Crisis Intervention Exam 1 - Chapter 1: Approaching Crisis Intervention

developmental theory

-many crises have their basis in developmental stages that humans pass through; movement through various developmental life stages is critical; basic human needs & wants that are neglected can make it harder for ppl to move through developmental stages effectively

3 major movements helped shape crisis intervention into emerging specialty

1) Alcoholics Anonymous (AA) 2) Vietnam veterans 3) Women's movement of the 1970's

stages in Lindemann's paradigm

1) disturbed equilibrium 2) brief therapy or grief work 3) client's working through the problem or grief 4) restoration of equilibrium

3 ways people can react to a crisis

1) ideally- they cope effectively by themselves & develop strength from the experience, change & grow in a positive manner & come out of the crisis both stronger & more compassionate 2) others appear to survive the crisis but effectively block the hurtful affect from awareness, only have it to resurface later 3) yet others break down psychologically at the onset of crisis & are incapable of proceeding with life w/o immediate & intensive assistance

"normal" grief behaviors (Lindemann)

1) preoccupation w/ lost one 2) identification with the lost one 3) expressions of guilt & hostility 4) some disorganization in daily routine 5) some evidence of somatic complaints

ecological counseling perspective operates w/ 3 fundamental propositions:

1) while behavior is personal (the individual) it's also contextual (physical env. & culture in which it occurs and which person operates) 2) behavioral is interactional in the sense that individuals influence environment & vice versa 3) people continuously attempt to make meaning of multiple contexts in environment so they can operate effectively

2 important pieces of information about chaos theory

1- big crises call for a lot of different people working from a lot of different perspectives in a well-coordinated manner who can connect the myriad dots in a chaotic situation, see the underlying patterns, make sense of them, and change to meet changing conditions as new eddies and vortexes swirl out of the crisis 2- transcribes come close to manifesting chaos theory at work; there IS an underlying pattern that exists

crisis intervention - 2 parts

1- first-order intervention (psychological first aid) 2- crisis therapy (second-order intervention)

crisis intervention models

1. The Equilibrium Model 2. The Cognitive Model 3. The Psychosocial Model Plus 2 new: 1. The Developmental-Ecological Model 2. The Contextual-Ecological Model

examples of crises experienced by families

A child's disclosure of sexual molestation, the birth of a drug-addicted infant, the discovery of a teenager's dependence on drugs, a parent's arrest for violent behavior, the threat of a family's eviction from public housing, or a parent overwhelmed with the needs of a child

developmental crises

Crises that occur when a person is unable to complete the developmental tasks of a psychosocial stage and is therefore unable to continue developing. dramatic shift or change produces abnormal responses; ex- in response to childbirth, college graduation, midlife career change, retirement, aging process *considered normal, but all are unique

stress-producing situations

Everyone experiences times then they feel upset, disappointed, or exhausted. When such feelings are combined with certain life events or situations, they often lead to mounting tension and stress.

international crisis intervention

United Nations Inter-Agency Standing Committee published guidelines for mental health provision in emergency situations; Europe has European Network of Traumatic Stress to develop evidence-based responses to large-scale disasters & provide assistance to places in EU lacking in psych. support

what is an important step in the recovery process?

ability to share emotional impact of a traumatic event

Lindemann's basic crisis theory was important because his work negated the prevailing perception that clients manifesting crisis responses should be treated as

abnormal or pathological.

Parasuicide

accidentally doing something or going into a situation a reasonable person wouldn't & getting him/herself killed

PTSD vs. transcrisis states

although a person who is suffering from PTSD may be in a transcribes state, not all people who are in a transcribes state suffer from PTSD

Transcrisis state

although the original crisis event may be submerged below awareness & the individual may believe the problem has been resolved, the appearance of new stressors may bring the individual to the crisis again. - a temporary state of equilibrium has been achieved, but the original trauma will usually reemerge & instigate a new crisis the moment new stressors are introduced. Dynamically, this pattern is defensive repression. Therapeutically, it calls for crisis intervention techniques

PTSD

an identifiable anxiety disorder caused by an extremely traumatic event & very specific criteria must be present for the diagnosis to be made.

definition of crisis

an upset in a steady state, a critical turning point leading to better or worse, a disruption or breakdown in a person's or family's normal or usual pattern of functioning -constitutes circumstances or situations which cannot be resolved by one's customary problem-solving resources; w/o obtaining relief, crisis has potential to cause severe affective, behavioral, and cognitive malfunctioning up to the point of instigating injurious or lethal behavior to self/others.

crises

are emotionally hazardous situations that place victims at high risk for maladaptive coping or even for being immobilized.

brief therapy theory

attempts to remediate more or less ongoing emotional problems

Cognitive Model

based on the premise that crises are rooted in faulty thinking about the events/situations that surround the crisis - not in the events themselves or the facts about the events or situations. goal is to help ppl change views & beliefs about crisis events or situations. people can gain control of crises in their lives by changing their thinking, especially by recognizing & disrupting irrational & self-defeating parts of their cognitions & by retaining and focusing on the rational & self-enhancing elements of their thinking. seems most appropriate after client has been stabilized & returned to approximate state of pre crisis equilibrium -- based on REBT (Ellis), CBT & cognitive system.

Psychoanalytic Theory

based on the view that the disequilibrium that accompanies a person's crisis can be understood through gaining access to individual's unconscious thoughts & past emotional experiences

Ecosystems theory

broadens the base of the system & looks at the crisis in relation to the environmental context within which it occurs systemic interactions may occur from the microsystem (family & community) out to the microsystem (nation) or vice versa * comes into play most typically in large-scale disasters

what is trauma tourism?

burgeoning industry in postintervention psychological trauma replete w/ trade shows & publications, talk shows, and charitable giving & bus tours of trauma areas -assumption is that disaster invariably leads to psychopathology & psychopathology sells; also, marginalized groups often seen as woe is me targets are in need of pity and a lot of help -in reality, most victims of a disaster come together & form sense of community in a crisis and do not panic

personnel competencies are fomalizied through

certification, licensure, and accreditation

Dr. Gerald Caplan

considered the father of crisis intervention, attempted to explain what a crisis is and to build a theory of crisis

Natural Elements

crises are created by disasters such as floods, hurricanes, fires, and earthquakes, or even extended periods of high heat and humidity, or gloomy or excessively cold weather.

indirect and noncommissioned behavioral emergencies

crises that happen w/ no directed purpose or intentionally to do something harmful to oneself or others - drunk driving, boating, snow skiing, swimming, and project constructions have potential to turn into behavioral emergencies that can escalate to injurious or lethal behavioral and call for intervention

If a situation can wait 24 to 72 hours for a response, without placing an individual or a family in jeopardy, it is a ___________ and not an emergency.

crisis

when we assess individuals in crisis, our focus is not only on the _______________________ of the individual, but also, and as importantly, on the ______________________ & the _____________________ that may have caused the crisis to arise

current clinical/diagnostic state; repetitious cycle of problems; historical precursors

adaptational theory

depicts a person's crisis as being sustained through maladaptive behaviors, negative thoughts, and destructive defense mechanisms based on the premise that person's crisis will recede when maladaptive coping behaviors change to adaptive behaviors client replaces old, debilitating behaviors w/ new, self-enhancing ones

expanded crisis theory

draws not only from psychoanalytic theory but also from general system, ecosystems, adaptational, interpersonal, chaos, and developmental theory. was developed b/c basic theory (which depended on a psychoanalytic approach alone) didn't adequately address social, env. & situational factors that make an event a crisis

situational crises

emerges with the occurrence of uncommon and extraordinary events that an individual has no way of forecasting or controlling. i.e. terrorist attacks, auto accidents, kidnappings, rapes, job loss or sudden illnesses it is random, sudden, shocking, intense, & often catastrophic

speciality areas develop their own __________

empirical base, professional research & writings

to attend to the MH needs of survivors of large-scale disasters, public health personnel are now being taught to use ________

empirically grounded, best practice techniques called psychological 1st aid - designed to provide immediate, palliative MH assistance to survivors

applied crisis theory

encompasses 4 domains 1. normal developmental crises 2. situational crises 3. existential crises 4. ecosystemic crises

Both Lindemann & Caplan dealt with crisis intervention following psychological trauma using an_________

equilibrium/disequilibrium paradigm -- their work gave impetus to use of crisis intervention strategies in counseling & brief therapy w/ people manifesting universal human reactions to traumatic events

1st identifiable crisis phone line

established in 1906 by National Save-a-Life League

significant life events

events that most view as happy, such as a marriage, the birth of a child, a job promotion, or retirement, can trigger a crisis in a family; a child enrolling in school, the behaviors of an adolescent, a grown child leaving the home, the onset of menopause, or the death of a loved one can also be very stressful life events.

Caplan

expanded Lindemann's constructs to the total field of traumatic events; viewed crisis as a state resulting from impediments to life goals that cannot be overcome through customary behaviors. impediments can arise from both developmental & situational events

true/false: a crisis is the same as a problem or emergency

false; while a problem may create stress and be difficult to solve, the family or individual is capable of finding a solution. Consequently, a problem that can be resolved by an individual or a family is not a crisis.

There are five types of situations or events that may produce stress and, in turn, contribute to a state of crisis:

family situations economic situations community situations significant life events natural elements

Community Mental Health Act of 1963

federal act that completely changed the way MH services were delivered in US by mandating development of community centers to deal w/ the mentally ill; replaced state-run asylums

1995

first annual conference on trauma, loss, and dissociation was held

basic crisis theory

focuses on helping people in crisis recognize and correct temporary affective, behavioral, and cognitive distortions brought on by traumatic events.

formula for gauging impact of crisis on the individual/system

function of proximity to the event, reaction to the event, relationship to the event & amount of change caused by the event which is then divided by the amt. of time that has passed. **no single component can be considered separately

Grassroots Movements

groups of individuals personally affected by a common problem

the media's role in creating awareness of crises & crisis intervention

has probably generated most profound change in public consciousness of what it mean to be in crisis after a largescale distaster; changes our perception of the world as ever smaller, more interconnected, and certainly more dangerous, unsafe

family crises are periods of ______________ and ___________ that require _____________

heightened family vulnerability; imbalance; carefully planned response

International Federation of Red Cross & Red Crescent Societies

helps individuals & communities heal psychological wounds & rebuild social structures after an emergency or critical event; mission is to change ppl. into active survivors vs. passive victims

existential crises

includes the inner conflicts and anxieties that accompany important human issues of purpose, responsibility, independence, freedom, and commitment. i.e. at age 40 one will not have impact in an organization

crisis agencies must ______________ and manage its vital functions via ________________

institutionalize; board of directors, establishing rigorous auditing and record-keeping functions, and requires more money, paid staff, & staff support

Developmental-Ecological Model

integrates dev. stages & issues w/ the env. within which the individual operates crisis worker needs to assess both individual & environment as well as the interrelationship btwn the 2 & then factor in the developmental stage within which the person is operating. Any situational crisis must always be considered in relationship to the person's developmental stage & potency of crisis may depend on how well there has ben stage mastery of the tasks affected by the crisis

Systems theory

interrelationships & interdependence among people & btwn people & events refers to an emotional system, a system of communications, and a system of need fulfillment & request in which all members within an intergenerational relationship will bring something to bear on the others & eacb derives something from the others -contextual -looks at environment & dynamic interactions

Caplan's paradigm

linked Lindemann's concepts & stages to all developmental & situational events & extended crisis intervention to eliminating the affective, behavioral & cognitive distortions that precipitated the psychological trauma in the 1st place

The Contextual-Ecological Model

looks at layers, relationships, and time when it examines a crisis. These layers are dependent on two elements: proximity to the crisis by physical distance and reactions that are moderated by perception and the meaning attributed to the event. reciprocal impact occurs btwn the individual & systems affected by the event; involves recognition of 2 elements: the interaction between primary & secondary relationships & the degree of change triggered by the event

Christine Courtois

major player in the field of trauma, stated critical need for inclusion of psychological trauma training in all helping service curricula

secondary relationship

mediated by at least one other individual or system. -- employee's family members terrified for safety of loved one that no amount of assurances would satisfy them, then the primary relationship btwn employee & company would be affected

secondary intervention

minimizing harmful effects that have already occurred

community situations

neighborhood violence, inadequate housing, a lack of community resources, and inadequate educational programs illustrate some ways the community may contribute to family crises.

Lindemann helped professionals & paraprofessionals recognize that behavioral responses to crises associated with grief and loss are ___________, ___________, & ______________

normal, temporary, & amenable to alleviation thru short-term intervention techniques

economic situations

sudden or chronic financial strain is responsible for many family crises, such as loss of employment, a theft of household cash or belongings, high medical expenses, missed child support payments, repossession of a car, utilities cut off from service, money "lost" to gambling or drug addiction, and poverty.

probably the best testament to center stage on which crisis intervention is now playing is ________

the birth of APA's newest division, division 56, Trauma Psychology & the provision of counseling and school psychology professional accreditation standards for training graduates in crisis intervention

emergency of hundreds of crisis-oriented orgs. in 70s-90s & realization the role that immediate intervention plays in alleviating traumatic stress attest to

the dramatic transformation & professional acceptance of crisis intervention from a psychological backwater field to a pervasive specialty

macrosystems

the total culture in which people live

beneficial outcomes in crisis intervention may be due to traditional agents of change such as:

- cohesion - catharsis - imitative behavior - sharing of information

Psychosocial Transition Model

Assumes that people are products of their genes plus the learning they have absorbed from their particular social environments. Crises may be related to internal/external (psych, social, env.) difficulties. The goal is to collaborate with the clients in assessing the internal and external difficulties contributing to the crisis and then help them choose workable alternatives to their current behaviors, attitudes, and use of environmental resources. like the cog. model, most apron. after client has been stabilized --influenced by Adler, Erikson & Minuchin

Australians have been in vanguard of dealing w/ MH issues of large-scale disasters particularly through ____

Australians have been in vanguard of dealing w/ MH issues of large-scale disasters particularly thru research & writing of Beverley Raphael

benchmark for crisis intervention

Cocoanut Grove nightclub fire in 1942

Equilibrium Model

People in crisis are in a state of psychological or emotional disequilibrium in which their usual coping mechanisms and problem solving methods fail to meet their needs. Goal is to help ppl recover a state of pre crisis equilibrium. Seems most appropriate for early intervention when person is out of control, disoriented, and unable to make appropriate choices. Main focus on stabilizing individual until person has regained some coping abilities -prob. the purest model of CI and most likely to be used at onset of criss

family situations

a child abuse investigation, spouse abuse, an unplanned pregnancy, a parent's desertion, a chronically ill family member, and lack of social supports

The three basic elements of a crisis

a stressful situation, difficulty in coping, and the timing of intervention - interact and make each crisis unique.

emergency/behavioral emergency

a sudden, pressing necessity, such as when a life is in danger because of an accident, a suicide attempt, or family violence. It requires immediate attention by law enforcement, CPS, or other professionals trained to respond to life-threatening events.

transcrisis points

occur frequently in transcrisis states within the therapeutic intervention. Can be seen as benchmarks that are crucial to progressive stages of positive therapeutic growth. characterized by approach-avoidance behavior in seeking help, taking risks, and in initiating action steps toward movement. encountering these transcribes points, a person will experience same kind of disorganization, disequilibrium, and fragmentation that surrounded original crisis event. do not occur in regular, predictable, linear progression. ex: abused spouse goes thru transcrisis points after talking to crisis worker over the phone before making a decision to leave the battering relationship, often calling crisis workers a dozen times in the course of a few days. they may then make the decision to leave relationship and go to a spouse abuse shelter, only to find that the necessity of making a geographic move or finding a job instigates a crisis almost as potent as the battering

ecosystems crises

occur when some natural or human-caused disaster overtakes a person or a group of ppl who find themselves inundated in aftermath of an event that may adversely affect virtually every member of the environment in which they live ex- hurricanes, floods, tornadoes (natural phenomena); ebola/disease epidemic (biologically derived); war (politically based); Great Depression (severe economic depression)

concept of support

one of the overarching tenets of crisis intervention

interpersonal theory

people cannot sustain a personal state of crisis for very long if they believe in themselves and in others and have confidence that they can become self-actualized and overcome the crisis when ppl confer their locus of self-evaluation on others, they become dependent on them for validation of their being; therefore, crisis will persist as long as they maintain external locus of control outcome goal is to return the power of self-evaluation to the person

what are some valid reasons for the widespread acceptance of crisis intervention?

people in general have become more positive in their acceptance of outreach strategies following a crisis and are more knowledgeable about psychological ramifications such as PTSD; there is less victim blaming, and it is cost effective - - for example, political leaders have found that reactive responding causes crisis to get out of control; leaders themselves are blamed & held publicly responsible - in a sense, then, political expediency has dictated the widespread acceptance of effective crisis intervention strategies & crisis intervention become proactive, preventive, & integrated on the local, nat'l & int'l levels

Institutionalization of crisis services usually occurs when:​

politicians see the political necessity for alleviating the crisis.

suicide prevention

prob. longest running intervention prog. in which ind. crisis is addressed from a mental health (MH) stdpt

how can psychotherapy help in the recovery process?

psychotherapy can provide support, knowledge, information and assistance in the recovery process.

Crisis Intervention

psychotherapy that focuses on acute critical situations with the aim of restoring the person to the level of functioning before the crisis

what are the primary objectives of an effective crisis solution?

responding quickly, efficiently, and effectively

psychological first aid

seeks to address the immediate crisis situation and provide immediate relief, possibly to a wide range of individuals. Establishes the safety of the client, reduces the stress-related symptoms, provides rest and physical recuperation, and links clients to critical resources and social support systems. also known as first-order intervention

crisis therapy

seeks to resolve crisis & generally provided by licensed, trained human service professionals; second-order intervention

the state of crisis is ______________, usually lasting __________ weeks

short-lived; 4-6

metastasizing crisis

small, isolated incident is not contained and begins to spread; ex) school system's neglect in dealing w/ isolated cases of bullying can lead to dangerous culture of bullying moving out of the classroom & into cyberspace

primary intervention

stopping problem before it starts

Chaos theory

theory of evolution when applied to human functioning such as crisis intervention. an open-ended, ever-changing, "self organizing" system whereby a new system may emerge out of the crisis - human service workers resort to spontaneous, trial-and-error experimentation to try to cope w/ the crisis messiness of crisis lies not in disorder but in an order that is unknown, unpredictable, and spontaneous, an ever-shifting pattern driven by millions of uncoordinated, independent factors that necessitate experimentation, yet may finally result in a global classification of the crisis -- such experimentation may lead to false starts, temporary failure, dead ends, spontaneous innovation, creativity, improvisation, brainstorming, cooperative enterprise, and other "evolutionary" attempts to make sense of & cope with the crisis

Primary relationships

those in which no intervening component (other individuals/systems) interacts w/ or mediates the connection -- employee & a company -- if accident occurred & company immediately took # of steps to ensure safety measures to prevent it in future - makes employees feel safe, secure & satisfied

Police Crisis Intervention team

trained to de-escalate & defuse people who are mentally ill & demonstrating dangerous behavior to themselves or others

systemic crisis

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 & psychological reactions to it

Dr. Eric Lindemann

treated many of the survivors of cocoanut grove nightclub fire; found that they seemed to have "normal" grief/emotional responses to a disaster

disequilibrium

upset in a crisis; accompanies every crisis -is actually acute in the sense that it is of recent origin

most crisis work in the U.S. is done by _______

volunteers

indirect behavioral emergency

when people make bad decisions & wind up placing themselves in potentially lethal situations

key differentiating element of transcrisis state is that ______

whether it is due to trauma, personality traits, substance abuse, psychosis, or chronic environmental stressors, the state is residual and recurrent and always present to some degree. although ppl in transcrisis state are generally capable of functioning at some minimal level, they are always at risk & any small added stressor may tip the balance & send them into crisis

Characteristics of a Crisis:

• presence of danger and opportunity -- pain impels person to seek help -- can ideally plant seeds of self-growth & realization • seeds of growth and change -- anxiety always present w/ disequilibrium; discomfort provides an impetus for change-- even if to the point where they've reached rock bottom b4 getting help • no panaceas or quick fixes -- brief therapy can be used in certain crises; but rare to fix problems of longer duration; quick fixes (i.e. pills) may alleviate dreadful responses but don't change the instigating stimulus, so the crisis deepens) • the necessity of choice -- in the realm of crisis, not to choose is a choice, which usually turns out to be negative & destructive; but choosing to do something plants seeds of growth & allows person chance to set goals & formulate plan to begin to overcome dilemma • universality and idiosyncrasy -- disequilibrium or disorganization accompanies every crisis; universal- no one's immune to breakdown, given the right constellation of circumstances. idiosyncratic b/c what one person may successfully overcome, another one may not, even given virtually the same circumstances • resiliency -- 1 of the key jobs of crisis interventionist is finding right combo of support systems & coping mechanisms & forming them into action plans leading to resiliency through & beyond the crisis • perception - of the event plays a huge role in a crisis vs. the precipitating event itself; how people appraise precipitating events & what the interventionist can do to reframe & temper catastrophic interpretations of the event influences how well & how quickly crisis is alleviated • complicated symptoms - when an event reaches a flash point, there may be so many compounding problems that crisis workers must intervene directly in a variety of areas; env. of crisis strongly affects ease/difficulty w/ which the crisis can be handled