edward m cantor_crisis intervention-theory and intervention

8/12/2019 Edward M Cantor_Crisis Intervention-Theory and Intervention

http://slidepdf.com/reader/full/edward-m-cantorcrisis-intervention-theory-and-intervention 1/11

Crisis Intervention, Kantor, 2002

Theory and PracticeTheory and Practice

Edward M. Kantor, M.D.Edward M. Kantor, M.D.

Department of Psychiatric MedicineDepartment of Psychiatric MedicineUniversity of VirginiaUniversity of Virginia


Teacher’s Fear Never Wanes After Assault

New York(AP) Students had threatened Susan Hudson before, but

when the attack came, she did not expect it: A magazine rolled

around some heavy object and secured with a rubber band was

slammed full force into her neck. It knocked her down, but the

middle-aged remedial reading teacher got up and taught her

remaining classes that day in February 1977. Then she went home.

She never returned again to her Brooklyn high school classroom.

She says she hasn’t gone back due to her neck injury…but also, she

says, she’s afraid.

“ I am petrified when I see more than two teenagers together... “

Ms. Hudson, a ten-year teaching veteran who needs only to complete her

dissertation to earn a doctoral degree, slides slowly, involuntarily into

tears as she describes her injuries and her feelings about the assault. “I

know I’m not handling this very well--I cry easily when I’m reminded

about this. It’s been two years and I’m getting worse. I’m really bitter.




CrisisCrisis What is it?

•Webster defines crisis as a turning point

•Sheehy describes crisis as a passage

•The English word is derived from theGreek krinein, meaning to decide.


Chinese term for crisis...

WeijiWeiji

Opportunity

Is composed of two characters:

one signifies ..…. …….the other

Danger



Crisis Intervention, Kantor, 20021. Slaikeu, 1984

Generally Accepted DefinitionGenerally Accepted Definition

A temporary state of upset and

disorganization, characterized by an

inability to cope with a particular

situation using customary methods

of problem solving, and by the

potential for a radically positive or

negative outcome. 1


BackgroundBackground•The origin of modern crisis intervention dates back to Eric

Lindeman (1942)& the Coconut Grove nightclub fire in

Boston. 493 people died. His report on the survivors and

relatives/friends became the basis for later theorizing on

the grief process and mass disaster. They focused on short

term intervention and therapy.

*Of note, many of the short-term therapy theorists were emergency at this

time, and possibly in response to this.

•The origin of modern crisis intervention dates back to Eric

Lindeman (1942)& the Coconut Grove nightclub fire in

Boston. 493 people died. His report on the survivors and

relatives/friends became the basis for later theorizing on

the grief process and mass disaster. They focused on short

term intervention and therapy.

*Of note, many of the short-term therapy theorists were emergency at this

time, and possibly in response to this.

•Caplan (1964) first formulated significance of life crises in

adult psychopathology . Looking at the hx of psychiatric pts.

he noted that during life crises, some individuals dealt with

problems in a maladjusted way, and seemed to emerge from

the event ‘less healthy’ than before.

•Caplan (1964) first formulated significance of life crises in

adult psychopathology . Looking at the hx of psychiatric pts.

he noted that during life crises, some individuals dealt with

problems in a maladjusted way, and seemed to emerge from

the event ‘less healthy’ than before.




• From these works, crisis centers and suicide hotlines popped up around the

country, often using peer counselors to make immediate intervention

available, further incorporating the concept of outreach. (the sixties). At thesame time, CMMHCs were developing, mandating crisis and emergency

services.

•Community Mental Health Models

Preemptive intervention - Primary prevention

Early intervention - Secondary Prevention

Follow-up - Tertiary Prevention

Most

Significant

components

of Crisis

Intervention•Crisis intervention has developed into the strategy of care

--at the time of the severe disorganization, resulting fromthe crisis. It is viewed as the most opportune time for

intervention ad defenses and usual coping strategies are not

working, and new ones must emerge.

Background cont...Background cont...


Crisis Theory: A general framework Crisis Theory: A general framework

Overview

Assumptions

Systems Framework

Overview

Assumptions

Systems Framework




Overview: Response to CrisisOverview: Response to Crisis

DysfunctionalResponse

Decompensation

and

Regression

Intervention

?

Recovery

Resolution

EventEventEvent

Perception

higher

lower

former

Level

of

FunctionVulnerability and

Reduced Defenses

(disorganization and

disequalibrium)


former

Even with a return to former functioning there

is often a shift of interest or change of course

Lateral Changes in Function




Assumptions about CrisisAssumptions about Crisis

• Existence of a crisis is based on the individual• Existence of a crisis is based on the individual

• Usual coping mechanisms are proving to be ineffective• Usual coping mechanisms are proving to be ineffective

• Crises can result from positive and negative events• Crises can result from positive and negative events

• No one is immune to crisis in right circumstances• No one is immune to crisis in right circumstances

• Crisis is time limited by definition• Crisis is time limited by definition

• Early intervention can maximize return to function• Early intervention can maximize return to function


Eight Typical Phases of Emotional Reaction*Eight Typical Phases of Emotional Reaction*

•High Anxiety

•Denial

•Anger

•Shame

•Guilt

•Remorse

•Grief

•Reconciliation

•High Anxiety

•Denial

•Anger

•Shame

•Guilt

•Remorse

•Grief

•Reconciliation

Order

May

Vary

*Epperson, 1977




Types of CrisesTypes of Crises

Situational Life Crises Typical Scenarios

Situational Crisis of Modern Life

Crisis Intervention in the Schools

Developmental Life Crises

Transition or Crisis

Preoccupations through the Lifespan

Situational Life CrisesSituational Life Crises Typical ScenariosTypical Scenarios

Situational Crisis of Modern LifeSituational Crisis of Modern Life

Crisis Intervention in the SchoolsCrisis Intervention in the Schools

Developmental Life CrisesDevelopmental Life Crises

Transition or CrisisTransition or Crisis

Preoccupations through the LifespanPreoccupations through the Lifespan


Social Readjustment Rating Scale*Social Readjustment Rating Scale*

100 Death of Spouse

73 Divorce

65 Separation

63 Jail term

63 Close family death

53 Personal injury/illness

50 Marriage

47 Fired from job

45 Marital reconciliation

45 Retirement

* Holmes/Rahe 1967

Scale spans from 100,

as most severe, to least

severe at 10 or 11

TOP TENTOP TEN




Principles of InterventionPrinciples of Intervention

First Order Intervention- Peer, Lay, Paraprofessional

Psychological First Aid

Intervention By Setting

Second Order Intervention- Professional

Multimodal Approaches

• Supportive, Cognitive,

Components

• Assessment

• Treatment

First Order Intervention- Peer, Lay, Paraprofessional

Psychological First Aid

Intervention By Setting

Second Order Intervention- Professional

Multimodal Approaches

• Supportive, Cognitive,

Components

• Assessment

• Treatment


Intervention SummarizedIntervention Summarized

1st Order Intervention

‘Psychological First Aid’

2nd Order Intervention

‘Crisis Therapy’

HowLong?

Minutes to Hours Weeks to Months

ByWhom?

Front LineCaregivers

Psychotherapistsand Counselors

Where? CommunitySettings

Office Settings

Goals? Re-EstablishImmediate Coping

Resolve Crisis

Procedure? PsychologicalFirst Aid

Multimodal CrisisTherapy




Psychological First Aid-First Level Intervention

•Early Contact/Not forced debriefings

•Easy Availability and Access

•Often Generic or Group Oriented

•Attempt to Minimize Stigma

•Facilitates need to be heard and understood

•Supportive, Non-judgmental

•Provided by Peers, Lay Counselors, Police, Rescue

•Early Contact/Not forced debriefings

•Easy Availability and Access

•Often Generic or Group Oriented

•Attempt to Minimize Stigma

•Facilitates need to be heard and understood

•Supportive, Non-judgmental

•Provided by Peers, Lay Counselors, Police, Rescue


Crisis Therapy

•More formal relationship

•Intervention as opposed to prevention

•Suggests more dysfunction

•Various modes target re-framing the incident and

recognizing guilt, shame, anger, self doubt

•Professionals provide service

•Usually longer term than psychological first aid

•More formal relationship

•Intervention as opposed to prevention

•Suggests more dysfunction

•Various modes target re-framing the incident and

recognizing guilt, shame, anger, self doubt

•Professionals provide service

•Usually longer term than psychological first aid




Diagnostic Considerations

•Adjustment Disorder•Adjustment Disorder

•Bereavement•Bereavement

•Brief Psychotic Disorder•Brief Psychotic Disorder

•Substance Abuse as 1° or 2° Factor•Substance Abuse as 1° or 2° Factor

•Acute Stress Disorder•Acute Stress Disorder

•Conversion Disorder•Conversion Disorder

•Dissociative Disorder•Dissociative Disorder

With Depressed Mood, with Anxiety, with mixed Anxiety and

Depressed Mood, with Disturbance of Conduct, with Disturbance of

Emotions and Conduct, Unspecified.


Emerging Concerns

•Disaster Psychiatry

•Training

•Credentialing & Affiliation

•Referral

•All Hazards Response

•Chemical

•Biological

•Conventional Weapon

•Natural Disaster

•ICS (Incident Command Systems)

•Disaster Psychiatry

•Training

•Credentialing & Affiliation

•Referral

•All Hazards Response

•Chemical

•Biological

•Conventional Weapon

•Natural Disaster

•ICS (Incident Command Systems)




CRISIS - Take Away Points

•Subjective to the individual experiencing it

•Destabilizing, dysfunctional, taxed defenses

•Time limited

•Most amenable to early intervention

•Access and availability

Goals:

Adaptation, Integration, Empowerment

and Decision-making

edward m cantor_crisis intervention-theory and intervention

Documents