Crisis Intervention

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Chapter 2

• Crisis Intervention

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TWO KEY FIGURES IN CRISIS INTERVENTION

• Gerald Caplan
• Eric Lindemann
• Created the Wellesley Project as a result of the
  Coconut Grove fire in Boston, 1942
• Preventive psychiatry emphasized early
  intervention to minimize psychological impairment

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1950s through the 1960s

• Introduction of psychotropic medications such as
  thorazine and lithium began the process of the
  deinstitutionalization of the state hospital
  mentally ill patients.
• Short-Doyle Act funded community mental health
  centers throughout the country

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1960s through 1970s

• Suicide prevention
• Journals and scientific research about crisis
  intervention and suicide
• Grass roots movements lead to the creation of
  non-profit agencies and use of paraprofessionals
• Colleges created counseling programs

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1980s through the 1990s

• Managed care
• Brief therapy was more cost effective
• Emphasis on crisis intervention, all mental
  health workers would provide case management and
  short term care

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21st Century

• Bills still pending in congress about the rights
  of the mentally ill.
• Funding at federal level is minimal
• California trend is to create new programs for
  mental health care (Proposition 63 has passed)
  this creates thousands of jobs and facilities for
  mentally ill
• Crisis intervention still the preferred mode by
  all funding sources.

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Timeline in the Development of Crisis Intervention
1942 Coconut Grove Fire / Use of Non-Professionals to counsel grief reactions.
1946 - 1964 Baby boom / Grief reactions to stillbirths and miscarriages.
1950s Discovery of Psychotropics/ deinstitutionalization of the Mentally Ill.
1957 Short / Doyle Act
1963 Community Mental Health Act / JFK Assassination
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Timeline in the Development of Crisis
Intervention (Continue)
1960s Journals about suicide prevention and crisis intervention, increase in professional studies in counseling
1960 - 1970 Grassroots movements, non-profit agencies, use of paraprofessionals.
1970 - 1980 Increase in college counseling programs, professionalization of mental health, movement toward longer mental health counseling.
1980 - 2000 Managed Care takes over the medical field, including mental health, return to crisis intervention in private and public mental health services.
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Contributions from other Modalities

• Psychoanalytic Approach
• Psychic energy is finite and limited. We can
  only handle so much stress and then something
  gives for a period of time until coping skills
  are learned or defense mechanisms are utilized.
• An individuals past experiences will determine
  how current experiences are dealt with and how a
  crisis will be resolved.
• Existential Approach
• Humans are responsible for decisions and capable
  of self-awareness and choice.
• Anxiety is a normal part of the human condition
  and impetus for growth.

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Contributions from other Modalities (Continue)

• Humanistic Approach
• Humans are capable of self-directed growth and
  there is hope and optimism about life struggles
  being manageable.
• A genuine relationship with a counselor where
  empathy is shown is vital to therapeutic change.
• Cognitive Approach
• Human emotions and behavior is related to
  cognitions and perceptions about our experiences.
• Helping an individual to alter cognitions when in
  a crisis state is therapeutic.

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Contributions from other Modalities (Continue)

• Behavioral Approach
• Brief, goal oriented counseling which is directed
  at changing behaviors which are maladaptive to
  normal functioning.
• Family Systems Approach
• Runaways in a family is analogous to a crisis in
  an individual in that normal counteractive
  mechanisms dont work to return to homeostasis.
• Solution oriented therapy aimed at helping
  families adjust to transitions in family members
  development cycle.

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BRIEF THERAPY

• Not the same as crisis intervention
• Clients explore past patterns of behavior and how
  these prevent successful lifestyles and choices.
• More explorative rather than structured
• Time limited, but not focused solely on the crisis

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THE ABC MODEL OF CRISIS INTERVENTION

• A Developing strong rapport
• B Identifying the nature of the crisis and
  altering perceptions
• C Offering coping skills