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CRISIS THEORY Crisis: A period of disequilibrium and decreased functioning as a result of an event or situation that creates a significant problem which cannot be resolved by using familiar coping strategies (Roberts, 2000)

CRISIS DEFINITIONS A Crisis may be viewed as the transitional period presenting an individual with, on the one hand, an opportunity for personality growth or maturation and, on the other, a risk of adverse affect with increased vulnerability to subsequent stress. W Thomas(1909): described Crisis as a threat, a challenge, a strain on the intention, a call to new action. Yet it need not always be acute or extreme. Of course a crisis may be so serious as to kill the organism or destroy the group, or it may result in failure or deterioration. But Crisis is not to be regarded as habitually violent. It is simply a disturbance of habit and may be no more than an incident, a stimulation, a suggestion.

CRISIS DEFINITIONS Erikson(1965): Viewed personality development as a succession of differentiated phases, each qualitatively different from its predecessor. Between one phase and the next are periods characterised by cognitive and affective upset. Gerald Caplan: Refers to Crisis as ‘an upset in the steady state’ A crisis is provoked when an individual, faced with an obstacle to important life goals, finds that it is for the time being insurmountable through the utilisation of customary methods of problem solving

ACCIDENTAL CRISES Traumatic events which might or might not happen at a given time. -These could either be major catastrophes such as earthquakes, floods, etc. , which could affect a whole section of society. -Or individual crises like a child losing its mother at an early age, even the loss of a job or a broken relationship, or any other sudden tragic event.

DEVELOPMENTAL CRISES Erikson calls these: ‘developmental crises’ as distinct from ‘accidental crises’ associated with various life hazards: Events such as birth, which is a crisis both for the mother and the infant, the onset of puberty and adolescence, marriage, the menopause, and so on as we progress through the biological stages of life. These differ from “accidental crisis” in that they necessarily occur at a given point in development and everyone has to pass through them.

SOCIO-CULTURAL CRISES These are situations like facing the first day at school, the Leaving Certificate, or marriage. Such situations are not part of our biological development, yet, we have structured our society so that, unless these hurdles are overcome, our future is severely curtailed. Thus we have institutionalised certain forms of crisis that, unless successfully dealt with, can have very deleterious effects. .

CRISIS The crisis is not the event itself, but rather the individual’s perception of and response to the situation (Parad, 1971)

A TURNING POINT A major crisis can often represent a turning point in a person’s life. It is a hurdle, that has to be surmounted if the person is to continue on satisfactorily through life. If a crisis can be handled successfully then the person will be more mature as a result. But if it cannot be overcome then some maladaptive pathway is likely to develop and this often signals the onset of what later becomes a formal mental illness. §.

TWO MAIN FORMS OF CRISIS WHICH REQUIRE A DIFFERENT RESPONSE - The type of crisis involved in facing an examination, tackling a new job, or the struggle in late adolescence to leave one’s family of origin and become independent. - This kind of crisis demands action, , having the courage to face the situation and overcome it. - The other form is one which involves hurt or loss, such as the death of someone close to us, or to suffer rape or sexual abuse. - In these situations the response required, is to ‘feel’ the pain and work through emotion which is appropriate to the situation and in this way resolve it

CRISIS Acute responses: helplessness, confusion, anxiety, shock, anger (Golan, 1978)

AWARENESS OF THE SIGNIFICANCE OF LIFE CRISES Until I went to the States in 1960 and was exposed to these ideas, there was no awareness in Ireland or Britain of the significance of life crises. People were simply diagnosed as suffering from endogenous depression or schizophrenia Etc. , with no sense of how these related to the crises that they had encountered, or how these had developed over time.

SIGNIFICANCE OF LIFE CRISES (CONT. ) Now some 40 years later ‘crisis intervention’ is generally accepted. But its relation to development of mental illness later is still not well understood. - Now, in major catastrophes like an air disaster or a terrorist bomb, there is often an exaggerated response. Droves of crisis counsellors descend on the scene when most people are in a state of shock and not in any sense ready to deal with the emotional effects of the trauma. -

INTERVENTION WHEN THE TIME IS RIGHT Later, when the time is right, and they feel safe enough to be able to emotionally react, crisis intervention can begin and they can be helped to integrate the pain and anguish surrounding what happened. Even so psychiatric diagnosis is still treated as something unrelated to environmental adaptation, or to the developmental history of the person, and past crises and traumas are ignored. It is as if these so-called illnesses existed outside of time, as some kind of rarefied independent entities

PHASES OF A CRISIS Phase 1: Initial rise in tension from the impact of the stimulus calls forth habitual problem solving responses. Phase 2: Lack of success and continuation of stimulus is associated with increasing upset and ineffectuality. Phase 3: Further rise in tension acts as a powerful internal stimulus and calls out emergency problem solving mechanisms - novel methods to attack the problem, trial and error, and attempts to define the problem in a new way.

PHASES OF A CRISIS (CONT. ) Phase 4: As tension mounts beyond a further threshold, its burden increases to breaking point. To avoid major disorganisation the person employs restitutive methods to reduce anxiety and opens up maladaptive pathways. These can lead eventually to the development of various psychiatric syndromes.

CRISIS THEORY E B Y IV O R B R O W N

CRISIS INTERVENTION Beginning Phase Action Phase Termination Phase (Payne, 1991; Roberts, 2000)

BEGINNING PHASE 1. Build relationship and joining 2. Define and assess the crisis situation 3. Develop goals and an action plan to meet these goals

BEGINNING PHASE Focus specifically on the crisis situation, but expand beyond the factual information to include patient’s current emotions Explore the meaning and importance of the crisis situation from the patient’s perspective, and identify the emotional and affective responses Partialize the crisis—break it down into manageable smaller issues which can be addressed individually (Ragg, 2001)

ACTION PHASE 1. Collect any additional information to guide actions 2. Address potential barriers to implementation 3. Draw on all strengths which can help the patient implement the plan 4. Implement the plan

TERMINATION PHASE HC provider and client review the actions taken and evaluate their success (but allow return to the action phase if crisis is not fully resolved) Anticipatory guidance: helping the patient think about potential future crises, how they might be addressed and where future support may be found (Hepworth et al. , 2002) Process patient’s feeling around ending therapeutic relationship

CRISIS INTERVENTION 1. Family, friends or neighbours may encourage adaptive responses, but in other instances may reinforce maladaptive responses; e. g. in the denial of grief. 2. A person may turn for help to front-line professionals in the community, i. e. clergy, general practitioners, police, public health nurses, solicitors, etc.

INTERVENTION (CONT. ) 3. During a crisis, an individual experiences a heightened desire for help, and the signs of distress evoke a helping response from those around, which seems like a primitive biosocial reaction. 4. During a crisis a person is more susceptible to influence by others. When the forces are teetering in the balance, a relatively minor intervention may weigh them down to one side or the other.

CRISIS INTERVENTION (CONT. ) 5. Direct Psychiatric intervention, but this is rare. Psychiatrists could be more effective by working through other professionals. This could be an effective use of their time, enabling them to reach people closer to the original crisis, rather than when illnesses have become fully defined and are relatively chronic. Unfortunately in the present system this seldom happens.

OUTCOME OF A LIFE CRISIS Will depend on: 1) Whethere were similar events previously in a person’s life history, which remained unresolved. e. g. where one is faced with the death of a loved one, was there an earlier death which was never healed. This is why to work through a life crisis is of such key importance because, not only will the current situation be resolved, but any past traumatic events of a similar nature will also be dealt with.

CRISIS OUTCOME (CONT. ) 2) The culture and family background will also effect the outcome of a life crisis. If a person comes from a background which tends to deny expression of emotion, this will affect their capacity to feel the pain necessary to resolve the situation. 3) Family advice can be helpful or destructive depending on whether it helps a person to fully experience what has happened, or enables them to deny the emotional implications of the crisis.

CRISIS - GROWTH OR FAILURE Not a negative phenomenon, it can be just as much an opportunity for personality growth and development. The outcome of a crisis therefore depends on how it is handled and whether the person manages to deal with it effectively. Indeed, if we did not have to face the stress of life crises, we would not develop at all.

RESOURCES Article & Text Resources Brown, Ivor

ACTIVITY ROLE PLAY Develop an individual clinical case study of a client with a potential crisis situation (for example a bad diagnosis with challenges related to decision making) Identify additional stressors (i. e. time frame, social support, finances, physical problems etc) Identify the crisis response Identify issues raised with this situation Role play the case study and interventions planned by the group using the crisis intervention phases