impact with
the event
 About the subject’s coping resources in front
of psychological aggression
 Practical issues: clinical and gynecological
assessment, nutritional status…
 Events/changes within the previous 2-3 weeks
 Brief psychiatric assessment – possible
symptoms (anxiety, depression) prior to the
crisis
FAMILY, COMMUNICATION
 Crisis (acute psychological unbalance) in a subject:
sign of disturbed family system, will also affect other
family members
 Roles in the family system will have to change in order
to accommodate the needs of the patient
 A list of problems for each family member to solve is
drawn up – this enhances the feeling of cohesion and
involvement in therapy
 Optimal communication in the family – listening to all
parties, excluding critiques, objective and sensible
assessment of alternatives to proposed solutions
 Active listening and unconditional support of the
subject by all parties involved is needed
THERAPEUTIC CONTRACT
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The therapist expresses his viewpoint
The connection between symptoms of subject and traumatic
events
The necessity of admittance is assessed, according to severity
of symptoms
Benefits and disadvantages of admittance
Subjects without psychiatric disorders are kept in their home
environment
A contract is drawn up with family members – responsibilities
of each party involved is detailed (family, friends, neighbors,
volunteers in NGO’s, physicians, psychologists, social worker,
nurse)
If the situation progressively improves, regular follow-up athome visits continue for a predetermined period (3 – 6 weeks)
PRIORITIES OF ACTION
 The specific problem of the subject in crisis is
avoided, if it cannot be solved in a short time
 If the problem can be solved, the specific
actions to eliminate the consequences of
“disaster” will be the focus of intervention
 The family is involved in action planning
 Multiple solutions are explored
 Tasks are divided
 All support resources are identified, mobilized
 Support resources for the therapist are
identified
d) REASSESSMENT
 The last stage: the subject and intervention
team evaluate the degree of positive
outcomes and resolution of crisis
 The best assessment tool: level of functioning
– the extent to which the subject has returned
to the level of functioning prior to the crisis
 Inventory of specific activities, daily routine
 Coping abilities in family and professional
situations