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Crisis Intervention, Kantor, 2002
Theory and Practice
Theory and Practice
Edward M. Kantor, M.D.
Edward M. Kantor, M.D.
Department of Psychiatric Medicine
Department of Psychiatric Medicine
University of Virginia
University of Virginia
Crisis Intervention, Kantor, 2002
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.
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Crisis Intervention, Kantor, 2002
Crisis
Crisis
What is it?
•Webster defines crisis as a turning point
•Sheehy describes crisis as a passage
•The English word is derived from the
Greek krinein, meaning to decide.
Crisis Intervention, Kantor, 2002
Chinese term for crisis...
Weiji
Weiji
Opportunity
Is composed of two characters:
one signifies ..…. …….the other
Danger
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Crisis Intervention, Kantor, 2002
1. Slaikeu, 1984
Generally Accepted Definition
Generally 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.
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Crisis Intervention, Kantor, 2002
Background
Background
•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.
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Crisis Intervention, Kantor, 2002
• 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 the
same 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 from
the 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 Intervention, Kantor, 2002
Crisis Theory: A general framework
Crisis Theory: A general framework
Overview
Assumptions
Systems Framework
Overview
Assumptions
Systems Framework
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Crisis Intervention, Kantor, 2002
Overview: Response to Crisis
Overview: Response to Crisis
Dysfunctional
Response
Decompensation
and
Regression
Intervention
?
Recovery
Resolution
Event Event Event
Perception
higher
lower
former
Level
of
Function
Vulnerability and
Reduced Defenses
(disorganization and
disequalibrium)
Crisis Intervention, Kantor, 2002
former
Even with a return to former functioning there
is often a shift of interest or change of course
Lateral Changes in Function
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Crisis Intervention, Kantor, 2002
Assumptions about Crisis
Assumptions 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
Crisis Intervention, Kantor, 2002
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
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Crisis Intervention, Kantor, 2002
Types of Crises
Types 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 Crises Situational Life Crises
Typical Scenarios Typical Scenarios
Situational Crisis of Modern Life Situational Crisis of Modern Life
Crisis Intervention in the Schools Crisis Intervention in the Schools
Developmental Life Crises Developmental Life Crises
Transition or Crisis Transition or Crisis
Preoccupations through the Lifespan Preoccupations through the Lifespan
Crisis Intervention, Kantor, 2002
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 TEN
TOP TEN
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Crisis Intervention, Kantor, 2002
Principles of Intervention
Principles 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
Crisis Intervention, Kantor, 2002
Intervention Summarized
Intervention Summarized
1st Order Intervention
‘Psychological First Aid’
2nd Order Intervention
‘Crisis Therapy’
How
Long?
Minutes to Hours Weeks to Months
By
Whom?
Front Line
Caregivers
Psychotherapists
and Counselors
Where?
Community
Settings
Office Settings
Goals?
Re-Establish
Immediate Coping
Resolve Crisis
Procedure?
Psychological
First Aid
Multimodal Crisis
Therapy
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Crisis Intervention, Kantor, 2002
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 Intervention, Kantor, 2002
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
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Crisis Intervention, Kantor, 2002
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.
Crisis Intervention, Kantor, 2002
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)
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Crisis Intervention, Kantor, 2002
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

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