1. Origins of Crisis Intervention Theory
Crisis intervention is a model of practice that describes the impact of crises on people, and offers a helpful framework for professionals working with people in crisis.
The model was developed during the mid 1960s based on Caplan’s research into community mental health, and the experience of individuals with acute mental health problems.
In the sections that follow we’ll explore the key features of the model and outline the stages and tasks involved in working with people in crisis.
2. What is a crisis?
Take a moment to reflect and write down your definition of the word ‘crisis’.
It’s tempting to make assumptions about the meaning of words like ‘crisis’. It’s often used to imply disaster or catastrophe. It can mean this, but not necessarily.
Veronica Coulshed (1998) wrote that: 'Teams talk about crises when they mean that an urgent referral has come in or that they can only 'do crisis work', that is engage in minimal activity because of overwork.' In other words, what might really be meant here is that a high volume of work needs to be prioritised in terms of response and allocation. Although a crisis might entail drama, panic and chaos, what emerges on closer scrutiny is the highly subjective nature of both the identification of a crisis, and the experience of being in crisis.
Now lets compare your earlier definition of ‘crisis’ with definitions offered in the literature on crisis intervention.
Rapoport (1970) states that, 'A crisis is an upset in a steady state.'
Pierson and Thomas (2002) are a little more specific, suggesting that, “(a crisis) is precipitated by hazardous events which may be a single catastrophe or a series of mishaps…(crises) may be brought about by something external to the person or by something that appears rooted in him or her.”
Some life events are so dramatic they would create a crisis for most people - for example the death of a loved one, the sudden onset of illness, an accident or physical assault. However, even in these cases, although there may be some common patterns of response across the population as a whole, individuals will vary significantly in their reactions. Whether a particular individual perceives a specific life event to be a crisis or not, will be highly subjective and influenced by unique biographical experiences and particular ego strengths.
3. Learning activity: personal experience of crisis
Before we explore crisis theory in detail, take a little time to reflect on your personal experience of a crisis. This doesn’t need to be a dramatic event, but should reflect a time of urgency, disorganisation and confusion. Now make some notes on this experience using the following headings:
Describe the nature of the crisis?
Describe what helped?
And what didn't help?
How did the situation move on or settle?
Did this experience remind you of a previous life event?
What feelings were engendered by this activity? Was it easy to analyse the event? Does your response to this time of crisis feel familiar? Can you identify a pattern to your management of such events? If you’re undertaking this activity as part of a class, try comparing your notes with those of your colleagues. Given the findings of research into responses to crises it’s likely you’ll discover that responses to change are often unique and depend on a wide variety of factors. Moving house might create a crisis for me, but not for you!
4. Exploring crisis intervention theory
So what does crisis Intervention theory tell us about the experience of crisis?
- Crisis are time limited
Caplan's work identified that crises are time limited - his research demonstrated that a crisis will tend to last for a period of around six weeks. It will then burn out and shift into another state of being.
- Follow a staged progression
The period of crisis has a staged progression - a beginning, a middle and end. Each stage having different characteristics.
- Beginning stage
An individual in crisis will tend in the beginning stage, to draw upon previously used coping strategies to manage the new threat. Familiar strategies will be employed even if they have previously been unsuccessful and counter productive. The choice of strategy is largely unconscious. An individual in crisis will strive to recreate their previous form of equilibrium. Service users experiencing threat may also utilise protective defence mechanisms – like denial, disbelief, projection etc.
- Middle stage
In the middle stage of crisis, people can be more receptive to help than at other times. Mental, emotional and physical energy can accompany this time of disorganisation and the individual can be assisted to employ different strategies, consider alternative choices. Learning new coping strategies at this stage can develop future resilience.
- Final stage
The final stage of crisis will involve either resolution of the perceived event/trigger, a re-definition of the problem or a shift in their management of the dilemma.
- Crises imply lose
Crises imply loss: both internal, connecting to previous experiences of loss and separation; or external and actual in terms of immediate life event.
- Some crises are normal
Some crises are situational and ‘normal'. Erikson's theory of human development is based on the identified crisis points of key life stages – for example, the crisis of moving from childhood to young adulthood. (Erikson 1965)
- Threat can be motivational
The experience of threat to the self as a result of crisis means that some people will be motivated to seek help who might not otherwise have become service users.
- Crises can create positive growth and change
Crises, whilst initially immobilising, can create positive growth and change and can be harnessed as significant, constructive experiences. Intervention at this point can be more successful than during periods of reduced tension. Don't be afraid of a crisis!!
5. Stages and Tasks
Crisis intervention theory states that a person in crisis will typically move through the following stages, and the professional helper will require to address different tasks at each stage.
- Identification of crisis.
This needs to be service user led. Is this situation being perceived as a crisis?
- Identification of the significance of this event for the service user.
Does it repeat an experience from another time in their life? Does the experience of crisis suggest a repeating pattern in this person's life? Does the apparent trigger actually disturb other aspects of their life's equilibrium? E.g. - going into hospital might be the event but the crisis might actually be in finding appropriate child care.
- Talking through/ release of tension.
By offering the opportunity for the expression of feelings within a listening context, the worker is assisting the service user to gain emotional relief. This in itself can relieve some of the manifestation of the event.
- Reality testing/cognitive restructuring
Sensitive challenge of the extent and reality of the presented difficulty. There can be a tendency for the individual in crisis to project forward in time, catastrophising repercussions which are not based in reality.
- Identifying tasks, prioritising problems, setting achievable goals.
Aim to involve the service user in some aspect of the tasks to be carried out in order to strengthen cognitive confidence in their coping abilities. Crises produce adrenalin in both the worker and the service user. Undertaking tangible tasks can make constructive use of this energy whilst simultaneously creating a positive release.
- Build upon existing strengths and strategies
but also suggest additional/alternative options for managing the situation. This might entail a directive but empowering approach to assist the individual to value and access their previous strengths which they might lose sight of in the midst of the crisis but also to create alternative options to their predicament
6. The role of the professional helper
Using the model of crisis intervention requires both action and stillness on the part of the professional helper. Action, in order to respond appropriately to the needs of the individual and the demands of the presenting situation. Stillness, in order to listen openly, act as a container for the expression of emotions and to offer a role model demonstrating that the problem is bearable.