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CRISIS THEORY
Crisis Theory postulates that crises are a normal part of life, Crises can either be predictable, for example growing older, or unpredictable, for example a family illness. In response to a crisis, individuals strive to maintain their equilibrium by using their usual coping mechanisms. Problems arise or crises persist when the precipitating event is threatening and the usual coping mechanisms don't work, or when recent events reactivate an earlier unresolved crisis.
The more unresolved earlier crises there are, the more vulnerable individuals are to being unable to resolve new crises. Conversely, when people learn new skills to resolve a crisis, this skills are retained and used to resolve further situations.
The Mandarin ideogram for ‘crisis’ contains two characters, the first, "wei," indicates a critical or dangerous situation, the second character, "ji," means a time to be alert and ready to take action or an opportunity for change.
Thus, these characters together suggest that a crisis consists of both danger, and an opportunity to change.
People in crisis are open to utilizing new coping strategies. In work with families, a crisis situation can be used to kick-start a new and positive way of being. For example people with drink problems often say that they had to hit ‘rock bottom’ before they were able to change. In childcare social work in the UK, I have often seen families under threat of breakdown use this crisis to accept the opportunity to learn appropriate new skills and so start a new way of life.
Human beings have a remarkable capacity for dealing with difficulty. It is only when difficulties are insurmountable, when people find themselves without the appropriate personal, social, spiritual, emotional or physical resources to deal effectively with stressful events, that they find themselves in crisis.
A stressful event alone does not constitute a crisis, crisis is determined by the individual's view of the event and their response to it. If the individual sees the event as important and threatening, if they have tried all of their usual coping strategies without effect, and are unable to pursue other alternatives, then the individual may find themselves in crisis.
Crisis is a state of psychological disequilibrium. People in crisis may experience a host of emotions, including feelings of anxiety, guilt, helplessness and fear. There may be a number of other indicators including changes in energy and activity levels, eating and sleeping patterns, inability to concentrate, withdrawal from friend and relatives, depression and so on. Most crises burn themselves out or reach some kind of stability within 4 – 8 weeks, however without skilled intervention, the crisis may have gone, but the behaviours will remain and the opportunity for change will be lost.
CRISIS INTERVENTION
When in crisis, people find themselves without solutions and at this time they may be most receptive to outside assistance. Skilled professional intervention during this 4 – 8 week window can provide an opportunity for behavioural change, the learning of new skills and a return to stability. Once successful, people are more likely to use these skills in the future.
Crisis intervention is a time limited professional response used to help individuals, groups and families using a number of practitioner skills. A helper's primary goals are to identify that the individual or family is in crisis, i.e. they are open to learning new skills and coping mechanisms, to reduce individual's feelings of distress, helplessness and isolation and if necessary activate social resources with the aim of returning the individual to his/her prior level of functioning as quickly as possible. This is done through listening, validation, acceptance, normalization, reassurance, education, advocacy and brokering resources.
A crisis intervention can be broken down into seven different phases.
1. establish communication and build hope that things can improve 2. assess the situation 3. explore existing strengths and resources 4. set some goals using those strengths 5. implement the plan, teaching new skills or mobilising other support if necessary 6. evaluate and adjust the plan if necessary 7. arrange follow up and terminate the relationship
While supporting and empathizing with the individual in crisis, the worker should use all their reflective listening skills so as to allow the individual full expression of feelings and emotions. The worker should convey an atmosphere of acceptance, support, and calm confidence about the future. Open communication is vital; this involves establishing rapport, using non-verbal communication, e.g. open body language and eye contact.
Exploration will include the individual’s perception of the problem, the sequence of events, feelings, and an exploration of attempts to deal with the problem. The worker needs to be aware of what the individual is saying as well as his nonverbal communication, facial expression, posture, body and eye movements, and mannerisms. An essential part of this assessment is an evaluation of the person's current safety as well as any risk to his or someone else's life. The aim is for the worker to develop an awareness of the significance of the crisis from the individual's point of view.
Following this it is often important to explore existing strengths and resources. People in crisis often feel, afraid, hopeless and helpless and so find it difficult to accept that they have strengths and that there are resources available to them and so the steps in this process are often very small ones, asking open ended solution focussed questions like ‘what do you like about him’, ‘what is he good at’, ‘how have you coped with this before’, ‘tell me about a time when it was different - why was it different’ and ‘what is stopping it from being worse’, may be very useful. The worker may need to be directive from time to time by returning the focus to the here and now.
This may be followed by using the miracle question to explore a preferred future and begin to look at strategies and sources of support. Taking into account the individuals network, personal strengths, culture and lifestyle the outcome of this process is to help the individual to begin to set some clear time-limited goals, planning a route forward step by step and considering any barriers to success.
The worker and the individual may at this time begin to focus on the individuals need to learn some new skills, the worker may teach or offer advice, model behaviour, or they may together role play specific situations or rehearse dealing with potential problems.
The worker and individual implement their plan and evaluate its effectiveness. They then adjust the plan as necessary. The worker then provides for follow-up or refers the individual to resources that can provide ongoing support if appropriate and not already done. The worker then terminates the crisis relationship.
REFERENCES
Caplan, G. (1964). Principles of preventive psychiatry. New York: Basic Books. Ehly, S. (1986). Crisis intervention handbook. Washington, D.C.: National Association of School Psychologists. Ell, Kathleen (1996). Crisis theory and social work treatment in F. Turner (Ed.), Social work treatment, (4th ed.). New York: Free Press. Greenstone, J. L. & Leviton, S. C. (1993). Elements of crisis intervention: Crises and how to respond to them. Pacific Grove, CA: Brooks/Cole Publishing Co. Hamer, M. (2005). Preventing Breakdown, Russell House Publishing, UK. Hoff, L. A. (1989). People in crisis: Understanding and helping (3rd ed.). Redwood City, CA: Addison Wesley Publishing Co. James, R. & Gilliland, B. (2001). Crisis intervention strategies, (4th ed.). Pacific Grove, CA: Brooks/Cole Parad, H.J. & Parad, L.G. (1990). Crisis Intervention. Milwaukee: Families International.
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All material is Copyright Mark Hamer 2006. |
