Abstract

This chapter provides a foundation for understanding the nature of a crisis, how a person may be impacted by a crisis, and the models, processes, and strategies a crisis counsellor uses to assess and intervene when people in crisis seek help and support. With an emphasis on how crisis intervention differs from other counselling interventions, a case study is provided with the aim to help the reader reflect on and apply relevant crisis models of assessment and intervention learned in this chapter. Further differentiation is made between crisis stressors resulting in exposure to a traumatic event and ongoing traumatic stress responses requiring long-term counselling, psychiatric services, or specialised mental health intervention. Due to the nature of crisis work, there is a high prevalence of burnout and work-related stress in this field. As such, counsellors working in crisis work need to practice self-care, regular clinical supervision, and the continuing maintenance of the counsellor’s general health and wellbeing.

Introduction

We live in a world where millions of people are confronted with crisis-provoking events each year that they cannot cope with or resolve on their own and, therefore, will often seek help from counsellors. Examples of crisis-inducing events include natural disasters such as bushfires, sexual assaults, terrorist attacks, the death of a loved one, a suicide attempt, domestic violence, relationship breakdown, retirement, promotion, and demotion, change in school status, pregnancy, divorce, physical illness, unemployment, and more recently, a world pandemic. These situations can be a turning point in a person’s life—either one of growth, strength, and opportunity or health decline, dysfunction, and emotional illness (Roberts & Dziegielewski, 1995; Roberts, 2005; Hoff et al., 2009). When people experience a crisis, it is the support they receive during and immediately after the crisis that often plays a crucial part in determining the impact of the crisis on their lives (France, 2014). Therefore, it is imperative crisis counsellors have the understanding, skills, and knowledge to offer a short-term intervention that assists people in crisis to cope, stabilise and receive the support and resources they need.

What is a crisis?

When a person experiences a crisis, they experience severe disruption of their psychological equilibrium and are unable to use their usual ways of coping. This then results in a state of disequilibrium and impaired functioning (Lewis & Roberts, 2001; Roberts, 2005). Because the person is unable to draw on their everyday problem-solving methods during a crisis, and there is a sense of diminished control over the events and limited options, they may experience confusion or bewilderment (Hendricks, 1985; Pollio, 1995).

Crisis states are temporary, lasting from hours through to an estimated six weeks, as the body cannot sustain being ‘off balance’ or in a state of disequilibrium, indefinitely. Resolving a crisis effectively may take some months, and this may involve learning new skills, reappraising the situation differently, or adapting to the new situation. Because people may resolve the crisis in a maladaptive or adaptive manner, some may be impacted by various mental health conditions such as depression, substance abuse, or post-traumatic stress disorder (PTSD) (Roberts, 2005).

There are four types of crises that a person may experience and include:

1. developmental crisis or crisis in the life cycle (adjustments to transitions such as ageing, parenting)
2. situational crisis (sexual assault, natural disaster, car accident)
3. existential crisis (inner turmoil or conflicts in relation to the way a person lives their life, and views of their meaning and purpose)
4. systemic crisis (the impact of colonisation on our First nations’ people or the 2009 Victorian ‘Black Saturday’ bushfires) (James & Myer, 2008).

Crisis is in the eye of the beholder

It is important to note the difficult task of defining a crisis. This is due to the subjectivity of the concept. Although the main reason for a crisis is usually preceded by a traumatic or hazardous event, it is imperative to realise that the individual’s perception of the event and their inability to cope with the event are two other conditions to consider. Focusing only on the event itself also suggests that one can categorise a crisis but that all people may respond in the same manner to a particular event. Thus, it is not the actual event that activates a crisis state, but how a person interprets or perceives these events, how they cope, and the degree to which they have access to social resources, that determine how they respond. In other words, crisis is in the eye of the beholder (Hoff et al., 2009; Hoffer & Martin, 2020).

This perception is influenced by several factors in a person’s life, such as personal characteristics, biological, gender, culture, attachment style, previous life experiences, social context, personal values, level of resilience, influences, availability of social support, previous trauma, and history of major mental illness (Loughran, 2011; Roberts & Ottens, 2005). It is also important to understand that people who are reacting to a crisis are not necessarily showing pathological responses but normal crisis responses to an abnormal event (Bateman, 2010; Hobfoll et al., 2007; James, 2008).

Principles and characteristics of crisis

The following principles and characteristics help to create an understanding of the nature of a crisis, and emphasise not only the important work of a crisis counsellor but the values and philosophical assumptions that need to guide their practice:

• crisis embodies both danger and opportunity for the person experiencing the crisis
• crisis contains the seeds of growth and impetus for change
• crisis is usually time limited but may develop into a prolonged crisis if the person experiences a series of stressful situations after the crisis
• crisis is often complex and difficult to resolve
• a crisis counsellor’s experiences of crisis in their personal life may greatly enhance their effectiveness in crisis intervention
• quick fixes may not be applicable to many crisis situations
• crisis confronts people with choices
• emotional disequilibrium or disorganization accompany crisis
• the resolution of crisis and the personhood of crisis workers interrelate (James, 2008, p. 19).

Common reactions to a crisis

Listed here are some of the common reactions a person might experience, which are normal responses given the abnormality of the event they have experienced.

Table content sourced from Massazza et al., (2021) used under a CC BY licence and Wahlström et al., (2013) used under a CC BY-NC licence.

What is crisis counselling?

Crisis counselling is an immediate response to people experiencing overwhelming events and may prevent the potential negative impact of psychological trauma. It focuses on the here and now, dealing with the immediate presenting needs at the point of crisis, and providing emergency psychological care to assist in helping the person return to an adaptive level of functioning (Flannery & Everly, 2000; Hobfoll et al., 2007).

The key goals that underpin crisis counselling frameworks and models are:

• meeting the person who is experiencing a crisis where they are at
• assessing and monitoring the person’s level of risk
• assisting them in mobilising of resources
• stabilising (by reducing distress
• improved or restored adaptive functioning (where possible) (Roberts & Ottens, 2005).

The difference between crisis counselling and other counselling interventions

Crisis counselling is different to the provision of ongoing therapeutic support. Because crisis counselling offers short-term strategies to prevent damage during and immediately after the person has experienced a crisis or devastating event, it requires that the counsellor be more active and directive than usual (James, 2008). Ongoing counselling may follow on from crisis to ensure the long-term improvement of a person’s mental health and wellbeing, but this is not the goal of crisis counselling. Instead, the goal is to provide a responsive and timely intervention to return a person to previous levels of functioning through the implementation of mobilising necessary resources, including the facilitation of links to these resources (Flannery & Everly, 2000). Given crisis counselling is the implementation of a short-term measure of support, it is often referred to as brief intervention or brief therapy. The timeframe for crisis counselling is between six to ten weeks and is guided by specific relevant models, guiding principles, and actions (Hendricks, 1985).

Traumatic stress, crisis, and trauma

The term crisis is not interchangeable with traumatic stress and trauma. Dulmus and Hilarski (2003) explain a person is in a crisis state when they have experienced a situation or event and they have been unable to cope with it by utilising their usual coping mechanisms to lessen the impact of the event. This results in the person entering a state of disequilibrium (Roberts & Ottens, 2005).

Traumatic stress is when a crisis or event, such as child abuse, rape, combat trauma, and catastrophic natural disasters, overwhelms normal coping skills and is perceived as life-threatening (Behrman & Reid, 2002). Trauma can be defined as ‘… an experience of extreme stress or shock that is/or was, at some point, part of life’ (Gomes, 2014).

It is adaptive and normal for a person who has been exposed to a traumatic event to exhibit some anxiety in the early stages as this enables them to maintain vigilance as a way to increase safety. Others may feel numb after being exposed to a traumatic event. This is also an adaptive and normal response as much-needed insulation is provided to a person’s psychological system after the traumatic event (McNally et al., 2003). Those who do experience a traumatic injury can suffer from long-lasting consequences that impact them physically, cognitively, emotionally, and financially (Herrera-Escobar et al., 2021).

It is common for acute stress symptoms to be experienced after a traumatic event. When a person is exposed to a threat, neurotransmitters and hormones inform a physical response. The sympathetic nervous system is activated through a series of interconnected neurons that initiate a fight or flight response. The body releases glucose and adrenalin, increases heart rate and respiration, and remains in a state of high alert to manage any additional threat. At this point in time, the person is trying to make sense of their experience and is often feeling afraid and vulnerable as they attempt to rationalise what just occurred. Anxiety, loss of appetite, irritability, sleep difficulties, concentration difficulties, and hypervigilance can occur whilst in this physiological state. Warchal and Graham (2011) further explain that a person can have recurrent and involuntary memories of the traumatic event. A heightened state of arousal makes it difficult for them to respond normally, make decisions, and complete paperwork to link them to resources. Walsh (2007) explains that most people adapt and cope and therefore do not suffer long-term disturbance.

Post-traumatic stress disorder

Ongoing therapeutic support is required if a person continues to experience feelings of helplessness, intense fear or horror, re-living the traumatic event, hypervigilance, or emotional numbness. Norris et al. (2002) identified ongoing support to include long-term counselling or psychiatric services, or specialised mental health intervention. People generally possess enough resilience to circumvent the development of trauma symptoms that inform a formal trauma diagnosis, such as post-traumatic stress disorder. The DSM5-TR classifies PTSD as an anxiety disorder that can develop after exposure to a traumatic event (American Psychiatric Association [APA], 2022). Rosenman (2002) reported that 57% of the Australian population reported a lifetime experience of a specified trauma. There are four different categories PTSD can be clustered into: (1) recurrent re-experiences of the traumatic event in the form of intrusive thoughts, nightmares, or flashbacks; (2) numbing and avoidance of trauma-related stimuli; (3) hyperarousal and reactivity; and (4) alterations in cognitions and mood (APA, 2022).

The origins and development of crisis counselling interventions

The research and development of crisis intervention originates in the 1940’s when the reactions of people whose loved ones had died in a fire at a nightclub in Boston in 1943 were recorded and studied by psychiatrist Erich Lindemann and his colleagues (Lindemann, 1944). Another psychiatrist, Gerald Caplan, expanded on this work and developed a four-stage model of crisis reactions (or phases of reactions that a person in a crisis may experience) which have formed the foundation for later contributions from theorists in crisis counselling. Caplan (1961, 1964) describes these phases as follows:

Phase 1: increase in tension and distress from the crisis-inducing event

Phase 2: there is an escalation in the disruption of the person’s life as they are stuck and cannot resolve the crisis quickly

Phase 3: the person cannot resolve the crisis through their usual problem-solving methods

Phase 4: the person resolves the crisis by mental collapse or deterioration, or they partially resolve it by adopting new ways of coping.

Erikson’s (1963) stage model of developmental crises and Roberts’ (1995) seven-stage crisis intervention model have led to the development of numerous crisis intervention models, particularly in the last two decades. Erikson’s focus was on World War II veterans’ disconnect from their culture together with the confusion associated with the traumatic war experiences rather than focusing on men suffering from repressed conflicts. Erikson assessed that veterans were experiencing confusion of identity about what they were and who they were in direct opposition to the lens of repressed conflict being used during this time period.

Characteristics of the crisis counsellor

The crisis counsellor’s ability to remain calm and simultaneously avoid subjective involvement in the crisis is crucial. This means that crisis counselling may not be suitable for every counsellor (Shapiro & Koocher, 1996). A crisis counsellor should communicate in a manner that is patient, sensitive, self-aware, and compassionate. Other characteristics and behaviours include warmth, understanding and acceptance, being available but not intrusive or controlling, trustworthy, empathic, caring, displaying effective listening skills, encouraging the person seeking appropriate referrals and support, and being able to maintain confidentiality (Bateman, 2010; Rainer & Brown, 2011; Westefeld & Heckman-Stone, 2003).

The crisis counsellor aims to establish a therapeutic relationship as they do in general counselling, however in crisis counselling, they do so in a shorter time-frame period. Other crisis intervention skills include encouragement, basic attending and listening skills, reflection of emotions, and instilling hope (cf. Ivey & Ivey, 2007; James, 2008).

Key crisis interventions

As mentioned previously, crisis intervention provides the opportunity for the crisis counsellor to help facilitate an independent decision-making process with the client by promoting them as the agent of change in their life and assisting them to identify and utilise their own resources (France, 2014).

Critical incident stress debriefing

Developed in 1974 by Jeffrey T. Mitchell, critical incident stress debriefing (CISD) or psychological debriefing is a seven-phase supportive crisis intervention process that was initially used with small groups of first responders such as firefighters, paramedics, and police officers to help them manage their reactions and distress following their exposure to a traumatic event (Mitchell, 1983). Over time, CISD became an intervention used with groups outside of emergency services, such as hospitals, businesses, schools, community groups and churches. However, although CISD is used extensively, current research shows mixed results for the use of this intervention with some findings suggesting that it is ineffective in preventing post-traumatic stress disorder (PTSD) symptoms and even contributing to the worsening of stress-related symptoms in individuals who received this type of intervention (Bledsoe, 2003).

The next section will address assessment in crisis intervention followed by an outline of two key crisis interventions, Roberts’ seven-stage model of crisis intervention and psychological first aid, and an application of these interventions to Brett’s case.

Assessment in crisis intervention

The responsibility of the crisis counsellor is to conduct a structured assessment in a timely and responsive manner to assess whether psychological homeostasis has been disrupted, there is evidence of dysfunction and distress, and usual coping mechanisms are not able to be utilised. Assessment is ongoing throughout the intervention process and allows the crisis counsellor to evaluate the person’s affective and cognitive state, and behavioural functioning. By assessing these three areas, the crisis counsellor can evaluate and monitor how adaptively or maladaptively the person is functioning, including whether they are a danger to themselves or others, and then apply the most appropriate intervention (James, 2008).

Listed below are examples of what a crisis counsellor is looking for across the three domains when assessing people who have experienced a crisis:

• Do they appear to be emotionally overwhelmed or severely withdrawn?
• Is what they are saying coherent and logical or are they not making sense?
• When observing their behaviours, are they pacing? Are they having difficulty breathing?
• Are they able to sit calmly?
• Are they unresponsive?

When people express suicidal ideation or have a plan to suicide, it is crucial to conduct a rapid suicide risk assessment which includes gathering information by inquiring about the following:

• How long they have been having suicidal thoughts?
• Have they made any suicide attempts in the past?
• Have they recently sought help?
• Do they have a plan to suicide?
• If they do have a plan, do they have access to the means to carry out this plan?

Further information and guidelines on suicide risk assessment can be found at the end of this chapter in the Recommended referral and resources list section. There is also a specific chapter in this book related to suicide.

Roberts’ seven-stage crisis model

Roberts’ (1995, 2005) seven-stage model of crisis intervention is a cognitive-behaviourally based, systematic, and structured model used for crisis assessment and intervention. It is a common model used by crisis counsellors to help people build and restore their ways of coping and improve their problem-solving skills that a crisis may evoke.

With a focus on strengths and resiliency, these sequential stages can be applied to a broad range of crisis situations and are as follows:

1. plan and conduct a thorough assessment including, danger to self and others, imminent danger, lethality
2. make psychological contact, establish rapport and rapidly establish the collaborative relationship by showing genuine respect for the individual and having a non-judgmental attitude
3. identify major problems or the dimensions of the problems including the precipitating event
4. encourage exploration of feelings and emotions including active listening, reassurance and validation
5. generate and explore alternatives including untapped resources and new coping strategies
6. develop and formulate an action plan
7. plan follow-up and leave the door open for booster sessions which may occur three to six months later (Roberts, 2005, p. 21).

Psychological first aid

Identified as the first level of post-incident short-term care, psychological first aid is an evidenced-based model that provides emotional and practical support to individuals, groups, and communities impacted by a natural disaster, catastrophic event, traumatic or terrorist event, or another emergency situation (Australian Red Cross & Australian Psychological Society, 2010; Ruzek et al., 2007). The aim of psychological first aid is to help people reduce their initial symptoms, have their current needs met, and support them in implementing adaptive coping strategies.

Psychological first aid meets the following four basic standards:

1. Consistent with evidence and research on risk and resilience following trauma (that is, evidence-informed)
2. Applicable and practical in field settings (compared with a medical/health professional office somewhere)
3. Appropriate for developmental levels across the lifespan (e.g., there are different techniques available for supporting children, adolescents, and adults)

4. Culturally informed and delivered in a flexible manner, as it is often offered by members of the same community as the supported individuals (Ruzek et al., 2007).

Psychological first aid is based on the understanding that, just as natural disasters, catastrophic events, traumatic or terrorist events, or other emergency situation differ vastly from each other, so do the psychological reactions of individuals, groups and communities experiencing them. Because some of these reactions can interfere with an individual’s ability to cope and manage the crisis, psychological first aid can help in their recovery. Psychological first aid has five basic elements that are to promote:

1. safety
2. calmness
3. self-efficacy (self-empowerment)
4. connectedness
5. hope (Hobfoll et al., 2007).

The crisis counsellor and self-care

In their book, The Resilient Practitioner, Skovholt and Trotter-Mathison (2016) offer their insights and research on burnout and compassion fatigue for those in the helping profession and emphasise the importance of implementing self-care strategies in its prevention. Given the demands of the work of a crisis counsellor and the risk of vicarious traumatisation, protective and proactive approaches are imperative in the sustainability and vitality of a career where one is working intensely with human suffering and adversity. Tools and approaches, such as frequent supervision, high commitment to self-care, creating a personal balance of caring for self and caring for others, proactively and directly confronting stressors at work and at home, and ensuring that one has enriching relationships and activities outside of the work environment, are essential components in professional wellness and in the prevention of burnout and compassion fatigue (Adamson et al., 2014; Skovholt & Trotter-Mathison, 2016).

Conclusion

This chapter has provided a brief foundation for intervening with people who have experienced a crisis. With a primary focus on psychological first aid and Roberts’ seven-stage model of crisis intervention, and an application of these models to a case study, this chapter has covered the essentials in understanding the nature and types of crisis, the common reactions of a person who has experienced a crisis, and the impact of ongoing traumatic stress responses that require long-term counselling intervention. A list of other supports available, referrals and resources are included at the end of this chapter for your information and further reading.

Recommended referral and resources list

Australian Psychological Society: Psychological first aid. This resource is a useful guide to supporting people affected by a disaster. The guide provides an overview of the implementation of best practices in psychological first aid as an immediate intervention following a traumatic event or disaster.

Suicide risk assessment. Working with the suicidal person Clinical practice guidelines for emergency departments and mental health services (Department of Health, Melbourne, Victoria, 2010).

Guidelines for integrated suicide-related crisis and follow-up care in emergency departments and other acute settings (2017).

Other Resources for telephone and online crisis support:

• Life in Mind: Australian suicide prevention services.
• Standby: Support after suicide. Face-to-face and telephone support.

Other counselling resources

Psychological first aid: This video [11:07] provides information on the application of psychological first aid to assist individuals to reduce stress symptoms and assist in meeting an individual’s basic needs and identify resources to aid in a healthy recovery, immediately following a crisis, such as a personal crisis, natural disaster, traumatic event or natural disaster.

Glossary of terms

compassion fatigue—a state of feeling emotional and physically exhausted from helping people who are distressed or traumatised resulting in a diminished ability to show compassion or empathise

crisis—a time of intense difficulty or danger

hypervigilance—being in a state of increased alertness where one is sensitive to surroundings

intervention—the action or process of intervening

model—describes how counsellors can implement theories

stress—a state of mental or emotional strain or tension resulting from adverse or demanding circumstances

principles—a fundamental truth or proposition that serves as the foundation for a system of belief or behaviour or for a chain of reasoning

reaction—something done, felt, or thought in response to a situation or event

suicidal ideation—thoughts of wanting to take one’s own life or suicide

theory—a plausible or scientifically acceptable general principle offered to explain a hypothesis or belief

therapeutic relationship—refers to the consistent and close association that exists between the counsellor and client. This is also known as a therapeutic alliance.

trauma—a deeply distressing or disturbing experience

vicarious trauma—trauma symptoms that a counsellor may experience as a result of the ongoing exposure to trauma stories from their clients

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Author Information

Claire Malengret
FDRP, B.Ed.,M.Couns., GDM, Family Dispute Resolution,
Cert IV TAE, PACFA Reg. (Clin.), MHE prac. 21971,
Accredited Supervisor (PACFA, AAOS)

Claire is currently the National Clinical Advisor at an Australian non-for-profit organisation that supports young people and their families who have been impacted by chronic illness. With over 15 years experience in education, counselling and organisational development roles, Claire is passionate about coming alongside people, building trust and transparency, and supporting them to grow their skills and build capability. She is a clinical counsellor, accredited supervisor, an endorsed mental health practitioner, and certified family dispute resolution practitioner who holds a Master of Counselling, a Graduate Diploma in Management, and a Bachelor of Education.

Claire Dall’Osto
BSocSc (with Distinction), GradCertPrac(Client assessment & Case management),
GradCertPrac(Statutory child protection), Dip(Couns), Dip(Just), CertIV(Train&Assess)

Claire has been working in the child protection industry within the government and NGO sector for 15 years, and has gained expert experience, knowledge, and skills in the child protection and foster care systems. She has worked with biological parents, foster and kinship carers, and children who have experienced harm, abuse, trauma, grief and loss, attachment disruptions, mental health issues, and behaviour and conduct problems. Claire has provided crisis intervention in refuges, providing specialist support, and safe and secure accommodation for women and children escaping domestic and family violence, as well as providing specialist trauma counselling for people who have experienced domestic and family violence, and sexual assault.