Chapter 3 – 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 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. In late chapters, we will talk about crisis communication, and we will see that crisis intervention responds first to these intense emotions. Nonetheless, our ability to help the individual in crisis depends on our sensitivity to and awareness of crisis itself. Just as conflict exists within the interaction between the individual and his situation, crisis is also a product of that same interaction. The individual is in crisis; the crisis is not in the individual. 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. As we will see, the interaction between the individual 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
In Figure 3, the individual 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 causes of such a crisis state the “precipitating event.” Whatever happened, an existing conflict worsened or a serious new conflict developed. 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?” Our effort here is to move gradually toward crisis reduction.
When seeking 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 place on a precipitating event immediately preceding the present crisis. The individual in crisis is a complex human being; his total situation is similarly complex. Moreover, the conflict between the individual 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.
Aaron, age twenty-two, comes in to the twenty-four-hour drop-in service at 3:30 a.m. He tells a rather confused and disconnected story, indicating that he could not sleep and had to talk to someone. His wife is five months’ pregnant and has worked at a Laundromat for two years. She is twenty-three. He has lived in this area for five years but has no close relatives or friends. Until a few months ago, she was fine. They talked about what they would name the baby and how things would be after the baby arrived. He pays her support, the rent on her apartment, doctor bills, and so on. She always wanted a baby, but she also seemed to want everything else: a new car, furniture, clothes, vacations, and so on. She has left him before. Last February, she was gone but sent him a beautiful card expressing her love and telling him how much she cared for him. They have been married for almost four years and have a beautiful house. His father-in-law does not like him and will not have anything to do with him. His mother-in-law says she is sorry but there is nothing she can do. They do everything for his brothers-in-law and their families but never seem to help him and his wife when they need help. They always tell her she’s better off without him. This hurts him, but his mother-in-law will talk with him sometimes. When his wife leaves, she always spends most of her time at her parent’s house. This time she got an apartment across the street from them. He was alone at Christmas. Their friends would come over, and one of them told him to get a divorce. That is when the trouble started. It was going okay until the sheriff served papers on him today. They say he has to stay away from his wife and cannot see his two-year-old son until the hearing, which is four weeks away. That was the final straw; he cannot even see his own kid now.
As we can see, there is continuing conflict in the interaction between Aaron and his wife. Apparently, this conflict extended to Aaron’s relationships with his mother- and father-in-law. His friends also seem to be interfering in his relationship with his wife. Even though Aaron’s situation seems very problematic, until now he has been able to cope with it. Learning that he would not be able to see his son, however, was more than he could take, and it precipitated the crisis seen in the drop-in center. In most crisis situations, the precipitating event is not so easily observable. Nevertheless, it will always be present in a crisis situation. In Aaron’s crisis, the precipitating event exacerbated the continuing conflict between him and his wife. Getting the papers from the sheriff set off the crisis. 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 or new factors are introduced into the 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 the terms of Figure 3, calling the individual’s present state of affairs a “crisis” is to say at least two things about it. First, it has high “now potential,” and second, it has a low “self-resolution factor.” Let us separately consider these two crisis characteristics.
NOW POTENTIAL
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 individual or someone else in his total situation die? Could someone get hurt? Could there be some other similarly serious consequence? Could the individual’s situation become so deteriorated or so permanently messed up 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 individual, 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?
Let me tell you about a situation out of my own experience. It seemed, at the time, like a real crisis. Looking back, the obvious flaw in my judgment was my failure to recognize that the now potential was very nearly approaching zero. The summer between my first and second years in graduate school was spent as a program director at a YMCA camp. About ten-thirty one evening, I was sitting in the dining hall with most of the camp staff, trying to make time with the camp cook. (I married her a couple of years later and am still married to her; so that worked out pretty well.) At any rate, it was girls’ camp that week, and all the campers and staff were girls (except for one college-age boy who helped in the kitchen and the camp director, who was gone that night). Sure! I thought it was great.
One of the younger counselors and two of her friends came running into the dining hall in near hysteria, and about all we could get out of them for a minute or two was “He’s dead. It’s a dead body.” They had tripped over what they thought to be a dead body on the footbridge across the river. With some embarrassment, I must admit that I became nearly as panicked as the girls. It seemed like a real crisis; I really do not want to go into the details that led to four police cars and seven deputy sheriffs being in camp. Remember the guy who helped in the kitchen? Well, it seems that he and his girl friend….They had not moved when the kids tripped over them because they were not supposed to be out there in the first place. A crisis? I sure thought so at the time, but on looking back, I can see that even had there been a dead body on the bridge, the now potential was pretty low. Dead bodies tend to stay in place and not make much trouble. Also, the likelihood of a dead body on a bridge in a summer camp is fairly remote itself.
However, specific note must be made of crisis situations that should always be interpreted as holding high now potential. For example, any reference to suicide, whether or not it initially seems to be a serious report of someone’s intention to kill himself; any report of a strong impulse to abuse or physically injure a child; any report of a drug overdose; any report of bizarre or unusually strange behavior; or any report of a “bad trip” with drugs should always be seen as a serious crisis with significantly high now potential. Alternatively, reports of continuing but more serious marital difficulty, concerns about poor schoolwork or unsatisfying interpersonal relationships, continuing but more serious difficulty in managing or controlling the behavior of children, or experience involving a somewhat increased sense of discontent and restlessness should be seen as holding less significant now potential.
Since threats of suicide, comments about suicide, and situations in which suicide appears to be a significant possibility frequently come up in crisis intervention practice, some special comments about the dynamics of suicide are in order. First, the now potential in suicide situations is critically high. Clearly, someone could die. Later in this text, we will discuss situations and circumstances that can prompt people to feel like killing themselves. Here we want to think about what is going on within the individual when he is considering killing himself. Most typically, people who are suicidal appear to be extremely depressed, somewhat withdrawn, and express feelings of futility and despair. At other times, however, people may talk about suicide in a light and casual way. In some cases, references to suicide may be very indirect and not appear to be particularly serious.
Next, having recognized the high now potential in any suicide threat, we want to keep in mind the fact that people very rarely kill themselves in the presence of other people. This is true despite the sensational news coverage given to people who have shot themselves in front of their family or friends. Suicide is almost always a solitary act. It thus becomes important to make sure that a potentially suicidal individual is not alone. If he has come to our office or drop-in center, we will either stay with him or make arrangements for someone else to stay with him until the suicidal crisis has passed. If he calls us on the hot line, we will try to learn if he is home alone, if there is someone who could come over to stay with him, if there is some place he could go where there are people, and so on. If he has called us on the telephone and if we can get no assurance that he will go to a friend, we should make every effort to find out where he is. Once we know where he is, we will waste no time in getting someone to him.
A situation with a real and immediate possibility of suicide is one of the very few in which we would call in the police. If the only way to get someone to the individual is to have the police knock on his door, then we will have the police do that. If we have overreacted, however, the individual will probably never again place any faith and confidence in us. He will probably be very angry and may well say very negative and destructive things about us to his friends. The only way to avoid this is to run the risk of under reacting. To under react is to run the risk of having a dead client.
What has happened to the person who becomes suicidal? Clearly, he has turned his anger in on himself. This fact comes as a surprise to many newcomers to crisis intervention. Ask yourself, “What is the most angry, aggressive act an individual can carry out?” He can kill someone. There is probably no act more expressive of extreme anger than murder. Most people would not be able to kill unless they had temporarily lost their senses or had gone into a violent rage. This kind of intense anger is something most people would find difficult to express directly. Suppose, though, that they were angry with themselves for something they had done or something they thought they had done. Suppose this led to their feeling unable to cope with their life situation, face their family or friends, or otherwise deal with things. Since there is no way to work things out or to make things better, the anger turns in on the individual. At the extreme, that anger causes the individual to kill himself. Sometimes this intense anger may be focused on an individual, a member of the family, a friend, an associate, or on the world in general. Because the individual in crisis feels unable to take out his anger directly on someone or cope with his situation, he may take it out on himself. Whatever the reason or circumstances, suicide is always an expression of extreme internalized anger.
In the crisis intervention process, the goal in suicidal situations is to enable and encourage the individual to express his anger, talk about what has made him mad, verbalize his frustrations, and generally “get it out where he can deal with it.” Working with people in suicidal crises is difficult, but you will be able to help them. Your efforts should be to get them to externalize their anger, tell you what frustrates them, talk about things that have made them angry, deal with their resentments, think through the situations and relationships with which they feel unable to cope. If they can verbalize their anger, focus their bad feelings on specific people and situations, and make plans about coping with their life circumstances, they are well on their way to getting through the potentially critical crisis.
SELF-RESOLUTION FACTOR
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 individual 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 has the knowledge, skill, and capacity to deal adequately 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.
In the cases discussed thus far, the self-resolution factor has been fairly low. The people in crisis seem to be temporarily unable to cope with their feelings or life situations. From the information we have about these cases, there appeared to be no one in the individual’s situation who could deal adequately with the crisis or who was in a position to help the individual deal with it. They had contacted us during their crises because their confusion, depression, loneliness, or anger interfered with their ability to handle their present situation. Sometimes, though, we will learn through discussions with individuals in crisis that there are other people in their situations who can help them. For example, we may find that the individual has a good and continuing relationship with his minister. We may want to encourage such a person to call the minister for help with this particular crisis. In other situations, we may find that a child has brought a serious problem to us but has not discussed it with his parents. We may learn that he has a good relationship with his mother and father and that they are interested in him and usually have no difficulty in communicating with him. We are just the first person who happened along. We might suggest to the child that he talk about it with his parents or that we give them a call and ask them to help him with his problem. In this kind of situation, the child is frequently quite willing to discuss the problem with his parents and has real confidence in his parents’ ability to handle the situation. At other times, an individual may contact us about a situation with which the family doctor is familiar. It may be that he has been working with his doctor on the problem. If he has confidence in the doctor, we should assume that the doctor has the skills and knowledge necessary to help the individual through this crisis. In all of these situations, we learn that there is someone else already in the situation with sufficient knowledge and skills to deal with the crisis. When this happens, we should calmly and politely refrain from becoming involved, encouraging the individual to rely on those people for help.
At other times, we may conclude that the individual really can deal adequately with the crisis himself. His doubts in his own ability to handle the problem may be considerably exaggerated. This situation frequently occurs with small children. They come to us quite upset and convinced that no one likes them, that other children do not want to play with them, and that they are really unacceptable people. To sympathize with them, to become alarmed about their situation, to act as if their crisis were legitimate is to reinforce the negative feelings and poor self-images. As we look at their crisis, we may conclude that they will be served in the long run if we do not become involved but ‘force” them to handle the situation themselves. Our judgment is that they can handle this problem if we do not interfere or support their feelings that they cannot handle it. We have concluded that the self-resolution factor in the child’s crisis is high and that he can handle it himself. In situations like this, both we and the child will be better off if we stay out of it. Most crisis situations that come to our attention will probably have relatively low self-resolution factors and may well require our intervention. But we must be alert to recognize the occasional situation in which the self-resolution factor is actually fairly high. Either the individual can handle it himself or there is someone else already in the situation who can deal with things quite nicely.
GUIDELINES FOR INTERVENTION
Do we have a right to intervene? If the situation really is a crisis (has high now potential and low self-resolution factor), we not only have a right to intervene but we also have a responsibility to intervene. This responsibility is based on our mutual responsibility and a very human interest in one another. A value framework underlying human services and crisis intervention specifically directs us to do what is reasonable and necessary for the well-being and welfare of people receiving our help. The parallel with the Good Samaritan is clear.
Will the individual in crisis get angry with us, accuse us of meddling, tell us to leave him alone? Perhaps. Will our efforts be appreciated? Will people see that we are making a sincere effort to help them? Perhaps not. The question for us is, “When the ‘now potential’ is high and the self-resolution factor is low, do we, at a feeling/valuing level, have any real choice other than to do what we can to help?” Of course, if someone might die or if something else terrible might happen, we will try to help. If the individual or someone close to him has asked, we will help. At other times, our intervention will be required by virtue of our job or position. Will you take a chance? There are personal, emotional, and interpersonal risks, and our willingness to take such risks is an important part of what we bring to crisis intervention. Professional counselors and psychotherapists know about the balancing act between over involvement and under-involvement. As a volunteer, student, or other newcomer to crisis intervention, you will need to develop a feel for and an understanding of the risks for yourself. Not to take the risk, though, many times means pulling back from the opportunity to help. Whatever the situation or circumstance, when a real crisis exists we will intervene, knowing that it is usually better to do too much than too little.
Our intervention should be directed by three specific considerations. First, is our intervention reasonable? Based on our knowledge and understanding of crisis intervention and people in crisis, does the present situation really have a high “now potential” and a low self-resolution factor? A different kind of crisis may illustrate the point.
A camp director is sitting in the dining hall one evening, enjoying the peace and quiet of a solitary cup of coffee. A counselor comes running into the hall. He is quite out of breath. “Do you know what I just saw? You’ll never believe it! Do you know what those kids are doing? [The director says: No, what are they doing?] There is a bunch of those high school kids fooling around down by the path to the swimming pool. What are we going to do about it? This is terrible! Come down there with me so we can get this straightened out. What are you going to do about it? [The director says: I don’t know. What do you think I should do about it?] You should go down there right now and break that up and have a good talk with them about that sort of thing.[The director says: If that’s all they’re doing, they will probably break it up in a little while, anyway. It’s almost time for taps. Let’s see if they don’t just go back to their cabins themselves.]”
The director seemed to understand that crisis intervention should be resorted to only when intervention is reasonable. The now potential of the situation was apparently fairly low, and since it was almost time for taps, the crisis would probably resolve itself fairly quickly. People will often try to get us involved in situations that are not really crisis. At other times, they may be extremely upset and try to manipulate us into doing things that the situation does not actually call for. Sometimes, the individual may be so upset that we overreact to a relatively minor crisis. We must be careful to assess the now potential and the self-resolution factor carefully in order to decide whether or not intervention is reasonable. In addition, our decision should include a judgment about how serious the situation really is. What level and intensity of intervention would be reasonable given the present situation?
Second, we should consider the appropriateness of our intervention. We have determined that intervention is reasonable and have made a judgment about the level and intensity of intervention required. There may be a lot of things we could do about the problem. We must carefully think about each of our options and choose only those that, given the particular individual and circumstances, are appropriate. In the earlier case of Ann, Mr. Z chose to report Ann to the police when he discovered that she was using drugs. He had several other intervention alternatives. He could have calmly discussed the problem with Ann, he could have referred her to the guidance counselor, he could have chosen to ignore the problem, he could have disciplined her within the school, he could have called her parents and involved them in the problem, and so on. In that situation, Mr. Z had to choose the most appropriate intervention option. In other situations, we may consider obviously inappropriate intervention approaches. For example, we may decide to let a runaway teenager stay with us for a few days without notifying his parents, the police, or other authorities. Even though intervention is necessary and the teenager needs someplace to stay, our failure to notify his parents or some other authority is probably inappropriate.
Third, our consideration of the reasonableness and appropriateness of our intervention must include the ethics of intervention. Obviously, a sexual or other intimate involvement with the individual in a time of extreme stress and crisis would be unethical. Similarly, it would usually be unethical to take it upon ourselves to inform other people about the individual’s problems, circumstances, feelings, and so on. Unless there are unusual extenuating circumstances, ethical considerations preclude violating the individual’s confidence. We have invited the individual to share his or her feelings and very personal thoughts with us. Implied in this invitation is our agreement to keep those thoughts and feelings confidential.
If you are a member of a professional group, your professional ethics will apply in all crisis intervention situations. If you are a volunteer involved in crisis intervention, the organization for which you work will have specific policies and standards regarding ethical conduct. If, however, you have carefully considered the crisis, have determined it’s now potential to be high and its self-resolution factor to be low, believe that intervention is reasonable, feel that your method of intervention is appropriate, and restrict intervention to ethical activities in the individual’s best interest, you can and should intervene. Not only do you have the right but you also have a responsibility to intervene.
IN SUMMARY
To say that an individual is in a crisis state, we must first be aware of a conflict between the individual and his total situation. Next, we must judge the conflict to hold high now potential. Finally, we must judge the conflict to have a low self-resolution factor. If these conditions are met, we have a crisis requiring our intervention. To conceptualize, a crisis state exists when a conflict holds immediate potential for significant deterioration in the person or in the situation, combined with a low probability of either the person or other individuals in the interaction being able to resolve the conflict.
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