CRISIS

1. CRISIS (c) 2012 Cengage Learning

2. MTLH 9208 CRISIS RESPONSE AND INTERVENTION LESSON 2 What is a crisis?

3. Objectives Lecture:What is a crisis? • Chapter 1- pre-chapter quiz • Review key terms • Introduction to Information Niagara website

4. QUIZ: What is Crisis Page 1 To improve your own learning, answer the quiz questions. In your notebook review and reflect on your responses and the correct answers after we have reviewed the material.

5. What is a Crisis? “CRISIS is a state that exists when a person is thrown completely off balanceemotionally by an unexpected and potentially harmful event or difficult developmental transition.” Okun, B. F. and Kantrowitz R.E.(2008) Effective Helping: Interviewing and Counseling Techniques 7th Edition Belmont CA Brooks/Cole (Chapter 9)

6. Discussion questions Case book p.1. • When was the last time that a friend called on you to help work through a crisis event in his/her life? What was the experience like for you? What did you do to assist with the resolution of the crisis? • Close your eyes for a moment. Think back to a particular crisis you had in your own life. Who was the most helpful to you in dealing with it? What did they do that was helpful? • What are some of the typical crises that a person faces in the 21st century? What do larger organizations face (schools, communities)?

7. Formula for Understandingthe Process of Crisis Formation 1. Precipitating event occurs 2. Perception of event leads to subjective distress 3. Subjective distress leads to impairment in functioning – coping skills fail

8. CRISIS: core components • A precipitating event occurs. The experience of stressful events is not in itself a crisis. (not always evident to client). First phase may not develop into full-blown crisis. • Perception of the event leads to subjective distress. It can take the form of many overwhelming or confusing feelings for the person. If this distress does not impair coping or functioning, one is not in crisis and can manage the stress. • If client cannot function emotionally, occupationally, and interpersonally, he/she is in crisis.Client’s usual coping methods fail. 8

9. The closest Chinese word to signify stress is written as two characters and can be translated as ….. DANGER OPPORTUNITY

10. Crisis as Danger and OpportunityFigure 1.4 p. 5. Opportunity: With help / counseling / intervention, the individual survives the crisis with increased coping skills, Emotional growth, and resources which prepare him for future stressors. Danger: Without help, the individual may return to a lowered level of functioning by use of the ego defense mechanisms or remain nonfunctional via suicide, homicide, or psychosis.

11. The Crisis Prone Person (Figure 1.5 – p. 6) Experiences a stressor perceived as threatening which leads to subjective distress and impairment in functioning. Coping methods fail. State of disequilibrium ensues for 4-6 weeks. Delayed or no intervention example (Box 1.1 – p.5) Individual uses ego strength to deny, repress, dissociate from the meaning of the precipitating event and subjective distress, and functions at a lower level. Individual is unprepared emotionally to cope with future stressors and easily enters into crisis states when faced with potential precipitating events.

12. Researchers’ comments on crisis • “… a danger is that the individual or family may be dramatically influenced by its negative effects on mental health”(Aguilera, 1994) • “….an opportunity because at times of crisis, individuals are more susceptible, more open to therapeutic intervention” (Wooley, 1990) • “Without crisis, development is not possible.” i.e. “…growth is preceded by a state of imbalance or crisis that serves as the basis for future development..” (Caplan 1961, p.19)

13. The experience of crisis • It is your emotional reactions to a situation, NOT the situation itself. • Disequilibrium • Disorientation • Disruption • Past coping skills no longer work

14. Our response to crisis Depends on…. • past learning and experiences • how we met previous crises • lifestyle • social support • one’s life philosophy • duration and intensity of crisis

15. Other Determining Factors Material Resources: money, shelter, transportation, food, clothing Personal Resources: ego strength, personality traits, physical well-being, intelligence and education Social Resources: friends, family, schoolmates, co-workers, church, clubs

16. Caplan’s Crisis Theory Gerald Caplan – a psychiatrist and master architect of crisis intervention. (colleague of Lindeman, 1961). Harvard research: in 50’s related crisis to mental health wellbeing. Caplan was first to apply the term crisis, in psychiatry, to relate the concept of homeostasis to crisis intervention, and to describe four stages of a crisis. He equated mental health with a mature ego, which he defined as: (1) the capacity to withstand stress and maintain equilibrium (2) an accurate perception of reality (3) a balanced repertoire of coping strategies based on sound reality testing.

17. COGNITIVE KEY (p.9) • The meaning a person gives to the precipitating event whether it be situational or developmental determines how severe the emotional distress will be. • Not all people will enter a crisis state, even with the exact same precipitating event, because of different cognitions.

18. Types of Crises Developmental normal, expected, transitional phases as people move from one stage of life to another people are often unable to cope with new roles and needs of family members (Ch. 7) Situational uncommon, extraordinary events; potential impact on community sudden onset unexpected; no way to control them have an emergency quality

19. LIST TYPES OF CRISIS • List different types of crises from chapters in text and relate to group project question. For example: • Situational or developmental crisis • Crises related to loss, suicide, homicide, psychosis, substance abuse, serious illness, disability and others

20. Stress Response Stress: is a specific response of the body to a stimulus, as fear or pain, that disturbs or interferes with the normal physiological equilibrium of an organism

21. Do we need stress?

22. STRESS It is NORMAL in daily life. Stress has all the characteristics of a crisis exceptthe person’s functioning is not impaired and/or they cope with the emotions on their own.

23. Crisis creates subjective distress • Increase in anxiety due to the experience of shock, disbelief, distress and panic. • Period of disorganization: feelings of guilt, anger, helplessness, hopelessness, dissociation, confusion, fatigue – unable to function as before • Anxiety can have the power to generate energy and increase coping ability

24. Curvilinear Model of Anxiety: a motivator for change(Janosik, 1986, p.30 - Fig.1.6) Too much anxiety is overwhelming and paralyzing Too little anxiety leaves very little motivation to change or accept interventions. Moderate anxiety is optimal in motivating people to change and allowing them to utilize personal resources. Sometimes an individual needs medication to reduce anxiety to the point where a person can respond to intervention. Other times anxiety is encouraged to increase motivation.

25. Failure of coping methods • Crisis (bewilderment, confusion, conflict) leads to vulnerability • Lack skills to help their situation • Subjective distress overwhelms them, prevents them from coping and functioning • Crisis worker finds coping areas not being demonstrated • See Table 1.1 (p.12) for effective coping behaviours NEXT SLIDE…………………

26. CAPLAN’S7 Characteristics of Effective Coping Behaviour 1. Actively exploring reality issues and searching for information. 2. Freely expressing both positive and negative feeling and tolerating frustration. 3. Actively invoking help from others. Breaking problems down into manageable bits and working through them one at a time. Being aware of fatigue and pacing coping efforts while maintaining control in as many areas of functioning as possible. Mastering feelings where possible, being flexible and willing to change. Trusting in oneself and others and having a basic optimism about the outcome.

27. Formula to Increase Functioning Alter/change perception of the precipitating event and offer coping strategies Subjective distress will be lowered Functioning level returns to previous level or higher. After this, appropriate referrals can be made for further interventions.

28. Health Education Fact Sheethttp://rnao.ca/sites/rnao-ca/files/Understanding_Crisis.pdf

29. Homework • Read Chapter 2: The history of crisis intervention • Study key terms • Complete pre-chapter quiz • Find “crisis services” within the "Information Niagara" website • Find RNAO - Best Practice Guidelines for Crisis

30. Examples of Niagara Crisis Resources • 911 – Police, Fire and Ambulance • 211 – Information Niagara – all resources for social services • Canadian Mental Health Association - Community Crisis Care Centers (at hospitals) • Niagara Distress Center – Telephone Warm Line • Niagara Victim Crisis Support Services – Trained Volunteers who respond to crises. • C.O.A.S.T. – Crisis Outreach And Support Team • The Salvation Army • F.A.C.S. – Family And Children’s Services • Pathstone Mental Health – Child and Youth Services