theories of crisis, crisis intervention

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THEORIES OF CRISIS, CRISIS INTERVENTION. DEFINITIONS OF CRI SIS. Caplan (1960) define s cri sis: brief episode of psychological unbalance which occurs when the subject is faced with a problem that cannot be solved or avoided . Triggers of a crisis : t raumatic e vents - PowerPoint PPT Presentation

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  • THEORIES OF CRISIS, CRISIS INTERVENTION

  • DEFINITIONS OF CRISISCaplan (1960) defines crisis: brief episode of psychological unbalance which occurs when the subject is faced with a problem that cannot be solved or avoided. Triggers of a crisis:traumatic eventslife changes entailed by the life cycle

  • CRISISStressful event or perceived threat + lack of efficient coping skills, resulting in emotional unbalanceLimited in time: 1-6 weeksDuring the crisis, the subject asks for helpDuring the crisis, the subject is more compliant to external interventionThe evolution in crisis depends on the timing of the intervention

  • COPING AND CRISISStages of coping in crisis:Stage I. Immediate response: astonishment, denialStage II. Emotional reactions: anxiety, anger, guilt, regression, depressionStage III. Resolution: acceptance, planning the future

  • Model of crisis (G. Caplan, 1961)

  • TYPES OF CRISISMATURATIONAL CRISISPeriods in life which entail changes in social roles, biological and social pressures;Adolescence, marriage, birth of a child, retirement;Adolescence: maturational crisis originality, hormonal and psychological unbalance

  • TYPES OF CRISIS2. SITUATIONAL CRISISA specific external event disrupts the internal psychological balance of the individual;Holmes & Rahe Scale:Death of spouse, divorceIllness, accidentsPregnancy, childbirthSexual dysfunction

  • SITUATIONAL CRISISThe experience of loss (of a loved one, of self-esteem, of normal functioning, of status, of job)2. Issues concerning change (transition in Romania, marriage, birth of a child, moving, change of job)3. Interpersonal issues (family conflicts)4. Environmental factors (polution, work environment)

  • TYPES OF CRISIS3. CATASTROFIC CRISIS (SOCIAL)accidental, unusual, unexpected: fire, earthquake, flood, kidnapping, nuclear accidentsThey do not occur in any subjects lifeSevere stress, requiring maximal coping strategies and abilities

  • CATASTROFIC CRISIS - STAGESImpactHeroic stageHoneymoon stageDisillusionment stageReconstruction, reorganisation

  • CATASTROFIC CRISIS - STAGESImpact: shock, extreme fear; poor/ distorted assessment of reality, and self-destructive behaviourHeroic stage: Cooperative spirit between friends, neighbours, and emergency teams; constructive activity at this time may help overcome anxiety and depression but excessive activity can lead to "burnout"Honeymoon: 1 week-several months after the disaster; the need to help others is sustained; psychological problems may be overlookedDisillusionment: 2 months to 1 year; disappointment, resentment, frustration, anger; victims often begin to show hostility toward othersReconstruction: Individuals admit that they must come to grips with their own problems; they begin to behave in a constructive manner

  • THE CONSEQUENCE OF UNRESOLVED CRISISSUICIDE!!!!

  • SPECIFIC GOALS OF CRISIS INTERVENTION (Korchin)a) Releasing the psychological tension and distress (anxiety, despair, confusion, agitation)b) Restoring the level of functioning and activity that the subject had prior to the crisisc) Reassuring the subject that the coping resources (internal, external) and support are available

  • TECNIQUES OF CRISIS INTERVENTION1. Abreaction remembering the highly emotionally charged events decreases the tension: "ventilation of emotions";2. Clarifying encouraging the subject to rationalize the relationship between previous life events and current situation;3. Suggestion persuasive discourse in order to improve personal and overall situation;4. Manipulation employing patients emotions and desires in the therapeutic process;

  • TECHNIQUES OF CRISIS INTERVENTION

    5. Positive reinvestment - positive answers to patients successful adaptive behaviors;6. Supporting effective defense mechanisms that maintain integrity of the ego;7. Encouraging the increase of self-esteem regaining the purpose of living, reassuring the subject of his/her value and meaning;8. Exploring solutions finding specific alternative solutions and problem-solving through teamwork;

  • PROBLEM-SOLVING SEQUENCE IN CRISIS INTERVENTIONStep-by-step sequence: Assessment of severity of crisisPlanning the actions according to available resourcesInterventionReassessment of the situation and planning of future actionsIf the specific goal has not been attained after these 4 steps, the crisis team has to start over and retrace the 4 actions.

  • a) ASSESSMENTThe first action in crisis intervention: assessment of the subject and of triggersThe therapist gathers specific information concerning the triggering eventThe current risk for suicide and violence are assessedIf the assessment indicates that hospitalization is not required, the therapist may proceed with the intervention

  • b) INTERVENTION PLANNINGThe decisive factor in planning: the time passed from the outbreak of crisis (commonly: the event occurs 1-2 weeks prior to the subjects cry for help)The impact of the event on subjects lifeThe impact on people close to the subjectCoping styles previously (but not currently) employed by the subject in difficult situationsTime required for interventionSize and structure of the intervention teamFirst specific actionsEstimated time until the first signs of improvement

  • c) INTERVENTIONFirst contact with the person in crisisEmploying a set of specific questions in order to find out specific information about the caseInvolving the family, facilitating communicationAccurate assessment of the situation, drawing up a therapeutic contract between all parties involvedInventory of the problems and establishing priorities

  • FIRST CONTACTEstablishing a normal environmentThe subject, other people present and their relationship with the subject are identifiedThe triggering event is debatedThe therapist informs all parties involved that they will all be required to take part in the resolution of crisis

  • SPECIFIC QUESTIONSAbout the triggering event of the crisisAbout symptoms generated by the impact with the eventAbout the subjects coping resources in front of psychological aggressionPractical issues: clinical and gynecological assessment, nutritional statusEvents/changes within the previous 2-3 weeksBrief psychiatric assessment possible symptoms (anxiety, depression) prior to the crisis

  • FAMILY, COMMUNICATIONCrisis (acute psychological unbalance) in a subject: sign of disturbed family system, will also affect other family membersRoles in the family system will have to change in order to accommodate the needs of the patientA list of problems for each family member to solve is drawn up this enhances the feeling of cohesion and involvement in therapyOptimal communication in the family listening to all parties, excluding critiques, objective and sensible assessment of alternatives to proposed solutionsActive listening and unconditional support of the subject by all parties involved is needed

  • THERAPEUTIC CONTRACTThe therapist expresses his viewpointThe connection between symptoms of subject and traumatic eventsThe necessity of admittance is assessed, according to severity of symptomsBenefits and disadvantages of admittanceSubjects without psychiatric disorders are kept in their home environmentA contract is drawn up with family members responsibilities of each party involved is detailed (family, friends, neighbors, volunteers in NGOs, physicians, psychologists, social worker, nurse)If the situation progressively improves, regular follow-up at-home visits continue for a predetermined period (3 6 weeks)

  • PRIORITIES OF ACTIONThe specific problem of the subject in crisis is avoided, if it cannot be solved in a short timeIf the problem can be solved, the specific actions to eliminate the consequences of disaster will be the focus of interventionThe family is involved in action planningMultiple solutions are exploredTasks are dividedAll support resources are identified, mobilizedSupport resources for the therapist are identified

  • d) REASSESSMENTThe last stage: the subject and intervention team evaluate the degree of positive outcomes and resolution of crisisThe best assessment tool: level of functioning the extent to which the subject has returned to the level of functioning prior to the crisisInventory of specific activities, daily routineCoping abilities in family and professional situations

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