Crisis intervention is a brief preventive assessment and psychotherapy administered following a personal or group crisis.
The term crisis intervention can refer to several different therapeutic approaches applied in a variety of critical situations affecting either individuals or groups of people. The common denominator among these interventions, however, is their brief duration and their focus on improving the stability of a person (or group of people) undergoing an acute reaction to a stressor rather than on treating longstanding mental disorders. Some common examples of crisis intervention include suicide prevention telephone hotlines, hospital-based crisis intervention, and community-based mental health services mobilized during a disaster.
Underlying most models of crisis intervention is what has been termed the trilogy (threefold) model of crisis. According to this model, a crisis has three parts or aspects: 1) a precipitating event; 2) intense distress on the part of a person involved in the event; and 3) a breakdown of the person's usual coping methods, causing the person to function at a lower level than before the event and have difficulty dealing with the stressor. On this basis, one can see that a crisis includes a subjective dimension (the person's reaction of distress and temporary loss of the ability to cope) as well as an objective dimension (the precipitating event).
It is the subjective element that is the focus of crisis intervention: The counselor seeks to help the distressed person change his or her perception of the stressor and to regain his or her ability to function. Thus, crisis intervention has an educational as well as a healing function; in many cases, the person in crisis benefits from learning better coping strategies as well as having his or her immediate physical and emotional needs met.
Crisis or suicide hotlines offer immediate support to individuals in acute distress. Since they are usually anonymous, individuals in difficulty may find themselves less embarrassed than in face-to-face interaction. Most hotlines are staffed by volunteers supervised by mental health professionals. Suicidal callers are provided with information about how to access mental health resources in the community and are encouraged to seek them and to feel hope. Further, some centers will arrange referrals to clinicians. Typically, crisis hotlines do not offer therapy directly. If a volunteer feels a caller is at immediate risk, however, confidentiality will be suspended and a mental health worker will be called to intervene.
Although crisis hotlines are numerous, whether they effectively reduce suicide has not clearly been demonstrated. Some researchers fear that the people who call may not be those at highest risk. For many centers a small fraction of callers appear to represent a large fraction (estimated up to 50%) of the total phone contacts. A further problem is that there appears to be significant discrepancies in the training of telephone operators at these hotlines.
Hospital-based crisis intervention usually refers to the treatment of people with psychiatric emergencies that typically arise during a crisis. The aim of this type of crisis intervention is usually the stabilization of some type of extreme behavior. Professionals regard patients who are suicidal, homicidal, extremely violent, or suffering from severe adverse drug reactions or psychotic disorders as major psychiatric emergencies. In the United States, when individuals appear to represent imminent danger to themselves or others, they may be admitted to hospital inpatient treatment against their will for a brief period (e.g., 72 hours). In Canada, one may be involuntarily committed and never receive treatment. When treatment is administered, however, it is usually in the form of psychotropic drugs with follow-up outpatient therapy scheduled upon release.
A relatively recent type of crisis intervention involves the mobilization of mental health professionals following transportation disasters, school shootings, natural disasters, and other mass casualty events. The professionals who arrive on the scene attempt to administer preventive procedures to avert such mental disorders as depression or post-traumatic stress disorder. The best-known of these is psychological debriefing, or CISD (critical incident stress debriefing), which originated in the military. CISD is a one-session group intervention conducted 1–3 days after a traumatic event. As originally designed, it has seven parts: an introduction; the facts of the event; immediate thoughts and impressions; processing of emotional reactions; normalization; planning for the future; and re-entry to previous routines.
Some investigations of CISD suggest that counselors should be more cautious about its use. Some observers maintain that having people focus on the upsetting event emphasizes the victimization that has already taken place, rather than people's innate abilities to overcome these challenges. In other words, CISD may make people feel worse by making them question their own coping abilities. Some studies of the use of CISD in schools following school shootings suggest that CISD may be more effective for adults than for adolescents or children. These studies serve as reminders that a particular psychological intervention may require further research and modification if necessary.
There are two commonly used models of crisis intervention used in training counselors to work with individuals in crisis. The first is the Roberts seven-step model, first presented by Alvin Roberts in 1991; the second is the so-called SAFER-R model, developed by George Everly Jr., in 2001. Both models outline the basic steps and the proper sequence involved in the process of crisis intervention.
The Roberts model is intended for effective brief treatment of a person in crisis:
This model uses the initial letters of its six steps to assist memorization:
See also Coping; Posttraumatic stress disorder; Stress; Suicide.
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American Academy of Experts in Traumatic Stress (AAETS), 203 Deer Rd., Ronkonkoma, NY, 11779, (631) 543-2217, Fax: (631) 543-6977, email@example.com, http://www.aaets.org/index.htm .
American Foundation for Suicide Prevention (AFSP), 120 Wall St., 29th Fl., New York, NY, United States, 10005, (212) 363-3500, (888) 333-AFSP, Fax: (212) 3636237, firstname.lastname@example.org, http://www.afsp.org .