Chapter 15: Crises & Crisis Interventions

• Crisis


  A breakthrough, a decisive moment. A dramatic change in the state of an organism or system (family, organization, community, state) or in the usual course of a process
• Characteristics of a crisis


  • Significant and definite
  • Occurs suddenly, unexpectedly or very quickly
• Crisis


  Any event that tests a person's adaptive abilities
• Crisis (according to Gerald Kaplan)


  A disfunction of an individual's steady state that occurs when a person finds that reaching important life goals is blocked by insurmountable obstacles, which cannot be overcome via the usual coping strategies
• A crisis is a disorder of a stable state, leading to a break in the usual patterns of functioning, which cannot be recovered from the individual using his known strategies and mechanisms to overcome
• As a consequence of a crisis, a lack of applicability of the old models of functioning emerges. In turn, personal abilities also lose their adaptive character, and the individual cannot cope on their own
• The crisis is characterized by its time limitation – from hours to days, depending on the potential of the personality
• Possible ways for dealing/exiting /solving the crisis


  • Restoring the balance to pre-crisis level
  • A higher and more adaptable level of functioning
  • Lower level of functioning or decompensation
• Age-related (normative) crises


  Certain psychophysiological features that contradict reality due to the lack of social skills. Natural states of the transition in life, which is the same for all people
• Age crises


  • Birth
  • Crisis "of stubbornness"
  • Crisis of the first year of school
  • Pubertal crisis
  • Maturity crisis
• Birth crisis


  The solution of the psychological task is associated with the activation of unconditioned reflexes, closeness to the mother's body, and satisfaction of basic needs. The deficit is expressed in immaturity of cognitive processes, motor skills and complete dependence on the care of the elderly
• Crisis "of stubbornness"


  The child shows "I-activity" in terms of getting to know the outside world. Its deficit is expressed in a lack of sense of time and space. Solving the psychological task is associated with teaching the child to achieve his own within the requirements of adults, postponing the impulse
• Crisis of the first year of school


  Children have good intelligence, understand much more than what is happening around them. They begin to realize the beginning and end of life. They are capable of modelled activity and to control their behaviour to some extent. The deficit is how to function successfully with their peers without engaging another adult. The psychological task is considered solved when the child develops the ability to make meaningful contact with one – a friend in the group
• Pubertal crisis


  Characterized by increased activity. The motto of adolescents is: "I want on my own". The deficit is socio-psychological – the result of their activity and impatience
• Maturity crisis


  Hormonal and body changes of the person have already occurred. In women, menopause begins, and in men, the beginning of a long process is marked that will lead to the onset of andropause
• Personality crises


  Related to microtraumas in life, psychological characteristics and trials (crises in marital relations, intergenerational relations, crisis of adjustment, sexual relations, acceptance of sexuality, etc.). People have tried to cope with their available resources, in which they have exhausted themselves and eventually, failed
• Situational crises


  Refer to losses: of health, death, disasters, ill-treatment, material losses, etc. They have the meaning of macrotrauma. Every single unresolved crisis turns into psychotrauma
• Elements of a crisis


  • Dangerous or traumatic event
  • Vulnerable or unbalanced state
  • Precipitating factor
  • Active crisis state - determined by the way of experiencing the individual
  • Resolving the crisis
• Indicators of predisposition to crisis


  • Single individuals – lack of ability to build lasting meaningful relationships
  • History of mental disorder
  • Habitually, the individual feels stressed or overwhelmed
  • Lack of adequate social support system
  • A history of previous crises from which he has not fully recovered
  • Rigidity in thinking and behaviour, inability to learn lessons from previous experiences
  • Low self-esteem
  • Impulsivity, easy irritability and the presence of explosive personality structure
  • Experiencing sadness for a long period, hopelessness, helplessness, irritability, sleep problems, changes in appetite
  • History of impaired marital or sexual relations
  • Abuse and/or dependence – psychoactive drugs or behavioural addictions
  • Unemployment or often change of employment
• Stages of the crisis (according to Kaplan)


  • Collision stage
  • Withdrawal stage
  • Reassessment and adaptation or disadaptation stage
• Collision stage


  Characterized by emotional (stress, anxiety, anger, fear, sadness, inappropriate laughter, loss of interests, helplessness), cognitive (confusion, feeling that this can not happen, lack of concentration and feeling blocked, difficulties in setting priorities, selflessness, low self-esteem), behavioural (numbness, excitement, disorganized behaviour, social isolation, aggressive tantrums, substance abuse, insomnia, overeating or lack of appetite) and vegetarian (shortness of breath, palpitations, dizziness, fainting) components
• Withdrawal stage


  Changes in emotions, cognitions, behaviour, and vegetative symptoms are observed again. The presence of disorganized and intense emotions such as anger and guilt that flow simultaneously. Manifestation of various bodily symptoms such as: headache, fatigue, upset stomach
• Reassessment and adaptation or disadaptation stage


  The phase of exiting the crisis, either successfully or unsuccessfully. Successful psychological experience leads to the development of new adaptive and supportive mechanisms - breakthrough, and unsuccessful - corresponding to maladaptive mechanisms, which in turn can lead to provoking future crises - failure
• Crisis intervention is short and limited in time. Not intended to promote a long-term therapeutic relationship or long-term personality change
• It is necessary to ensure the safety of both the patient and the therapist before an effective crisis intervention can take place
• Crisis intervention is more active than passive. It is necessary for therapists to act quickly and engage the patient in the therapeutic process within their first appointment
• The clinical matter, not related to the current crisis of the patient, has a great value in crisis interventions
• Effective crisis intervention demands therapeutic flexibility. It uses evaluation and intervention techniques from different theoretical paradigms – cognitive, behavioural, family systems, etc.
• Professionals cannot afford to let their patients "bypass" the immediate problems associated with the crisis being experienced. Resistances and protections in the course of crisis intervention are interpreted and commented on at a later stage of the process.
• The clinical matter, not related to the current crisis of the patient, has a great value in crisis interventions.
• Rapid evaluation of the patient's problem is essential and often has to be carried out on incomplete information. In some cases, a patient's resistance to dealing with the current crisis may be exacerbated by an unintentional emphasis on childhood and other pre-existing events of early life. Similarly to Yalom's creative principles for group work (Yalom, I.,1995), crisis intervention aims to focus on "here-and-now".
• Effective crisis intervention


  • Demands therapeutic flexibility
  • Is eclectic, using evaluation and intervention techniques from different theoretical paradigms - cognitive, behavioural, family systems, group, existential, humanistic, personality-oriented, dynamic, reality-based, etc.
  • Requires professionals to be qualified in a range of therapeutic techniques and to be familiar with a variety of guidelines and formulations for work
• Effective crisis intervention


  • Demands constant ethical evaluation and consideration
  • If the intervention proceeds as intended, the activity of the specialist allows the patient to achieve a significant psychological gain in merely a few sessions
  • The immediate danger is that the specialist (consciously, inadvertently, or unconsciously) can use their position of authority and force the patient to make important decisions not based on the patient's own values and beliefs, but on the basis of those (personal) of the specialist
  • The majority of patients seeking crisis intervention are in a state of cognitive imbalance and imbalance, as well as carriers of a significant amount of distress
• Crisis intervention allows it to be carried out in different conditions. With the main exception of in vivo in the treatment of phobias and other anxiety disorders, most traditional psychotherapeutic and counselling interventions are conducted in an office or controlled hospital setting. The difference with many forms of crisis intervention is that they occur, literally, outside such a traditional, controlled environment.
• Crisis specialists need to be prepared to work with a variety of patient groups. Crises occur regardless of age, gender, sexual orientation, ethnicity, cultural background, disability, intelligence, religious affiliation or socio-economic status. Being open to different cultural, religious and other beliefs becomes a necessity for the specialist.
• Patients need crisis intervention with respect to different clinical scenarios. For example, someone may seek therapeutic support for the first time after experiencing an accident, another may be in the process of psychotherapy and experience a crisis. Each of the clinical scenarios is uniquely different and requires an equally unique approach to treatment.
• The purpose of crisis intervention is to return the patient to the normal level (for them) of functioning before the crisis event.
• Diffusion


  A procedure implying interference at the site and during the traumatic event "here and now", within 7-12 hours
• Debriefing


  Takes place for a relatively short period after the onset of the crisis (according to some authors) up to a week. The situation itself is most often over, but the acute stress caused by the experiences during the crisis is present.
• Crisis intervention finds applications in all areas of medicine: dying (terminally ill), loss of a loved one (grieving and mourning), reporting bad news, managing occupational stress, etc. Any form of anti-crisis work proceeds from socio-cognitive theoretical structures. One of these paradigms is Alber Bandura's social learning theory, which was established in the late 1970s.