Crisis Intervention Dr. Paul Standal focuses on reducing your anxiety by helping you in understanding the crisis you are undergoing and recognizing and using your personal strength and inner resources for managing crisis.
STAGES AND FEELINGS IN CRISIS
A crisis is an acute state of emotional/environmental upheaval. Individual coping is overwhelmed and something has to change to bring back balance and resolution. Crises are precipitated by emotional, psychological or environmental upheaval that can’t be tolerated indefinitely.
Crises are time-limited, lasting from several minutes to 4-6 weeks before breakdown occurs. The individual feels a sense of resolution when they are able to reach a decision of his own toward some action. This sometimes requires a catharsis aimed at resolution.
Conflict between self-image, conditions of worth, and the reality of life circumstances produces internal pressure. Extraordinary disparity between role and reality stresses coping strategies, creating either abrupt or gradual onset of symptoms of breakdown.
Usual coping mechanisms have been stretched and re-stretched to handle each new aspect of the situation. The last straw is an event that may not be related to the crisis, but precipitates a breakdown, a paradigm shift. It is only the tip of the iceberg. Pressure of a PE is relative. What is a PE for one person is not necessarily sufficient for another. Typical precipitating events involve loss (loss of loved one, job, money, prestige, status, health, accident, loss of face). You must evaluate it from your own point-of-view, rather than from the societal or others’ points-of-view.
First line of coping mechanisms is shorted-out, while internal and external pressure increase. You may reach out to secondary resources: minister, therapist, cab driver, friend, acquaintance, or bartender. If these resources also fail to help or resolve the crisis, helplessness, a sense of personal failure and lowered self-esteem become more pronounced.
When primary and secondary resources fail, tension raises sharply and pressure becomes unbearable. People will grasps at anything to make themselves feel better. They can have a relapse using substances or alcohol. They often find themselves hospitalized, either voluntarily or involuntarily. This is a stage where police involvement increases and active suicide attempts happen.
Feelings and emotions have been vented. The person begins to have an emerging recognition of what is so and an emerging acceptance with regard to the situation and place of self in the situation. Acceptance of the situation occurs. The problem becomes more sharply focused and defined. Parameters of the problem become more defined. Less all-or-nothing-thinking or catastrophic thinking occurs. The therapist can help a person in a non-judgmental, warm, encouraging manner to seek out areas of strength and to use those strengths to point the person towards full resolution of the crisis.
You are restored to a comfortable, functioning paradigm, where energy levels are within boundaries. You are able to make choices and to take action. You have renewed confidence to handle things.
TYPICAL FEELINGS EXPERIENCED DURING CRISIS
Emotions are motivational factors in crisis:
1. Unrecognized emotions: client is unable to label emotion 2. Unacknowledged emotions: client can label their emotions, but denies them, not wanting to admit to having them. 3. Unexpressed emotions: un-vented 4. Expressed, but uncontrolled, emotions: wreaks havoc on client stability
Common Feelings in Crisis
Distorted perception of problem and inability to understand the root of the upset.
Anxiety, in small amounts, can be a motivator to mobilize client’s coping strategies. Steadily increasing anxiety distorts perception and produces confusion. Crisis leads to poor problem solving, judgment, and decision-making that produce self-defeating patterns.
Loss of individual competence and inability to manage our affairs. CW (what does this stand for? Not referenced earlier and meaning is not intuitively clear) of competence and independence is compromised. Emotionality sets aside reason. Personal power (potency ability to put reason above feeling) is threatened or to feel that he is not being allowed to achieve status by internal or external events is shattering. Having to or feeling the need to admit those feelings to another often accentuates the feeling. Feelings of helplessness and inadequacy feelings convince the individual that the situation is totally beyond their control and nothing they do or say will alter the situation.
Society, culture, significant others and composite significant others impose arbitrary standards of honor and behavior on the individual. (Right/wrong, “should,” “ought to’s,” good/bad, moral/immoral) . Expectations are violated. CW’s (again, meaning of this abbreviation is unclear), self-imposed or inherited, are violated and client feels that they are outside the limits of how a proper person must conduct themselves. Individual sees himself as having violated those precepts in some manner, thus triggering a sense of guilt or shame.
4. Anger/ Hostility
Anger: sudden, violent displeasure, accompanied by an impulse to retaliate (need for revenge).
Hostility: applying to the spirit, attitude or action of an enemy.
• Client feels this way towards the perceived cause of his problem • Overt motivator sequence (what does this mean? Recommendation: provide clarification or state it differently in layman’s terms) • Projection • Displacement • Distorted perception of cause of this problem • Above feeling decrease in self-esteem and increase in vulnerability. (The meaning of this sentence is unclear and doesn’t seem to fit. Please clarify, if desired) • Increased low self-esteem • Vulnerability • Distorted sense of order
Client’s idea of an orderly, carefully constructed world becomes shaky and uncertain. The new emerging paradigm of reality can be the end product of a crisis and depends on the type and level of help the client is provided.
POSSIBLE EXPECTATIONS OF INDIVIDUALS IN CRISIS
1. “I’m saved. The helper should shoulder my burden.”
Unrealistic, but common, expectation, since regular coping has not worked, (adaptive or maladaptive). Client wants someone else to either assume the burden or give him permission to run from the responsibility or conflict. Client displays helplessness, whinny, manipulative, angry or demanding behaviors. Do not accept the burden for the client. Do not allow the client’s manipulative behaviors to get in the way of your caring communication to his crisis. Continue to encourage him to find his own solutions.
2. “This person cares about me and my problems.”
Real and appropriate expectation for client. You can respond warmly to this expectation using skills, training, knowledge of resources and empathic listening. Maintain empathic response even when faced with upsetting venting…persevere. Sometimes this requires helper’s ability to receive disturbing, often-intense feelings vented by the client. Remember that what you are feeling is not about you. The client’s actions are about their crisis, not about you. The venting is really part of the resolution and has nothing to do with you or actions of your own. Do not retaliate, but receive and persevere.
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