ERIC Identifier: ED405535
Publication Date: 1995-00-00
Author: Stevens, Brenda A. - Ellerbrock, Lynette S.
ERIC Clearinghouse on Counseling and Student Services Greensboro NC.
Crisis Intervention: An Opportunity To Change. ERIC Digest.
Crisis intervention is emergency first aid for mental health (Ehly, 1986).
This digest provides a brief, conceptual overview of crisis intervention, and
summarizes the steps a worker may use to identify, assess, and intervene with an
individual experiencing crisis.
The Chinese language contains two characters which, taken together, connote
the concept of crisis. The first character, "wei," indicates a critical or
dangerous situation, while the second one, "ji," means an opportunity for
change. Thus, these characters together indicate that crisis is a point in time
that allows the opportunity to change.
Crisis intervention involves three components: 1) the crisis, the perception
of an unmanageable situation; 2) the individual or group in crisis; and 3) the
helper, or mental health worker who provides aid. Crisis intervention requires
that the person experiencing crisis receive timely and skillful support to help
cope with his/her situation before future physical or emotional deterioration
A crisis may occur when an individual is unable to deal effectively with
stressful changes in the environment. A stressful event alone does not
constitute a crisis; rather, crisis is determined by the individual's view of
the event and response to it. If the individual sees the event as significant
and threatening, has exhausted all his/her usual coping strategies without
effect, and is unaware or unable to pursue other alternatives, then the
precipitating event may push the individual toward psychological disequilibrium,
a state of crisis (Caplan, 1964; Smead, 1988).
Psychological disequilibrium may be characterized by feelings of anxiety,
helplessness, fear, inadequacy, confusion, agitation, and disorganization
(Smead, 1988). At this point, the individual experiencing this disequilibrium
may be most receptive to outside assistance, thus providing an opportunity for
behavioral change and a return to balance. To summarize, a crisis results from a
person's negative perception of a situation.
Psychologists, counselors, social workers, mental health personnel, and
therapists are trained to provide services to individuals in crisis. These
workers can assist an individual or group in crisis by providing direct
intervention, by identifying alternative coping skills, or by consulting with
others. A helper's primary goals in a crisis are to identify, assess, and
intervene; to return the individual to his/her prior level of functioning as
quickly as possible; and to lessen any negative impact on future mental health.
Sometimes during this process, new skills and coping mechanisms are acquired,
resulting in change.
Identification recognizes that a problem
exists and it focuses on 1) the event's significance in the person's
environment, and 2) the person's current functioning. The event or crisis may be
categorized as either developmental or situational (Smead, 1988). Developmental
crises result from predictable change, and are due to normal growth or
development, such as the onset of adolescence. Situational crises are either
predictable, arising from certain events, such as divorce or failing a grade, or
are unpredictable, such as an accidental death or natural disaster. Both types
involve a change in circumstances, usually accompanied by a loss, which can
precipitate a crisis reaction in an individual.
Therapists must promptly identify a person in crisis, as well as assess the
degree to which his/her functioning is impaired. In addition to psychological
disequilibrium, other signs and symptoms may indicate a problem for those
experiencing a crisis. Physical symptoms such as changes in overall health,
energy, or activity level, as well as in eating or sleeping patterns, may point
to a problem. Emotional signs that may indicate a person in crisis include
increased tension or fatigue, and changes in temperament, such as angry
outbursts or depression. Behavioral signs such as the inability to concentrate,
being preoccupied with certain ideas, or social withdrawal may also indicate a
person in crisis (Ehly, 1986; Greenstone & Leviton, 1993).
After identifying a crisis situation and a
person in crisis, workers assess the crisis's impact on the individual. This
assessment usually takes the form of an interview, during which the worker
strives to convey an atmosphere of acceptance, support, and calm confidence
about the future. Communication with the person experiencing a crisis is vital;
this involves establishing eye, and sometimes, physical contact. Questions
addressed to the individual may include his/her perception of the problem, the
frequency and sequence of events, his/her feelings, and a history of attempts to
deal with the problem. Forced choice or open-ended questions may be used to
assess the individual's ability to communicate, as he/she may experience
difficulty in expressing him/herself, in making decisions, or in solving
Assessment may include what the individual is saying as well as his/her
nonverbal communication, i.e., facial expression, posture, body and eye
movements, and mannerisms. An essential part of this assessment is an evaluation
of the person's current safety as well as any risk to his/her own or someone
else's life. Additionally, factors such as alcohol and drug use, current stress
level, and emotional affect, such as hopelessness and helplessness, should be
After identification and assessment of the
crisis and the person involved, the intervention occurs. While specialists
(Hoff, 1989; Greenstone & Leviton, 1993; Sandoval, 1988; Sandoval, 1991;
Zins & Ponti, 1990) in this area may differ on the name and number of steps
involved, they agree that certain points are integral to intervention and are
basic to a best-practice, problem-solving approach. First, while supporting and
empathizing with the individual in crisis, the worker should listen and avoid
using the phrase "I understand" so as to allow the individual full and open
expression of feelings and emotions. Second, the individual in crisis should
answer the worker's questions so as to define and clarify the incident and
acknowledge any social and cultural factors which may relate to the crisis. This
second step places the problem in a framework. As Burak (1987, p. 1) states,
"Understanding of and respect for the differences inherent in each culture are
needed for rapid, effective, and sensitive treatment of emergency situations" (p. 1). Third, the worker develops an awareness of the significance of the
crisis from the individual's point of view. These first three steps may have
been partly completed during the identification and assessment stages of the
crisis; it is important that they be finished before going on to the fourth
Fourth, mutual brainstorming of alternatives and discussion of available
resources are jointly carried out by the individual in crisis and the worker. At
this point, the worker may need to be more directive, by focusing on the current
situation, proposing ideas and strategies for action, as well as suggesting
other resources for support, instead of just listening and reflecting.
(Sandoval, 1988). Fifth, the individual in crisis and the worker choose one or
more specific, time-limited goals which take into account the person's
significant others, social network, culture, and lifestyle. Complete planning,
including recognition of all the steps involved, as well as consideration of any
barriers to success, should be completed before the solution is attempted. Some
brief education, modeling, role playing or rehearsal of potential situations may
be done in this step to empower the individual further. Sixth, the worker and
individual implement their plan and, if possible, evaluate its effectiveness.
They then adjust the plan as necessary. Seventh, the worker provides for
follow-up or refers the individual in crisis to a resource that can provide
ongoing support. The worker then terminates the established crisis relationship.
In summary, crisis intervention provides the
opportunity and mechanisms for change to those who are experiencing
psychological disequilibrium, who are feeling overwhelmed by their current
situation, who have exhausted their skills for coping, and who are experiencing
personal discomfort. Crisis intervention is a process by which a mental-health
worker identifies, assesses, and intervenes with the individual in crisis so as
to restore balance and reduce the effects of the crisis in his/her life. The
individual is then connected with a resource network to reinforce the change.
Thus, as the Chinese characters suggest, crisis truly holds the opportunity for
Burak, P. A. (1987). Crisis management in a
cross-cultural setting Washington, D.C.: National Association for Foreign
Student Affairs. (ERIC Document Reproduction Service No. ED 329 870).
Caplan, G. (1964). Principles of preventive psychiatry. New York: Basic
Ehly, S. (1986). Crisis intervention handbook. Washington, D.C.: National
Association of School Psychologists.
Greenstone, J. L. & Leviton, S. C. (1993). Elements of crisis
intervention: Crises and how to respond to them. Pacific Grove, CA: Brooks/Cole
Hoff, L. A. (1989). People in crisis: Understanding and helping (3rd ed.).
Redwood City, CA: Addison Wesley Publishing Co.
Sandoval, J. (Ed.). (1988). Crisis counseling, intervention, and prevention
in the schools. Hillsdale, NJ: Lawrence Erlbaum Associates.
Smead, V. S. (1988). Best practices in crisis intervention. In A. Thomas
& J. Grimes (Eds.), Best practices in school psychology (pp. 401-414).
Washington, D.C.: National Association of School Psychologists.
Zins, J. E. & Ponti, C. R. (1990). Best practices in school-based
consultation. In A. Thomas, & J. Grimes (Eds.), Best practices in school
psychology II (pp. 673-693). Washington, D.C.: National Association of School