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Unit 15 Crisis Intervention

1. How would you define crisis?

Crisis can be defined as a perception of an event or situation as being intolerable and difficult in which the person's resources and coping mechanisms are also inadequate.

2. What are the common features of crisis?

Following are the common features of crisis: 

i) A triggeling event perceived as threatening, 

ii) Unexpected events, 

iii) Person experiences discomfort causing fear, tension, and confusion, 

iv) Loss of daily routine, 

v) Failure of usual coping methods to reduce impact of stress, 

vi) Uncertain future, 

vii) Continuation of distress (about 2 to 6 weeks), and 

viii) State of disequilibrium followed by rapid transition to an active state of crisis.

3. What is a 'Precipitating factor'?

A precipitating factor can be described as a minor accident that may turn into a crisis depending upon the person's coping and problem-solving methods.

4. Enumerate the phases of development of crisis.

The phases of development of crisis are:

• A period of impact
• A period of recoil
• A post-traumatic period

5. What are the outcomes for a person in crisis? List at least three.

Three outcomes for a person in crisis are:

• The person returns to pre crisis state but there is no personal growth, 
• The person discovers new resources and problem solving methods, there is personal growth, and 
• The person lapses into behaviour that is pathological and destructive. 

6. How can one do the psychosocial assessment?

Psychosocial assessment is done at two levels:

1. Assess for threat to the person in crisis; or for others. Suicidal thoughts or ideas can mean a risk to self; risks of assault and homicide mean threat to others for example, children, spouse, other family members, neighbours or helpers. 
2. Check if the person functions in the usual role or is the person in danger of being excluded from her or his natural settings. 

7. What are the steps of helping a person manage a crisis? What are the four steps of managing crisis?

The four steps of managing a crisis are:

1. Psychosocial assessment
2. Making a plan with the person
3. Putting the action plan to work
4. Evaluating the action plan for crisis resolution

8. State at least 2 myths about persons in a crisis.

Two myths about persons in a crisis are:

• People in crisis are mentally ill.
• People in crisis are always helpless.

9. What are stages of reaction to loss?

Following are the stages of reaction to loss: 

i) Denial and avoidance of the memory of the lost object, 

ii) Reactions such as anxiety, sleeplessness, sadness, preoccupation with thoughts about loss obstructs normal activity, 

iii) Anger towards loss and others, 

iv) Guilt due to perceived neglect by self or others on object of loss (person may feel guilty about having survived - termed 'death guilt'), and 

v) Attempting to recreate the lost object (for example, building lost homes). 

10. List some of the listening skills.

Some listening skills are:

• Eye contact
• Body language
• Tone of voice
• Use of open and closed questions
• Reflection of feelings
• Clarifying and summarising

11. What are the reasons for crises in a family?

Families can face crises due to the following reasons:

• Hospitalisation of a family member (due to illness or accident)
• Death
• Marital problems
• Financial and job loss
• Suicide

12. What are the crises that communities can face?

Communities can face crises due to:

• Religious conflicts
• Caste issues
• Lack of housing or slums
• Poverty
• Poor access to water, education, and healthcare
• Natural disasters like floods, tsunamis, droughts, earthquakes. 

13. What is crisis intervention? What are its goals?

Crisis intervention is a brief and structured approach designed to help individuals, families or communities cope with a difficult event or situation that has overwhelmed their usual coping mechanisms. Crisis intervention is not concerned with underlying psychological causes and the goal is not to bring about fundamental change. 

The goals of crisis intervention are:

• To reduce the intensity of the immediate crisis.
• To restore the individual's, family's or community's pre-crisis level of functioning.
• To help individuals, families or communities develop coping mechanisms to deal with future crises.
• To facilitate access to resources and support.

14. Explain the different types of crisis.

There are several types of crises, including:

• Situational Crises: These arise from unexpected events or circumstances, such as natural disasters, accidents, or job loss.
• Developmental Crises: These occur when an individual transitions from one life stage to another, such as adolescence or retirement.
• Social Crises: These originate from social issues like discrimination, harassment, or violence.

15. Describe the key principles in crisis work.

Key principles in crisis work include:

• Immediacy: Providing prompt assistance to reduce the intensity of the crisis.
• Focus on the present: Addressing the immediate issues and concerns rather than exploring past experiences.
• Active involvement: Taking an active role in planning and providing support, recognising that those in crisis may not be able to make decisions independently.
• Flexibility: Tailoring the intervention to the unique needs of the individual, family or community.
• Empowerment: Tapping into the person's strengths, abilities and resources to restore control.
• Collaboration: Working with other professionals or support networks to ensure holistic care.
• Follow-up: Planning for follow-up to monitor progress and ensure the effectiveness of the intervention.

16. Outline the various steps in crisis intervention.

The steps in crisis intervention typically involve:

• Psychosocial assessment: Gathering information about the crisis situation and the person's or family's resources, strengths, and vulnerabilities.
• Planning: Developing an action plan that is realistic, flexible, and focused on immediate needs.
• Intervention: Putting the action plan into practice, which may involve active listening, providing support, and connecting to resources.
• Evaluation: Monitoring the effectiveness of the intervention and adjusting the plan as needed.

17. How do you understand loss? What are the stages of reaction to loss?

Loss refers to the experience of losing something or someone significant, leading to grief and emotional distress. Reactions to loss vary for each individual and may include:

• Denial: Refusing to accept the reality of the loss.
• Anger: Expressing frustration and resentment about the loss.
• Bargaining: Trying to negotiate with a higher power or fate to reverse the loss.
• Depression: Feeling sadness and hopelessness in response to the loss.
• Acceptance: Coming to terms with the loss and adapting to the new reality.

18. What are the different techniques used in crisis intervention?

Various techniques used in crisis intervention include:

• Active Listening: Providing full attention to the person, using verbal and non-verbal cues, and listening for unspoken messages.
• Effective Communication: Using clear, concise and supportive language.
• Verbal and Non-Verbal Skills: Being attuned to body language, tone of voice, and other cues that communicate emotions.
• Empathy: Understanding and sharing the feelings of the individual or family in crisis, without losing the 'as if' quality.
• Paraphrasing: Restating the message in your own words to ensure clear understanding.
• Summarising: Putting together important parts of the message to make a cohesive statement.
• Use of Questions: Using open and closed questions to gather information and encourage reflection.
• Providing Reassurance: Supporting the client’s feelings and instilling hope.
• Working through loss and grief: Supporting individuals, families or communities, in dealing with the emotional aftermath of loss.
• Psychosocial Assessment: Assessing the needs and resources available, and then creating a plan.
• Action Planning: Collaboratively developing a plan, with the individual/family/community, to address the situation and provide support.

19. What are the origins of crisis? 

Origins of crisis: Crises can originate from various sources. These include:

• Situational origins: These stem from unexpected events such as environmental disasters (like fires or earthquakes), personal or physical incidents (heart attacks, accidents, or diseases), and interpersonal losses (death of a spouse or divorce).
• Social/cultural origins: These are rooted in values and social structures, including discrimination towards women, children, or specific castes or classes, as well as social changes and deviance such as robbery, rape, and physical abuse.
• Transitional origins: These relate to life passages, both universal (like moving from infancy to old age) and non-universal (such as transitioning from student to employee or homemaker, retirement, or migration).

20. State the difference between formal and natural crisis management. 

Formal vs. Natural Crisis Management:

• Natural crisis management refers to when a person manages a crisis using their local supports and resources, often within communities that have built-in socio-cultural support systems. This occurs when individuals use available resources to avoid negative outcomes.
• Formal crisis management involves receiving help from professionals or institutions, such as doctors, mental health professionals, counsellors, or health workers. This can involve specific interventions like grief work and the use of listening skills.

21. How does a precipitating factor play a role in crisis? 

Role of a precipitating factor: A precipitating factor is a specific event or situation that triggers a crisis. It may be a seemingly minor incident, but it pushes a person into a state of crisis because their usual coping mechanisms fail. A precipitating factor can turn a minor accident into a crisis depending on a person's coping and problem-solving methods. For example, in the case of Ravi, the precipitating factor was the news of his impending job loss, which led to him being distracted and having a motorcycle accident.

22. Describe the four phases in the development of crisis. 

Phases of crisis development: The development of a crisis typically involves the following phases:

• Phase 1: The period of impact: This is the initial reaction after a crisis event. This stage includes the immediate reactions after the crisis event which are reflexive, emotional, and behavioural in nature. These reactions can vary and may include panic, shock, anger, or hysteria.
• Phase 2: The period of recoil: In this phase, individuals may experience denial or intrusive thoughts, often alternating between emotional numbing and flashbacks. It is a stage where the person may experience a blocking of the impacts of the crisis through emotional numbing or they may have involuntary thoughts and feelings about the crisis.
• Phase 3: Anxiety levels and tension rise as the person tries to use available resources to solve the problem. Unresolved issues and increasing tension can result in depression. This phase is when available resources are used to reduce anxiety and solve the problem.
• Phase 4: The active state of crisis: This stage is characterized by a psychological breakdown when poor social support and lack of inner strength can compound the problem. If previous phases are not resolved and tensions increase, a full blown crisis can occur.

23. Discuss as to how crisis affects a person's normal functioning. 

Impact of crisis on normal functioning: A crisis can significantly affect a person's normal functioning:

• Emotional impact: People may experience intense feelings such as fear, anxiety, guilt, shame, and shock.
• Cognitive impact: Confusion, inability to concentrate, and difficulty making decisions may occur.
• Behavioural impact: Normal daily activities may be disrupted, with changes in behaviour and the potential for unhealthy coping methods (like excessive drinking or substance abuse).
• Physical impact: Physical symptoms like migraines, chest pains, sleeplessness, and abdominal pains are common.

24. How does culture play a role when we make an action plan? 

Role of culture in action planning: Culture plays a crucial role in making an action plan because it influences how individuals perceive and cope with crisis. It's essential to consider:

• Cultural values: Different cultures may have varying customs and rituals for dealing with death, mourning, physical illness, and significant life events.
• Imposing values: Helpers must avoid imposing their values and customs on individuals from different cultural backgrounds and be respectful of differences in religious, ethnic, or regional perspectives.

25. State some of the supports a person in crisis may have. 

Supports a person in crisis may have: People in crisis may have various support systems available to them:

• Family: Support from family members can be critical. However, a family can also be the source of crisis.
• Friends: In urban areas, "new age" families might have more support from friends as compared to traditional families who may rely only on relatives.
• Community: Local resources and community support networks can offer help.
• Professionals: Support from mental health professionals, counsellors, and health workers is also available, when formal crisis management is required.

26. Discuss the necessary skills for a helper working in the area of crisis. 

Skills for a helper in crisis: A helper working in crisis needs a specific set of skills:

• Effective listening: This involves paying attention, using verbal and non-verbal cues, and showing empathy. Active listening is a crucial skill in building trust and establishing rapport with the person.
• Understanding of grief: Helpers should be able to assist individuals working through loss and understand their emotional reactions during the grieving process.
• Flexibility: Plans should be flexible and tailored to the individual needs of the person, considering ongoing changes in their life.
• Ability to provide immediate help: A helper needs to be able to offer concrete help and restore the person to a pre-crisis state.
• Cultural awareness: Being aware of and sensitive to different cultural contexts and values to avoid imposing personal beliefs on the person in crisis.
• Psychosocial assessment skills: The ability to assess the person's condition, identify the origin of the crisis, and understand how the person is coping.
• Planning and evaluation: Helpers must be able to create, implement, and evaluate action plans that are collaborative and fit the individual’s needs. They should also be able to provide concrete interventions and know when to terminate so that the person is once again in charge of their life.
• Knowledge about resources: Knowing what resources and support systems are available in the community.
• Ethical considerations: Being aware of the ethical issues involved in crisis situations, such as the need to consult with specialists in situations involving suicide or homicide risks.

Important Points

1. Some of the origins of crisis are situational and social.
2. Crisis can manifest in a person in three areas:
1. Emotional
2. Physical
3. Behavioural
3. Formal crisis management includes listening skills and grief work plan.
4. Negative resolution of crisis can lead to suicide attempts, alcohol/drugs and severe depression.
5. A major disaster has the potential to turn into a crisis.
6. Crisis usually resolve within a few weeks.
7. Crisis may be harmful.
8. A person experiencing crisis may experience sudden changes in behaviour, anxiety, or even depression.