This paper is an analysis of crisis intervention and how different strategies associated with it can be used to deal with a real-world traumatic incident. As such, the paper is a critical analysis of both the theoretical and practical aspects of crisis intervention. A literature review of recent and appropriate resources is provided to aid in the evaluation process. The paper also identifies a real-world traumatic incident, describes its type, characteristics and stages and analyzes the different components of the identified incident. In addition, a discussion of the link between therapeutic interventions of the identified traumatic incident and the crisis theory is provided. With this paper, the level of the intervention together with its goals and the technical aspects become apparent and offers an increased understanding of the methods of dealing with real world crises. In the context of community psychology, effective utilization of crisis intervention strategies facilitates problem solving and prevention of future crises.
Crisis intervention can be thought of as an emerging field in psychology that focuses on helping individuals in a state of catastrophe or disaster restore equilibrium or balance to their normal functioning. Crisis intervention is also used as a means of managing disasters or catastrophes on a large scale and to restore balance in social existence to reduce the likelihood of psychological trauma. The main focus of crisis intervention is to create stability and to resolve the problem causing or escalating the crisis. There are different strategies that can be used to resolve any given crisis. For instance, the Roberts’ Seven Stage Crisis Intervention Model highlights seven stages of crisis resolution. When confronted with a person in crisis, an expert must address the person’s distress, impairment and instability to help him regain balance or equilibrium. The expert does this by operating in a logical and orderly process that follows well understood procedures.
Historical Overview of Crisis Intervention
In community psychology, crisis intervention can be regarded as a relatively new field of study (Hillman, 2013). The origin of crisis intervention is often dated to the 1940s and 1950s with common reference to the pioneering works of different psychiatrists such as Erich Lindemann and Gerald Caplan. Lindemann’s work about grief and bereavement contained significant ideas about crisis intervention was inspired by the coconut Grove Club fire in Boston that occurred on November 28, 1942 that killed 492 people and injuring scores of people (Al, Stams, Asscher & Laan, 2014). Caplan’s work in the 1960s and 70s was inspired by Lindemann’s work, and personal circumstances and observations. Caplan collaborated with his colleagues at Harvard University to build on Lindemann’s work and to introduce new theories and approaches to crisis intervention (France, 2015). Lindemann and Caplan argued that people in a crisis are anxious, motivated to change and open to help. As such, the underlying principle of crisis intervention programs is the belief that offering support to people in a crisis will help eradicate or reduce the probability of prolonged and/or acute mental problems.
As far as the history of development of crisis intervention is concerned, the 1960s and 1970s were periods of continued progression and elaboration (Blake Buffini & Gordon, 2015). These periods were characterized with the development of numerous theories and strategies of crisis intervention. The development of these theories played a critical role since different states were beginning to construct elaborate crisis centres and hotlines, specifically to deal with the increasing rate of suicide attempts (Draper, Murphy, Vega, Covington & McKeon, 2015). Other agencies were also being developed both by the government and the private sector to help deal with different crises that plagued the community as a whole at the time. It was also during this period that critical innovations and novel conceptualization of services pertaining to the area of crisis intervention were developed. Psychiatrists and psychologists realize the importance of creating an effective framework to address the growing concern by members of the public about increases in mental and other health problems due to exposure to traumatic incidences.
During the 1980s and the 1990s, all efforts focused on the development of efficient evaluation programs for crisis intervention programs. The efforts in the 1960s and 1970s that focused on developing the field of crisis intervention bore fruit and a need to develop new methods of evaluating the crisis intervention programs emerged. It was necessary to evaluate the crisis intervention programs to determine their effectiveness and contribution in the improvement of social health (Boscarato et al, 2014). Programs that were found to be ineffective on inefficient were eradicated while new and improved programs were being encouraged and constantly developed. Crisis intervention as a field of community psychology was initially developed due to the increasing prevalence of situations or circumstances where people needed immediate assistance (Denis, Hendrick & Bruffaerts, 2015). Because of high demand and poor development at the time, some intervention strategies were found to be less effective and further development was necessary. Developing and constantly improving evaluation programs for intervention strategies became the only reliable way of identifying areas that needed improvement in the relatively new field of crisis intervention.
Since crisis intervention is relatively new, the 1990s experienced a critically low count of professionally trained psychologists to deal with crisis intervention (Chan, Kee & Chan, 2012). Most methods used at the time were crude and supported by little or no evidence from research. Despite this reality, there was a growing demand for specialists in crisis intervention to offer their services and to contribute to the further development of crisis intervention practice. At the time, a deliberate effort was made to ensure efficient utilization of registered specialists of crisis intervention. For instance, the duration of most therapists was deliberately made shorter than would have been ideal to ensure therapists attend to the large and ever extending numbers of individuals seeking or requiring their services. Although it may not have been ideal medically, the fact that most therapy processes are short term made it appealing to many patients, most of which chose the process as their preferred choice of treatment.
Further development of the field of crisis intervention was necessitated by the increase of more acute stressors in the 1990s and the 2000s. The increase in terrorist attacks, for example and increases in natural catastrophes such as earthquakes and hurricanes made it necessary to develop the field in order to deal with and treat the survivors and those affected by these horrific events (Davidson, 2014). For instance, the 9/11 attacks in New York City claimed the lives of almost 3,000 people, unleashing one of the worst traumatisation of the citizens of the United States since the Second World War. Those that were affected became vulnerable to mental illnesses and immediate psychological help was necessary to help them achieve balance. In addition to the terrorist attack in 2001, hurricane Katrina in 2005 that claimed at least 1245 people also greatly devastated the United States, barely five years since the worst terrorist attack on US soil according to official reports.
Conceptualization of theories that related to family crises was first achieved by Hill in the 1950s. The ABC-X model as it came to be known was developed as a way to help individuals reconnect with family members that had disappeared during the Second World War (Comans, Visser & Scuffham, 2015). It was also discovered at this time that survivors of major stressors such as war, loss of loved ones, terrorist attacks or natural disasters could be helped to go through a most difficult phase of their life; accepting their loss. Medical prescription and treatment were found to be less effective in dealing with affected family members and an alternative method of managing the increased depression, stress and personal crisis that came with the occurrences of deadly disasters. As such, most people that worked as psychiatrists dealing with crisis intervention during the early phases of development of this field possessed no medical knowledge or training. Most were specialists in other fields and received only short training in crisis management before engaging as active professionals in the field.
Today, the field of crisis intervention continues to develop in light of new challenges and improving technology. Today, effectiveness of the associated therapies depends almost entirely on the utilization of better and improved diagnosis processes. The strategies employed in crisis intervention today also rely to a great extent on the nature and severity of the trauma suffered by individuals. Unlike the past, there are more psychiatrists and psychologists today dealing with crisis management (France, 2015). These individuals are also more skilled than their counterparts were when the field was emerging in the 1940s. The concepts of crisis intervention have also been extensively expanded to cater for the changing needs of communities today and the manner in which they apply the different concepts of development. Today, the processes involved in crisis intervention are more reliable and are even taught in institutions of higher learning. Improved development of the crisis management processes in the future would depend on further research, technological advancement and the nature of current and future crises that may emerge.
Literature Review of Crisis Intervention
Since its introduction, crisis intervention has been studied numerously by different authors. According to Al, Stams, Asscher, and Laan (2014), a crisis can be defined as a critical disruption of an individual’s psychological homeostasis to the level that his coping mechanism for demanding situations fails often characterized by functional impairment, distress and poor judgement. It can also be defined as the subjective reaction of certain life experiences or circumstances in a manner that negatively affect a person’s ability to function, stay focused or mentally stable (Blake Buffini, & Gordon, 2015). ADRF argue that life’s crises are caused majorly by events that can be defined as intensely stressful, hazardous or traumatic. Elevated crises result from a combination of these events with the perception of an individual towards the causers of these stressing events and the inability of the individual to cope with these events using the normal coping mechanisms (Chan, Kee & Chan, 2012). Davidson (2014) suggests that the individual’s perception and inability to cope with the intensely stressful events using ordinary coping mechanisms causes a disruption in the steady state.
Draper, Murphy, Vega, Covington and McKeon (2015) argue that a crisis is composed of five major elements that interact with each other, these are: a hazardous or traumatic event, a vulnerable or unbalanced state, a precipitating factor, an active crisis state based on the person’s perception, and the resolution of the crisis. Due to the nature of crises, crisis therapists must develop and use a guiding framework or blueprint while attending to different clients with crisis problems (Hillman, 2013). The blueprint acts as a model of intervention and is needed for the therapist to address effectively the distress of the patient amongst other reasons (Draper, Murphy, Vega, Covington & McKeon, 2015). According to Davidson (2014), since the field of crisis intervention has been in existence for more than seven decades now, it has evolved into a specialized and independent mental health field and as such should not be regarded as a new development or an emerging field. Further, Chan, Kee, & Chan (2012) contends that the more-than-half- a-century-old discipline has a solid empirical and experiential grounding and is thus multidimensional in nature and employs flexible intervention methods.
Lindemann deed pioneering work in the 1940s working at Massachusetts General Hospital based on his interaction with many acute and grief stricken survivors and relatives of the 493 dead victims of Boston’s worst nightclub fire at the Coconut Grove and based on his work, different crisis intervention models have been promulgated (Boscarato et al., 2014). Comans, Visser and Scuffham (2015) contends that although the origins of crisis intervention theory can be traced back to Lindemann’s work, the foundations for the development of the crisis intervention theory are deeply rooted in the work of Gerald Caplan and his colleagues at Harvard University. According to Denis, Hendrick and Bruffaerts (2015) quoting Caplan’s work, the occurrence of a crisis in the life of an individual depends on the existence of an imbalance between the perceived difficulty and significance of the threatening circumstances as well as the combined resources including emotional support available immediately to enable the individual deal with the imbalance.
According to France (2015), the crisis intervention theory is based on the concept of homeostasis as suggested by Caplan. Thus, an individual relentlessly endeavors to attain and maintain a state of balance or homeostasis with the external environment (France, 2015 p.50) Often, an individual would engage in different types of problem solving activities every time the balance between the individual and the external environment is threatened or destroyed (Hillman, 2013). When the problem solving activities do not succeed in restoring the balance, an individual enters a state of crisis and would require support and professional help to rebuild the lost balance (Draper, Murphy, Vega, Covington, & McKeon, 2015). Although the homeostasis theory proposed by Caplan has received support, it has not been accepted by all psychological theorists. For instance, Davidson (2014) argue that the theory as proposed by Caplan to explain individual crisis limits or reduces individuals to simple reactors of environmental changes and does not differentiate between the different types of balance such as adaptive and maladaptive balance.
Those that disagree with the Caplan theory propose a new approach to the study and analysis of crisis intervention. For instance, Al, Stams, Asscher, and Laan (2014) recommend that crisis theory be understood in light of the concept of emotional response where an individual’s specific emotional response to a given situation depends on his cognitive processes and the manner in which these processes perceive, evaluate and interpret different circumstances or situations. Once the cognitive processes have interpreted a situation, they stimulate appropriate bodily mechanisms to cope with the situation where coping is possible (Chan, Kee & Chan, 2012). In this regard, Denis, Hendrick and Bruffaerts (2015) define a person in a crisis as an individual whose cognitive processes perceives or appraises a circumstance or situation as extremely threatening to his existence and whose cognitive processes cannot stimulate the right coping mechanisms or the available mechanisms cannot cope with the identified situation or circumstance (Blake Buffini, K., & Gordon, 2015).
Action Evaluation of Use of Crisis Intervention in a Real-World Incident
Recommendations for Improvement
TO BE CONTINUED …
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