CRISIS INTERVENTION

Nurliana Cipta Apsari

Fase utama intervensi krisis1. Fase awal: langsung setelah ada kejadian atau

48 jam setelah kejadian. Biasanya melaksanakan SOP tim-tim yang bertugas langsung untuk menangani kejadian. Dilaksanakan misalnya oleh tim SAR, PMI, BNPB, dll

2. Fase intervensi krisis: setelah beberapa hari atau bahkan minggu setelah kejadian. Model praktik yang dikembangkan: assessment, boiling down the problem, coping alternatives. Dilaksanakan oleh pekerja sosial klinis dan psikolog, counseling center untuk anak dan keluarga, unit intervensi krisis di rumkit

Kejadian-kejadian pemicu krisis1. Kekerasan kejahatan (bom teroris, kdrt,

kekerasan seksual, pembunuhan dan percobaan pembunuhan, pembunuhan massal, kekerasan di sekolah)

2. Situasi pemicu stress/trauma/krisis (perceraian, phk, putus cinta, terkena stroke atau penyakit parah, kecelakaan, di vonis terkena kanker atau AIDS, melihat orang terdekat meninggal)

3. Kesehatan mental yang terganggu (schizophrenia, bipolar, personality disorder, phobia, panic disorder, ptsd, major depression)

4. Bencana alam (angin topan, gunung meletus, longsor, banjir, gempa bumi)

5. Kecelakaan (pesawat terbang jatuh, tabrakan kereta api, tabrakan beruntun, kecelakaan bis, kecelakaan kapal laut)

6. Kejadian transisi dalam perkembangan hidup (pindah ke tempat baru, pindah sekolah di pertengahan semester, kehamilan yang tidak diinginkan, memiliki bayi dengan kecacatan, menjadi cacat fisik, ditempatkan di panti jompo)

What is a crisis? A state that exists when a person is

thrown completely off balance emotionally by an unexpected and potentially harmful event or a difficult developmental transition or that mention beforehand

Unpredictable and unexpected Common feeling responses to crisis:

apathy, depression, guilt and loss of self-esteem

People in crisis find that the ways they solved problems and coped with difficulties in the past no longer work, and they become more and more upset and frightened

Referring to people’s emotional reactions to a situation

Responds and reactions toward crisis: depend on one’s past learning and experiences, lifestyle and philosophyNo reaction is “better” or ”more normal” than the other

Mempengaruhi Krisis1. Kejadian yang membuat stress/berbahaya2. Persepsi individu yang berpikir bahwa kejadian

tersebut akan membuatnya menjadi sangat sedih dan/atau sangat mengganggu

3. Ketidakmampuan individu untuk menyelesaikan ketergangguannya tersebut dengan metode-metode coping yang biasanya ia gunakan disaat mengalami kejadian menyedihkan

Crisis intervention (Parad, 1965): seorang therapist yang memasuki kehidupan seseorang atau keluarga untuk mengurangi dampak dari sebuah krisis untuk membantu mengarahkan sumber-sumber yang terkena langsung oleh kejadian krisis tersebut

Crisis Theory Parad and Caplan (1960): crises have a peak

or sudden turning point Caplan (1961): a relatively minor force, acting

for relatively short time, can switch the balance to one side or another, to the side of mental health, or the side of mental ill health

Naomi Golan (1978): crisis situations can occur episodically during “the normal life span of individual, families, groups, communities and nation”. They are often initiated by a hazardous event. This may be catastrophic event or a series of successive stressful blows which rapidly build up a cumulative effect.

Crisis theoryThe impact of the hazardous event disturbs the

individual’s homeostatic balance and puts him in a vulnerable state

If the problem continues and can not be resolved, avoided or redefined, tension rises to a peak and a precipitating factor can bring about a turning point, during which self-righting devices no longer operate and the individual enters a state of equilibrium…..(an) active crisis

Duration of crisisSeseorang tidak bisa selamanya berada dalam keadaan krisis

dan selanjutnya adalah dia menjadi seorang “survivor”Caplan (1964): equilibrium / keseimbangan seseorang pasca

kejadian yang menakutkan akan kembali dalam 4 hingga 6 minggu.

Meski begitu, ada juga yang berpendapat bahwa crisis resolution dapat terjadi dari beberapa minggu hingga beberapa bulan

Tujuan resolusi krisis yang efektif: menghilangkan kerawanan (vulnerabilities) masa lalu seseorang dan memperkuat / mendukung penambahan keterampilan beradaptasi yang dapat berfungsi sebagai penyangga disaat dia mengalami kejadian yang serupa di kemudian hari

ROBERT’S SEVEN STAGE CRISIS INTERVENTION MODEL

1. Plan and conduct a thorough psychosocial and lethality assessmentLethality assessment should examine the following

factors:- Determine whether the crisis caller needs medical

attention- Is the crisis caller thinking about suicide?- Determine whether the caller is a victim of domestic

violence, sexual assault and/or violent crime- Determine whether any children are in danger- Does the victim need emergency transportation to a

hospital or a shelter- Is the caller under the influence of alcohol or drugs?- Is the caller is about to injure himself?- Inquire whether there are any violent individual living

in the residence

2. Make psychological contact and rapidly establish the relationship Involve initial contact between the crisis

intervenor and the potential client. Establish rapport by conveying a genuine

respect for and acceptance of the client. Provide assurance to the client that he or she

can be helped and that this is the appropriate place to receive such help

3. Examine the dimensions of the problem in order to define itIdentify the following:1.The precipitating event that led the client to

seek help2.Previous coping methods 3.Dangerousness or lethality

The focus must be on now and how rather than then and why

4. Encourage an exploration of feelings and emotions Examining and defining the dimensions of the

problem, particularly the precipitating event Primary techniques used is active listening

5. Explore and assess past coping attempts Previously coping mechanism used in life Integrating solution-based therapy,

emphasizing working with client’s strengths. Important to help the client to generate and

explore alternatives and previously untried coping methods or partial solutions.

6. Restore cognitive functioning through implementation of action plan Using cognitive approach helps the client

focus on why a specific event leads to a crisis state and simultaneously, what the client can do to effectively master the experience and able to cope with similar events should they occur in the future.

7. Follow up Client should be told that if at any time he or

she needs to come back for another session, the door will be open

Aware that victims of violent crimes often go into crisis at the anniversary of the crime