212 10 Principles of Crisis Intervention

10 Principles of Crisis Intervention
Dr. Dawn-Elise Snipes Ph.D., LMHC, LPC-MHSP
Executive Director, AllCEUs.com
Objectives
~ Define crisis
~ Identify the 6 basic threats and how they relate to crisis
~ Discuss characteristics of crisis
~ Examine cultural influences in behaviors
~ Explore the SAFERR model
~ Identify 10 principles of crisis intervention
Definition of Crisis
~ People are facing an untenable obstacle to goals
~ People’s life cycles are significantly disrupted

AND

~ The person has no appropriate response to deal with a situation

Temperament
~ Defines how we tend to prefer to act and interact.
~ Extrovert/Introvert (Awareness/Socialization)
~ Sensing/Intuitive (Problem Conceptualization)
~ Thinking/Feeling (Meaning)
~ Judging/Perceiving (Structure/Spontaneity)
Characteristics of Crisis
~ Presence of opportunity and danger
~ Change causes crisis and crisis causes change
~ Increasing anxiety can lead to violent reactions
Characteristics of Crisis
~ Complicated
~ Generally does not have one simple cause
~ Beliefs may be operating when an emotion or reaction seems out of proportion
~ Precipitating events may impact many different areas of life
~ No Panaceas or Quick Fixes
~ May provide temporary, immediate relief
~ Ensure they do not make problem worse
~ Necessity of Choice
~ Making a choice requires action
~ Choosing not to act is a still a choice

Types of Crisis
~ Developmental
~ Identity formation
~ Empty nest
~ Mid-life
~ Medical/Physical
~ Chronic Illness/Pain (HIV, Fibro, Paralysis)
~ Spouse chronic illness
~ Situational
~ Death
~ Relationship
~ Job Loss
~ Homelessness*
~ Cabin Fever
Exacerbating & Mitigating Factors/Vulnerabilities
~ Emotional: Pre-existing mood issues
~ Mental/Cognitive
~ Critical inner voice
~ Negative perceptions
~ Unhelpful thoughts (Cognitive distortions)
~ Physical
~ Pain/illness
~ Sleep deprivation
~ Low blood sugar/dehydration
~ New meds or med change

Exacerbating & Mitigating Cont…
~ Social:
~ Lack of healthy, supportive social environment
~ Spiritual
~ Sense of interconnectedness and connection to something bigger than ourselves
~ What gives hope, faith, meaning and courage
~ What are a person’s values
~ Environmental
~ Visual triggers
~ Auditory triggers
~ Audience

6 Basic Threats
~ Fear and anger represent responses to a threat
~ Threats to consider in assessment
~ The unknown
~ Loss of control or power
~ Rejection
~ Isolation
~ Failure
~ Death

Models of Crisis Intervention
~ Equilibrium/Stabilization
~ Remove reinforcers for aggressive behavior
~ Identify reasons to calm down
~ Cognitive
~ Gain control by changing thinking
~ Psychosocial
~ Assess internal and external exacerbating and mitigating factors
~ Choose workable alternatives

Cultural Competence
~ There is no one “normal” range of behaviors
~ Individualistic vs. collectivistic society
~ Language is not always interpreted in the same way
~ We must accommodate the client’s needs
~ Past history certainly impacts current events
~ Be aware of personal assumptions
Crisis Intervention-SAFERR
~ Basic Steps
~ Stabilize
~ Acknowledge
~ Facilitate understanding
~ Encourage adaptive coping
~ Restore functioning
~ Refer as needed

Stabilize
~ Ensure Safety
~ Physical
~ Remove the client from the situation (if possible)
~ Inform client you want to help, but it is hard for you to focus while… Propose solution that does not take away his power
~ Psychological
~ Remove bystanders (an audience also adds fuel)
~ Reframe the situation with client not being “bad.”

Stabilize
~ Assess (ABCs)
~ Affective state
~ Behavioral Functioning
~ Cognitive Functioning
~ Severity of the crisis

Acknowledge
~ Define the problem
~ Seek help from the client in understanding what is going on
~ Listen to identify the person’s orientation
~ Feelings or solutions (MBTI)
~ Visual, auditory, kinesthetic
~ Empathize to see the problem as the client does
~ Ask open-ended questions
~ Pay attention to verbal and nonverbal messages
~ Acknowledge the situation and/or the client’s feelings

Facilitate Understanding
~ Own your feelings
~ Be aware of transference and countertransference reactions
~ What do you represent to that person
~ What is that person triggering in you
~ Convey understanding
~ Don’t say “I understand”
~ Don’t assure the person everything is going to be alright.
Facilitate Understanding
~ Provide positive reinforcement for behaviors
~ Avoid value judgments
~ Set limits and do not tolerate controlling or aggressive behavior

Encourage Adaptive Coping
~ What thoughts, reactions and behaviors help you get closer to a rich and meaningful life
~ Reduce tunnel vision or increase focus to things that are meaningful to the person
~ This is a really awful situation right now. You keep mentioning your kids. Tell me a bit more about them.
~ Examine Alternatives
~ Supports
~ Coping Mechanisms
~ Thinking Patterns
Restore Functioning
~ Promote Mobilization
~ Make plans
~ Implement Order
~ Obtain commitment with assertion statements
~ I need you to…
Refer
~ Medical/psychiatric
~ Medication
~ Support groups
~ Vocational counseling
~ Legal assistance (DV, Child Welfare, Divorce, Bankruptcy)
~ Specialized counseling
~ Childcare/Respite care

Summary
~ Change causes crisis
~ Crisis is a state of extreme anxiety
~ It is important to “hear” the client
~ Help the client
~ Re-establish equilibrium
~ Identify environmental and social supports
~ Develop a plan
~ Take action
~ SAFER-R Model
~ Stabilize
~ Acknowledge
~ Facilitate understanding
~ Encourage adaptive coping
~ Restore functioning or,
~ Refer

Summary
• Crisis represents the presence of opportunity and danger and necessitates choice
• Crisis is complicated there are no panaceas/quick fixes
• Persons in crisis are initially at high risk for maladaptive coping or immobilization.
• Emotional, mental, physical, social, environmental and spiritual factors can exacerbate or mitigate crisis
• Crisis intervention involves regaining equilibrium, gaining control of thoughts(wise mind) and identifying and choosing workable alternatives
• There is no one “normal” range of behaviors
• Crisis impacts the person emotionally, cognitively, physically, socially, environmentally and physically
• Resource mobilization should be immediate in order to provide persons in crisis with the tools they need to return to some sort of order and normalcy,
• Facilitating understanding of the event by processing the situation or trauma helps the person gain a better understanding of what has occurred and allowing him or her to express feeling about the experience.
• Problem solving within the context of their situation and feelings is necessary for developing self-efficacy and self-reliance.

~ Me, Me, Me: I am the sole cause of every problem I encounter

~ Strength: Taking responsibility
– Accept responsibility for your actions
– Determine the appropriate level of personal responsibility
– Examine all the contributing factors
– Limit self-criticism

~ Always, Always, Always: Believing that problems are unchangeable and I have little or no control over them

~ Intervention
~ Conduct a problem analysis
~ Identify what you can and can’t change
~ Develop a plan of action
~ Accept reality: “Embracing the bad”

~ Them, Them, Them: Outside circumstances cause of every problem

~ Intervention
~ Assess the cause of problems
~ Accurately identify factors that contributed to the problem
~ Look at the facts
~ Examine how you may have contributed

~ Nobody understands

~ Intervention
~ Build cohesion
~ Identify supportive others or referral sources
~ Help them focus on what’s important

~ Jumping to conclusions despite having little or no evidence to support it

~ Intervention
~ Understand complex events
~ Review events objectively
~ Realistically appraise situations
~ Acknowledge personal limits in preventing problems

~ What Ifs and Shoulds

~ Intervention
~ Facilitate acceptance
~ Remember that change takes time
~ Be aware of memories/grudges/resentments
~ Talk it out/Write it out
~ Focus on what I can control