Crisis Intervention What to do till professional help arrives.

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Crisis InterventionWhat to do till
professional help arrives.
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PSYCHOLOGICAL FIRST AID"A helping process aimed
at assisting a person to move past an unsettling
event so that the probability of debilitating
effects e.g., emotional scars, physical harm is
minimized, and the probability of growth e.g.,
new skills, new outlook on life, more options is
maximized."This material is generally
excerpted from Salikeu - Crisis Intervention
-1990 with commentary from Haldane - Emotional
First Aid - 1988.
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THE SEMANTIC ROOTS OF CRISISThe semantic
analysis of the word crisis reveals concepts that
are rich in psychological meaning. The Chinese
term for crisis weiji is composed of two
characters which signify danger and opportunity
occurring at the same time. The English word is
based on the Greek krinein meaning to decide.
Derivations of the Greek word indicate that
crisis is a time of decision, judgment, as well
as a turning point during which there will be a
change for better or worse.
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A crisis is a temporary state of upset
and disorganization, characterized chiefly by
an individual's inability to cope with a
particular situation using customary methods of
problem solving, and by the potential for a
radically positive or negative outcome.
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A crisis state is time limited, is usually
touched off by some precipitating event, can
be expected to follow sequential stages, and
has the potential for resolution toward higher
or lower levels of functioning.
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How a person perceives the crisis event,
especially how the event fits in with the
person's existing frame of reference about
life, makes the situation critical.
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At certain times in the crisis state, people
are ready for new ways of to explain the data
and to understand what has happened or is
happening. This vulnerability, suggestibility
or reduced defensiveness is what produces the
opportunity for change.
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The Stages of Crisis
Outcry Denial Intrusiveness Working
Through Completion
Event
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PSYCHOLOGICAL FIRST AID Time Minutes to
Hours Goal Reestablishing immediate
coping provide support assumes that people
should not be left alone as they bear
extraordinary burdens. reduce lethality take
measures to minimize destructive possibilities
and to defuse the situation. link to
helping resources Rather than try to solve the
whole problem immediately, pinpoint critical
needs and then make appropriate
referral. Place Anywhere - but if you can,
move the person into a calm area away from
stimuli.
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PSYCHOLOGICAL FIRST AIDProcedure Tune
In Get the Picture Explore
possibilities Assist in taking
action Follow up
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Step Number One MAKE PSYCHOLOGICAL CONTACT
TUNE IN - empathetic listening is a
precondition for any helping activity.
- invite the person to talk - articulate
the obvious - I can see you are very upset or
angry. - communicate concern. - listen for
what happened facts - listen for the
person's reaction to the events
feelings - use reflective statements so
the person knows you have really heard what
they said. - physically touch or
hold. - maintain a calm, controlled manner
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Step Number TwoEXAMINE THE DIMENSIONS OF THE
PROBLEM Ask questions which focus on three
areas immediate past - what were the events
leading up to the crisis? Especially the
specific event that triggered the
crisis. present - Who, what, when,
where, how? Have the person tell the story.
immediate future - What are the likely future
difficulties that might be impacted?
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BASICsBehavioral includes patterns of work,
play, leisure, exercise, diet eating and
drinking habits, sexual behavior, sleeping
habits, use of drugs and tobacco, presence of
suicidal, homicidal or aggressive acts.
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BASICsAffective includes feelings about any of
above behaviors presence of feelings such as
anxiety, anger, joy, depression, etc.
appropriateness of affect to life circumstance.
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BASICsSomatic refers to general physical
functioning or health.
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BASICsInterpersonal refers to the nature of
relationships with family, friends, neighbors,
and co-workers number of friends, frequency of
contact with acquaintances roles taken with
various intimates passive, independent, leader
conflict resolution style assertive, aggressive,
withdrawn interpersonal style congenial,
suspicious, manipulative, exploitative,
submissive, dependant.
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BASICsCognitive refers to current day and night
dream mental pictures about past future self
image life goals philosophy of life presence
of catastrophizing, overgeneralizing, delusions,
hallucinations, irrational self talk, general
positive negative attitudes towards life.
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Step Number ThreeEXPLORE POSSIBLE
SOLUTIONS The helper takes a step-by-step
approach, asking first about what has been tried
already, then getting the person in crisis to
generate alternatives, followed by the helper
adding other possibilities. It may be
important to coach some people to even consider
the idea that a possible solution exists.
Make room for untried prematurely rejected
options, and guide the person in fully
considering them. Examine obstacles to
implementation. Take the responsibility to
address these issues before a plan is
implemented. If agreement on a solution
between you and the person in crisis has not
occurred there is need to talk further about the
parameters of the problem, solutions, and/or a
match between the two. Sometimes it is
important to separate the crisis into components
and to deal with one at a time. Part of the
solution may include implementing the person's
social network find a significant person who
can help.
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Step Number FourTake Action The objective
is very limited, no more that taking the best
next step given the situation implementing the
agreed upon immediate solutions(s) aimed at
dealing with the immediate need(s). Depending
upon two major factors lethality and capability
the helper takes either a facilitative or
directive stance. The facilitative stance is
one in which (1) the helper and person in crisis
talk about the situation, but (2) the person
takes major responsibility for any action.
Further, (3) any contract regarding action is a
matter involving only the helper and the person.
Facilitative approaches may range from active
listening to advice. The directive stance is
different. Though the (1) talk is again between
the helper and the person in crisis, the (2)
action part may include the helper as well as the
client. Similarly, the (3) contract for action
might involve others. Directive action ranges
from actively mobilizing resources to controlling
actions.
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Step Number FiveFollow up The last component
involves getting information and setting up a
procedure to check progress. the objective is
first and foremost to complete the loop, to
determine whether or not goals have been met 1)
support provided, 2) reducing lethality, and 3)
making linkage to resources. If the immediate
needs have been met by one of the agreed upon
immediate solutions, followed by concrete action
steps, and if linkage for later needs has been
accomplished, then the process is complete.
If the above issues have not been met, then
the helper goes back to exploring the dimensions
of the problem and reexamines the situation as it
presently stands.
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Post Trauma