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Course Sample:
It is within the human condition to experience crisis. We live in high stress times; at any given moment many of us will be in a state of crisis over one thing or another. As nurses, a large part of our professional practice is comprised of clients (individuals and family members) who are struggling, many who would self-define as being in a crisis state. There are diverse approaches, methods and techniques to helping clients in crisis. This course will explore various conceptualizations of crisis and will help the practitioner with specific suggestions and intervention approaches to be applied in a variety of crisis situations.
What is a Crisis?
There are many definitions of crisis. Several are presented here, each with a slightly different emphasis. Caplan (1961), referred to as the father of modern crisis intervention, states that people are in a state of crisis when they face an obstacle to important life goals, an obstacle that is, for a time, insurmountable by the use of customary methods of problem solving. A period of disorganization ensues, a period of upset, during which many abortive attempts at solution are made (p. 18). Rapoport (1965), another seminal writer in crisis work, defines crisis as an upset in a steady state caused by a hazardous event; the event can be conceived as a threat, a loss, or a challenge. There is the potential to grow from a crisis or have a more protracted, severe, reaction to the situation. Reber (1985) adds another dimension by noting that crisis can be either a sudden improvement in things or a sudden deterioration in the normal course of events. Ell (1996) defines crisis as an acute emotional upset in an individual's steady state, accompanied by a perceived breakdown in his or her usual coping abilities. The acute upset is manifested by physical, psychological, cognitive, and relational distress and symptoms. A crisis is preceded by an identifiable stressful life event (p. 169-170). Kanels (1999) definition adds that crises are a part of life and should not be considered abnormal, that crises occur in the lives of normal, average individuals who are just having difficulty coping with stress. Sheafor, Horejsi and Horejsi (2000) add that when an individual is in crisis, he or she perceives a particular situation to be intolerable and overwhelming and one with which he or she is unable to cope. Consequently, the individual reacts with great anxiety, panic, despair, and disorganization (p. 484).
In sum, several important features emerge from these definitions: 1) there is nothing abnormal about experiencing an event as a crisis; 2) there is no implication that a crisis occurs because of some weakness in the person; 3) there is a possibility that the outcome of any crisis will be either positive or negative, that the individual involved may emerge at a higher or lower level of functioning; 4) that a period of disorganization is to be expected during which the individual is vulnerable to emotional upset, anguish and fear.
To further refine the definition of crisis, it is necessary to understand that a crisis is preceded by an identifiable stressful life event that causes the individual, family, organization or society to experience the perception of loss or threat of loss. The unit (individual, family, organization, society) has not developed the coping skills necessary to manage the event and is crippled by the experience of it. This crisis state is time limited, usually taking between four and eight weeks for the unit to develop new and necessary coping skills to manage the event, to be able to deal with things that happen to them (Roberts, 1995). This is not to suggest that the emotions and upset caused by the event have disappeared but that the unit has developed new skills to give the event some perspective, meaning, and some degree of control.
For example, an individual receives a diagnosis of a serious illness. Initially, most people would experience a sense of being out of control, in a panic, anguished, etc. and find themselves in a crisis state. For many, within a short amount of time, they have accessed information about their illness, spoken to others who have the same condition, sought medical advice and other opinions. In this case, the illness has not gone away, nor the emotional impact of a serious illness been resolved, but the coping skills to help manage the condition - recent information, medical advice, social supports - have been put in place.
It is also important to understand that certain life events can be experienced as a crisis. These events even though they can be anticipated (i.e., marriage, parenthood, a job change, moving, retirement) are not always smoothly articulated and can create a crisis state for the individual. Erikson (1963) spoke of these as developmental crises and noted that they are part of the role changes imposed by society. These crises usually occur at developmental transition points and can be a time of vulnerability and stress.
Working with Those in Crisis, Principles of Crisis Intervention
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