In today’s uncertain world, we need to be prepared for any eventuality. The following statement may seem obvious:
When any crisis occurs today, we hear that “grief counsellors are on site.” I find myself hoping that they are also trained in “crisis management,” because there is a huge difference in the two techniques. As funeral directors, police, paramedics, firefighters and others involved in critical incidents soon discover, people exposed to traumatic events often react in a much more primitive and basic than simple grief.
Here is a vitally important distinction. A crisis is not an event; a crisis is a reaction to any event. Disasters like earthquakes, volcanoes, tsunami’s and other natural or man made calamities involve many losses, but these are not necessarily crises in themselves.
It is the individual or community reaction to what is lost through these situations that constitute a crisis. In other words, it is not the event itself that determines whether or not this is a crisis, it is the person’s perception that defines an event to be a critical incident. This explains why in the same situation some people appear to cope well and handle things, while others fall apart.
In short, any situation can cause a traumatic reaction which may or may not result in a crisis, depending on how well the individual’s coping mechanisms are able to handle the stress caused by that event. The crisis occurs when a person’s coping mechanisms are overwhelmed.
Eight basic practical steps are needed to help a person or group in crisis, although flexibility in adaptation is required applying them to specific situations. In this article and the next we will look at all eight.
The first necessity in crisis management is immediate intervention. Crises are perceived as danger and a threat to someone in the experience. This is a time of turmoil and a high level of distress, and their primary focus is on RELIEF. Therefore this is not a time for delay or for making appointments three days, weeks or months hence. The person needs to be seen and the situation dealt with NOW. In a true crisis situation, help is needed immediately.
a) Create or Restore a State of Equilibrium.
People simply cannot tolerate the stress of a crisis for very long and will try to get help wherever they can. In a crisis, the tension and sense of urgency can lead to misperceptions and lowered efficiency. They are desperate for “quick relief.” Your speedy assistance can make the crisis less severe, by reassuring the person that they will be OK, that you will be there to help, thus reducing their sense of desperation.
Even if you cannot see or meet them right away, a phone call can reassure them that help will be available for them soon. However, keep that phone call brief, and use it mainly to set up when you will get together. Don’t discuss too much of what has happened over the phone because the person may later hesitate to tell you again later. It is “face to face” that you can best assess reactions by not only hearing words but by observing body language and other indicators of the person’s state of mind and reactions.
A crisis involves a loss of stability, and you must seek to restore that equilibrium as soon as possible.
b) Use Sustainment Techniques.
Sustainment techniques are used to lower anxiety, tension and guilt and to provide emotional support. The question is, “How can you calm things down?” When everyone is panicked, try to be quiet and reassuring. Slow down your responses and your speech. Lower your voice, both in volume and in pitch and speak in a very slow and methodical way. This approach alone can give the assurance of strength and control which will help the person feel less anxious. Practice this and you will be surprised how calming an effect it can have.
c) Begin by talking about the LIFE rather than the DEATH.
Often, when a person is in crisis after a death, it is better begin by asking them to talk about the person’s life, because the death is just too traumatic to even think about. When we can put the death in the context of the life, it is often easier for the person to “go there.”
People in crisis tend to flounder because they feel unstable. Something needs to HAPPEN right away. But what? We need to move them towards meaningful and goal directed behaviour. They need to know that something is being done BY them and FOR them. The person needs to understand the crisis and recognize the feelings that are being experienced.
a) Probe into the past.
It is important to determine how the person was functioning before the crisis, and how that functioning has changed as a result of the crisis. We should not assume that any dysfunction is necessarily due to the crisis so we have to assess what was their emotional state, their behavioural patterns, thought processes, relationships with other people and any physical problems. Then you seek to determine what happened, who is involved, when it happened, and how life is different etc. The “who, what, when, where and how” questions will help you paint a picture.
b) Determine Immediate Needs.
As you gather this information, you are seeking to discover which issues in the person’s life need to be attended to immediately, and which issues can be dealt with later.
c) Seek Clarification.
If you are confused by what is said, ask for clarification. Even asking the person to explain what they mean by a vague statement can give you more information and clues.
d) Explore their Strengths and Weaknesses.
What resources can we draw upon to help the person through this time? Does the person have abilities or strengths in their life style that you can draw on? For example someone who is involved in a physical exercise programme or a sport may draw upon that for self confidence or comfort. Is family going to be strength or a weakness?
While action is essential, the counsellor’s dilemma is always whether to take a facilitative role or a directive role. There are several issues. First, we should recognize that crisis management is different from many other types of intervention. In a crisis the person’s coping mechanisms are not able to handle the situation. Even simple tasks like decision making may seem too overwhelming. Therefore, the helper may need to be more directive than they might in different circumstances.
On the other hand, we need to be careful. Given that the goal of overcoming trauma is “empowerment of the survivor”, we should be anxious to enable them to do whatever they can for themselves, albeit with help and support. You and they make a plan of action, but then allow the person to carry out the plan, albeit with some assistance. This will greatly enhance their self esteem, and enable them to operate from a position of strength rather than weakness.
The principle is “never do anything for someone that they can do for themselves”. However if the person is so emotionally overwhelmed that they have no ability to function or take care of themselves, or if they are on drugs or under the influence of alcohol, or if they have been injured, or are a danger to themselves or to others, then you may need to take a more directive role. This involves the two of you making a plan but the action involves both of you.
e) Consider New Alternatives.
Encourage the person to consider new approaches and actions, or an alternate way of looking at the situation. When people feel like they or the situation is out of control, it can be terrifying. Here is often an opportunity to let the person know that their reactions are natural and understandable, which often comes as a relief. Statements like “have you considered this possibility … “ or “What would happen if you would … “ or “What if you were to …” can enable them to consider possibilities.
The short term goal of crisis counselling is simply to avert a catastrophe and to restore the person to a state of balance. Some of the more severe outcomes of crises are suicide, homicide, running away, physical harm, psychosis, family breakup, or engaging in dangerous or life-threatening behaviours, like taking unnecessary chances in a vehicle.
Our task is to help the person achieve some type of limited goal. Just the simple task of completing some action will encourage them to believe that they will make it through this crisis, and this alone will bring a sense of relief.