Crisis intervention:

Crisis intervention is a short-term approach to assisting individuals during times when their coping mechanisms are overtaxed. It may be employed at the scene of the crisis, or it may be a form of short-term therapy.

Crisis intervention theory was first developed in the 1940’s by Erich Lindemann and later expanded on by Gerald Caplan. Lindemann developed this time-limited treatment after the Cocoanut Grove nightclub fire in Boston. After the fire, he witnessed both acute and delayed reactions of survivors and relatives of survivors. Lindemann discovered that people need to grieve after a tragedy. If the grieving process is impeded, negative outcomes are far more likely to develop. Caplan expanded on Lindemann’s work in the 1960’s and studied crisis points in people’s lives.

A crisis can take many forms: a natural disaster, a criminal victimization, a medical emergency, bad news, or personal and family difficulties. A crisis can also occur when an individual receives unexpected information. There are some events, like a sudden death or illness, that will cause a crisis for most individuals. Some events, such as the terrorist attacks on September 11, 2001, are national and international crises. Generally speaking, any emotional, mental, physical, or behavioral stress can be perceived as a crisis; however, a stressful event does not necessarily lead to a crisis response. A crisis situation develops if the event exceeds the individual’s perceived (not actual) coping skills.

Response to Emergencies

A crisis intervention response to emergencies and crisis intervention therapy differ, but in both, a variety of techniques are used in the short term to assist an individual dealing with a traumatic situation. A crisis intervention response may be necessary in a variety of situations from a suicide attempt to a hostage situation, to the aftermath of terrorist attacks. Generally this response involves law-enforcement personnel or other first responders (such as firefighters or paramedics) in some way.

Immediately on arrival at the scene, responders must identify the type of crisis and devise an intervention strategy based on the specific situation. The situation is first contained and controlled, then diffused. Common crises are hostage situations, barricade situations, and individuals threatening suicide.
Once any crisis has been resolved, whether completely successfully or not, debriefing will occur. How each member of the crisis team responded will be examined so that this knowledge can be used to improve future crisis responses. Crises can also have long-term effects on interventionists, which also must be addressed.

Crisis Hotlines

In the 1970’s and 1980’s, crisis hotlines began to be used as a method of assisting individuals in crisis. Individuals who call in crisis can receive very brief counseling. This may be appropriate for a person considering suicide or for someone who has recently been victimized. Hotlines can also provide information to callers, links to needed services, and educational outreach.

Crisis Intervention Therapy

The purpose of crisis intervention therapy is to reduce emotional distress and to increase coping skills. The ultimate goal of crisis intervention is not just to return the individual to a prior functioning level but also to raise it. Crisis intervention presents the psychologist or mental health worker with unique opportunities because individuals are most open to change when they clearly see that previously used coping strategies are no longer working.

Individuals can seek treatment from psychologists and therapists in private practice. Most cities have rape crisis centers, centers for victims of violent crime, and women’s health clinics where crisis counseling can be found. College and university campuses offer counseling services to students.

Children in crisis situations can be especially vulnerable because they have had fewer years to develop coping skills. Violence can occur in schools or within the home. School psychologists and social workers can help children deal with stress. When children are exposed to long-term stress through abuse or neglect at home, intervention may focus on the entire family and helping everyone develop better coping skills.

The therapist and client will meet to define the current problem and examine responses that have not worked. From that point, alternative responses will be discussed. A behavioral therapist may have the client rehearse new responses. In some cases, medication can also be used to lessen anxiety or depression and facilitate progression in therapy.

Stress Response

Hans Selye conceptualized the stress response as a biological response that progressed through alarm, resistance, and exhaustion. Unremitting stress can result in a variety of physical disorders involving the cardiovascular system, gastrointestinal system, immunological response, and even skin conditions. Stress can also result in psychological disorders. In the short term, severe stress can result in the development of panic attacks and acute stress disorder. When stress continues over an extended period of time, post-traumatic stress disorder, mood disorders, sleep disorders, and a variety of other psychological disorders may arise.

Sources for Further Study

Doherty, George. Crisis Intervention Training for Disaster Workers: An Introduction. Laramie, Wyo.: Rocky Mountain Disaster Mental Health Institute, 2007. A basic text designed as a training manual for those who work in the aftermath of disasters.

Freeman, Arthur. Cognitive-Behavioral Strategies in Crisis Intervention. 3d ed. New York: Guilford Press, 2007. This book is intended for those who are interested in doing treatment with individuals in crisis. This book discusses a variety of crises: psychological, medical, child and family, environmental, and situational.

Heath, Melissa Allen, and Dawn Sheen. School-Based Crisis Intervention: Preparing All Personnel to Assist. New York: Guilford Press, 2005. Children can be particularly vulnerable to crises. This book is intended to assist those individuals working with children in a school setting in both recognizing and responding to a multitude of crises that can occur in the lives of children.

Roberts, Albert R., and Kenneth R. Yeager. Pocket Guide to Crisis Intervention. New York: Oxford University Press, 2009. A handbook on appropriate methods of intervention in crisis situations.

Seeley, Karen M. Therapy After Terror: 9/11, Psychotherapists, and Mental Health. New York: Cambridge University Press, 2008. An account of the psychological effect of the September 11 terrorist attacks, from the perspectives of New York mental health professionals who treated patients after the attacks.

-Birdy