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Chapter: Psychiatric Mental Health Nursing : Psychosocial Theories and Therapy

Crisis Intervention - Psychosocial Theories and Therapy

A crisis is a turning point in an individual’s life that pro-duces an overwhelming emotional response.

Crisis Intervention


A crisis is a turning point in an individual’s life that pro-duces an overwhelming emotional response. Individuals experience a crisis when they confront some life circum-stance or stressor that they cannot effectively manage through use of their customary coping skills. Caplan (1964) identified the stages of crisis: (1) the person is exposed to a stressor, experiences anxiety, and tries to cope in a custom-ary fashion; (2) anxiety increases when customary coping skills are ineffective; (3) the person makes all possible efforts to deal with the stressor, including attempts at new methods of coping; and (4) when coping attempts fail, the person experiences disequilibrium and significant distress.


Crises occur in response to a variety of life situations and events and fall into three categories:


·    Maturational crises, sometimes called developmental crises, are predictable events in the normal course of life, such as leaving home for the first time, getting mar-ried, having a baby, and beginning a career.


·    Situational crises are unanticipated or sudden events that threaten the individual’s integrity, such as the death of a loved one, loss of a job, and physical or emotional illness in the individual or family member.


·    Adventitious crises, sometimes called social crises, include natural disasters like floods, earthquakes, or hurricanes; war; terrorist attacks; riots; and violent crimes such as rape or murder.


Note that not all events that result in crisis are “nega-tive” in nature. Events like marriage, retirement, and childbirth are often desirable for the individual but may still present overwhelming challenges. Aguilera (1998) identified three factors that influence whether or not an individual experiences a crisis: the individual’s perception of the event, the availability of emotional supports, and the availability of adequate coping mechanisms. When the person in crisis seeks assistance, these three factors repre-sent a guide for effective intervention. The person can be assisted to view the event or issue from a different perspec-tive, for example, as an opportunity for growth or change rather than as a threat. Assisting the person to use existing supports or helping the individual find new sources of support can decrease the feelings of being alone or over-whelmed. Finally, assisting the person to learn new meth-ods of coping will help to resolve the current crisis and give him or her new coping skills to use in the future.


Crisis is described as self-limiting; that is, the crisis does not last indefinitely but usually exists for 4 to 6 weeks. At the end of that time, the crisis is resolved in one of three ways. In the first two, the person either returns to his or her pre-crisis level of functioning or begins to function at a higher level; both are positive outcomes for the individual. The third resolution is that the person’s functioning stabi-lizes at a level lower than pre-crisis functioning, which is a negative outcome for the individual. Positive outcomes aremore likely when the problem (crisis response and precipi-tating event or issue) is clearly and thoroughly defined. Likewise, early intervention is associated with better outcomes.


Persons experiencing a crisis usually are distressed and likely to seek help for their distress. They are ready to learn and even eager to try new coping skills as a way to relieve their distress. This is an ideal time for intervention that is likely to be successful. Crisis intervention includes a variety of techniques based on the assessment of the indi-vidual. Directive interventions are designed to assess the person’s health status and promote problem-solving, such as offering the person new information, knowledge, or meaning; raising the person’s self-awareness by providing feedback about behavior; and directing the person’s behav-ior by offering suggestions or courses of action. Supportive interventions aim at dealing with the person’s needs for empathetic understanding, such as encouraging the per-son to identify and discuss feelings, serving as a sounding board for the person, and affirming the person’s self-worth. Techniques and strategies that include a balance of these different types of intervention are the most effective.


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