|THE CONFLICT STATE|
Understanding crisis intervention starts with focusing on the individual, the total situation, and the interaction between the two. A careful look at each of these three perspectives is, then, where we will start to develop an understanding of and a feeling for the social interaction approach to crisis intervention.
As we think about the individual in crisis, it is clear that his physical, emotional, and social functioning play an important part in his overall adjustment and in his ability to cope with life's situations. Singly and in combination, these areas of functioning hold high potential for crisis. In times of crisis, the inability of the individual to work things out causes intense and varied physical/emotional/social reactions.
Our task is to help the person in crisis and others within his total situation to work with their rational, reasoning, planning dimensions in ways that help the individual in crisis gradually understand and cope with his crisis.
The person in crisis is a whole person with feelings, emotions, thoughts, ideas, abilities, limitations, and personality. Like all of us, he loves and hates, is sad and excited, wants and fears, feels happy and hurts, and experiences a full range of feelings, emotions, joys, sorrows, and humanness. Also, he has his rational, objective, intelligent, analyzing, understanding, reasoning dimension. Our task is to keep focus on the fact that we are relating to a particular person interacting in particular ways within a particular situation. We are interacting with a whole person with our task being to respond to and work with the whole, multi-dimensional individual.
THE TOTAL SITUATION
Next comes the person's total situation. This includes everything external to him that affects him or is affected by him. This is his now. It is his present, including people, relationships, things, circumstances, events, and so on. The person's total situation also includes then and when. Then is the person's past, and it shapes and affects the way things are now in his present. It is important to see that when is not the future; rather, it is the way the person feels or thinks the future will be when certain things happen or do not happen, when he does or does not accomplish some goal, if circumstances change or do not change, and so on. It is not how things actually will be, but rather, it is how the person thinks things probably will be.
Of course, then and now are also, for the person, a blend of actual events and circumstances, on the one hand, and his perception of those events and circumstances, on the other. It is important to understand, however, that when is an anticipated set of events and circumstances combined with the person's thoughts, feelings, anxieties, and uncertainties about those events and circumstances. It is this anticipatory anxiety and future uncertainty that give when its special significance in crisis situations. In such situations it is common to find that the person's perception of future events, within the context of his total situation, has a significant influence on his present feelings, emotions, attitudes, ideas, judgments and so on.
A person's present (NOW) is affected by his past life (THEN) and by how he thinks the future will be (WHEN). Understanding the person's total situation now necessarily involves not only understanding his then but also includes understanding his when.
Effective intervention in crisis situations requires that we bring together our understanding of the individual's total situation. This understanding will probably be somewhat sketchy, but our goal is to develop a mental picture of the person and his total situation. Such a picture, although lacking in full detail, will include an outline of important family and friendship relationships; important social, economic, and environmental factors; and a sensitivity for strong emotions, feelings, beliefs, and attitudes. It represents, for us, a real feel for the person and his total situation.
As this understanding of his present situation develops, we may want to ask what kind of events and circumstances in his past life are especially affecting his present situation. In addition, we will want to know a little about how he thinks the future will be, what the outcome of his problem might be, how things will be when the crisis is over. In general, we want to understand his then, when, and now, his total situation, and him as a person.
We have focused on the total situation and on the person. Next comes the interaction between the two. The total situation is everything affecting or effected by him. This affecting or being effected by is what is meant by interaction. The interaction is between the person and his total situation. Conflict, then, from this social interaction perspective, is in that interaction. The difficulty or problem is with some conflict or tension between the person and his situation. This is the first focal point in understanding crisis intervention. The type of conflict considered here is neither in the person nor in his total situation. It is, rather, in the interaction between the two. The crisis is not in the person, the person is in the crisis.
Similarly, the crisis is not located in the situation, within the people interacting with the person, or in the person's environment in a manner such that it can be separated from the person. The conflict in general and crisis in particular are functions of the interaction or adaptive fit between the person and his total situation. This interactive understanding of conflict is essential to understanding the crisis intervention process.
Essentially, conflict is whatever people think it is. If the individual or others in his/her total situation think or feel that things are not right or are not as they should be, there is conflict.
If the person or someone in his total situation thinks or feels that the effect on the person or on his behavior is not as it ought to be or that something or someone within his total situation is having a negative or an undesirable effect on him, then there is conflict. Less specifically, if the person or someone in his total situation thinks or feels that the interaction between the person and his total situation is problematic, there is conflict.
In crisis intervention, our orientation is to the person in crisis. We will start with his understanding of the conflict, knowing that he is usually the best judge of whether or not there is a conflict. If he tells us that a conflict exists within his interaction, we will accept the existence of the conflict as a fact. Alternatively, if someone else in his total situation tells us that there is a serious conflict or crisis, we will initially accept that report as true and follow through with our efforts to understand and resolve the conflict. The task is to find out for ourselves by evaluating the person, his total situation, and the interaction. If there is a crisis, we can help the person resolve it. If no crisis exists, our interests and intervention will help others to calm down, better understand the situation, and not worry so much.
A further point about the conflict state can now be made. We know that the conflict is located in the interaction between the person and his total situation, and from our own observations and the report of the person or someone else, we have an idea about what the conflict is. We also need to know why a conflict exists between this person and his total situation. At a rather simplistic level, the why of the conflict is because someone or something is causing it. The conflict is itself within the interaction between the person and his total situation. However, the cause of the conflict is due either to the person or to someone or something in his total situation. The point here is that the cause can come from either side of the interaction or can represent some causal mix from both sides.
THE CRISIS STATE
Initially, it may be difficult to make the conceptual transition from conflict to crisis. If so, the difficulty probably lies in a tendency to think about the crisis and then trying to understand the crisis state. If someone is extremely upset, angry, or depressed, we are first aware of the intensity of his emotional state. Nonetheless, our ability to help the person in crisis depends on our sensitivity to and awareness of the crisis itself. just as conflict exists within the interaction between the person and his situation, crisis is also a product of that same interaction. The person is in crisis; the crisis is not in the person. He is caught up in the crisis state.
What is the crisis state? It is nothing more or less than a limited and special instance of the conflict state. The interaction between the person and his total situation has become so conflicted that it has temporarily gotten out of hand. Why did the conflict get out of hand? What happened that intervention is now required?
THE PRECIPITATING EVENT
The person has shifted from the conflict state to the crisis state. What happened? Either suddenly or gradually a new conflict within his interaction developed or an already existing conflict worsened. We will call the cause of such a crisis state the precipitating event. Whether what happened involved an already existing conflict worsening or a serious new conflict developing, we will say that the precipitating event set off or caused the crisis. When we are dealing with people in crisis, then, one of our first questions will be, 'What happened?'
When trying to identify precipitating events, the tendency is to look for complex psychological or social causes. This leads to very complicated notions of cause and to considering factors, situations, conditions, and circumstances substantially removed in time from the crisis. In the social interaction model, emphasis is placed on a precipitating event immediately preceding the present crisis. The person in crisis is a very complex human being and his total situation is similarly complex. Moreover, the conflict between the person and his situation may be complex. However, the precipitating event tends to have the quality of the straw that broke the camel's back. Something relatively definable brought the interaction to a crisis point.
In other situations, there may not be a continuing conflict. The precipitating event may be something quite unexpected, a totally new set of circumstances, or some other problem arising in an otherwise smooth situation. Whether a new set of circumstances develops, new factors are introduced into the present situation, or an existing conflict is made worse by some new or unexpected event, crisis is always preceded by a relatively definable and observable precipitating event.
In considering the now potential in crisis, emphasis is first given to the 'potential,' which refers to what might or could happen. What is the worst possible outcome of the crisis? Could the person or someone else in his total situation die? Could someone get hurt? Could there be some other similarly serious consequence? Could the person's situation become so deteriorated that no amount of help or concern could return it to its pre-crisis state? The potential of the crisis lies somewhere between no bad consequences or effects and the serious injury or death of someone in the total situation.
The 'now' in the now potential refers to the immediacy or emergency quality of the crisis. We need to know how quickly things might deteriorate or get worse. How quickly might the potential be actualized? Will it take a week, a few days, a few hours, or could the worst possible outcome occur almost immediately? This how soon is the now in the now potential. As we intervene into crises by trying to find out what happened and by developing a picture of the person, his total situation, and the interaction between the two, we simultaneously need to consider and develop a judgment about the now potential of the crisis. How bad could it get? How soon?
Once we have determined the now potential of the crisis, we want to judge whether or not our intervention is necessary. We may think that the person can handle the situation himself. But if our faith in his ability to deal with things lacks enthusiasm, we may decide that someone else in his total situation can adequately deal with it. In other situations, we may conclude that the crisis has already passed its most serious stage and that the situation and the people in it will be able to work things out satisfactorily without our help. In any of these cases, our judgment tells us the crisis will be satisfactorily resolved without our intervention. In short, we judge the self-resolution factor of the crisis to be high.
If, instead, we think that the situation will worsen or that the crisis will not be resolved unless someone does something, we would conclude that the self-resolution factor is low. It is in such situations that our intervention is required. This would also include those times when we believe that, even though the crisis may be resolved, it is unlikely to be resolved in a manner that will be in the short or long term best interests of the person. People who become involved in crises frequently find themselves in a pattern of recurring crises. The pattern includes resolution of the recurring crises. The issue is that the pattern of resolution does not serve to decrease the likelihood of the recurrence of the crisis or increase the person's capacity to deal with and ability to manage those crisis situations as they recur.
THE ASSESSMENT SET
Thus far, we have located the conflict within the interaction between the person and his total situation. We have determined that it has a high now potential and a low self-resolution factor, justifying our intervention. We have asked, 'What happened?' and are developing an understanding of the precipitating event. Our picture of the crisis is taking on form and content. We are ready to consider the assessment set.
From this point on, crisis intervention is unlike more traditional forms of counseling and therapy. Traditionally, we want to know as much as possible about the person; his total situation; his now, then, and when; and as many other related factors, situations, conditions, circumstances, and events that possibly concern the person and his situation now. Our picture needs to be as complete and as detailed as possible. To achieve this level of understanding requires long-term interaction between therapist and patient as well as a high level of skill and training on the part of the therapist.
In crisis intervention, our focus is considerably more narrow, centering sharply and clearly on the crisis. As a test of crisis focus, we should always consider these questions:
1. Specifically, what is likely to get worse?
2. How bad might it get?
3. If things get worse, what is the potential effect and on whom?
4. Why do we think the person or someone else in the crisis will not be able to deal with it?
If we can adequately and clearly answer these questions, we may conclude that we have clear crisis focus. Crucial to effective intervention, then, is maintaining that clear focus throughout the crisis intervention process. Establishing and maintaining this crisis focus enables us to avoid going off on tangents or becoming involved with unrelated problems and concerns. Generally, our effectiveness in crisis situations is thereby increased.
Clear crisis focus leads to a clear definition of the crisis. If we can confidently answer the four focus questions, then we can define the crisis. We know what the crisis is, what is wrong, how bad it may get, who is affected, and why our intervention is required. Knowing these things gives us a firm foundation for the development of our intervention strategy.
POTENTIAL CUMULATIVE EFFECTS
Once we have a clear crisis focus and a satisfactory definition of the crisis, our assessment turns to the person and his situation. In crisis intervention, we concentrate on looking for immediate and potentially long-range cumulative effects. The notion here is that crises tend to spread out or diffuse. It is rather like the well-known snowball effect. As a generalization, crisis tends to be contagious. In any crisis, anticipated diffusion is included as a special part of the crisis definition.
We need to see that people in crisis tend to act in impulsive and sometimes self-destructive ways.
One of the main reasons for this is that they tend to be functioning less as rational, reasoning people and more as feeling, emotional, impulsive people for whom feeling and emotion have supplanted reasoning and planning. This destabilizing effect of crisis applies to a more or less extent in virtually all crisis situations. When working with people in crisis, the destabilizing effect impacts on judgment, reasoning, and perspective with the effect being directly observable within the functioning of the person. Thus, it is difficult for people in crisis to think ahead, anticipate the consequences of their behavior and actions, or develop plans leading to a satisfactory solution for their problems. This is, in large measure, what we mean when we judge a crisis to have a low self-resolution factor.
As we intervene into crises, then, along with asking, 'What happened?' we want to ask the person, 'What ideas do you have for dealing with the problem and what do you think will happen if you follow through with those ideas?' In that way, we can help him consider possible implications of his ideas and impulses and begin to help him think about alternative ways of dealing with the crisis. Considering such possible cumulative effects, focusing on the nature and implications of crisis behavior, and influencing alternative behavior and planning, give us further insight into the nature of crisis intervention.
As we think about potential cumulative effects, we are thinking beyond the now potential, which is, of course, the worst possible outcome of the crisis. In addition to the worst possible outcome, a crisis may have other outcomes and implications. People in crisis are generally not in an emotional position to be able to think through these possible outcomes and implications. They have difficulty fully understanding and thinking about the cumulative effects of their situation. Nevertheless, they feel compelled or impelled to do something about the problem. It is important to see that people in crisis are extremely uncomfortable and feel a strong need to reduce this discomfort or pain.
In psychological terms, most people tend to have a low tolerance for situational ambiguity or confusion, on the one hand, or if it is not possible to reduce it, they have a strong need to avoid it, on the other hand. Emotionally, they are pressed either toward doing something about the problem or, in some way, running away from it. This fact of human nature is what accounts for the cumulative effects of crises. The person is upset and probably agitated. His efforts to do something about the problem result in making things worse. Similarly, if he chooses to avoid or run away from the problem, that too can make things worse. This point is a state of maximum vulnerability. They feel frequently with a lot of reality justification, that whether they try to deal with the situation or try to escape from it things are simply not going to work out for them. This type of severe bind is frequently the socioemotional driver that ends in suicide.
In most crisis or tension situations, doing nothing is, in fact, extremely difficult. Yet, in crisis intervention, the wisest course may be to encourage the person to tolerate the discomfort, the pain, the confusion, and the ambiguity. The suggestion is therefore, when in doubt, do nothing. As we talk with those in crisis about their possible courses of action, we should ask them, 'What would happen if you simply did nothing?' This question surprises people. It has not occurred to them that one of their options is to do nothing. They can wait to see what happens.
As you think with them about possible cumulative effects, about possible undesirable outcomes, it is important to help them think through the implications of following their impulses or first inclinations. As you do this, you and they may come to the conclusion that, in the present crisis, their best course of action is to wait and see.
CAUSES OF CRISIS
Following from our consideration of crisis focus, crisis definition, and cumulative effects, let us now focus our attention on causes and effects. What could cause a crisis like this one? It is important to see that the question is not 'What did cause?' but rather, 'What could cause?'
The focus on could cause is, on the one hand, a relatively simple notion but, on the other hand, one that goes against our usual way of thinking about problems. Typically, we look at a problem and want to know, in detail, the situations, circumstances, and events leading to the specific problem.
In crisis intervention, however, we need to have in mind a set of likely causes of a variety of crisis situations. When we are dealing with a person in crisis, we need to know the most likely causes of a crisis such as the one we now see. For each type of crisis situation with which we deal, there are one or more likely causes. As we look at the person and his crisis, we want to consider the kinds of things that probably have caused his crisis.
Understanding the possible causes of crisis reinforces the social interaction characteristic of this crisis intervention model. The model argues that crises always involve disruption or conflict within the interaction between the person and his total situation.
Possible causes of crises, then, always relate to factors, situations, conditions, and so on, that cause conflict or disruption in the interaction. As we know, crises are caused or set off by precipitating events. Our own life experience, our experience with people in conflict, our supplementary reading, and our understanding of precipitating events help us understand the kinds of things likely to cause a variety of crisis situations. As you encounter various crisis situations, it becomes increasingly less difficult to speculate about the possible problems and factors in a person's interaction that were sufficient to cause the crisis.
We see the crisis and have a good understanding of the situations, circumstances, and events that could cause this kind of problem.
Our next step is to look carefully at the person and his total situation in order to discover what did cause his particular crisis. Knowing that gives us two special advantages. First, we know what a cause looks like. This point may seem trivial, but it is important to be able to recognize a cause when we see it or are told about it. People in crisis are frequently unable to tell us what happened or to explain what caused the crisis situation. They tend to attribute causality to situations or circumstances that are either too far removed from the crisis to have caused it or else are only incidentally related to it.
A clear notion of the most likely possible causes of crisis also enables us to help people think in a relevant way about what happened when they are feeling confused, somewhat disoriented, or are having difficulty organizing their thinking and feelings. Moreover, the person will develop feelings of security and trust because we understand what causes people to find themselves in crisis and are able to understand how things got that way.
Let us emphasize a point that may be easily overlooked. Since the crisis developed now or at least in the immediate past, the cause or at least a major portion of the cause also occurred in the immediate past. As we work with people in crisis, we will remember the significance of the precipitating event and we will continue our search for it until we have found it. In crisis intervention, our commitment to the person is in part an implicit agreement to continue our involvement with him until the crisis is resolved and until both of us understand what happened.
As you think about the possible causes of a variety of crisis situations, you begin to develop notions of possible effects or undesirable situations that frequently accompany such crises. Considering and thinking about this dimension of crisis intervention will stimulate your imagination and enable you to foresee possible consequences by drawing on your own experience and common sense.
Crisis intervention should always have the effect of constricting and reducing movement toward the crisis potential without spreading out or precipitating or influencing movement toward other negative potentials. This point holds both for the person in crisis and for others involved with him in the crisis or potentially involved in the consequences of the crisis.
|By Gary A. Crow, Ph.D. March 23, 2017|