Crisis Case Study: What are the Crisis models?

Discover the resilience that lies within you as we dissect the journey through life's most challenging moments. Crisis is a multifaceted beast, but in our latest episode, we guide you through its complexities, unveiling the stages from the initial calm to the inevitable aftermath. We bring to light the ABCX model, a framework that helps us understand how families weather the storms of stress and crisis. With the story of John and Mary as our backdrop, we explore how their unique perceptions and the resources at their disposal dictate whether a life event spirals into a crisis or becomes a manageable bump in the road. We'll also share insights into the objectives and processes of crisis intervention, emphasizing the crucial step of immediate, practical support to help individuals bounce back to their pre-crisis selves, all while walking through Robert's Seven-Stage Crisis Intervention Model to ensure a resilient and stable recovery.

Then, we'll arm you with the tools to craft your own crisis intervention action plan. As we delve into the collaborative efforts between therapist and client, you'll see how exploring alternatives, evaluating supports, and the power of reframing can shift perspectives towards a more positive horizon. The planning phase takes on a new light as we discuss the client's role in steering their own course to stability, with the therapist's guidance ensuring independence and control. It's about securing a commitment to the plan, feeling empowered, and taking actionable steps. So get ready to be enlightened with strategies that will equip you to face life’s sudden twists with newfound confidence, ensuring you come out of any crisis on solid ground.

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Transcript

Eric Twachtman: 0:05

What is a crisis? Experiences in life are subjective for each individual. Therefore, what one person may experience as a crisis, another may not. The level of a person's resilience, skill or experience will determine his or her subjective experience. A crisis is, by definition, stressful and or disruptive. If an event does not overwhelm the individual's coping skills, the person is less likely to perceive the event as a crisis. The less an event is disruptive to the person's environment or functioning, the less likely it is to be perceived as a crisis or functioning, the less likely it is to be perceived as a crisis.

Eric Twachtman: 0:50

During a crisis, individuals have a sharp reduction in their overall ability to cope. Problem-solving skills are limited and they are vulnerable to further psychological stressors. The ability to defend themselves is decreased. Individuals who typically function at a high level find themselves unable to cope with seemingly minor tasks. They may become confused, depressed, anxious, angry, have trouble remembering things and or show physical symptoms such as stomach upset, headache or difficulty breathing. A crisis could be triggered by a natural disaster such as a hurricane, a natural life event such as a birth of a baby, marriage or retirement, a deliberate act of violence like a sexual assault, an adolescent pregnancy, the sudden absence of a family member through divorce or military deployment, illness or injury, environmental change, threats, not only of a violent nature, but threats involving the individual's loss of a sense of integrity or autonomy, job, spouse, home, reputation or status, any other great loss or even something the individual perceives as a challenge or failure.

Eric Twachtman: 2:19

Stages of a crisis One pre-crisis state this includes all event leading up to the crisis. 2. Impact the distressing situation or event occurs. 3. Crisis Acute emotional reaction to the situation with two elements A period of confusion and disorganization, and a period when the individual tries many alternatives, some of which work and some of which do not. 4. Resolution the end of the event, where the individual works toward adjustment to the circumstances remaining in the aftermath of the event. 5. Post crisis the individual lives with whatever alterations in circumstances that occurred during the crisis.

Eric Twachtman: 3:18

The ABCX model of family stress and coping. Ruben Hill's ABCX model is used to analyze stress and a family's coping methods in dealing with stress. The formula focuses on pre-crisis factors that determine the likelihood of a crisis happening. A is the stressor or event. Hill defined a stressor as a situation that a family is ill-prepared for and, as such, should be viewed as problematic. B is the resources available to the family. The resources that are available to the family largely determine whether or not the stressor will turn into a crisis. C is the family's perception of the stressor. The way in which a family defines or perceives the stressor and related hardships will also impact the likelihood of the stressor morphing into a crisis. X is the crisis. The likelihood that a crisis will develop is dependent on the resources the family has at their disposal to deal with the stressor, as well as the family's perception of the stressor. Is it a crisis-provoking situation or just a challenge to figure out how to deal with it? To sum up in a formula B and C determine whether A results in X. Let's look at an example.

Eric Twachtman: 4:58

John and Mary have a young daughter, harper. Mary is a stay-at-home mom and John recently lost his job, creating a financial hardship for the family. John has a lead on a new job that pays well, but it's out of state. The couple is anxious about moving away from friends, but they feel confident in their ability to deal with what's ahead and are looking at the job loss as an opportunity to try something new. Mary's parents have offered to help the couple secure a new house and even set up their camper nearby so they can be a source of support while John and Mary settle in. We can identify A the stressors these include the job loss and possible move. B the resources this includes Mary's parents. C the couple's perception of the stressor they see John's job loss as an opportunity to try something new. And. X the crisis. We can see that, based on B and C, the likelihood of a crisis X developing is very low.

Eric Twachtman: 6:16

Crisis intervention. The goals of crisis intervention are to 1. Stabilize the situation and protect the individual from additional stressors. 2. Mobilize whatever resources are required to assist the individual, ie assist the person in managing and recovering from the unusual circumstances. 3. Restore the person to adaptive or pre-crisis level of functioning. The crisis intervention process should be brief, immediate, practical and, if possible, take place close to familiar settings. It is especially helpful if the therapist suggests that there will be a positive outcome. This helps to instill a sense of hope for the future and keep in mind that any long-term issues should be referred Robert's Seven-Stage Crisis Intervention Model 1.

Eric Twachtman: 7:14

Psychosocial and Lethality Assessment. The therapist completes a biopsychosocial assessment of the client in crisis, including information about the client's support system, stressors, medical issues, drug or alcohol use and coping skills. It's also imperative to assess suicidality. 2. Establish rapport the therapist works to quickly establish a trusting relationship with the client. 3. Identify the major problems or crisis precipitants. The therapist focuses on gathering information to understand the client's current problems. The therapist identifies what events led up to the crisis.

Eric Twachtman: 8:04

4. Deal with feelings and emotions. The therapist lets the client express his or her feelings. The therapist uses active listening skills, such as paraphrasing and reflecting feelings active listening skills such as paraphrasing and reflecting feelings. Eventually, the therapist starts to work in challenging responses into the conversation, such as reframing and interpreting.

Eric Twachtman: 8:28

5. Generate and explore alternatives. At this time, the client should be back to an emotionally balanced state. The therapist has the opportunity to explore how the client has coped with similar situations in the past. The therapist may consider using solution-focused techniques. 6. Implement an action plan. An action plan is put together involving several elements Removing the client's means to commit suicide, for example, involving parents or significant others in creating a safe environment. Creating a safety contract. Instilling future connection with the client by scheduling phone calls and follow-up clinical sessions. Increasing social support for the client by mobilizing friends or family. And hospitalization if the client is not able to contract for his or her safety.

Eric Twachtman: 9:29

7. Follow-up At this time, a post-crisis evaluation is in order to make sure that the crisis is being resolved. The therapist observes the client's condition, finds out if the client now has an understanding of the crisis itself, assesses the client's level of functioning, assesses for current stressors, if any, and how the client is dealing with them, and makes referrals if necessary. The ABC model of crisis intervention the ABC model is intended to provide immediate relief for clients in crisis is intended to provide immediate relief for clients in crisis. Stage A is all about establishing a therapist-client relationship. During this stage, the therapist develops rapport with the client by utilizing basic attending skills, good eye contact, validating the client's feelings, etc. Stage B is where the therapist tries to understand the problem. During this stage, the therapist identifies the problem and reason why the client is seeking assistance. A variety of targeted, open and closed questions may be used in order to get a clear picture of the client's issues. Stage C involves taking action. Once the problem has been defined, it's time to move on to the final stage, where the therapist works with the client to learn to cope with the crisis. The ultimate goal is to return the client to a pre-crisis level of functioning.

Eric Twachtman: 11:16

Gilliland's Six-Step Model of Crisis Intervention. The first three steps involve listening. 1. Define the problem. The therapist uses active listening skills, empathy, genuineness and positive regard to understand the client's view of the problem. 2. Ensure the client's safety the therapist assesses for danger to self and danger to others. 3. Provide support the therapist demonstrates care toward the client, providing emotional and informational support. The therapist demonstrates care toward the client, providing emotional and informational support.

Eric Twachtman: 11:58

The next three steps involve action. Number four explore alternatives. The therapist and client assess situational supports. People who care about what happens to the client Assess situational supports. People who care about what happens to the client Identify coping skills, behaviors and or environmental resources that can help the client navigate through the crisis and explore the client's thought patterns to see if the client's view of the problem can be reframed. 5. Make plans. The client works with the therapist to create a plan to regain stability. The plan lists sources of support, positive coping strategies and steps the client can take in the short term to return to a level of stability. The key here is that the client is the captain of his or her ship. The therapist promotes the client's sense of independence and sense of control during this process. 6. Get the client's commitment. The therapist asks the client to summarize the plan and feel empowered to commit to the plan.