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http://www.sagepub.com/upm-data/14229_Chapter5.pdf
The practice of social work, charles zastrow
Social work practice, a generalist approac-Louise C Johnson
The term crisis derives form the greek word «krisis» which means decision or turning point. This definition of the word as a decisive stage that has important consequences in the future of an individual or a system, has been preserved up to our days and has provided the framework for the development of the theory and practice of crisis intervention. Crisis intervention postulates that in crisis situation, the current or usual levels of functioning are disrupted and previously manageable psychological difficulties stirred up.
Crisis intervention was initially developed as a response to the growing demand for services in situations where immediate assistance was required for large numbers of individuals. Ell notes that there are infinite number of crisis situations in which CI is appropriate. These crisis include serious illness, trauma, death of a loved one, disaster, violent crimes, moving away from home and unplanned pregnancy.
Since people are often in a frozen position when a crisis arises, CI services often have two tasks : to resolve the current crisis and resolve the problems people have been denying previously or ignoring.
Definition of Crisis :
According to Lindemann, persons experiencing acute grief display one or more of the following symptoms:1. somatic distress; 2. preocupation with the image of the deceased; 3. guilt, 4. hostile reactions, and 5. loss of patterns of conduct. Sometimes the person experiencing crisis of bereavement may have distorted or
delayed grief reactions. Lindemann also stated that the grief work includes achieving emancipation from the deceased, readjustment to the environment in which the deceased is missing and formation of new relationships.
Caplan has provided various definitions of crisis (1964, 1974): he considers that a crisis is provoked when a person faces a problem for which he appears not to have an immediate solution and that is for a time insurmountable through the utilization of usual methods of problem solving. A period of upset and tension follows during which the person makes many attemps at the solution of the problem. Eventually, some kind of adaptation and equilibrium is achieved which may leave the person in a better or worse condition than prior to the crisis. Caplan suggests that the essential factor determining the occurrence of a crisis is an imbalance between the perceived difficulty and importance of the threatening situation and the resources immediately available to deal with it; the crisis refers to the person's emotional reaction not to the threatening situation itself.
crisis as defined by Rapoport as «an upset in a steady staten where an individual finds himself in a hazardous situation. The crisis creates a problem that can be perceived as a threat, a loss or a challenge. Rapoport argues that 3 interrelated factors usually produce a state of crisis: a hazardous event, a threat to life goals and the inability to respond with adequate coping mechanisms.
Components of Crisis :
SIFNEOS(1 960) has identified 4 components of an emotional crisis:
1) The hazardous event that starts the chain of reactions that lead to the crisis. Sometimes it is a sudden unexpected event, while other times it can be a developmental change.
2) A vulnerable state of the individual which is essential for the crisis to develop.
3) The precipitating factor that is the final event or circumstance that makes the hazardous event
unbearable and results in the crisis, and
4. The state of active crisis.
SHULBERG& SHELDON(1 968) have developed a probability formula
for a crisis: the probability of a crisis situation occurring because of a hazardous event is a function of the interaction between the hazardous event, the exposure of the individual to the event and the vulnerability
of the individual:
P Crisis = f (hazardous event exposure vulnerability)
Characteristics of Crisis :
time limited
Stages of Crisis :
According to CAPLAN(1 964) most crisis reactions follow 4 distinct phases:
1. In the initial phase the individual is confronted by a problem that poses a threat to his homeostatic state: the person responds to feelings of increased tension by calling forth the habitual problem-solving measures
in an effort to restore his emotional equilibrium.
2. There is a rise in tension due to the failure of habitual problem-solving measures and the persistence of the threat and problem. The person's functioning becames disorganized and the individual senses feelings
of upset and ineffectuality.
3. With the continued failure of the individual's efforts, a further rise in tension acts as a stimuli for the mobilization of emergency and novel problem-solving measures. At this stage, the problem may be
redefined, the individual may resign himself to the problem or he may find a solution to it.
4. If the problem continues, the tension mounts beyond a further threshold or its burden increases over time to a breaking point. The result may be a major breakdown in the individual's mental and social functioning .
Rapoport's (1962) three phases of a crisis reaction overlap with Caplan's stages, with the difference that Rapoport has merged Caplan's phases 1 and 2 and considered them the initial phase of crisis. She also
points out that some type of equilibrium is restored during the end phase of the crisis; yet this equilibrium can be lower, the same or higher than the one previous to the crisis.
Types of Crisis :
According to Erickson ; Maturational/developmental crisis and situational
according to rapoport : developmental crisis which is biopsychosocial in nature, crisis of role transition and accidental crisis
According to Baldwin emotional crisis includes 6 types of crisis situation : problematic situations, life transition crisis, crisis resulting from traumatic stress, developmental crisis in interpersonal situation, crisis reflecting psychopathology, psychiatric emergencies
Identifying the type of crisis that a person is going through is an important step of the crisis intervention process, that facilitates to a great extent the therapist's work with the person in crisis.
Crisis Intervention
EWING (1978) has defined crisis intervention as the informed and planful application of techniques derived from the established principles of crisis theory, by persons qualified through training and experience to
understand these principles, with the intention of assisting individuals or families to modify personal characteristics such as feelings, attitudes and behaviors that are judged to be maladaptive or maladjustive.
HAFER and PETERSON (1982), in a less formal definition, refer to crisis intervention as the kind of psychological first aid that enables to help an individual or group experiencing a temporary loss of ability to cope with a problem or situation.
According to Charles Zastrow Crisis Intervention progresses in the following manner:
1. An attempt is made to alleviate the disabling tension through ventilation and creation of climate of trust and hope
2. Next the worker attempts to understand the dynamics of the event that precipitated the crisis
3. the worker gives his impression and understanding of crisis and checks out these perception with the client
4. client and worker attempt to determine specific remedial measures that can be taken to restore equilibrium
5. new methods of coping may be introduced
6. finally termination occurs
Levels of Crisis Treatment
Levels of Crisis Treatment JACOBSEN,S TRICKLER& MORLEY( 1968) and MORLEY( 1970) have
discussed different levels of crisis treatment:
a) Environmental manipulation. In this case the helper serves as a
referral source, getting the client in touch with a resource person or facility.
b) General support. It consists basically of active listening in a non threatening manner, allowing the person to speak in some detail about is problem without challenging him.
c) Generic manipulation. It is helping the person resolve a crisis by accomplishing certain psychological tasks that are the same for al1 the people experiencing the same crisis regardless of individual differences.
d) Individual approach. It focuses on the specific needs of the person in crisis and emphasizes the assessment of the psychological and psychosocial processes that are influencing the client. It looks at the specific
psychoIogica1 tasks and problem solving activities that each person must accomplish in resolving a particular crisis.
Models of Crisis Intervention
LANGSLEY& KAPLAN(1 968) have classified crisis intervention models according to their main focus:a) Recompensation Model. It is a patient-oriented model, that is, it focuses on the patient exclusively. The main goal of the treatment intervention is to stop the decompensation, get the symptoms under control
and return the patient to his pre-crisis leve1 of functioning. The model does not aim at explaining the failure to cope nor at understanding the past dynamics of the person that led him to the crisis. Moreover, there
is not much concern about the person's future adjustment. The military treatment of the traumatic neuroses is a typical example of the recompensation approach to treatment.
b) Stress-Oriented Model. It takes into account the stress event. The goal of the intervention is to achieve successful resolution of the specific tasks posed by the stress event. It emphasizes the development of problem- solving strategies and coping skills and it is concerned with the future adjustment of the individual to other stressful situations. This model has been developed to great extent by Lindemann and Caplan.
c) System-Oriented Model. It is the one advocated by Langsley and Kaplan; it takes into account the social field in which the person deals with the crisis. It is based on the belief that not only the development
but also the outcome of the crisis depend in part on the social field of the person in crisis, and therefore emphasizes the systems approach to intervention. Family-Oriented crisis treatment is an important development of this model, which is based on the assumption that the symptoms of the family member who seeks treatment are usually an expression of family conflicts.
Process of Crisis Intervention (refer link given above)
Assessment in Crisis Intervention
1. focus on immediate identifiable problem
2. understand the problem from the client's point of view
3. explore the client's coping strategies, strengths and social support
4. if possible get information from client significant others
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