10 principles of crisis intervention

10 Principles of Crisis

Intervention

Dr. Dawn-Elise Snipes Ph.D., LMHC, LPC-MHSP

Executive Director, AllCEUs.com

AllCEUs Unlimited CEUs $59 | Online Addiciton Counselor Certification Training $149 | Webinars $4

Objectives

Define crisis

Identify the 6 basic threats and how they relate to crisis

Discuss characteristics of crisis

Examine cultural influences in behaviors

Explore the SAFERR model

Identify 10 principles of crisis intervention


Definition of Crisis

People are facing an untenable obstacle to goals

People’s life cycles are significantly disrupted

AND

The person has no appropriate response to deal with a

situation


Temperament

Defines how we tend to prefer to act and interact.

Extrovert/Introvert (Awareness/Socialization)

Sensing/Intuitive (Problem Conceptualization)

Thinking/Feeling (Meaning)

Judging/Perceiving (Structure/Spontaneity)


Characteristics of Crisis

Presence of opportunity and danger

Change causes crisis and crisis causes change

Increasing anxiety can lead to violent reactions


Characteristics of CrisisComplicated

Generally does not have one simple cause

Beliefs may be operating when an emotion or reaction seems

out of proportion

Precipitating events may impact many different areas of life

No Panaceas or Quick Fixes

May provide temporary, immediate relief

Ensure they do not make problem worse

Necessity of Choice

Making a choice requires action

Choosing not to act is a still a choice


Types of CrisisDevelopmental

Identity formation

Empty nest

Mid-life

Medical/Physical

Chronic Illness/Pain (HIV, Fibro, Paralysis)

Spouse chronic illness

Situational

Death

Relationship

Job Loss

Homelessness*

Cabin Fever


Exacerbating & Mitigating

Factors/Vulnerabilities

Emotional: Pre-existing mood issues

Mental/Cognitive

Critical inner voice

Negative perceptions

Unhelpful thoughts (Cognitive distortions)

Physical

Pain/illness

Sleep deprivation

Low blood sugar/dehydration

New meds or med change


Exacerbating & Mitigating Cont…

Social:

Lack of healthy, supportive social environment

Spiritual

Sense of interconnectedness and connection to something

bigger than ourselves

What gives hope, faith, meaning and courage

What are a person’s values

Environmental

Visual triggers

Auditory triggers

Audience


6 Basic Threats

Fear and anger represent responses to a threat

Threats to consider in assessment

The unknown

Loss of control or power

Rejection

Isolation

Failure

Death


Models of Crisis Intervention

Equilibrium/Stabilization

Remove reinforcers for aggressive behavior

Identify reasons to calm down

Cognitive

Gain control by changing thinking

Psychosocial

Assess internal and external exacerbating and mitigating

factors

Choose workable alternatives


Cultural Competence

There is no one “normal” range of behaviors

Individualistic vs. collectivistic society

Language is not always interpreted in the same way

We must accommodate the client’s needs

Past history certainly impacts current events

Be aware of personal assumptions


Crisis Intervention-SAFERR

Basic Steps

Stabilize

Acknowledge

Facilitate understanding

Encourage adaptive coping

Restore functioning

Refer as needed


Stabilize

Ensure Safety

Physical

Remove the client from the situation (if possible)

Inform client you want to help, but it is hard for you to focus

while… Propose solution that does not take away his power

Psychological

Remove bystanders (an audience also adds fuel)

Reframe the situation with client not being “bad.”


Stabilize

Assess (ABCs)

Affective state

Behavioral Functioning

Cognitive Functioning

Severity of the crisis


Acknowledge

Define the problem

Seek help from the client in understanding what is going on

Listen to identify the person’s orientation

Feelings or solutions (MBTI)

Visual, auditory, kinesthetic

Empathize to see the problem as the client does

Ask open-ended questions

Pay attention to verbal and nonverbal messages

Acknowledge the situation and/or the client’s feelings


Facilitate Understanding

Own your feelings

Be aware of transference and countertransference

reactions

What do you represent to that person

What is that person triggering in you

Convey understanding

Don’t say “I understand”

Don’t assure the person everything is going to be alright.


Facilitate Understanding

Provide positive reinforcement for behaviors

Avoid value judgments

Set limits and do not tolerate controlling or aggressive

behavior


Encourage Adaptive Coping

What thoughts, reactions and behaviors help you get

closer to a rich and meaningful life

Reduce tunnel vision or increase focus to things that are

meaningful to the person

This is a really awful situation right now. You keep

mentioning your kids. Tell me a bit more about them.

Examine Alternatives

Supports

Coping Mechanisms

Thinking Patterns


Restore Functioning

Promote Mobilization

Make plans

Implement Order

Obtain commitment with assertion statements

I need you to…


Refer

Medical/psychiatric

Medication

Support groups

Vocational counseling

Legal assistance (DV, Child Welfare, Divorce,

Bankruptcy)

Specialized counseling

Childcare/Respite care


Summary Change causes crisis

Crisis is a state of extreme anxiety

It is important to “hear” the client

Help the client

Re-establish equilibrium

Identify environmental and social supports

Develop a plan

Take action

SAFER-R Model

Stabilize

Acknowledge

Facilitate understanding

Encourage adaptive coping

Restore functioning or,

ReferAllCEUs Unlimited CEUs $59 | Online Addiciton Counselor Certification Training $149 | Webinars $4

Summary1. Crisis represents the presence of opportunity and danger and necessitates choice

2. Crisis is complicated there are no panaceas/quick fixes

3. Persons in crisis are initially at high risk for maladaptive coping or immobilization.

4. Emotional, mental, physical, social, environmental and spiritual factors can exacerbate or

mitigate crisis

5. Crisis intervention involves regaining equilibrium, gaining control of thoughts(wise mind)

and identifying and choosing workable alternatives

6. There is no one "normal" range of behaviors

7. Crisis impacts the person emotionally, cognitively, physically, socially, environmentally and

physically

8. Resource mobilization should be immediate in order to provide persons in crisis with the

tools they need to return to some sort of order and normalcy,

9. Facilitating understanding of the event by processing the situation or trauma helps the

person gain a better understanding of what has occurred and allowing him or her to express

feeling about the experience.

10. Problem solving within the context of their situation and feelings is necessary for developing

self-efficacy and self-reliance.


Me, Me, Me: I am the sole cause of every problem I encounter

Strength: Taking responsibility

– Accept responsibility for your actions

– Determine the appropriate level of personal

responsibility

– Examine all the contributing factors

– Limit self-criticism

Thinking Trap 1

Always, Always, Always: Believing that problems are unchangeable and I have little or no control over them

Intervention

Conduct a problem analysis

Identify what you can and can’t change

Develop a plan of action

Accept reality: “Embracing the bad”

Thinking Error 2

Them, Them, Them: Outside circumstances cause of every problem

Intervention

Assess the cause of problems

Accurately identify factors that contributed

to the problem

Look at the facts

Examine how you may have contributed

Thinking Error 3

Nobody understands

Intervention

Build cohesion

Identify supportive others or referral sources

Help them focus on what’s important

Thinking Error 4

Jumping to conclusions despite having little or no evidence to support it

Intervention

Understand complex events

Review events objectively

Realistically appraise situations

Acknowledge personal limits in preventing problems

Thinking Error 5

What Ifs and Shoulds

Intervention

Facilitate acceptance

Remember that change takes time

Be aware of memories/grudges/resentments

Talk it out/Write it out

Focus on what I can control

Thinking Error 6

10 principles of crisis intervention

Healthcare