Once we have a clear crisis focus
and a satisfactory definition of the crisis, our assessment turns to the
individual and his situation. Remember,
we are not seeking full understanding in the psychiatric sense. In crisis intervention, we concentrate on
looking for immediate and potentially long-range cumulative effects. The notion here is that crises tend to spread
out or diffuse. It is rather like the
well-known snowball effect. As a generalization,
crisis tends to be contagious. In any
crisis, anticipated diffusion is included as a special part of the crisis
definition. Consider this very
exaggerated example. Suppose Dicks
crisis involves a severe marital disruption.
The precipitating event was a serious argument in which he learned of
his wifes marital infidelity. We find
him very hurt, frustrated, angry, and feeling that the only solution is for him
to pack his bags and leave. Lets think
about what the snowball effect (the potential cumulative effects) of his
leaving might be. If Dick leaves his
wife, his boss might fire him. If he loses
his job, his wife may not have enough income to care for the children. As a result of her frustration and
discouragement, she may neglect them. If
she finds herself unable to care for the children, she may leave them with her
mother, whom Dick and the children detest.
If the children are forced to stay with their grandmother, the oldest
one (age sixteen) may run away. If she
runs away, she may get hurt or in trouble with the police. If the police get involved, Dicks friends
and business associates may find out about it.
If they find out about it, his social position and interpersonal
relationships may be jeopardized. If
that happens, he may become even more angry, hurt, frustrated, and at a loss as
to what to do.
This example is, of course, quite
exaggerated. Nevertheless, we need to
see that people in crisis tend to act in impulsive and sometimes
self-destructive ways. One of the main
reasons for this is that they tend to be functioning less as rational,
reasoning people and more as feeling, emotional, impulsive individuals. Most crisis situations result because feeling
and emotion have supplanted reasoning and planning. Thus, it is difficult for people in crisis to
think ahead, anticipate the consequences of their behavior and actions, or develop
plans leading to a satisfactory solution for their problems. This is, in large measure, what we mean when
we judge a crisis to have a low self-resolution factor. As we intervene into crises, then, along with
asking, What happened? we want to ask the individual, What ideas do you have
for dealing with the problem? and What do you think will happen if you follow
through with those ideas? In that way,
we can help him consider possible implications of his ideas and impulses and
begin to help him think about alternative solutions and alternative ways of
dealing with the crisis.
Considering such possible
cumulative effects, focusing on the nature and implications of crisis behavior,
and influencing alternative behavior and planning, gives us further insight
into the nature of crisis intervention.
We are beginning to deal with the most common question asked by
newcomers to crisis intervention methodology; namely, What do I say? We also can see that in crisis intervention
we are developing a relationship in which our primary role is to understand
what is happening, to ask questions, and to serve as a sounding board for the
feelings and ideas of the person in crisis.
As we think about potential
cumulative effects, we are really thinking beyond the now potential, which is,
of course, the worst possible outcome of the crisis. In addition to the worst possible outcome, a
crisis may have other outcomes and implications. People in crisis are generally not in an
emotional position to be able to think through these possible outcomes and
implications. They have difficulty fully
understanding and thinking about the cumulative effects of their
situation. Nevertheless, they feel compelled
or impelled to do something about the problem.
The tendency is to do something very drastic. In some crisis situations, the individual may
consider the possibility of killing himself.
In one situation already discussed, a teenager (Ann) had decided to go
to a friends house and get turned on with drugs. In another situation, a mother (Mrs. F) had
decided to take her son to juvenile court.
It is important to see that people in crisis are extremely uncomfortable
and feel a strong need to reduce this discomfort, or pain. In psychological terms, most people tend to
have a low tolerance for situational ambiguity or confusion. They have a need to reduce the ambiguity or
confusion, on the one hand, or if it is not possible to reduce it, they have a
strong need to avoid it, on the other hand.
Emotionally, they are pressed either toward doing something about the
problem or, in some way, running away from it.
This fact of human nature is what accounts for the cumulative effects
discussed earlier. The individual is
upset and probably agitated. His efforts
to do something about the problem result in making things worse. Similarly, if he chooses to avoid or run away
from the problem, that too can make things worse, but at least he feels that he
is doing something. Very rarely do
people in crisis consider the possibility of doing nothing.
Do nothing? That seems too easy. In most crisis or tension situations, doing
nothing is, in fact, extremely difficult.
Yet, in crisis intervention, the wisest course may be to encourage the
individual to tolerate the discomfort, the pain, the confusion, and the
ambiguity. The suggestion is therefore,
when in doubt, do nothing. As we talk
with those in crisis about their possible courses of action, we should ask
them, What would happen if you simply did nothing? This question surprises people. It has not occurred to them that one of their
options is to do nothing. They can wait
to see what happens. As you think with
them about possible cumulative effects, about possible undesirable outcomes, it
is important to help them think through the implications of following their
impulses or first inclinations. As you
do this, you and they may come to the conclusion that, in the present crisis,
their best course of action is to wait and see.