Crisis Intervention: Understanding The Nature Of Crisis

Written by Reeta Kohli, excerpted from Towards Equal Access: A Handbook for Service Providers Working with Immigrant Women Survivors of Wife Assault, edited by Fauzia Rafiq (Ottawa, ON: Immigrant & Visible Minority Women Against Abuse, 1991).

"A crisis occurs when a person faces an obstacle to important life goals that is for a time insurmountable through the use of herlhis customary methods of problemsolving."

The term 'CRISIS' has its roots in a Greek word meaning 'decision', or more 'roadly speaking, 'a turning point'. Crisis is a common human condition which displays itself in varying degrees of intensity and can not be taken as a peculiar state of individual pathology, rather a genuine struggle of a person who is responding to reallife situations.

In other words, a person in crisis, at that particular time, is unable to rely on her familiar coping mechanisms and is faced with an acute sense of disequilibrium and disorientation. Experiencing strong and conflicting emotions, tensions and anxiety, she may enter a stage where her thinking becomes illogical, confused and fragmented. In short, the stress of a crisis upsets the balance between thoughts, feelings and behaviour. The fundamental task then, is to restore the confidence of an individual in her coping abilities as well as to provide the possibility of new coping mechanisms.

Crucial to an effective and meaningful crisis intervention with assaulted women, is a clear analysis of the nature of the oppression of women. A clear understanding, for example, of the fact that the world has historically been defined by men and for men, with women seen primarily as property and as  marginal to the fundamental issues of historical struggle and change, can empower a woman in crisis enabling her to recreate her abilities to cope.

The link is easily established since patriarchy openly advocates the natural inferiority of women and conversely the natural right of the male to rule the female. This power differential, maintained by various social, political, legal and religious institutions renders women powerless globally. As a result women continue to be loyal to individual men in their lives, and to blame themselves when any trouble emerges. The patriarchy endeavours to command and dictate total conformity of women to the statusquo, glorifying it along with an implicit doubleedged message: 'Be loyal, chaste ... or else'. It is therefore not surprising that men continue to beat women as a function of the domination they exercise over women, a domination that is inherent in the very structure of societies that men have created in their own image. Violence against women, be it in the form of sexual harassment, violent pornography, rape, sexual abuse, incest or battering, is nothing but a manifestation of the sexist and patriarchal system of social control of women.

Being brought up with such control and domination does not help women to cope with a crisis which emerges as a direct result of this control as well as the training in submission that women receive in their upbringing.

This is a global commonality of the situation of women. But there are factors such as language barriers and peculiarities of cultural indoctrination that make an assaulted immigrant woman in Canada more helpless and powerless. To quote an immigrant woman,

"being a woman is one strike against being, being coloured another, having a different sexual orientation than the prescribed hetrosexuality another. "

And one could go on.

Elements Of A Crisis Situation

To understand the nature of a crisis situation, we can refer to the following categories: 3

1) Hazardous Event

Is a specific internal or external occurrence. It may be a single catastrophic occurrence or a series of successive mishaps which build up a cumulative effect making a change in the ecological balance and can usually be found by probing t e person's relatively recent past. Such events can e anticipated/predictable or unanticipated/unpredictable.

2) Vulnerable State

Ensues from the impact of the hazardous event which has disturbed the homeostatic balance of the woman. It may be a subjective reaction to the initial blow, both at the time it occurs and later. In this stage an individual usually goes through a series of predictable phases:

• Experiences tension. Responds with customary repertoire of problem solving mechanisms;


• if not successful, mobilizes new emergency methods to cope with this situation. Failure in those new methods increases disorganization in functioning; feelings of depression and hopelessness take hold resulting in regressive behaviour.

3) Precipitating Factors

Are the link in the chain of stress. They provoke events that convert the vulnerable state into a state of disequilibrium bringing tension and anxiety to a peak. The precipitating factor may coincide with initial hazardous blow leading to the next stage. Or it may be a negligible incident in itself, not even directly related to the Hazardous Event. But its occurrence at a particular time can overload the system and tip the delicate balance and equilibrium.

4) The State of Active Crisis

Or the state of active of acute crisis describes the person's subjective condition once the homeostatic mechanisms have broken down, tension has topped and disequilibrium sets in. Ibis becomes the determining factor in the decision of whether or not to use the Crisis Approach or the Treatment Of Choice. This state can have one or both of the following elements:

• EXHAUSTION CRISIS: The person has coped effectively under prolonged conditions of emergency but suddenly reaches exhaustion, the result 'quasibungling'4 of the total coping structure.
   


• SHOCK CRISIS: A sudden change in the social environment creates an explosive release of emotions which overwhelms the available coping mechanisms; gives no time to assimilate impact and projects the person into emotional shock. Women are usually found to be motivated to accept and use help in this situation. Minimum support can produce more effect as opposed to intensive help during periods of less emotional accessibility. The person has coped effectively under prolonged conditions of emergency but suddenly reaches exhaustion, the result 'quasibungling' four of the total coping structure.

5) Stages of Reintegration

Or Crisis Resolution is an extension of the previous stage but here new adaptive styles are learned which enable the woman to cope more effectively with other situations in the future. This state consists of clearly identifiable phases:

• CORRECT COGNITIVE PERCEPTION: Problem is maintained at a conscious level as the person struggles to fill in gaps in her knowledge and understands what has happened both at objective and subjective level.
   


• MANAGEMENT OF AFFECT: Appropriate acceptance and release of feelings associated with elements in the crisis situation.
   


• DEVELOPMENT OF NEW PATTERNS OF COPING: The person begins to adopt constructive means of dealing with the problems that arise and seeks out and uses help, if needed. If, at this time, help is not available or is inadequate or maladaptive, result might be a weakened ability to function adequately in the period ahead; Problem is maintained at a conscious level as the person struggles to fill in gaps in her knowledge and understands what has happened both at objective and subjective level.

Learned Helplessness

If the individual believes that action and outcome are independent and that she has no control over the unfolding of events, whether or not objectively true  will cease responding  essential to resolve crisis and will lapse into learned helplessness the belief that nothing makes a difference.

Goals of Crisis Intervention

The goals of crisis intervention are relatively limited, relate to the immediate crisis situation and are the following:

• Reduction in disequilibriurn or relief of symptoms of crisis


• Restoration to precrisis level of functioning


• Some understanding of the relevant precipitating events


• Identification of remedial measures which the woman or family can take or make available through community resources.


• Connecting the current situation with past life experiences and conflicts


• Initiating new modes of thinking, perceiving feeling and developing new adaptive and coping responses which are useful beyond the immediate crisis situation, leading to an emancipated maturation and empowerment.

Steps In Crisis Intervention

Given that a therapeutic alliance has been established between the individual in crisis and the therapist/worker; the disruptive current life is known to both; the individual is motivated; suicidal risk and lethability potential are evaluated; following steps ensue in crisis intervention:

• A supportive, anxiety reducing rapport is established. The therapist/counsellor listens and helps the person gain perspective both on internal and external environments and to work collaboratively for potential solutions;


• As the working alliance develops, information is collected to identify the crisis, precipitants and sequence of events, thereby eliciting the crisis incident and to focus towards reformulation and resolution;


• Through clarification and method of linking events, simple hypotheses and explanations are offered which expand the person's understanding thereby promoting a cathartic reexperience of the crisis situation;


• Encouraged and guided, the person modifies assumptions, considers options and selects the most appropriate solution gaining insights and learning;


• The person's own solution is accepted, supported, tested and reinforced.

The intervention is of a short-term nature and usually terminates once the acute crisis is over and adaptive means lead to a reestablishment of equilibrium. The short term nature puts maximal responsibility for self direction, supports self-esteem and minimizes the risks of dependency.

Requisites for Effective Crisis Intervention

In addition to being nonjudgmental, flexible, objective, supportive and empowering, following are considered to be essential requisites for service providers to enable an individual to journey from a vulnerable crisis state to equilibrium and empowerment:

• Ability to create trust via confidentiality and honesty;


• Ability to listen in an attentive manner;


• Provide the individual with the opportunity to communicate by talking less;


• Being attentive to verbal and nonverbal cues;


• Pleasant, interested intonation of voice;


• Maintaining good eye contact, posture and appropriate social distance if in a facetoface situation;


• Listening for feelings, hearing what is said and not said, focussing on what person is feeling;


• Remaining undistracted, open, honest, sincere;


• Being free of prejudice and abstaining from stereotyping;


• Asking openended questions;


• Giving feedback and receiving feedback whenever possible if the person is prepared to hear;


• Asking permission, never acting on assumptions;


• Checking out sensitive crosscultural factors;


• Being aware of one's own prejudices;


• Responding appropriately to woman's cultural reality.