Crisis Intervention is emergency first aid for mental health, therefore individuals must receive timely and skilful support to help cope with their situation before future physical or emotional deterioration occurs (Ellerbrock, 1995). This Assessment is based on a case study of 16-year-old Emma which will include a six-session plan of intervention. The Assessment will look at the types of crisis applicable to Emma, her coping mechanisms and how I will go about assessing her emotional state. It will proceed into models, theories and/or principles of interventions and techniques, and it will conclude with my feelings of countertransference and the layers of crisis presented in Emma’s case.
The Definition of and types of crisis/es applicable
“A crisis can be defined as a person’s perception or experience of an event as an unbearable difficulty that exceeds his/her current resources and coping mechanisms (Dada, 2016, p. 137)”. Therefore, a crisis is not necessarily traumatic, but it can have severe consequences that need to be dealt with immediately (Herbst & Reitsma, 2016).
Looking at Emma’s case, I think she is experiencing a developmental and situational crisis. Developmental as she as entered adolescence and experiencing physical and mental changes and situational because of the split of her parents, her gaining weight and broken relationship with her boyfriend of 1 year. Everything in intensified, therefore she is experiencing some anxiety and cannot fully accept these changes, as she does not have the interpersonal resources required (Dada, 2016). By the change of Emma’s appetite, sleep patterns and psychological reactions such as numbness, I would say that Emma is in the acute phase of her crisis (James & Gilliand, 2017). I think Emma is frustrated with the situation she is in, which is disrupting her psychological state (James & Gilliand, 2017).
“Crisis is a temporary breakdown of coping” (James & Gilliand, 2017, p. 9). Reduction of functioning impacts coping mechanisms immensely. In a crisis, the two components of coping, namely problem solving, and self-management are overwhelmed, hence Emma cannot problem-solve nor manage their internal responses to the precipitating event (Parikh & Morris, 2011). “This is similar to the individual psychology assumption that individuals experience distress when their lifestyles is no longer adaptive to their current situation (Parikh & Morris, 2011)”. Therefore, a person’s expectations are violated and various emotions such as anger, anxiety and grief rise to the surface, as well as old problems and losses, hence severely impacting the response to the crisis (James & Gilliand, 2017). Emma is experiencing numerous challenges at once, from her grades to her relationship with her mother and her boyfriend and to add to it, she is still coping with the broken relationship with her father, hence various emotions are coming to surface and she cannot cope. Emma may also be experiencing a behavioural emergency has her crisis has escalated to the point where she may harm herself (James & Gilliand, 2017), indicated by her statement “I would just like to go to sleep and never wake up” (Crisis and Trauma Counselling Module, 2017).
Assessment and Identification of Emma’s Emotional State
Identification recognises that there is a problem and it focuses on the crisis significance in the individual’s environment and their current functioning. In Emma’s case, she is faced with adolescence (developmental crisis), failing grades, divorce and a break up (situational crisis), both involve a change in circumstances (Ellerbrock, 1995). In addition to psychological disequilibrium, Emma displays various other signs and symptoms which indicate an issue. Physically, she has gained weight, has difficulty with her studies, as she just passes, she cannot concentrate and has sleepless nights. Emotionally, she had a recent onset of sadness, unexplained tearfulness, is ashamed of her body, feels like a burden and that no one likes her.
Assessment is vital as it determines the severity of the crisis, the client’s current emotional, behavioural and cognitive status, the clients level of lethality and the how well the counsellors has defused the situation and assisted the client in returning to a state of mobility and equilibrium (James & Gilliand, The Intervention and Assessment Models, 2017).
Crisis is time limited and can last days or weeks, therefore I think 6 sessions with Emma will definitely help her regain normality and assist her to overcome challenges and issues in life. I would use the ABCs of assessment to analysis the severity of Emma’s case. I would firstly focus on her affective state as she may be overemotional and detached. If so, I would help her regain control by helping her express her feelings and gather from her responses, her feelings towards the situation (James & Gilliand, The Intervention and Assessment Models, 2017). I would then look at Emma’s behavioural functioning, by asking appropriate questions to get Emma to take action, because once she is involved in something concrete, control is restored and a degree of mobility is provided (James & Gilliand, The Intervention and Assessment Models, 2017). Lastly, Emma’s cognitive state will reveal important information, such as how realistic is her thinking, how long has she been in crisis thinking and her thinking patterns about the crisis, does she want to resolve it or not (James & Gilliand, The Intervention and Assessment Models, 2017). By assessing these three areas, I can sense how Emma is functioning and which intervention path is well suited (Crisis Intervention, 2009).
Emma’s Coping mechanisms and relationship with anxiety and loss
Crisis is not only about dealing with the immediate crisis, but also what the individual has to cope with after the crisis, hence coping refers to “collection of strategies used to solve problems which cause distress” (Herbst & Reitsma, 2016, p. 14). The act of coping starts off with a decision that there is a problem that needs to be dealt with, this is otherwise known as primary appraisal. An evaluation must then be made about the individual’s capabilities to deal with the situation, known as secondary appraisal (Herbst & Reitsma, 2016).
Carver and Weintraub (1989, as cited in Baqutayan, 2015) state that in addition to problem and emotion focused coping, there is another model names dysfuncational coping, which focuses on emotional venting, denial, mental and behavioural disengagement. Therefore, I think Emma uses dysfunctional coping as she just wants it all to end and not feel anything and it shows in her phrases and her viewpoint of herself. Furthermore, Emma may be avoiding her problems, her grades and her social scene with her boyfriend and school, by her statement that “she would rather sit at home in front of the TV”. Additionally, I think by Emma not having her mother to talk too, she cannot cope with her anxiety, and may see her situation as bigger than it actually is. I think Emma has become the mom of the house, from taking care of her brother and now having to get a part-time job, yet mentally she is not mature enough to handle challenges and because she has so much to deal with family-wise, she cannot comprehend how to tackle her own situation, and rather hopes that it will disappear by her ending it all.
Principles/theories/models of crisis intervention used to manage Emma and her concerns
Crisis intervention is the immediate provision to crisis victims to help them return to normal functioning (Dada, 2016). It deals with emotional issues before they turn into psychological problems (Dada, 2016). Therefore, timely intervention is vital as individuals remain in crisis state for approximately 4-6 weeks (Parikh & Morris, 2011).
I would use the six-step model of crisis intervention to guide me through the six sessions with Emma. This two-phase model (listening and acting phase) will allow me to define the issue/s, ensure Emma’s safety and provide support (Dada, 2016). Emma’s safety is vital because she can cause harm to herself, which is my immediate concern. However, suicidologists state that most suicidal individuals do not wish to die but simply cannot imagine continuing to live in their current state of psychological turmoil (Granello,, 2010). Furthermore, suicidal crisis is typically the result of a temporary, reversible state, therefore, with successfully navigated interventions, suicidal crisis need not be fatal (Granello,, 2010). I think this may be the case with Emma, she is overwhelmed and wants help, but the intensity of her turmoil is resulting in her wanting to not feel anything. Hence, I think Emma needs support and guidance to help restore her hope and confidence (Granello,, 2010). Emma is faced with numerous situational issues and I think she needs guidance on how to resolve it and cope with such stressors.
Additionally, I would solution-focused brief therapy (SFBT) and background of basic crisis intervention theory to help Emma tackle her issues and lead her into positive thinking patterns. SFBT attempts to remediate more or less ongoing emotional problems (James & Gilliand, 2017), which is applicable to Emma, because for example, her grades are low, so she thinks she’s useless, she picked up some weight, now she thinks no one likes her. Therefore, I would use SFBT to focus on what is possible and help Emma search for solutions and for what she wants to achieve, as she has the ability to resolve any challenge, but has lost her sense of direction and awareness of her competencies (Corey, 2014). Erich Lindemann’s research and writings gave a new understand of crisis which states that individuals behavioural responses to crisis are normal, temporary and amenable through short-term intervention techniques (James & Gilliand, 2017).
Techniques of crisis intervention to help Emma
There are various techniques I would use for Emma, as I think there are numerous issues that need to be resolved. These techniques are aimed to calm Emma down, keep her safe from harm and link her to care (Herbst & Reitsma, 2016). During this time, it is vital that I keep two important questions in mind, when counselling Emma, those are ‘will this intervention benefit Emma?’ and ‘will this intervention harm Emma?’ (Herbst & Reitsma, 2016). Upon meeting I would use psychological first aid to address the immediate crisis situation and provide some relief to Emma (James & Gilliand, 2017). Additionally, person-centred approach is very applicable to those in a crisis, therefore giving Emma the opportunity to fully express herself, by use of sensitive listening, hearing and understanding (Corey, 2014). This will help Emma to be open to receiving help later on, should she wish to see a psychologist after the six sessions.
I think emotional support is critically in this case because Emma does not have anyone who she can share her thoughts and troubles with, and it will help build a caring, trusting relationship. The use of empowering words and phrases and supportive comments, such as ‘no wonder you feel’, or ‘it sounds like you are being…’, will help Emma feel understood and supported (Herbst & Reitsma, 2016). I think by use of relaxation exercises and breathing techniques (Herbst & Reitsma, 2016). Furthermore, the use of scaling questions from SFBT will allow me to assess the magnitude of Emma’s situation as well as the intensity of her harming herself (Corey, 2014). A suicide risk assessment will allow me to ask Emma questions about her intentions and thoughts regarding suicide (Dada, 2016). Lastly, I would use the miracle question from SFBT to gain perspective on how Emma would like her situation to be. This will allow me to find solutions based on this, as it will motivate Emma to change, but also focus on a positive range of possibilities (Corey, 2014).
Feelings about the layers of crisis presented and my feelings of countertransference
This case study was close to my heart because Emma was me a few years ago. I struggled with my weight, had no friends, was judged and felt useless and a burden just like Emma. Therefore, this assessment entailed emotions and difficulty. Furthermore, I think because this case study was so close to me, I chose the six-session plan to help Emma, because if that was me a few years ago, I would want someone to help me though my crisis and provide support and guidance. I think there are numerous challenges Emma is faced with at once, which resulted in a crisis. I think being in the adolescence developmental stage and coping with the physical and emotional changes added to the crisis, however I think Emma just needs someone close to her whom she can talk too and learn how to cope with stress and obstacles she will face in the future. I personally think Emma is a smart, confident person, she just needs to find her strength and voice.
Countertransference, a psychological concept is a hallmark of dealing with those in crisis, and if not understood and dealt with, it has the potential to infect the counsellor and can lead to burnout (James, & Gilliand,, 2017). Countertransference is understood as the counsellors emotional-cognitive and behavioural responses to their clients ( Cartwright, 2017), which can impact the counselling process. I therefore, need to be very self-aware of what I give off, and treat Emma in a professional, respectful, non-judgemental manner.
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