Description, key skills required, intervention strategies, social work practice approach
This page has three sections:
Background Material that provides the context for the topic
A suggested Practice Approach
A list of Supporting Material / References
Feedback welcome!
Background Material
(Regehr, 2011) Two primary types of events can result in a crisis response: situation and developmental. Situational crises span a wide range of events including diagnosis of a life-threatening or serious illness, job loss, or divorce. Developmental crises include the birth of a child, adolescence, marriage and retirement. Whether an event results in a crisis response is highly individualized.
Crisis = the event + the individual’s crisis-meeting resources + other concurrent stressors + the individual’s perception of the event.
Crisis intervention is action oriented, based on a certain situation. It is about immediate concerns, the here-and-now. After the crisis subsides, it is about support to help people adjust. It is a goal-oriented, short-term approach.
You have to be a calm person; keep equilibrium in stressful situations. You need to be aware of self.
You have to make accurate assessments and not make assumptions – experiences are unique. People’s life experience will determine how they cope.
People generally live their lives in a steady state of homeostasis. Events occur throughout life that challenge the homeostasis, and the individual mobilizes resources (physical, psychological, emotional, intellectual and social) to restore balance. When that balance is not quickly restored or a solution to the challenge is not evident, the experience of crisis can occur, i.e. a period of psychological disequilibrium, experienced as a result of a hazardous event or situation that constitutes a significant problem that cannot be remedied by using familiar coping strategies. The inability of normal coping strategies to manage the situation leads to a number of consequences, including (i) emotional distress, (ii) impaired sense of personal self-worth, (iii) inability to enjoy interpersonal contacts, and (iv) impaired task performance, all of which result in the experience of a crisis state.
The central tenant of crisis intervention is that a little help, rationally directed and purposefully focused at a strategic time, is more effective than more extensive help given at a time of less emotional accessibility. In crisis intervention the social worker must engage with the client on a cognitive level to quickly work to solve the problem rather than explore unconscious issues.
(Harms, 2007) Some of the key skills used in crisis intervention are
A rapid assessment of functioning Formal tools are often available for this
Reassurance of basic, physical safety is often critical
Maintaining a needs and rights focus People, during a crisis, can still remain empowered and make their own decisions. Overlooking this has been a major criticism of debriefing situations where people have not been able to act in ways in which they wanted.
Validation of feelings As distinct from the task-centred approach, crisis intervention focuses on the often intense emotional state someone is experiencing. Ventilation or expression of emotions is encouraged. This is connected to the psychodynamic approach where cathartic release of all emotions is the first step in being able to control them. Listening and supporting through probing, reflecting and paraphrasing is important. Listening is accompanied by validating all emotions.
Information and resource provision Crisis intervention strategies are immediate, active and directive interventions such as education, clarification, and reassurance about the normative, expectable reactions to trauma. The worker’s knowledge of crisis and trauma, and the expectable immediate and longer-term reactions is drawn on at this time. It may involve a normalising statement where the worker draws upon his or her knowledge base to provide resources for the client.
Direct influence In some instances you may use directive or influencing skills, e.g. suggest a plan if nothing emerges from the client—contain the options the client is presented with to help the client get through the immediate situation. 195 Maslow’s hierarchy of needs may be relevant, e.g. people in crisis often need the basics attended to in relation to shelter, food, clothing and communication.
(O’Connor et al., 2008) In many situations workers draw on more than one theoretical approach to identify appropriate intervention strategies.
Practice Approach
(O’Connor et al., 2008) There are three broad intervention tasks: form a relationship, model effective behaviour that will assist the client to move from dependency to more self-sufficiency, and provide resources needed to help the client adjust to their circumstances.
(Roberts & Ottens, 2005) Crisis intervention focuses on the resolution of an immediate problem to prevent further deterioration and return to at least a pre-crisis level of functioning. There are seven stages of crisis intervention:
Planning and conducting a thorough assessment including any acute risk of harm to self or others. If possible, allow this to emerge as the client’s story unfolds. Look for the client’s environmental supports and stressors, medical needs and medications, current use of drugs and alcohol, and internal and external coping methods and resources.
Rapidly establishing rapport—through showing concern for the problems that are being experienced and a desire to assist with basic needs. Instill trust and confidence in the client through good eye contact, nonjudgmental attitude, creativity, flexibility, positive mental attitude, reinforcing small gains, and resiliency.
Identifying various dimensions of the current problem—the biopsychosocial domains; clients will present a wide range of problems that are not new—the social worker needs to organise these in his or her mind and not be overwhelmed. The question asked from a variety of angles is “Why now?”
Active listening while exploring and describing previous coping strategies and successes and resources available—their strengths and social network; celebrate the successes of positive coping if evident. There are two aspects: (i) allow the client to express feelings, to vent and heal, and to explain her or his story about the current crisis situation; (ii) challenge the client’s perception by giving information, reframing, offering alternatives.
Generating and exploring alternative strategies for managing the problem—summarise the issues, suggest some can be dealt with later, look at the most recent, gently search for solutions with the client. This stage can often be the most difficult to accomplish in crisis intervention. Clients in crisis, by definition, lack the equanimity to study the big picture and tend to doggedly cling to familiar ways of coping even when they are backfiring. Hospitalisation may be necessary if the client cannot engage in problem-solving and the risk, for instance of suicide, remains high.
Restore functioning through developing and formulating an action plan with the client; generally, the client and social worker have some responsibilities in the plan.
Establish follow-up plans—these tend to be short-term in crisis intervention, e.g., client can agree to phone the social worker the next day.
Supporting Material
(available on request)
Australian Psychological society. (2013, updated 2017). Psychological first aid: An Australian guide to supporting people affected by disaster. Retrieved September 22, 2020 from https://www.psychology.org.au/getmedia/c1846704-2fa3-41ae-bf53-7a7451af6246/Red-cross-psychological-first-aid-disasters.pdf
Useful organisations are included in this Australian Psychological society publication
Harms, L. (2007). Working with people: Communication skills for reflective practice. South Melbourne, Australia: Oxford University Press.
O’Connor, I., Wilson, J. Setterlund, D., & Hughes, M. (2008). Social work and human service practice (5th ed.). Frenchs Forest, Australia: Pearson Education Australia.
Regehr, C. (2011). Crisis theory and social work treatment. In F. Turner (Ed.), Social work treatment: Interlocking theoretical approaches (5th ed.), (pp. 134-143). Oxford, England: Oxford University Press.
Roberts, A. R., & Ottens, A. J. (2005). The seven-stage crisis intervention model: A road map to goal attainment, problem solving and crisis resolution. Brief Treatment and Crisis Intervention, 5(4), 329-339.
University of Tasmania. (2015). Information to help you cope with a traumatic event.